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Archive for the ‘Insurance Claim Disputes’ Category

Deadline for Florida Hospital and United Health Contract Negotiations Approaches

Friday, July 23rd, 2010

The contract expiration date for one of Central Florida’s largest hospitals, Florida Hospital, and one its largest health carriers, United Healthcare,  is rapidly approaching.  According to the Orlando Sentinel, the two companies have been at the negotiating table since last November to no avail.

Both entities have sent letters to United Healthcares’ insureds informing them of an August 15th expiration date and the fact it does not appear that a new contract will be inplace in time to extend service.  The letters go on to say that if the insured is a patient of a doctor employed by Florida Hospital, that patient will no longer be covered under any of United’s insurance plans. Any service provided would then be considered “out-of-network”.  And because the urgent care provider CentraCare is also owned by Florida Hospital, those too would be considered an out-of-network provider.

Patients are urged to discuss this situation with their physicians to find out (1) if their doctor has medical privileges at another local hospital, or (2) get a referral to a doctor who does have priviledges at another hospital.  The second option can be a difficult one for patients if they have a serious medical condition and they have long term relationship with their doctor.  It can be very unsettling.

I know that the whole nationalized healthcare issue is a hot potato that no seems to want to touch.  But if they could at least establish fair and reasonable rates for all medical services, including physicians, hospitals and labs, everyone would be on the same playing field playing by the same rules.  Because the only one that gets hurt by all of this squabbling is the patient.

Backyard Trampolines – Summer Fun or Huge Liability?

Monday, June 15th, 2009

As I take my daily walk, I see several trampolines in my neighbor’s yards.  It makes me wonder:  did they contact their insurance company before they bought it?  If not, do they know that they may have no liability coverage if the trampoline is forbidden under their homeowner’s insurance policy? 

According to InsuranceSalesman.com

The insurance policies that will cover trampolines usually insist on stringent safety measures, like a safety net, or a fence that is at least 4 feet high. This is still no guarantee that you will find a policy to cover you; these things can vary from state to state. If you owned a trampoline before you bought your policy, or if you did not inform the insurance company of its existence, don’t be surprised if you get an unscheduled inspection and are asked to remove it.

The Consumer Products Safety Commission (CPSC) reports that in 2001 there were almost 92,000 emergency room visits due to injuries sustained on a trampoline.  As would be expected, approximately 93% were under the age of 15, and 11% were under the age of 5. 

The American Association of Pediatrics (AAP) is of the opinion that trampolines should not be used in backyards at all.   The AAP stresses -

Adult supervision will not adequately prevent injuries on home trampolines. Trampolines should be used only in supervised training programs for gymnastics, diving, or other competitive sports.

If you follow the recommendations of the AAP, you should never buy your kids a trampoline.  The risk of injury and possible insurance difficulties does not warrant the few hours of enjoyment the kids might have.

You should also not let them visit friends or neighbors who have a trampoline.  If your child gets injured on your neighbor’s trampoline, there may be no insurance to cover them except your own. 

Insurance Providers to Testify on Using Credit Scores

Tuesday, February 17th, 2009

The Florida Office of Insurance Regulation has scheduled a hearing to question insurance companies on their usage of credit scores when setting insurance premiums.

Allstate, Geico, Nationwide, Progressive and State Farm Florida have all received subpoenas requesting that a representative attend the hearing.  The representative should be prepared to discuss how their company uses the credit scores, explain their rate setting models, and discuss what measures have been taken to ensure that a certain class of citizen is not being discriminated against (based on either race or income).

It is a public hearing set for Wednesday, February 18th at 9:00 am in the Cabinet Meeting Room in the Capital in Tallahassee.