Missouri Insurance Lawyer Blog

The Missouri Department of Insurance has issued a warning for people who are planning on Medicare enrollment during the current open enrollment period. There are people who are presenting themselves to Medicare applicants as "Medicare-endorsed agents" when in fact, they are there to try to sell you life insurance, annuities, or other coverages.

The Missouri Department of Insurance offers a free program called CLAIM. This free service provides one-on-one counseling for Missourians with Medicare questions. For information on the CLAIM program, visit the MO DOI CLAIM wesbite at missouriclaim.org or call 800-390-3330.

Missouri, along with other states and the federal government, have reached an agreement with the Elan Corporation. The Elan Corporation's subsidiary, Elan Pharmaceuticals, INC.(EPI), marketed its anti- epileptic drug, Zonegran, for uses that were not approved by the FDA. EPI paid health care professionals to prescribe Zonegran for other uses such as obesity and headaches. EPI agreed to plead guilty to a federal misdemeanor and is to pay a criminal fine of $102 million dollars to the federal government. EPI will now be closely monitored because of a Corporate Integrity Agreement by the United States Department of Health and Human Services.

Medicare enrollment is currently open through December 31st. If you want to apply for Medicare benefits for yourself or help a loved one apply but don't know where to start, call the Missouri Department of Insurance or visit their website. They're offering free assistance to anyone who needs help with the enrollment process via the CLAIM Insurance Assistance project. You can also visit the CLAIM website for more information.

It was reported on Tuesday, September 21st by the Missouri Department of Insurance that eight companies and individuals have been accused of selling fake health plans. The fines against these companies and individuals is more than one million dollars.
The companies sold plans that were disguised as medical insurance. The plans were marketed through unsolicited faxes which at least 150 Missouri Consumers bought. The faxes said things such as "Dependent Coverage" and "Group Health Plan."

$130,000 in fines were imposed by regulators. Cease and desist orders were also issued for the following individuals and buisnesses:Thomas J. Sullivan; Richard Bachman; James M. Doyle; Bart S. Posey Sr.; Christopher Ashiotes; and Obed Kirkpatrick; Smart Data Solutions; Affinity Group Benefits Association Inc. Discount- plan marketers caught violating the court orders will likely face criminal prosecution.

Individuals who have been cheated by insurance companies have the right to sue the insurance company for damages. Government agencies police business but don't get compensation for the damages the consumer suffered. If an insurance company cheated you, you should speak to an experienced attorney about your legal rights

Continue reading "Fake Medical Insurance" »

All 50 states have been affected by a Tennessee based entity called the American Trade Association (ATA) plus other affiliated firms, which was selling fake health insurance. The program was supposed to work by the ATA taking out money directly from consumer's accounts. Consumer's thought they were saving hundreds of dollars each month on premiums until an issue with their health came up and they found out they were not insured.

Some consumer's have shared their stories through Smart Data Solutions where one person stated, "I tried to get prescriptions through my card and it is not covered. They say they are getting a new plan, but did not inform anyone. Their phone goes unanswered, or it is busy. Their website; http://www.myatabenefits.com doesn't work either. This is either an incredibly poor run organization, or a scam."

After investigations were held consumers found out that their money had actually been used to pay for personal items such as cars, real estate, and loan payments. Some claims were paid, but only the small ones to maintain the appearance of legitimacy.

The state of Maine actually ordered the American Trade Association to pay a $1.2 million penalty because of the unlicensed products sold to consumers, the unlicensed agents, and for not adequately paying for consumer's medical bills.

Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services describes how this is just the beginning. There will be more scammers out there because they know people are seeking cheaper insurance coverage.

Consumers who want to research a company can check with their State Department of Insurance. If you are scammed by insurance company or a company that promises to provide insurance and does not, you have legal rights. In Missouri an insurance company that does not honor its promise can be sued for breach of contract and in some circumstances for bad faith. If a company poses as an insurance company but is a fake, you can sue for damages for breach of contract, misrepresentation and fraud. If you have been scammed you should also report the company responsible to law enforcement.

Continue reading "Health Insurance Scam Affects 26,000 People Across the U.S." »

In a case handed down August 6, 2010 by the Missouri Court of Appeals, Southern District, the court found that the proposed lien of a health insurer was an invalid attempt to require assignment of the Participant's personal injury claim and, as such, it was contrary to longstanding Missouri public policy. Scroggins v. Red Lobster, No. SD 30214.

In 2007, Pamela Scroggins was seriously injured in a trip and fall accident at a restaurant. Ms. Scroggins' medical expenses were covered by an employee contributory self-funded health plan that provided benefit coverage to her under her employer provided health care plan. As a result of her injuries, Ms. Scroggins sued the restaurant and the lawsuit resulted in a settlement.

One of the health insurance plan provisions purported to grant the health insurer a lien upon the proceeds of the Participant's tort recovery, and a right to payment from any recovery, to the extent of the sum that the Insurer paid for injuries Ms. Scroggins suffered. This is not unusual. Insurers paying benefits to insureds as a result of injuries caused by third persons often claim an interest in recovering those costs if the insured obtains a settlement or collects upon a judgment against the third party. To that end, insurers have repeatedly attempted to draft policy provisions or establish other requirements for the purposes of seeking reimbursement from the insured in such situations.

Continue reading "HEALTH INSURER CANNOT ASSERT LIEN UPON THE PROCEEDS OF THE PARTICIPANT'S TORT RECOVERY" »

The Missouri Department of Insurance recently announced that health insurance companies in Missouri are now required to cover dependant children up through age 26 under a parent's health insurance policy. The requirement takes effect for policy years beginning September 23rd or later. The age 26 requirement does not apply to adult children who have other health insurance available to them, such as through their own employer's policy. Coverage must include all the benefits of younger dependents and at the same price.

Some insurance companies are making this new policy available now including United Health Care, Anthem Blue Cross and Blue Shield, Aetna, Cigna, Blue Cross and Blue Shield of Kansas City, Coventry, and Humana. These companies cover almost 66 percent of licensed health insurance for covered Missourians.

Almost 20,000 more Missouri children will now have health insurance. The new policy will only apply to health insurance plans that offer dependent coverage, though most insurers and employer based plans do offer dependent coverage even though there is no requirement to do so.

You can read more about this new extension of coverage at the Missouri Department of Insurance website.

On July 6, 2010 Missouri Department of Insurance Director James M. Huff announced that $81 million in federal funding will be used on new health coverage for Missourians who have had trouble getting health insurance because of pre-existing conditions.. The idea was proposed by the Missouri Health Insurance Pool (MHIP) and was approved by the federal government. The program will also be funded by premiums that are paid by policy holders and will provide insurance coverage at competitive rates. Eligibility requirements state that you must be a Missouri resident with pre-existing medical conditions, and that you have been uninsured for at least six months. The federal and state high risk pools are available until 2014, then all applicants, regardless of health status, will be offered coverage at market rates because the new federal law will require it.

You can apply online at the MHIP website, or you can call (800)821-2231.

Insurance is critical to protect your security in good and bad times. Life insurance, liability insurance and disability insurance are key to protecting yourself and your family. This article discusses some of the key points.

Wealth Matters - Never Mind Your 401(k). How's Your Insurance? - NYTimes.com.

The Missouri Department of Insurance has issued guidance on the implementation of a new law limiting the amount of the co-pay insurance companies can impose on services provided by a Chiropractor. Many people choose to receive services for back injuries and similar injures. You can read the bulletin here.

Missouri to Study Timeliness of Health Insurers' Reimbursements.

The Missouri department of Insurance is studying something doctors and insurance customers already know, health insurance companies do not pay timely. Anyone who has had a medical problem and had to deal with the doctors, hospitals and insurance company EOB's knows the games insurance companies play. Despite clear regulatory rules for the fair treatment of insured in Missouri the Department has done a poor job of holding health insurance companies accountable for the fair and timely resolution of claims. Hopefully, this study will demonstrate the need for action by the department.

A good read from the New York Times.

Personal Health - Patient Advocates Help to Manage Care - NYTimes.com.

A recent article in the LA Times demonstrates how insurance companies make life and death decisions. A man needing an organ transplant was approved by his insurance company to have the operation in California, but the wait list was very long. His doctor recommended having the operation in Indiana where he could get the organ sooner, but the insurance company denied the procedure to save money. Read the whole story hear.

Missouri has adopted a law that allows employees of small Missouri businesses to continue coverage after their employment has ended under terms identical to COBRA. The notice issued by the Missouri Department of Insurance can be read here<.

HMO claims-rejection rates trigger state investigation -- latimes.com.

Here is an interesting story from the LA times. That means 20% of all claims made are denied, despite a diagnosis and a doctor's orders.