It should come as no surprise that the interests of health insurance providers and the people they insure sometimes conflict. Providers want to minimize costs while plan participants want comprehensive coverage with minimal restrictions or out-of-pocket costs. Federal healthcare reform legislation that provides U.S. citizens with a number of legal rights is expected to take effect in 2014.
Access to Medical Services Not Subject to Dollar Limits
The federal government recognizes that U.S. citizens often fail to receive needed medical treatments simply because insurance companies won't pay for them. Under the Patient Protection and Affordable Care Act, however, health insurance companies will no longer be allowed to limit your access to essential medical care through annual or lifetime cost limitations. For healthcare plan participants, this means that a lack of financial resources to cover the expenses yourself will not prohibit you from seeing a doctor when you need to.
Companies Must Clearly State Coverages
Health insurance plans vary widely. In some cases, choosing the right coverage requires a thorough reading of fine print and legal jargon. Many participants are unclear about what is and what's not covered under different plans. Federal law will minimize this confusion by requiring health insurance companies to draft plain-English summaries of what each plan covers. Hopefully, this will minimize unexpected costs to participants who find out too late that a treatment is not covered, and that they are personally liable for the cost.
Preexisting Medical Conditions
Sometimes, the people who most need health insurance are denied coverage because of a preexisting medical condition. Insurers know that these individuals are likely to use a lot of costly benefits. Once the healthcare reform laws go into effect, this practice will be illegal. Although insurance companies can't deny coverage, they can charge different premiums for the same coverage based on factors like age and tobacco use. If an insurer increases the monthly premium by $100 for one 24-year old smoker in Delaware, the insurer cannot increase premiums by $500 per month for other 24-year-old Delaware smokers. The rules must be consistent.
Your State May Grant Additional Rights
If you suspect that your insurance company is in violation of the law, you should determine whether your state has its own healthcare reform laws. These might expand on the federal legislation or have an earlier effective date. In a few states, for example, laws already exist that preclude health insurance companies from denying coverage based on preexisting conditions.
An Insurance Lawyer Can Help
The law surrounding healthcare reform is complicated and constantly changing. Plus, the facts of each case are unique. This article provides a brief, general introduction to the topic. For more detailed, specific information, please contact an insurance lawyer.