Can I make my insurance company honor its own billing statements?

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Can I make my insurance company honor its own billing statements?

My employer went out of business at the end of June. For the month of July I called my health care provider to make sure I was still on my employers health insurance policy before making any appointments. My insurance company told me I was still on an active policy. I got my July statement from my health care provider that backed up I was covered and they would honor the claims. Days later I got another letter from my health care provider that they were not going to honor my July claims because my employer did not pay her dues and that they closed the policy July 1st.

Asked on August 17, 2010 under Insurance Law, Florida

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

You should speak withh an attorney, assuming the amount at stake is worthwhile doing so. It is possible, depending on the exact language and  timing of the statement and any other representations made by the insurer, that you can force them to at least  honor the July claims under either a contract theory or a "promissory  estoppel" theory (the latter if you went to the doctor after having spoken with the insurer, in reliance on the represenentation that you had coverage). Also, depending on the terms of your policy, it might be the case that there may have been a "grace period" for making payments, which would have allowed you to pay the full premium and have coverage. Finally, it may be the case that under COBRA, you would have to have the right to make the premium payments yourself to maintain coverage. Bring the policy, the statement, and all other documentation or correspondence to an attorney who can evaluate the sitaution for you.


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