How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask TexLaw Your Own Question
TexLaw, Attorney
Category: Legal
Satisfied Customers: 4430
Experience:  Lead trial/International commercial attorney licensed 11 yrs
Type Your Legal Question Here...
TexLaw is online now
A new question is answered every 9 seconds

I have the following situation: 1. I had a health insurance

This answer was rated:

I have the following situation:
1. I had a health insurance with a company Easy Choice Health Plan since 2008
2. In March-April of 2012 I had to use medical services
3. I did not pay insurance bill for March - April 2012
4. On 4/13 I received the letter from Easy Choice saying that I was denied of coverage for non payment, but I can be reinstated if I will pay.
5. I sent a check that was cleared (they accepted a payment)
6. In June 2012 I received bills from medical providers, because Easy Choice denied coverage.
7. I called to Easy Choice (in July 2012) to find out the reason of denied coverage and they admitted that I paid the bill up to 5/1/2012, but they denied coverage.
8. Then the EC rep said, that by manager decision they can reinstate me starting from May 2012, but not for March and April (the medical bills are for March and April services), because i was more than 30 days late to pay. (They received my payment on 4/25).
What should I do in this situation to make them pay the bills, that were forwarded to me because they denied coverage?

Thank you for your question. I need some more information in order to answer it.

1. What state are you in?

2. When you say you paid to be reinstated, did you pay the premiums for all the months you had previously missed?

3. Are the medical bills too high to pay now and seek reimbursement from the insurance company, rather causing the medical provider to send you into collections while the insurance dispute is sorted out?

I look forward to hearing back from you.

Customer: replied 4 years ago.
1. New York
2. Yes
3. The medical bills are high (approx $6000), but I can pay them.
I'm looking at NY law on this. In the meantime, I have some follow up questions.

1. When you paid the overdue premiums, did the insurance company state they are issuing you a new policy, or are they reinstating your old policy with continuous coverage?

2. When you paid, did they send you any sort of letter confirming payment or any sort of document which is a "certificate of coverage"?

Customer: replied 4 years ago.
1. no
2. no
Pursuant to NY law, in your situation, the terms of the policy control the right of the insurance company to terminate. Generally, if you have paid premiums for a certain period, you should be granted coverage for that period.

If the insurance company did not state that they had terminated the policy and were issuing a new policy, and you are still under the old policy, then you are entitled to coverage on the medical bills. On the other hand, if the insurance company terminated the policy and issued a new policy with a new coverage date, you are not covered for the missing time.

In either situation, I believe you have a claim against the insurance company for unfair practices. The first thing you need to do is request a certificate of coverage on your policy which shows the dates of coverage. This is a standard form that all insurance companies issue.

Next, you should check the policy information that they have sent you. Did the policy number change?

After you gather this information, if they tell you that you have the exact same policy as you did before the gap in payment, and your certificate of coverage states that you are covered, you should attempt to file the claim again pointing to your evidence of coverage.

If that is denied, then you should file a claim with the NY Department of Financial Services (the department in charge of insurance regualtions). It will be a "prompt payment complaint" and you can find the form for complaint at:

You will want to try to resolve this quickly before you medical provider sends you to collections and it affects your credit. They generally give you a decent amount of time before doing this, but you will want to get on the phone with the health insurance company and request the documents I referenced above ASAP.

If the medical provider attempts to send you to collections before the issue with the insurance carrier is resolved, it is wisest to pay the claim and seek reimbursement so as not to negatively affect your credit score.

If all that fails, I believe you have a claim for bad faith and breach of contract against the insurance company. These types of claims are complex and have to be handled by an attorney. Hopefully, you won't get to that point and the Department of FS will force the insurance carrier to pay the claims.

Please let me know if you need clarification or further information.

Best Regards,
TexLaw, Attorney
Category: Legal
Satisfied Customers: 4430
Experience: Lead trial/International commercial attorney licensed 11 yrs
TexLaw and 3 other Legal Specialists are ready to help you

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
< Previous | Next >
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
  • My Expert was fast and seemed to have the answer to my taser question at the tips of her fingers. Communication was excellent. I left feeling confident in her answer. Eric Redwood City, CA
  • I am very pleased with JustAnswer as a place to go for divorce or criminal law knowledge and insight. Michael Wichita, KS
  • PaulMJD helped me with questions I had regarding an urgent legal matter. His answers were excellent. Three H. Houston, TX
  • Anne was extremely helpful. Her information put me in the right direction for action that kept me legal, possible saving me a ton of money in the future. Thank you again, Anne!! Elaine Atlanta, GA
  • It worked great. I had the facts and I presented them to my ex-landlord and she folded and returned my deposit. The 50 bucks I spent with you solved my problem. Tony Apopka, FL
  • Not only did he answer my Michigan divorce question but was also able to help me out with it, too. I have since won my legal case on this matter and thank you so much for it. Lee Michigan

Meet The Experts:

  • Tina



    Satisfied Customers:

    JD, BBA Over 25 years legal and business experience.
< Last | Next >
  • Tina's Avatar



    Satisfied Customers:

    JD, BBA Over 25 years legal and business experience.
  • Ely's Avatar


    Counselor at Law

    Satisfied Customers:

    Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
  • JPEsq's Avatar



    Satisfied Customers:

    Experience as general attorney, in house counsel, SSDI, Family Law attorney, and law professor
  • Law Educator, Esq.'s Avatar

    Law Educator, Esq.


    Satisfied Customers:

    JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
  • FiveStarLaw's Avatar



    Satisfied Customers:

    25 years of experience helping people like you.
  • Guillermo J. Senmartin, Esq.'s Avatar

    Guillermo J. Senmartin, Esq.


    Satisfied Customers:

    7+ years of experience handling various legal matters.
  • Dimitry K., Esq.'s Avatar

    Dimitry K., Esq.


    Satisfied Customers:

    Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.

Related Legal Questions