What Private Insurance Companies Can and Can't Do

A wide range of state and federal laws outline what private health insurance companies can and can't do. For the most part, these laws are in place to protect plan participants and provide them with certain rights. If your rights are ever violated or an insurer doesn't live up to its end of the bargain, you can always fight back, even if it means taking your insurance company to court.

Right to Appeal a Denied Claim

All too often, uncovered but necessary medical procedures lead to years of deep indebtedness, or even bankruptcy. If you suspect your health insurance company's justification for rejecting a claim, you always have the option of challenging the decision, even if it means taking legal action. Otherwise, you'll be personally liable to the medical provider for the services you received.

Your Medical History Is Private

Doctors typically document the reasons for your visits and the medical treatments provided in your medical history. Most people consider this information to be private and confidential. Private health insurers may require access to those records but must provide you with a notice that explains how it will use your medical, dental, and vision records. Private insurers never have the authority to use your medical history for profit, such as by selling your information to advertisers. They may not disclose the information to others, such as your employer.

You Have the Right to Choose

States usually have laws that can provide you with certain rights when dealing with private health insurers. In New York, for example, state law gives you the right to use a medical specialist when faced with a serious condition, regardless of what your insurer or HMO tells you. In fact, it may violate the law if they don't have a written procedure in place for making such a request.

Prohibitions Against Cancellation

Some states, such as Texas, make it illegal for your current health insurance provider to cancel or decide not to renew your policy. This remains true even if (and especially when) you suffer from a medical condition that becomes expensive for the insurer. However, depending on the level of protection your state provides, it may not prevent dental and vision insurers from cancelling your policy.

An Insurance Lawyer Can Help

The law surrounding private health insurers and payment for claims is complicated. 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.

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