HomeCompanyCan A Health Insurance Company Refuse To Insure You

Can A Health Insurance Company Refuse To Insure You

We Are Cancelling Your Policy And Not Giving You Any Notice

Medicare Supplement Health Questions – Can Medigap Companies Deny Your Pre-existing Conditions?

Required notice will vary by state but your insurer must give you written notice of a cancellation or non-renewal and the reason why. For instance, Texas requires 10 days’ notice, while Massachusetts gives you 20 days. If you feel the cancellation is based on inaccurate information, you have the right to appeal.

If you experience a cancellation, look for a new policy immediately

“A lapse of just one day can result in a penalty, and a lapse will typically cause your rates to go up,” says Penny Gusner, consumer analyst with Insure.com.

Know Why Your Claim Was Denied

As we mentioned above, it is hard to make a successful appeal if you do not understand the reasons why you should appeal. Take a look through the letters or emails you have received. Do they explain the reason behind the denial? Do they point you to a provision or a paragraph of your insurance policy explaining the denial? For instance, in the case of a denied healthcare claim, your insurance company will send you an explanation of benefits that details the reasons why your claim was denied.

Or has the denial occurred because the company needs more information? In the auto insurance context, your insurance company may require a note from a doctor saying that you cant work before the company will pay you for wage loss. Or the company may require you to fill out an application for benefits before you can receive an auto insurance payout for auto-related health costs.

Insurance companies will often use codes to explain their decision. If the company does not include a key to help you understand the codes, you can call them and ask them to explain it. Under the Affordable Care Act, the insurer has a responsibility to explain to you the reasons they denied your insurance claim in understandable terms.

Your Employers Family Coverage Is Too Expensive

Work-based coverage is considered affordable if the employees share of the annual premium for the lowest-priced individual plan costs no more than 9.5% of annual household income. For that reason, premiums for your entire family can total more than 9.5% of your income, yet you still wont qualify for tax credits to buy insurance through a health insurance marketplace.

If this is true, its smart to shop around for options, including provided by your employer and available on the private market, to determine where you can land the best coverage for your family at an affordable price.

You May Like: How Much Is Health Insurance In Ny Per Month

How Your Health Insurance Company Can Still Screw You Despite Obamacare

No law has done more to reform health insurance and protect consumers against the industry’s most heinous practices than the Affordable Care Act. But Obamacare didn’t magically transform insurers into benevolent entities solely devoted to taking care of sick people.

Health insurance companies, even those that are not-for-profit, have to collect more money in premiums than they shell out in claims for medical care. That means they have a financial incentive not to pay for things.

And since health insurance companies can no longer shun the sick to maximize profits — either by denying coverage to people based on their medical histories or by rescinding the policies of paying customers who fall ill and rack up bills — insurers are employing other tactics to shift costs to sick people and make it harder to get health care, consumer advocates say.

“One of the things that occurred to me, even as the bill was working its way through Congress, was that once it was passed, insurers would do all they could to try to preserve profit margins,” said Wendell Potter, a former Cigna executive turned industry critic.

Here are a few of the tactics that consumers and advocates have complained about:

Refusing to pay for medical care that should be covered

Nothing in Obamacare says insurance companies have to pay any bill that comes their way. That’s fine, because doctors and patients want things all the time that are wasteful and unnecessary, and everyone shares the cost for that.

Do I Have To Tell My Insurer About My Mental Health Problem

Can A Health Insurance Company Refuse To Insure You

It’s understandable to wonder if you should tell an insurer about your mental health problem or not. But if you don’t answer questions about your mental health completely truthfully, and your insurer finds out, this could have some serious consequences.

For example:

  • Your policy could be cancelled or become void, resulting in any claim you make being dismissed, even if it’s not related to your mental health problem.
  • You could be charged a lump sum fee to make up the difference between the rate you were paying and the rate you would have paid if the insurer had known about your mental health problem.
  • They may take legal action against you to recover the amount they paid out, if they find out after a claim has been settled.
  • You may find it harder to get insurance the next time you apply.

So its not a good idea to hold back information about your mental health if an insurer asks you about this.

Read Also: Which Part Time Jobs Offer Health Insurance

Failure To Notify The Insurance Company

As we mentioned above, you are required to notify your insurance company that you have been in an accident in a timely fashion. If you have been in a car accident, for instance, and you are injured, your insurance company should be one of the first calls that you make after the accident. If you wait a week or longer to report the accident, the insurance company will say there were unable to investigate the incident and deny your claim.

Are Insurance Companies Dictating Your Medical Care

Disability insurance provides a crucial safety net that can protect your ability to earn an income in the event of a serious illness or injury. However, not all policies are created equal, and in some rare cases an insurance company may deny disability benefits based on a claimants method of recovery.

For instance, if your injury requires you to undergo a certain surgery in order for you to return to work, and you refuse the operation, depending on your policy, your insurance company may have the right to withhold your benefits.

Many people are taken by surprise by these provisions when it comes time to file a claim and are surprised and dismayed thinking insurance companies dictating medical care is a privacy problem. So to avoid confusion, heres a look at the two most common insurance policy provisions regarding medical care:

You May Like: How Much Is Health Insurance For Self Employed

Before You Buy Medigap

Here are some things to keep in mind before you purchase your Medigap policy:

  • You must have Medicare Part A and Part B to be eligible to buy Medigap.
  • Theres only one Medigap policy per person, spouses need separate policies.
  • If you buy a Medicare drug plan in addition to Medigap, you will have to make two separate premium payments.
  • You cannot have drug coverage in both Medigap and a Medicare drug plan.
  • Medigap premiums can vary for similar coverage, so it’s important to compare plan costs before buying.
  • In some states, you can buy another type of Medigap policy called Medicare SELECT, which requires the use of in-network hospitals or doctors for full coverage. If you purchase Medicare SELECT, you have 12 months to switch back to Medigap if you change your mind.
  • Can I Be Denied Health Insurance If I Have A Pre

    No, insurance companies cant deny coverage for being unvaccinated

    If you are enrolled in a plan since 2010, then your insurer cant legally deny you coverage or charge you higher premiums because you have a pre-existing condition.

    The Affordable Care Act, passed in 2010, made it illegal for insurers to deny you coverage or charge high rates for pre-existing conditions. Additionally, if your health changes and you develop a chronic medical condition while enrolled in a health plan, your insurance carrier cannot raise your rates because of that medical condition. However, annual premium increases may apply to your plan for other reasons.

    If, however, you are enrolled in a plan that started before 2010, you have a grandfathered plan. These plans can cancel your coverage or can charge you higher rates due to a pre-existing condition.

    If you are exploring coverage options, its important to be aware of any potential changes to health care law that could impact how pre-existing conditions are covered.

    You May Like: Do You Legally Have To Have Health Insurance

    When Your Medical Insurance Is Refusing To Pay

    Having your medical insurance company refuse payment for ANYTHING has to be one of the most maddening and helpless experiences healthcare has to offer. For those of us lucky enough to have medical insurance of any kind, we depend dearly on its support, emotionally for reassurance, and more importantly, physically for health and life itself. Having a critical diagnosis or chronic disease that demands a certain level of either acute or long term care to guarantee an optimum outcome, and being denied that care because your insurance wont pay and you cant afford it, speaks for itself!

    Let us offer you some basic reasons for denials, and actions you can take both proactive and reactive, to ensure the best possible outcome. No guarantees, but knowledge is power, and taking charge, even in small and simple steps can sincerely tip the scales.

  • What you need is not a covered benefit of your plan: When your pre-authorization or claim is refused, check your policy thoroughly. It may not be, but insurance companies DO make mistakes.
  • Missing information: If denied, they will inform you that pertinent information has not been provided. Call them immediately, clarify whats missing, and resubmit with all the information needed.
  • Your free annual exam was not billed as free: The ACA MANDATES a yearly free exam. If denied for this reason, this is an easy fix. This of course may not be true going forward with the current changes being made.
  • Ask these important questions ahead of time:

    Getting Insurance When You Have Multiple Claims

    Once you have all the facts, you should try to get insured with another company, agent, or broker. Don’t forget that you have to look out for yourself and what is best for you.

    Every insurance company offers diverse products, so while one might not work for you, another one will.

    While you wait for their review of your case, you should check other options, especially if youre being told you might lose your plan.

    Although insurance companies will use some of the same tools to see what claims have been made in the past, the way they assess risk is diverse. You often see examples of that when you get a quote with one company, and it is much higher than another. The reason is in the diverse ways that each one works the rates and decides risks. The same may be true in how they will look at your situation.

    Not every insurance company has the same underwriting rules, and if you have a solid case, you may find another one to help you. Working with a broker who deals with several companies, not just one, may also be very helpful. The most important thing is to have the facts and to be honest about your situation.

    Make sure you do all you can to keep your insurance. Letting it get canceled or leaving yourself uninsured even for a day is a huge risk and financial burden to you. Fight to keep your home and assets insured.

    You May Like: Can Foreigners Buy Health Insurance In Usa

    Review Your Policy And Paperwork

    Look over the summary of benefits in your insurance documents. The paperwork must spell out what’s covered. It also has to list the limitations or exclusions, which are things your insurance won’t cover.

    Then read over the letter or form your insurance plan sent you when it denied your claim. It should tell you why the claim was denied. The letter should tell you how to appeal your health plan‘s decision, and where you can get help starting the process.

    Is There Health Insurance For Pre

    Can A Health Insurance Company Refuse To Insure You

    Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment. However, there may be health plans that are a better fit for you than others if you have a chronic, or pre-existing, medical condition.

    For example, if you need regular medical care, surgeries, or treatments, then a plan with a little higher monthly premium and lower deductible may provide you with the coverage you need and help you manage more predictable costs.

    Don’t Miss: Will Health Insurance Go Down

    Could My Health Plan Have A Pre

    No. There are no waiting periods for medical plans, including for pre-existing conditions.

    When choosing a health plan, consider your medical needs. If you have a chronic or ongoing medical condition that requires more frequent care, those needs could affect the type of plan you choose, but you cannot be denied coverage or charged more due to a pre-existing condition.

    Can I Get Coverage If I Have A Pre

    Yes. Under the Affordable Care Act, health insurance companies cant refuse to cover you or charge you more just because you have a pre-existing condition that is, a health problem you had before the date that new health coverage starts. They also cant charge women more than men.

    The only exception to the pre-existing coverage rule is for grandfathered individual health insurance plans — the kind you buy yourself, not through an employer. They dont have to cover pre-existing conditions.

    Read Also: How To Cancel Anthem Health Insurance

    We Cannot Insure You Because You Purchased From An Assigned

    The vast majority of high-risk drivers do not have to resort to assigned-risk plans, the last-resort insurance for drivers unable to find coverage on the open market. But because every state requires some kind of liability coverage for all drivers, insurers in those states agree to share the burden of these highest-risk clients. But they cannot deny you a policy later on because you were previously insured by an assigned high-risk plan.

    Reasons Your Health Insurance Wont Pay For The Care Your Healthcare Provider Says You Need

    How to Appeal Denied Medical Insurance Claims | NBC4 Washington

    1. What you need isnt a covered benefit of your health plan.

    When your health plan denies your claim or refuses your pre-authorization request for this reason, its basically saying that your policy doesnt cover that test, treatment, or drug no matter what the circumstances are.

    Your insurer should know exactly what benefits your policy provides and what isnt covered, but sometimes your insurer is wrong. Check your policy carefully. If your health insurance is through your job, check with your employee benefits office to see if you actually do have coverage for the service your health insurance says isnt covered.

    In the United States, small group and individual health plans with effective dates of January 2014 or later have to cover the Affordable Care Act’s essential health benefits. But large group employer-based plans and grandfathered/grandmothered plans dont have to provide this same coverage.

    If you feel youre being denied the benefits of coverage your policy says you actually have, follow the appeals procedure your health plan booklet outlines. Also, enlist the help of your employee benefits office if your coverage is job-based, or your states insurance commissioner .

    2. You got the care from an out-of-network provider when your health plan coverage is limited to in-network providers.

    However, if youve already gotten the care and your health plan won’t pay your claim because you went out-of-network, youre going to have a more difficult fight on your hands.

    Also Check: Can I Put My Mom On My Health Insurance

    Why Your Health Insurance Can Be Denied

    Technical development has provided advanced medical treatments for several illnesses. However, such treatments have increased the cost of advanced healthcare. As a result, you may not always be able to afford the best treatment due to lack of funds.

    Health insurance is beneficial in such situations. These policies cover hospitalization expenses, including pre and post-hospitalization and in-patient treatments. In addition, domiciliary expenses, day care procedures, and much more are covered under health plans. You may choose from different types of plans that suit your personal requirements.

    Like most people, you may feel financially secured with a good health insurance policy. Consider a situation where you need to file a claim under this plan. Although the procedure to file a claim is simple and quick, some claims are rejected. Here are three reasons why your claim may be denied.

    Learn About The Appeal Process

    If your insurance company refuses to pay the claim, you have a right to file an appeal. The law allows you to have an appeal with your insurer as well as an external review from an independent third party.

    • You must follow your plan’s appeal process.
    • Check your plan’s web site or call customer service. You’ll need detailed instructions on how to file an appeal and how to complete specific forms.
    • Be sure to ask if there is a deadline for filing an appeal.

    If you’re filing an appeal, let your doctor or the hospital know. Ask that they hold off on sending you bills until you hear back from your insurance company. Also, make sure that they won’t turn your account over to a collections agency.

    You May Like: Which Health Insurance Is Most Widely Accepted

    Your Coverage Has Expired Or Lapsed

    Coverages are not always automatically extended, and policyholders can sometimes forget or neglect to renew these coverages. A simple mistake can result in a denial that will cost you thousands of dollars. When you purchase insurance coverage, make sure you thoroughly read the fine print so you understand what coverage will renew automatically and what you will need to renew yourself.

    Popular Articles

    explore more