Attorney Maria T. Santi's Legal Cases

Health insurance

Q.H. v. Sunshine State Health Plan, 307 So.3d 1 (Fla. 4th DCA 2020)

Oct 07, 2020

OUTCOME: AHCA order was reversed and remanded and Sunshine State Health Plan and Medicaid had to cover growth hormone treatment for the child.

Medicaid recipient sought judicial review of decision by the Agency for Health Care Administration (AHCA), which concluded that recipient's growth hormone treatment was not medically necessary and ther ... efore not eligible for coverage under the Medicaid Act's early and periodic screening, diagnostic, and treatment (EPSDT) program. The District Court of Appeal held that evidence was sufficient to establish that the growth hormone treatment was medically necessary.

Health insurance

A.W. v. Humana Medical Plan, Inc., 270 So.3d 400 (2019)

Mar 27, 2019

OUTCOME: AHCA and Humana violated due process. AHCA order was reversed.

Following denial by Medicaid plan administrator of coverage for certain outpatient services, Medicaid recipient requested a Medicaid Fair Hearing through state Agency for Health Care Administration, pr ... oviding her contact information, including her e-mail address, during the initial phone call to request the hearing. Notice of recipient’s hearing was sent only via e-mail. Recipient did not appear at hearing. Agency’s order to show cause why recipient’s request for a fair hearing should not be dismissed due to her failure to appear was also sent only via e-mail. Agency’s subsequent final order deeming recipient’s request abandoned was sent via e-mail and regular mail. Recipient appealed.

Health insurance

Medically Necessary Prescriptions Authorized within 24 Hours

Jul 18, 2018

OUTCOME: We obtained the necessary authorization within twenty four hours of the insurance company's receipt of our request.

A major health insurance company failed to authorize an insured's medically necessary prescription medication in a timely manner. After more than three weeks of no results in handling the issue, the In ... sured hired us to obtain the necessary authorization. We submitted a request for authorization pursuant to our standard guidelines.

Health care

Outrageous Medical Bill

Jul 10, 2018

OUTCOME: Reduced medical bill to ZERO dollars and saved patient thousands of dollars and prevented the initiation of collection activities against the patient.

A major local hospital charged a patient an outrageous medical fee for a medical procedure and diagnostic exam that was almost ten times (1) the fair price amount allowable after a short term policy ha ... d paid a fee for the covered medical procedure. We disputed the bill on behalf of the patient.

Health insurance

Necessary Medical Treatment Authorized after Health Insurance Denied Appeal

Jun 10, 2018

OUTCOME: We overturned the appeal denial and obtained the necessary medical coverage for the patient. We saved the patient thousands of dollars and prevented delay in the patient obtaining necessary medical services.

A major health insurance company denied a necessary medical procedure to continue medical treatment for a patient in South Florida. The patient's primary care physician and internal medicine specialist ... had submitted an appeal to the health insurance company with documentation. The appeal was denied by the health insurance company. We were hired to dispute the decision after denial of the appeal for the patient. After submitting the patient's disagreement with the decision and providing documentation to the health insurance company in support of the patient's case.

Health care

Patient Obtains Necessary Medical Care

Apr 01, 2018

OUTCOME: We prevented the patient from suffering major medical injury and possibly death by causing the hospital to provide necessary medical care.

A patient was denied access to care at a major local Florida hospital due to arbitrary decisions taken by hospital staff. We were hired to represent the patient to obtain the necessary access to care a ... nd proper post operative care.

Health care

Continuation of Care for Elderly Woman covered by Medicare

N/A

OUTCOME: Coverage was afforded for continuation of care

Maria represented an elderly woman insured by a private healthcare plan through Medicare that had eye surgery at an out of network hospital considered the best for eye care and surgery. The healthcare ... plan did not want to approve the continuation of care at the out of network hospital post surgery.

Health care

Medical Coverage Denial

N/A

OUTCOME: Coverage was afforded for the medical equipment

Maria represented a young man who had knee surgery and was covered by a state subsidized health plan. The plan denied coverage for medical equipment post-surgery that had been ordered by the orthopedic ... surgeon.

Health care

Medical Bills Discharged for Bone fracture treatment

N/A

OUTCOME: Medical bills were discharged

Maria represented a family that had received multiple medical bills related to a young child's bone fracture in one of her arm's. The insurer was a private health insurer and the child had been treated ... at an in network hospital. The bills were excessive and the insurance had already paid for services rendered.

Health care

Medical Bills Discharged for Percentage Due Under Health Insurance Contract

N/A

OUTCOME: Medical bills were discharged

Maria represented a young man post surgery who was insured by a health plan subsidized by the State. A healthcare provider billed for his percentage of the medical bill. However, after a detailed revie ... w it was apparent the billing practices were inappropriate under the circumstances.

Maria T. Santi's Legal Cases (11)

Q.H. v. Sunshine State Health Plan, 307 So.3d 1 (Fla. 4th DCA 2020)

A.W. v. Humana Medical Plan, Inc., 270 So.3d 400 (2019)

Medically Necessary Prescriptions Authorized within 24 Hours

Outrageous Medical Bill

Necessary Medical Treatment Authorized after Health Insurance Denied Appeal

Patient Obtains Necessary Medical Care

Continuation of Care for Elderly Woman covered by Medicare

Medical Coverage Denial

Medical Bills Discharged for Bone fracture treatment

Medical Bills Discharged for Percentage Due Under Health Insurance Contract