The Health and Medicine Law Firm Stands up for Patients

 

•A Due process violation for a fair hearing proceeding through AHCA office of fair hearings occurred. The Medicaid beneficiary requested a hearing after Humana denied medical benefits, and requested a fair hearing with the agency and never received notice of fair hearing because it was only sent via email. AHCA dismissed her fair hearing proceeding and she never had the opportunity to present her case. We appealed and sought reversal of the order and remand to the agency. The Fourth District Court of Appeal made it clear they agreed there was no due process and that when a medicaid beneficiary provides an email to AHCA when they request a fair hearing, simply providing the email does not indicate an affirmative election for service by email under controlling rule of the Florida Administrative Code. AHCA violated its own rules by electing service by email for beneficiary rather than paper mail.  Read the published opinion here​.

•A major insurer refused to pay benefits to an Insured under a critical illness insurance policy. The Health and Medicine Law Firm was hired to represent the patient. After less than three weeks, the insurer reversed its claim decision and paid the full policy limits to the insured patient.

•A patient was confined to a facility under the Marchman Act. The Health and Medicine Law Firm was hired to defend the patient in the proceeding after a Motion for Contempt and Incarceration was filed. After hearing and public policy arguments were presented by attorney Maria T. Santi, Esq., the Motion for Contempt was dismissed against the patient. 

•An international travel health insurance plan failed to pay medical benefits to an out of state resident after she traveled abroad. The travel insurer claimed that the medical expenses were not covered and refused to pay no more than $1,500. The Health and Medicine Law Firm filed suit. The travel insurance company covered the patient's medical expenses incurred while traveling abroad and also paid for the patient's attorney's fees and costs for a total exceeding $20,000.

•A major health insurance company denied a patient's prescription medication claiming that it was not medically necessary. The cost of the prescription was more than $2million dollars. The Health and Medicine Law Firm filed legal action. The health insurance company covered and delivered the prescription to the patient within two weeks.

•A major health insurance company denied a patient's claim for a spine surgery that was performed by an out of network healthcare provider in an in network facility leaving the patient with a $60,000 bill. The Health and Medicine Law Firm filed suit. The health insurance company covered and re-processed the claim and paid for the patient's attorney's fees and costs.

•A major health insurance company denied a patient's emergency hospital claim leaving her with a $30,000 bill. The Health and Medicine Law Firm filed suit for breach of contract. The health insurance company covered and re-processed the claim and paid for the patient's attorney's fees and costs.

•A home equipment company was billing a patient's insurance in a manner that was causing the patient to incur thousands of dollars in out of pocket expenses. The Health and Medicine filed suit to compel the proper billing method and the patient was reimbursed out of pocket costs paid and attorneys fees and costs.

 

•A patient made a payment of more than $12,000 for a surgery to a physician. The procedure was thereafter covered by the patient's health insurance. The physician refused to return the monies paid by the patient to the patient. The Health and Medicine filed suit to compel return of the monies paid by the patient. The patient was reimbursed out of pocket costs and attorneys fees and costs.


•Multiple medical bills were reduced for a patient after an emergency hospital stay and after the patient's short term policy did not cover the majority of the bills. The amount of the bills were reduced from 60-70% of the total being charged by the hospital.

•A patient sought approval for a prescription medication through Medicaid. Medicaid denied all levels of appeal. A fair hearing took place and Medicaid still denied the medication. Thereafter, the Health and Medicine Law Firm sought an appeal to the Third District Court of Appeal and the prescription medication was approved for the patient's lifetime.

•A patient was billed over $20,000 after a major insurance company refused to pay for the medical bills as a result of an emergency medical treatment. It was determined the Health Insurance company processed the claim incorrectly. The insurance company failed to consider that the procedure was an emergency and denied the patient’s appeals. After our involvement the insurance company reversed its denial and paid for the claim.

•A patient was billed over $40,000 after a major insurance company refused to pay for the medical bills as a result of an accident requiring emergency medical treatment. A collection agency began the collections process which was terminated once the Health and Medicine Law Firm became involved. The firm also handled an appeal and overturned the decision by the health insurance company. The bill was paid and the patient only had to pay for the deductible and copay.

•An estate was billed approximately $160,000 for a medical bill. The medical bill was settled for approximately $19,000.

•A patient received a medical bill in the approximate amount of $800 which we disputed. The provider erroneously sent the medical bill to collections and reported to the patient's credit. As a result the Health and Medicine Law Firm recovered approximately $3,000 for the patient and had the item removed from the patient's credit report.

•A patient was confined to a facility under the Marchman Act. The Health and Medicine Law Firm was hired to defend the patient in the proceeding which was to move forward on a Petition for Involuntary Confinement. However, after our involvement the case against the patient was voluntarily dismissed within 24 hours.

•A patient was seen at a clinic that allegedly provided treatment to cure cancer. The clinic was not properly licensed and initially quoted the patient $35,000 in out of pocket costs. After making a $5,000 deposit for medical services, the patient was unable to continue treatment because it went against the advice of her physician. The clinic refused to return the deposit. After we were hired to protect the patient's interests, the clinic gave a full refund and paid attorneys fees and costs.

•A patient was receiving medical bills for services not received and the healthcare provider, a laboratory, threatened collections. After we were hired to dispute the bill, the laboratory halted all collections against the patient, and fraudulent billing practices were discovered.

•A patient received bills from a major hospital for urgent care treatment as a result of an accident. The hospital was seeking over $4,000 for a visit that was less than one hour. After we were hired, the bill was reduced by 75% and the remaining 25% was covered by the patient's insurance, resulting in a ZERO balance for the patient.

•A physician group was attempting to collect an exorbitant fee for emergency services in an emergency room that was duplicative of service in the hospital bill. We represented the patient and were able to discharge the entire bill to a balance of ZERO.
 
•A major hospital was attempting to collect a medical bill through a collection law firm and threatened to file a lawsuit against the patient. After we were hired to dispute the bill, the medical bill was sent back to the hospital for further negotiations.

•A major health insurance company was refusing to pay over $150,000 of prescription and specialty treatment claims for a patient based upon technical assertions related to the policy. We were hired to prepare an appeal and also addressed the issue with general counsel of the insurance company. Within one week, the insurance company reserved the denial and paid the claims.
 
•A health student registered for classes at an out of state institution which worked with students in the state of Florida. The school did not deliver the certifications and licensure promised. The Health and Medicine Law Firm obtained a full refund for tuition and lost wages.

•The Florida Department of Health was seeking to impose medical treatment on a patient. However, the patient was under the care of a private physician. We represented the patient and were able to prevent the Florida Department of Health from imposing unnecessary treatment, and instead, the patient continued medical treatment with the private physician.

•A major hospital attempted to bill their patient, a Medicare beneficiary over $220,000 and sent the account to collections. We were hired to represent the patient and obtained a full discharge of the bill, making the patient balance ZERO.

•Physician groups and laboratories attempted to bill, a Medicare beneficiary over $15,000 and threatened to send the account to collections. We were hired to represent the patient and obtained a full discharge of the bills, making the patient balance ZERO.

•A major health insurance company denied a necessary medical procedure to  for a patient. The patient's primary care physician and specialist submitted an appeal. The appeal was denied on two occasions. We were hired and overturned the appeal and obtained the necessary coverage for the patient, saving the patient over One-Hundred thousand dollars for the calendar year.

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Contact

305-444-5969

Address

2601 S. Bayshore Drive, 18th Floor

Coconut Grove, FL 33133

Satellite Office

150 S. Pine Island Road
Suite 300
Plantation, FL 33324 

THE INFORMATION YOU OBTAIN AT THIS SITE IS NOT, NOR IS IT INTENDED TO BE, LEGAL ADVICE. YOU SHOULD CONSULT AN ATTORNEY FOR ADVICE REGARDING YOUR INDIVIDUAL SITUATION. IF YOU CONTACT US BY PHONE OR ELECTRONIC MAIL IT DOES NOT CREATE AN ATTORNEY-CLIENT RELATIONSHIP. PLEASE DO NOT SEND ANY CONFIDENTIAL INFORMATION TO US UNTIL SUCH TIME AS AN ATTORNEY-CLIENT RELATIONSHIP HAS BEEN ESTABLISHED.

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