Category Archives: Health Insurance

I Don’t Want Health Insurance, and You Can’t Make Me!

By some measures, the Affordable Care Act (aka ACA aka Obamacare) added 20 million previously uninsured people to the rolls of the insured. This was accomplished in part through an individual mandate that requires people to either get insured or pay a penalty through their income tax. Most of the previously uninsured welcomed the ability to get access to good health plans and the ability to pay for coverage through their employer or with the help of premium assistance tax credits.

Open Enrollment versus Special Enrollment in the Health Insurance Marketplace®

If you don’t currently have health insurance or have a plan but want to change it, what are you waiting for? Well, you might be waiting for the enrollment period to open up so you can purchase a plan through the Health Insurance Marketplace. This is the place to go if you want to dramatically lower the dollar amount of your premium through tax credits.

Can You Appeal an Unfavorable Decision From the Health Insurance Marketplace®?

According to the Centers for Medicare and Medicaid Services, over 8.2 million people chose a plan during the recent open enrollment period for participation in the Health Insurance Marketplace established under the Affordable Care Act. Out of those numbers, approximately 1.8 million enrollees were new to the marketplace, with about 6.4 million people renewing their coverage in Obamacare.

Fighting Insurance Claim Denials: Will an Attorney’s Contingency Fee Eat Into My Benefits?

You need to fight that denial, and you are probably going to want to hire an experienced insurance law attorney to represent you.

Learn more about how the contingency fee can be beneficial to ensure you get the legal rep you need for your case.

Is Your Insurance Company Stalling on Your Health Insurance Claim? Here’s What to Do.

When you need coverage for a medical issue, you might not have time to wait, and any delay might seem unreasonable.

If you think your insurer is taking too long to come around, here are some things you can do to assert your rights.

My Insurer Won’t Return My Calls. Does That Mean They Are Not Working on My Case?

Your health insurer is responsible for communicating with you about your case on a regular basis. If your claims adjuster is ignoring your calls, they could be engaging in bad faith conduct geared toward getting you to drop your claim or accept a lowball settlement.
Learn about the applicable laws in your state, and don’t be afraid to assert your legal rights and hold your insurance company to any applicable timelines.

Is Artificial Disc Replacement “Experimental and Investigational”?

If you ever see the phrase “experimental and investigational,” it’s likely to be in the context of a letter from the insurance company refusing to cover your requested surgery or other medical procedure. “Experimental and investigational” is a favorite phrase of the insurance industry. Carriers create internal memos, called Policy Bulletins, that label a particular procedure or medical device as experimental and investigational, and then they rely on that memo to issue blanket denials of all requests for the treatment, without conducting an individualized assessment of the patient’s condition and whether the requested procedure might be appropriate. These blanket denials could be seen as an abdication of the insurer’s duty to investigate each claim individually and make a decision based on the specific facts of the case. Denials like these might even be considered insurance bad faith. Additionally, lawyers who represent patients have found that insurance companies label some treatments as “experimental and investigational” despite abundant evidence demonstrating the procedure is neither experimental nor investigational. Artificial disc replacement is one such example.

What You Need to Know About Independent Medical Review

In a previous post, we talked about using an insurance company’s internal appeals/review process if the insurer denies your claim or request for treatment when you think they should have approved it (see Why an Internal Appeal is a Really Big Deal). There, we noted how a federal law (ERISA) that governs employer-sponsored health plans requires that insurers have such a procedure in place and further requires policyholders to use that procedure before they can file a lawsuit. We also noted how important those appeals are because if you later go to court, the arguments you want to make or evidence you intend to give can be limited by the record you created at the administrative level.

Why an Internal Appeal is a Really Big Deal

If your insurance company denies your claim for coverage, this denial could mean you don’t get the medicine or procedure you need, or you have to go into your own pocket to pay for costly medical treatment that you can’t afford (medical bills are the number one reason families file for bankruptcy). Some people don’t know there is anything they can do about a denial, and they simply give up, either paying for medical care on credit or going without. Others who read their policy and letters from the insurer carefully do realize there are ways to fight a denial, but even then, they don’t always go about it correctly.

What if the Insurance Company Makes a Mistake in Calculating My Deductible?

Your deductible is the yearly amount you have to pay out-of-pocket for medical costs before your insurance benefits really start to kick in. The deductible is a key feature of a health insurance policy, and generally speaking, the lower deductible you choose, the higher your premiums, and vice versa. When you go to the doctor’s office, you typically only pay a very small amount, like ten or fifteen dollars. This amount is known as a co-pay. While co-pays don’t count toward your deductible, they are a great cost savings to you.