Class Action Blog : Class Action Lawyer & Attorney : Meiselman, Denlea, Packman, Carton & Eberz : Consumer fraud, Personal Injury

New York State insurance regulators have fined American Medical and Life Insurance Company (“AMLIC”) for marketing limited health insurance policies through “misleading” advertisements which promised “peace of mind” for just $5 a day.  In reality, AMLIC policies were not comprehensive health insurance and left patients only with huge hospital bills.

For example, AMLIC advertised that its health insurance policies were a low cost option for the uninsured and underinsured, intimating that its policies provided comprehensive coverage.  In fact, the policies were limited coverage policies that did not provide comprehensive coverage.  Moreover, in one television advertisement the narrator states that AMLIC health insurance is available, “regardless of any pre-existing conditions,” while the print on the television screen stated, “most pre-existing conditions accepted” and the fine print on the policy itself stated that there was a six-month waiting period.

New York’s two year investigation of AMLIC found a Rochester woman who had purchased an AMLIC policy and ended up with hospital bills totaling $28,000.  Her AMLIC limited policy covered only $1,164 of the hospital bills.  In another case, a 36 year old New Yorker who suffered a stroke found out that his AMLIC policy covered just $250 in medical bills, leaving him with a bill of $29,917.

In commenting on AMLIC’s misleading ads, Governor David Paterson said, “Many New Yorkers are desperate for affordable health insurance. Unfortunately, some businesses are taking advantage of that need to sell limited health insurance in ways that mislead consumers into believing they are getting full coverage.”

If you purchased a health insurance policy from American Medical and Life Insurance Company, please contact us to discuss your legal options.

• Email This
• Print
• Comments (2)
• Trackbacks
• Share Link

State insurance regulators in Michigan have charged two businesses with selling fake health insurance policies, and the Georgia Insurance Commission issued cease and desist orders to two organizations allegedly acting as unlicensed insurers.

The Michigan Office of Financial and Insurance Regulation (“MOFIR”) ordered American Consumers Insurance (“ACI”) and its partner agency, Real Benefits Association (“RBA”), to stop selling allegedly fake health insurance policies.  The allegedly fake policies, which were marketed through radio advertisements, were sold in Michigan, Arkansas, New Jersey and New York.  “Basically these consumers [who purchased health insurance] were holding worthless pieces of paper,” said Jason Moon, a spokesman for MOFIR.  Regulators have also advised consumers who purchased health insurance coverage from ACI and RBA to immediately seek out and purchase legitimate medical insurance.

In Georgia, the Insurance Commission issued cease and desist orders to The Butler Aid Society and God First Missionary Membership Association and Floral Club.  Both organizations offered cash payments to members upon death, though neither entity is a licensed insurance company or registered as a pre-need funeral business.  “There’s a serious financial risk to consumers whenever you have a small operation like this, run out of somebody’s hip pocket without proper capitalization and regulatory oversight,” said Insurance Commissioner John W. Oxendine.

If you have purchased a health insurance policy through ACI and/or RBA, or a policy from The Butler Aid Society and/or God First Missionary, please contact us to discuss your legal options.

• Email This
• Print
• Comments (1)
• Trackbacks
• Share Link

Most physicians are quite familiar with the following scenario. The insurance company advises the physician that he or she will be paid according to a certain fee schedule. Time passes, the physician examines the amounts reimbursed for services rendered and it is evident that the amounts paid are far less than what was agreed. The physician complains and the insurance company advises the physician that the fee schedule was modified and that the physician was notified about the modification before it was implemented and, in fact, had agreed to the modification. On further inquiry the insurance company explains that it faxed a “notice” to the physician informing the physician of the change and that unless the doctor opted out within a certain period of time (usually 30 days) the doctor is deemed to have accepted the revision. The insurance companies have used this notification methodology for years because they understand that most physicians are simply too busy to review every piece of paper that comes to them by fax or mail and that by the time the physician finds the “notice” (that is assuming the physician even received it), the physician is deemed as having accepted the modification. Such “notices” have been used to revise many important components of the provider-payor relationship.

Now the insurance companies are using this methodology coupled with potentially fraudulent practices to force physicians who never agreed to treat Medicaid patients to accept Medicaid patients at Medicaid rates. First, the insurance companies send the physicians the “notices” advising them that, unless they opt out within 30 days, they will be deemed as having accepted treating the insurance companies’ Medicaid insured at the Medicaid rates. The physicians never see the notices so they are deemed as having accepted the obligation. Second, when the Medicaid patients show up at the physicians’ offices, they present health coverage cards that identify them, not as Medicaid patients, but rather as commercial HMO patients (which has a higher reimbursement rate). The physicians render the services not realizing that they are treating Medicaid patients at Medicaid rates. It’s only when the physicians are reimbursed (assuming they are even reimbursed) that they realize what has happened. But by then it’s too late!

If you are a physician and find yourself encountering this situation, please contact us at mdpcelaw.com or (914) 517-5000. 

• Email This
• Print
• Comments
• Trackbacks
• Share Link