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Insurance Claims and Denials

Consumer Alert: “Pop-up ER’s”

You see them popping up around town. But do you really know what they are?

What is a Free Standing Emergency Room?

A freestanding emergency center, or pop-up ER, is essentially an emergency room without being directly attached to a hospital. Since a Texas law set new licensing guidelines for these types of facilities, they’ve been popping up everywhere. There were only about 25 of these centers in 2011, but now there are close to 200 across the state, with more being built. On the outside, these centers look just like your typical ‘doc in a box’ urgent care facilities, but they’re not. The good news is that they usually have more expensive equipment and can admit patients to the hospital if necessary. At an urgent care, you might see a nurse practitioner, but at a pop-up ER, there is a licensed physician on staff 24 hours a day. However, and most importantly, it’s essential to understand that a free standing ER is an emergency room for billing purposes, meaning the cost of your visit will be well over a thousand dollars. In addition, many of the pop-up ER’s are not in network for many health insurance plans. Even some pop-up ER’s will claim to take “most health insurance policies” although the patient later finds out that not only is the ER out of network but the treating physician (who may bill separately) may also be out of network. Thus, the unknowing patient may be stuck with paying very large medical bills.

How to Identify a Pop-up ER

At this time, these centers are required to have the words ‘emergency room’ in their names to identify to consumers that they are in fact, true emergency rooms and not urgent care clinics. Listed below are a few freestanding emergency centers that are ‘popping up’ around Wichita Falls.

  • Select ER
  • Neighbors ER
  • ER Now

The popularity of these freestanding ERs is growing, but don’t wait for a surprise multi-thousand-dollar bill to find out if the center you visited was an emergency room or an urgent care clinic. If you’re not sure if you’re at an emergency room or an urgent care clinic, ask a few important questions before you see anybody.

  1. Is this facility an emergency room?
  2. Is the facility and doctor in my insurer’s preferred provider network?
  3. What is the approximate cost of my visit today?

Consumer advocates in Texas are calling on lawmakers to require more signage and identification on freestanding emergency rooms. Think twice before going to a freestanding emergency room. At first, you might think it is an urgent care clinic, only to find a shockingly high bill in the mail after your visit. Please understand why it’s so important to let the public know there is a huge (and expensive) difference between traditional urgent care clinics and free standing emergency rooms. A recent report from NBC DFW News Channel Five looked into consumer complaints about freestanding emergency rooms.

 

Representing Victims And Families
since 1982

Our attorneys are happy to accommodate difficult schedules. We can meet you in the early morning or late afternoon hours.

We can even schedule appointments on the weekends. We are also available to meet you at home or in the hospital if you do not have transportation, or if your injury doesn’t allow you to travel.

What We Offer Clients And Their Loved Ones:

Initial consultations on personal injury cases are always free.
You do not pay us unless we win your case on personal injury cases.
We`re available to answer your legal questions.
We can be an advocate for your loved ones.
Help provide families with resources and advice.
Resolve automobile property damage claims.
Help you find a doctor, even if you don`t have insurance.
We can deal with the insurance companies.

Free Consultation

Over 40 Years of Experience

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Class-Action Lawsuit Against USAA

USAA is in hot water over allegations of unethical ‘cost containment schemes’ to avoid paying out on insurance claims. USAA is being accused of delaying, denying or reducing medical payouts to faithful policyholders who have been injured in auto accidents. According to San Antonio Express News, the company has been defending similar allegations for over a decade. Recently, a judge in Montana certified a class-action lawsuit against the insurance company.

USAA Facing Class-Action Lawsuits

This is far from the first lawsuit of this kind. Last fall, USAA agreed to pay up to approximately $4.2 million to settle a class-action lawsuit brought by three Washington state health care providers and a USAA member. Although they denied the allegations, they did pay the multi-million-dollar settlement. Similar lawsuits have been filed in Florida, Arizona, Illinois, Oklahoma and Oregon.

Delay, Deny, Defend

Sadly, this practice is not unique to USAA alone. It has become commonplace for big insurance companies to delay, deny and defend in order to avoid paying out on accident and injury claims. In fact, the American Association for Justice has rated Allstate as one of the worst insurance companies in the nation. For many of these large insurance companies, there has been a consistent and dedicated effort to put profits over policyholders. It’s all about the bottom line. These insurance companies are putting shareholder profits over the coverage their policyholders are entitled to.

What to do After a Car Accident

While you might think you’re in “good hands,” the truth is that you might not find your insurance company as easy to deal with as you had hoped. Although many of us think that because we faithfully pay our premiums for insurance coverage, that in the event we need that coverage, it will be there. For many Americans, that’s just not the case. This is just one of the many reasons why it’s important to not try and handle your accident claims on your own. Big insurance gets away with even more when the individuals aren’t represented.

If you have been injured or if you have lost a loved one in a car accident in Wichita Falls, Lawton or the surrounding Texoma communities, contact the skilled team at the Altman Legal Group at 940-761-4000 for a free case consultation. Don’t let your insurance company deny and delay your claims until you’re out of options. Let a professional be your advocate during this difficult time.

Representing Victims And Families
since 1982

Our attorneys are happy to accommodate difficult schedules. We can meet you in the early morning or late afternoon hours.

We can even schedule appointments on the weekends. We are also available to meet you at home or in the hospital if you do not have transportation, or if your injury doesn’t allow you to travel.

What We Offer Clients And Their Loved Ones:

Initial consultations on personal injury cases are always free.
You do not pay us unless we win your case on personal injury cases.
We`re available to answer your legal questions.
We can be an advocate for your loved ones.
Help provide families with resources and advice.
Resolve automobile property damage claims.
Help you find a doctor, even if you don`t have insurance.
We can deal with the insurance companies.

Free Consultation

Over 40 Years of Experience

Contact Form

Flood Damage in Wichita Falls and Texoma

On Monday, an additional 24 counties across Texas were declared in a state of disaster. A few of the Texoma counties hardest hit were Wichita, Archer, Henderson, Caldwell, Clay, Denton and Wilson. The recent heavy rain, thunderstorms, tornadoes and flooding has ravaged the state and caused considerable flood damage in our own home town, Wichita Falls, where the Red Cross has been assisting flood victims all week.

Flood Damage in Wichita County Neighborhoods

Residents in various Wichita Falls neighborhoods have been dealing with flood damage this week. KFDX News Channel Three reports that approximately 25 homes in the Wranglers Retreat and Horseshoe Bend neighborhoods have been flooded. Officials with Oncor have been out assessing the damage and working to restore power to customers. The Sheriff’s office is asking residents to be patient as the process could take time. Some evacuated residents were expected to be able to return to their homes this past Monday.

Flood Insurance: Need to Know

Unfortunately, standard homeowners insurance policies don’t typically cover flood damage. In most cases, you will need to have additional separate polices to have coverage for disasters like floods and earthquakes. It’s also important to note that not all water damage is created equal in the eyes of your insurance provider. For example, your insurance company may view water damage from a storm and water damage from a flood differently. Additionally, even homes in non-floodplain areas can sustain water and flood damage.

After a Flood

We would all like to think that our insurance companies are looking out for us, or that we’re in “good hands,” but that’s just not always the case. In fact, many times, insurance companies are looking out for their own bottom line and shareholder profits rather than the wellbeing of their policyholders.

If you think your insurance company is acting in bad faith or treating you unfairly, contact the skilled team at the Altman Legal Group at 940-761-4000 for a free consultation. Our experienced lawyers can help you file a claim with your insurance company. You don’t have to go through this alone. Residents in Wranglers Retreats and Horseshoe Bend neighborhoods or any other impacted areas can call our team for experienced claim help.

Representing Victims And Families
since 1982

Our attorneys are happy to accommodate difficult schedules. We can meet you in the early morning or late afternoon hours.

We can even schedule appointments on the weekends. We are also available to meet you at home or in the hospital if you do not have transportation, or if your injury doesn’t allow you to travel.

What We Offer Clients And Their Loved Ones:

Initial consultations on personal injury cases are always free.
You do not pay us unless we win your case on personal injury cases.
We`re available to answer your legal questions.
We can be an advocate for your loved ones.
Help provide families with resources and advice.
Resolve automobile property damage claims.
Help you find a doctor, even if you don`t have insurance.
We can deal with the insurance companies.

Free Consultation

Over 40 Years of Experience

Contact Form

Wichita Falls Insurance Agent Arrested for Fraud

Last week, an insurance agent with SIG Insurance was arrested after a 10-month fraud investigation. The Wichita Falls Police Department reports that Shawn Chambers was arrested in Clay County and charged with insurance fraud and misapplication of fiduciary property. Apparently Chambers was taking payments from people and depositing the money directly into his personal accounts. Meanwhile, policy holders were going without coverage, and they didn’t even know it.

Details of the Investigation

This arrest was the result of a 10-month long joint task force investigation between the Wichita Falls Police Department and the Texas Department of Insurance’s Fraud Division. These two departments were also able to solicit help from the president of SIG Insurance, Missy Pollard. Their investigation found that at least 25 clients with patterns of non-payment insurance coverage were connected with Chambers. Basically, although these clients were paying their premiums, they were listed as non-paying, because Chambers was depositing the checks into his personal bank account.

His policy holders paid money to keep their policies current, but they didn’t receive a receipt of coverage. Additional investigative efforts found that Chambers’ bank records also reflected that the checks went into this personal account.

The investigation also charges Chambers with acting in a fiduciary capacity knowingly, intentionally or recklessly misapplying property entrusted to him in a manner that involved substantial risk of loss to the victims, to the tune of over $100,000, which is a second degree felony.

A Second Complaint

Apparently, a second complaint and investigation was also discovered during the initial investigation. This time, it was filed by the Hartford. This compliant involved a claim Chambers filed on behalf for an individual he sold a policy to for damages that reportedly occurred on December 25, 2012. Not surprisingly, the claim was denied due to dropped coverage for non-receipt of payment. It remains to be seen if any other victims of Chambers’ fraudulent actions are discovered or come forward.

What to do if You’ve been Defrauded

If you’ve been defrauded in this type of insurance scheme, you need to speak with a personal injury attorney as soon as possible. The WFPD reports that SIG Insurance has identified and reimbursed a total of $106,296.59 in connection with this case. Since insurance companies can be notoriously difficult to deal with, it’s a good idea to have an experienced attorney on your side, especially if you were denied coverage due to non-receipt of payment while you were being defrauded.

Representing Victims And Families
since 1982

Our attorneys are happy to accommodate difficult schedules. We can meet you in the early morning or late afternoon hours.

We can even schedule appointments on the weekends. We are also available to meet you at home or in the hospital if you do not have transportation, or if your injury doesn’t allow you to travel.

What We Offer Clients And Their Loved Ones:

Initial consultations on personal injury cases are always free.
You do not pay us unless we win your case on personal injury cases.
We`re available to answer your legal questions.
We can be an advocate for your loved ones.
Help provide families with resources and advice.
Resolve automobile property damage claims.
Help you find a doctor, even if you don`t have insurance.
We can deal with the insurance companies.

Free Consultation

Over 40 Years of Experience

Contact Form

Insurance Assistance Event for Oklahoma Tornado Survivors

John Doak, the Oklahoma Insurance Commissioner, is planning a consumer assistance event for tornado victims who still have unresolved claims. This Tuesday evening event is going to take place at Westmoore High School’s lecture hall. According to KSWO News Channel Seven, almost 100,000 insurance claims have been filed since last year’s tornadoes. So far, payments have topped $1.1 billion. Although most residents have already settled their claims, many families are still dealing with their insurance companies.

Answering Questions and Assisting Consumers

Doak is hoping that this forum will help to get the remainder of unresolved claims moving along. A variety of representatives will be on hand to answer questions. There will be representatives from the Oklahoma Insurance Department’s Consumer Assistance Office, legal help, an anti-fraud department and Medicare assistance. According to Doak, the claims that haven’t yet been settled are going to be some of the most difficult cases to resolve. If you’re unable to make it to this event or you still have questions, it may be helpful to speak with a personal injury attorney who has experience dealing with insurance companies.

May 20, 2013

On the afternoon of May 20, 2013, an EF5 tornado swept through the town of Moore, Oklahoma. This tornado was part of a larger system that sent at least five other tornadoes across central Oklahoma the day before. In Moore, 51 people lost their lives and at least 230 others were injured. The tornado was over a mile wide and left nothing but devastation in its wake. More than 56,000 tons of debris had to be removed from the damaged areas in the months after the tornado struck.

Is Your Insurance Company Acting in Good Faith?

If you’re still going back and forth with your insurance company, and you suspect they aren’t acting in good faith, you need to speak with an experienced attorney as soon as possible. Insurance companies are required by law to treat their policy holders fairly. Unfortunately, that’s not always the case. It’s not uncommon to hear about some very well known insurance companies denying and delaying claims to avoid paying on claims or to wear down policy holders. If your insurance company is denying or delaying payments without just cause, contact the skilled team at the Altman Legal Group for a free consultation. Our lawyers have extensive insurance litigation experience. Our Lawton, Oklahoma office can be reached at 580-353-4878.

Representing Victims And Families
since 1982

Our attorneys are happy to accommodate difficult schedules. We can meet you in the early morning or late afternoon hours.

We can even schedule appointments on the weekends. We are also available to meet you at home or in the hospital if you do not have transportation, or if your injury doesn’t allow you to travel.

What We Offer Clients And Their Loved Ones:

Initial consultations on personal injury cases are always free.
You do not pay us unless we win your case on personal injury cases.
We`re available to answer your legal questions.
We can be an advocate for your loved ones.
Help provide families with resources and advice.
Resolve automobile property damage claims.
Help you find a doctor, even if you don`t have insurance.
We can deal with the insurance companies.

Free Consultation

Over 40 Years of Experience

Contact Form

Education Level, Data Mining and Your Insurance Rates

An article out of The Wall Street Journal recently reported on the disturbing news about what education level and data mining have to do with insurance rates. As it turns out, data mining and education level have quite an impact on what you’re paying for car insurance each month. Insurance corporations can actually use data to determine what customers are willing to put up with price hikes, whether they can afford it or not. The Wall Street Journal also found that auto insurance customers are being charged more for reasons that have nothing to do with driving ability or history, like their highest level of education attained.

The Low Down on Data Mining

Data mining means corporations can more effectively deliver services and goods to their customers, right? Unfortunately, this isn’t exactly the case where some very well-known insurance corporations are involved. According to the Consumer Federation of America, auto insurance companies are trying to maximize profits by analyzing data to find out which customers will tolerate repeated price hikes. These customers are likely way too busy to shop around for deals every six months or a year to get the best rate for their car insurance. This practice is known as “price optimization,” which might more accurately be called price gouging.

What About Education Level?

Your level of education, which has nothing to do with your driving ability, also impacts what you pay for car insurance. Two people who are purchasing the exact same coverage can expect two very different premium prices based on their education level or employment position. The New York Public Interest Research Group found that less-educate drivers and those with non-professional, non-managerial jobs can expect to pay an extra $1,000 in premiums.

Why You’re Not Always “in Good Hands”

Although big-budget advertising campaigns and feel-good commercials may give you a false sense of security when dealing with your insurance company, it’s important to remember that large insurance company executives are always looking out for their own bottom lines. At the end of the day, increasing shareholder profits is the goal. Many well-known big-name insurance companies made the American Association for Justice’s list for the Ten Worst Insurance Companies in AmericaHow They Raise Premiums, Deny Claims, and Refuse Insurance to Those Who Need it Most. If you think your insurance company is acting in bad faith, contact the experienced team at the Altman Legal Group at 800-772-0828 for a free consultation today.

Representing Victims And Families
since 1982

Our attorneys are happy to accommodate difficult schedules. We can meet you in the early morning or late afternoon hours.

We can even schedule appointments on the weekends. We are also available to meet you at home or in the hospital if you do not have transportation, or if your injury doesn’t allow you to travel.

What We Offer Clients And Their Loved Ones:

Initial consultations on personal injury cases are always free.
You do not pay us unless we win your case on personal injury cases.
We`re available to answer your legal questions.
We can be an advocate for your loved ones.
Help provide families with resources and advice.
Resolve automobile property damage claims.
Help you find a doctor, even if you don`t have insurance.
We can deal with the insurance companies.

Free Consultation

Over 40 Years of Experience

Contact Form

Is Your Insurance Company Treating You Fairly?

The Associated Press recently reported that nearly 71,000 insurance claims have been filed in relation to the tornadoes that swept through Oklahoma last month. Insurance adjusters are likely working overtime to get claims reviewed. Under the law, your insurance company has certain duties to treat your fairly. There are deadlines for responding to claims. The law reflects the understanding that policy-holders are typically at the mercy of their insurance companies. The insurance company has to respond to your claim within a reasonable amount of time. By law, your insurance company has to pay for any damages due under your policy in a timely fashion.

Policy holders may not be aware of their legal rights when they file an insurance claim. Your insurance company has a legal duty to ‘act in good faith.’ Claims are usually filed after life-altering events. You may be in the hospital after a car wreck, or you may be rebuilding your house after a natural disaster. Victims may not be able to get on with their lives until their claims have been reviewed and paid. If your insurance company isn’t treating you fairly, you may be entitled to an additional settlement to cover damages.

Signs Your Insurance Company May be Acting in Bad Faith

  • Failure to respond to a claim within a reasonable amount of time
  • Unreasonable delays
  • Failure to pay
  • Offering unfair ‘low-ball’ settlements
  • Unfairly denying coverage
  • Misrepresenting the facts
  • Threatening cancellation or rate increases to force an unfair settlement

Insurance companies have a duty to act in good faith, because policy holders may be facing difficult financial situations when they file claims. Unfortunately, unscrupulous insurance companies have the ability to take advantage of potentially desperate situations. Victims may not know how to protect their legal rights. When claims aren’t handled in good faith, it’s time to contact an attorney. Victims who are out of work and devastated by natural disasters can’t have their claims unfairly delayed or denied. They are counting on the money from their settlements. Policy holders deserve to have their claims handled in a timely and professional manner.

If you’re not being treated fairly, contact an insurance claim attorney immediately. A skilled insurance lawyer can evaluate your claim to determine if your insurance company is acting in good faith. Call the experienced attorneys at the Altman Legal Group at 940-761-4000 for a free consultation.

Representing Victims And Families
since 1982

Our attorneys are happy to accommodate difficult schedules. We can meet you in the early morning or late afternoon hours.

We can even schedule appointments on the weekends. We are also available to meet you at home or in the hospital if you do not have transportation, or if your injury doesn’t allow you to travel.

What We Offer Clients And Their Loved Ones:

Initial consultations on personal injury cases are always free.
You do not pay us unless we win your case on personal injury cases.
We`re available to answer your legal questions.
We can be an advocate for your loved ones.
Help provide families with resources and advice.
Resolve automobile property damage claims.
Help you find a doctor, even if you don`t have insurance.
We can deal with the insurance companies.

Free Consultation

Over 40 Years of Experience

Contact Form