Insured Sues After Expenses Incurred in Canada Rejected

On Tuesday a case was removed from Miami-Dade County state court to the Southern District of Florida. The case was filed against Careplus Health Plans Inc., alleging false advertisement and failure to pay for medical services for a medicare member.

The plaintiff is a Medicare-aged insured who saw a commercial for Careplus Medicare Advantage plans on television, according to the complaint. Similar to many Florida residents, the plaintiff is not resident in Florida year round, but only during the winter months. During the summer, the plaintiff returns to Canada, and the plaintiff specifically inquired of the insurance agent he spoke to when inquiring about the possibility of becoming a member if medical expenses incurred while in Canada would be covered benefits and the agent indicated that they would be.

After enrolling in the plan, the plaintiff suffered a stroke while in Canada and was hospitalized. After incurring these bills, the plaintiff was informed that they were not covered by the plan and the plaintiff was directly responsible for the charges.

The plaintiff is suing for false misrepresentation and fraud in the inducement. The case has been removed to the district court by the defendants on a federal question jurisdiction regarding the scope of medicare coverage. The plaintiff is represented by Kelsky Law, PA. The defendants are represented by Squire Patton Boggs LLP