Joseph Romano Law

The parents had a child born with cerebral palsy. The parents called their HMO and were told that they had a $1 million dollar lifetime maximum plan covering the child and "not to worry, they had good coverage". The hospital was also told that the parents had "good coverage". After the initial hospitalization stay, when it was time for the child to be discharged, the parents and the hospital learned from the HMO that home care, attendant care, rehabilitation care and long term nursing care would not be covered, since the policy specifically excluded children whose care, in the opinion of the HMO, was "custodial in nature". I accepted this case and successfully argued that the HMO was "acting in bad faith", since they initially told the family in the hospital that there was coverage and were now attempting to deny the needed care.

Some studies show that over 40% of the time, the coverage information provided by health insurers to parents and healthcare providers is wrong, outdated, incomplete, or misleading. It is critical that you have a trained person read the policy language of your health insurance policy to determine what short term and long term benefits you are entitled to from your health insurer.