The Law Office of James C. Spitz
Florida Legal Counsel With Decades Of Insurance Law Experience

Florida insurance company being sued for misleading clients

Health Insurance Innovations, an insurance company based in Tampa, Florida, is being sued by two different policyholders. Both claim that they did not receive the insurance coverage that they were promised.

A prospect in Ohio spoke with a Health Insurance Innovations sales representative in 2016. The sales rep assured her that he would find her the best policy at the lowest price. He offered her a policy for $240 a month. She believed that it was a traditional health plan with coverage guarantees and purchased the policy.

Not until the policyholder found herself with $48,000 in medical bills did she realize that she was sold a limited benefit plan, which paid an extremely low amount toward medical bills. It was shocking and devastating for her—the bills cost more than her annual salary.

Another policyholder paid premiums on an insurance policy for two years before finding out that his insurance would not cover his surgery.

A Kansas resident bought a policy that he believed to be full coverage. In early 2018, he was diagnosed with a form of breast cancer. He needed surgery to remove the cancer, but the hospital informed him that his insurance would not cover the procedure, ultimately leaving him with $40,000 in medical bills.

The issue

Both policyholders believed they were being sold Affordable Care Act plans at the time of purchase. Not until much later did they realize that their plans provided only limited coverage, leaving them with thousands of dollars in unpaid medical bills.

Although these limited coverage policies were not meant to cover catastrophic health injuries, the insurance company may be held responsible if the policyholders can prove that the sales representative wrongfully portrayed information.

Health Insurance Innovation denies all allegations, stating that they will be defending all accusations of wrong-doing. With $352 million in sales last year, they claim that the lawsuit has no merit.

If the court finds that Health Insurance Innovations has improperly denied coverage or has failed to pay the full value of the claim, they will subject to reprimand. In addition, Health Insurance Innovations will be required to pay for both plaintiffs’ attorney fees, as mandated by Florida law.

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