Get free answers to your Insurance Bad Faith legal questions from lawyers in your area.
Are illegal immigrants allowed insurance under the affordable care act?
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answered on Dec 13, 2024
Under the Affordable Care Act, undocumented immigrants are not eligible to purchase health insurance through the federal or state marketplaces. They cannot receive premium tax credits, cost-sharing reductions, or other federal benefits through the healthcare exchanges.
However, you can... View More 
When I renewed my car insurance policy, I was told that some optional add-ons were not optional and I had to accept. I found out a day later that she lied and it was not true. Now the company is saying it can be fixed by the agent but they're making it EXTREMELY difficult. I'm on my 6th... View More
answered on Dec 8, 2024
This looks like something that could be remedied without attorneys. You could try to continue to work with their customer service to get the options you want. If the first person you spoke with was inexperienced and provided incorrect information, it's possible you may have to pay whatever... View More
I have been fighting with them for the last 4 months with no resolution. They refuse to by the vehicle back. I returned that car with in 1 year of purchase. It was a 2011 GMC Terrain, I have a loan on it as well.
This process has been dragged since the day of the accident which is July 24, 2024. I’ve received one very small payment in almost 4 months. I feel like I’m being punished for even filing
a claim… I’ve had utilities shut off, car insurance policy cancellation, phone shut off, etc.... View More
answered on Nov 2, 2024
I'm sorry about your accident and the upheaval that it has caused in your life. I hope you are okay and recovering from your injuries. What you describe is not uncommon. Although no-fault benefits under New York insurance law cover medical expenses and lost wages, self-employed claimants often... View More
My $3000 electric motorbike was stolen two months ago, and there are security photos of the theft. The insurance company, suspicious due to the bike being taken out of storage two days before, implies the theft was intentional. After 5 hours of phone calls and now being asked for numerous... View More
answered on Jul 30, 2024
I'm sorry your motorbike was stolen. The answer to your question is an individual call. Your frustration is understandable. If you're thinking of bringing an attorney on board, you could start reaching out to law firms to try to arrange free consults to discuss their terms for assisting... View More
answered on Dec 5, 2023
This isn't an Insurance Bad Faith matter (the category where it is posted). You could repost and add "Elder Law" and "Health Care Law" as categories for better chances of a response - attorneys there could have the best insight into this. Good luck
A patient was seen as a new Medicare wellness visit but had previously had one within the year by another physician unbeknownst to the office. So the claim was denied and the Dr. Wants to recode and resubmit.
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answered on Sep 28, 2023
In New York, a doctor generally can recode and resubmit a claim to insurance if the original claim was denied. However, the recoding must accurately reflect the services provided, and the practice could be subject to audit. Additionally, Medicare has specific rules and timelines for resubmitting... View More
I was undergoing physical therapy for back/ spine issues with intermittent numbness and improving. Additional authorizations by my insurer were suddenly denied. PT office did not appeal immediately and only did once I received a copy of the letter and informed them. An appeal would take 30 days to... View More
answered on Sep 16, 2023
You raise a very good question - and one that does not go overlooked by attorneys in challenging denials of medical care. Unfortunately, it is also a difficult issue to argue in most settings where a claim is closely processed with valid independent medical exams or peer reviews. If you have an... View More
I received a dental service which is fully covered by my dental insurance, according to the Plan Summary document which my insurance company posted on the webpage. However, it turned out that the summary document was wrong, and it was not covered according to the full benefit document.
Is... View More
answered on Aug 16, 2023
You could make the argument that they are responsible for the incorrect information. They could respond with an argument that the long version policy applies, or that their post is subject to changes, or other provisions. If the denial is substantial, there are health care attorneys who litigate... View More
My dad had signed up for a term life insurance policy for $7000 until he reaches 90 years old, or when he dies. At the time when the insurance company called him to sign up he spoke very little English, that term was set to fully paid in 2013. But he kept paying the policy every month, he passed... View More
answered on Aug 13, 2023
I'm very sorry for the loss of your dad. One option is to try to arrange a brief consult with an attorney - it would be helpful to know the basis of the carrier's denial of a refund. It could be a matter of weighing the costs of litigating the potential refund against chances for a... View More
What payment structure does an attorney use for a balance billing case in New York by an in-network provider?
In network provider balance billed me though insurance EOB shows $0 owed as their claim from 2021 was discounted to $0. Provider's billing company refused to resubmit their... View More
answered on Apr 24, 2023
Attorneys who handle medical billing disputes apply various fee arrangements, depending on the type of insurance (no-fault, private, etc.), volume of claims (in terms of whether it's a high-volume institutional client, such as a large medical office or single-transaction individuals),... View More
Hi I just wanted to ask if it's legal or illegal for a health insurance company to deny a hospital claim just because you have secondary insurance. I reside in NY state if that matters
answered on Mar 29, 2023
It's difficult to comment whether there was an insurance law or policy violation without knowing the types of insurance, policy conditions, sequence in which hospital billed or otherwise coordinated the claims process between the two carriers. There are health care attorneys who handle billing... View More
Emblem was my former insurance through my former employer. I suffer from hip pain. I was approved for an X-ray of my hip which showed normal. However the pain was severe. My PCP requested an MRI on my behalf several times, but Emblem denied the request each time. My coverage ended with Emblem on... View More
answered on Oct 5, 2022
I'm sorry for your ordeal. You ask if you could sue. I think it would be difficult to find a law firm to handle such a matter on a contingency basis. MRIs are often initially denied as a knee-jerk reaction in many instances. They are big-ticket items compared to other less-sophisticated... View More
I am on a monthly medication paid for by my insurance, I switched jobs and thus got new insurance, but the pharmacy kept billing the old insurance.
The old insurance continued paying for my medications for 5 months. Now they're charging me a hefty ammount for the months they paid for... View More
answered on Apr 19, 2022
I'm sorry you find yourself at the end of a collection action with the medications. It's difficult to comment definitively on your position without seeing the terms of the policy and other paperwork. However, it sounds like they may be relying on the position that the patient has a... View More
So my dilemma is I have a car accident reported on my car accident history last year. I have never been in an accident in my life. My mom got in an accident last may and i was in the car. She called me a week later and told me her insurance wanted to speak with me i explained the situation to them... View More
answered on Mar 12, 2022
Some elements of the scenario are not fully clear, but from the brief facts, it does not look like a case of insurance fraud. Insurance fraud cases generally involve deliberate conduct with the intent to deceive the other party. This looks more like it could be an administrative or communications... View More
A dentist office accepts my current insurance. But make me pay full price, bills my insurance separately then sends me a check for less than 50% of what I payed when my insurance covers 80% of the total visit. They also only make some people who have the same insurance pay. So if you and I both had... View More
answered on Feb 11, 2022
It could be difficult to speculate why a dental or medical office would apply different billing protocols. As a convenience to the patient, some offices do not bill patients but instead, have them complete paperwork enabling their billing staff or contractor to bill on patient's behalf. When... View More
Hi,
I have a very large chest and as such I also suffer from crippling back pain. It has gotten to the point I can no longer function normally and cannot even get out of bed some days due to sciatica. I tried to get my insurance company to pay for a breast reduction and they denied me. In... View More
answered on Dec 16, 2021
I'm sorry for your ordeal with the back pain. In terms of having a case on which to sue, a law firm could offer a more meaningful response after reviewing the file with the input of medical professionals. What you are really probably wondering is whether you could sue in a manner where a law... View More
I am the third party in a product liability insurance claim. The claim was denied earlier this month and just yesterday, the adjuster called me wanting to "resolve" the claim by offering payment for "pain" from the injury.
Before the insured sent the complaint over to... View More
answered on Oct 4, 2021
When you state you're the "third party" I'm assuming you mean you're the claimant and not a third-party defendant. Regardless, as my colleague correctly advised, the claims adjuster's change in position can be due to many reasons. More likely than not, the adjuster... View More
If somebody claims that got hurt in front of my house how can request to be paid by my house liability insurance? My security system is old and cannot record, just view. Out of nowhere you just try to get money from your neighbors ?
answered on Sep 25, 2021
Your homeowner insurance company will thoroughly investigate the matter. It is not enough for someone to simply fall. They must show that it resulted from a defect in the surface or negligence on your part. The claims adjustor or defense attorney from your insurance company should be able to... View More
So I live with my grandmother. I’m 19 years old and moving out in august. She loves having control of everything! The thing is she has my insurance cards and refuses to give them to me. I’m going to need them when I move out. My college requires me to have my own insurance and I would like to... View More
answered on Jul 7, 2021
One option might be to contact the insurance carrier to request duplicate cards. Good luck
Tim Akpinar
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