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Alexia Esq.
Alexia Esq., Managing Attorney
Category: Legal
Satisfied Customers: 11699
Experience:  19 Years of Legal Practice Experience in this precise field.
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Writing from Silver Springs FL....we are senior citizen with

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Writing from Silver Springs FL....we are senior citizen with a Medicare Advantage type health care insurance. We received notice from them about a month ago that we had to give up the primary care, cardiologist , pain management and kidney doctors we trusted and find other doctors. The insurance company, for some unknown reason, known only to them, canceled or broke the contract between it and the family clinic we trusted with our health care. This breach of contract took place 6 months before the end of the contract date at the end of December 2013. As far as we are concerned it's a breach of contract
not only between the clinic and insurance company but a breach in the contract between the insurance and us. Each time I asked questions of the why's and why not's as to this problem, the insurance lied to me. I have been told so many lies I wouldn't know the truth if they decided to tell it to me. We cannot change medicare insurance providers until the enrollment period which starts in October. Then we can change to another company BUT cannot start using the new company until January 1, 2014. Considering they broke the contract we'd like to file legal actions against them so we can remain with our current medical providers. Any advice for us?
Sincerely,
Dale and Ruth McIntyre XXX@XXXXXX.XXX
Submitted: 1 year ago.
Category: Legal
Expert:  Alexia Esq. replied 1 year ago.
Hi, Dale and Ruth, my name is XXXXX XXXXX I thank you for your inquiry. I have been practicing law for 19+ years and look forward to assisting you.

With regard to your post:

Writing from Silver Springs FL....we are senior citizen with a Medicare Advantage type health care insurance. We received notice from them - May I presume that by "they" you mean your health care provider?

about a month ago that we had to give up the primary care, cardiologist , pain management and kidney doctors we trusted and find other doctors. Did they say you had to give them up? Or that they were no longer in network, but were now "out of network"?

The insurance company, for some unknown reason, known only to them, How do you know that it is known only to them? Did you speak to your doctors' facilities business management to see if they know why? How did you learn that no one else knows?

canceled or broke the contract between it and the family clinic we trusted with our health care. How do you know that the K was cancelled or broke? Are you presuming this because they are no longer doing business together in a particular way?

This breach of contract(1) took place 6 months before the end of the contract date at the end of December 2013. (1)OK, you are saying a breach? Whose breach? You are presuming that either your carrier or your doctors breached (legally violated) a legal contract with each other, right? Do you have reason to know this? Can you provide the basis for this particular detail of knowledge? (2) End of contract? Do you mean the end of your contract with your carrier - i.e. you are stuck with your carrier until near year end when you can change up?


As far as we are concerned it's a breach of contract That is fine, but won't help you unless there actually IS a breach of contract, legally.


not only between the clinic and insurance company Why would you think that? Businesses part company extremely frequently in this particular industry. Very frustrating, but true. We are living it here, in fact.

but a breach in the contract between the insurance and us. You willl need to cut/paste or retype the terms of the contract you believe has been breached by the carrier if you want me to entertain that possibility.

Each time I asked questions of the why's and why not's as to this problem, the insurance lied to me. In what way?

I have been told so many lies I wouldn't know the truth if they decided to tell it to me. We cannot change medicare insurance providers until the enrollment period which starts in October. I know! So annoying, I dislike that restriction intensely.

Then we can change to another company BUT cannot start using the new company until January 1, 2014. Considering they broke the contract we'd like to file legal actions against them so we can remain with our current medical providers. Any advice for us? If you know that they DID legally break a term of your contract, you will likely have to assert it and make your demand. I can almost guarantee that they will do nothing supportive of your efforts. So, you will likely have to sue them - that is the only legal recourse when someone breaches a contract that they have with us. As you know, suits take a long time, so this will likely not help you in the time frame you want it. A reality. So if you want to stay with your current providers while you sue your carrier, you certainly CAN, but you will pay the out of network price (hopefully) (sometimes is it cheaper than in network, but it all depends, and probably not for a specialist). And I don't know if YOU need to file the claim or they will - but the cost may not be as bad as you think. Before you go through too much effort, you may just want to find that out, because damages for breach will only typically be what that lost money is, not the aggravation.

As an aside, I would like to see a law where those that engage in Medicare patients (and the carriers) can not change up mid term. This would prevent the stress, aggravation etc. of either not getting needed treatment or having to find someone we are not comfortable with in a flash. I know it is not easy!


I hope this helps! My goal is to provide you with excellent and accurate service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions. Kindly rate me "excellent" when you are done. I look forward to assisting you in the future, should you have legal questions.

Sincerely,
Alexia Esq.
Alexia Esq., Managing Attorney
Category: Legal
Satisfied Customers: 11699
Experience: 19 Years of Legal Practice Experience in this precise field.
Alexia Esq. and 6 other Legal Specialists are ready to help you

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