Moda insurance secondary health plan deductible class action lawsuit investigation
May 26, 2023
Moda secondary insurance: Who’s affected?
Do you have a secondary health insurance policy through Moda Health? Are you an Oregon resident? Have you had issues with overcharging or deductibles in the last three years?
Moda Health may violate the terms of its secondary insurance policies by failing to credit consumer deductibles as required by Oregon law and its policy terms.
A class action lawsuit against Moda Health argues that the policy terms promise to credit secondary insurance deductibles as it would be in the absence of any other coverage. However, according to policyholders, Moda fails to credit secondary insurance deductibles unless the customer pays money out of pocket. As a result of this conduct, insured Oregonians are allegedly forced to pay thousands of dollars to satisfy their deductibles even though they or their employers already pay two health insurance premiums per month.
Oregon policyholders who have secondary health insurance policies through Moda could be eligible to take legal action and recover economic damages for payments they made after their deductible should have been covered.
Do you qualify?
If you live in Oregon and have a secondary health insurance policy through Moda Health, you may qualify to participate in this Moda Health secondary insurance class action lawsuit investigation.
Fill out the form on this page for more information.
Secondary insurance: overview
Secondary health insurance is an additional medical insurance plan that pays benefits in parallel with your primary plan and may supplement the deductible, copay, coinsurance and other out-of-pocket costs left unpaid by a primary insurance policy.
Consumers may have a secondary health insurance plan if they get their primary medical plan through their employer or if they purchase their primary coverage themselves and they are also covered by another (secondary) plan, for example, through their spouse’s or parent’s employer.
Insurance class action lawsuit mode
According to a class action lawsuit against Moda Health, the insurer fails to meet the legal obligations of its secondary health insurance policies.
The plaintiff in the case argued that his secondary health insurance plan through Moda Health was supposed to credit payments to its deductible as if no other healthcare coverage existed. Instead, Moda Health allegedly only credited secondary plan deductibles if the customer actually paid for out-of-pocket medical expenses. For example, if a customer with a $6,000 medical expense had primary and secondary health insurance plans that both had $3,000 deductibles, both plans should pay $3,000 and credit $3,000 to their deductibles, thus paying the medical expense in full and satisfying both deductibles without the customer paying any money out of pocket.
As a result of Moda Health’s conduct, the plaintiff claims he had to pay additional out-of-pocket expenses even after his secondary plan deductible should have been fulfilled under the policy’s terms. This unlawful conduct allegedly forced the plaintiff to pay thousands of dollars he should not have.
“As a result of the defendant’s breach of its secondary insurance policy plan, the defendant further breached the policy by refusing to pay the plaintiff’s subsequent claims, instead crediting the claim amounts to the plaintiff’s secondary insurance policy plan deductible, which should have already been satisfied, causing the plaintiff to afterward pay money on claims made during the same plan year, resulting in economic damages,” the Moda insurance class action lawsuit claims.
According to the secondary insurance class action lawsuit, Moda Health’s breach of contract violated Oregon state laws.
Join a Moda Health secondary insurance class action lawsuit investigation
If you were forced to pay for medical expenses that should have been covered by your Moda Health secondary insurance plan, you may be eligible to take legal action and recover compensation for out-of-pocket medical payments that should have been covered after your deductible was satisfied.
If you live in Oregon and have a secondary health insurance policy through Moda Health, you may qualify to participate in this Moda Health secondary insurance class action lawsuit investigation.
Fill out the form on this page for a FREE case evaluation.