What to do when your health insurance company denies you coverage?

Challenging a coverage denial by a health insurance plan is a legal right guaranteed to all insured individuals. Every plan—including private policies, employer-sponsored health plans, Medicare, Medicare medication plans and Medicaid—must provide a process for reconsideration of any adverse determination of coverage by the plan.

What happens if your employer denies you medical benefits?

For example, the employer might limit insurance benefits to employees who regularly work 40 hours per week; if you’re a part-time employee, you don’t qualify. The healthcare plans themselves might limit coverage for all employees so specific conditions aren’t covered — cancer, for example, might be excluded.

Can a health insurance company appeal a denial?

The good news is, you have the right to appeal the decision. And, while it can be time-consuming to deal with, many health insurance denials may be resolved through the insurance appeals process.

When is my employer allowed to take me off the group health plan?

As of Jan. 1, 2014, renewed group health plans can no longer deny coverage due to health issues. However, they can impose a waiting period of no more than 90 days before health coverage begins. If I leave my employment, when is my employer allowed to take me off the group health plan?

Can an employer deny me of health benefits?

Because of this, it typically costs more to provide health insurance to older workers than it does to provide it to younger and healthier employees. But, this is no reason for an employer to deny an employee health benefits or offer them fewer benefits.

What to do if your insurance company denies your claim?

Internal appeal: If your claim is denied or your health insurance coverage canceled, you have the right to an internal appeal. You may ask your insurance company to conduct a full and fair review of its decision. If the case is urgent, your insurance company must speed up this process. External review: You have…

Can You appeal an employer health insurance decision?

Yes. If your employer self-funds the plan and contracts with an insurance company to provide administration services only, then under the Federal Employee Retirement Income Security Act (ERISA), your employer’s plan is exempt from many state requirements. However, you have a right to appeal any decisions of the plan.

Can a company penalize you for not having health insurance?

These incentives should be part of your decision-making equation, too. Note that your employer might have a vested interest in keeping employees on the workplace plan. Under the Affordable Care Act, employers can be penalized if their health insurance is too costly. The smaller the group, the higher its rates may be.