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When a insurance company does not pay or deny medical claim in a timely manner?

34112 |

The Florida statute 627.6131 (5) (e) ,,A claim must be paid or denied within 120 days after receipt of the claim. Failure to pay or deny a claim within 140 days after receipt of the claim creates an uncontestable obligation to pay the claim.,, Later it states ,,Payment of a claim is considered made on the date the payment was mailed or electronically transferred. An overdue payment of a claim bears simple interest of 12 percent per year. Interest on an overdue payment for a claim or for any portion of a claim begins to accrue when the claim should have been paid, denied, or contested. The interest is payable with the payment of the claim.,, My insurance company did not deny within 140 days, I have paid all 3 claims out of pocket, what can I do to get the money back?

I have submitted a letter of appeal for these claims, but I was not aware of The Florida statute 627.6131 (5) (e) when I did. The insurance company must have know when they denied my claims that they had long past the time they had to deny according to the statute. Is that lawful? One more thing, can an insurance company change there reason for the denied claim (as on the EOB) when faced with having to pay?

Attorney Answers 3

  1. Seek legal help with your paperwork. Not possible to answer your questions without seeing the paperwork.

    The answers given are limited to the facts as given and presumed by the answer itself. Without seeing actual written documentation or having a conference to more fully explore the issues, this short answer has only limited application. Make sure to seek legal counsel and provide all documentation to get assistance in making informed legal choices.

  2. No way to answer without seeing the docs, so have a local lawyer review them

  3. In order to answer your question properly, an attorney needs to go over the facts and the documentation to determine what appropriate steps are need to proceed with a potential case against the insurance company. Good luck.

    Miguel A. Amador is licensed to practice law in Florida and the District of Columbia only. The information provided is for general informational purposes only and is not intended to be legal advice. No attorney-client relationship is formed nor should any such relationship be implied. The information provided is of a general nature is not intended to substitute for the advice of an attorney