What to do when your health insurance does not cover bills

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Recently, many Americans have been asking questions about what to do if the insurance company refuses to fulfill its obligations to cover medical services. NPR.org collected the most popular questions and qualified answers.

Question: The insurance company in which my father is serviced has canceled payments for health insurance without notifying my father. Then they continued to pay for the purchase of drugs for multiple sclerosis and medical services for 10 months, and now they demand payment. What to do?

Answer: Insurance companies can reduce medical expenses during the year, but they must notify the customer 60 days before the proposed changes.

“Perhaps the insurance company audited the claims and decided that they should not pay for this type of service at all. Such audits are conducted regularly to prevent consumer fraud, said Dania Palanker, an assistant professor at Georgetown University's Center on Health Insurance Reform.

First of all, it is necessary to obtain information on the health insurance plan and find out why the claims for the purchase of drugs were canceled retroactively.

You may need to file an appeal for a review of health insurance and file a complaint with the state insurance regulator or the federal department of labor.

Question: I am an entrepreneur and bought insurance plans on my own. I purchased a short-term health insurance program and did not know that it did not meet the requirements of insurance for the protection of patients with ASA. The price was the same. Shouldn't people have to sign a document that they understand which insurance program they buy?

Answer: Since January of last year, there has been a requirement that all applications for a short-term health insurance program should contain a warning that the plan does not satisfy the requirements of insurance coverage by ASA. But people should not have confirmed in writing that they understood this warning. You may have to pay a fine, like people who do not buy insurance.
But perhaps you acquired the plan before the warning requirement came into force, says Timothy Jost, a professor at Washington and Lee Law School.

You should sign up for a comprehensive health insurance program from January 1.

Question: I was hospitalized with a traumatic brain injury, had surgery and spent two months in the intensive care unit. Now my insurer no longer covers my medical care. Does my insurer have to notify me about this change, or is it enough that the administrator of the insured accident of the hospital tells me orally?

Answer: The insurance company is obliged to notify you in writing when they reject the claim for insurance. But in your case, there may not have been an actual failure, says Palanker.

The hospital staff constantly communicate with representatives of the patient’s insurance company and discuss which services will be covered by a health insurance package. Often, doctors want the patient to stay in the hospital while the insurer insists on discharge. In such cases, there is no actual request to the insurance company, and accordingly the insurance company does not need to send you a notice, it is enough that your doctor verbally notifies the insurer's decision.

If you think this decision is unfair, then specify what the hospital manager agreed with the insurer, collect the necessary documents and submit an appeal request to the insurer.

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