How to Enforce Medical Insurance Consumer Rights
Health insurance is necessary in order to receive proper health care in America. However, it is sometimes difficult to receive fair treatment from health insurance companies. Consumers have certain rights in regards to medical insurance. It's important to know what rights you can enforce in order to receive proper medical attention.
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Instructions
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Enforce your right to information from your health insurer regarding your coverage. Your insurance provider must tell you what kind of coverage you will receive, what your financial responsibility is, the process for addressing grievances, the review process when coverage of certain treatments is denied, how and where to receive care and how to contact the company.
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Receive access to health care. Your insurance provider should be able to provide you with access to a primary-care doctor, access to specialty-care doctors and provide you with an adequate network of providers. Your insurance company also should not prevent your doctor from discussing your medical status and treatment with you and should be able to reimburse your doctor if she is not part of the insurance network.
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Receive emergency care. You should expect coverage for emergency care from your insurer when you need it. This should not require that you seek approval before you use it.
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Receive coverage for certain health care services for women. Amongst other medical services, women should receive coverage for OB/GYN visits and examinations, bone mineral density testing, cervical and breast cancer screening, contraceptive drugs, mastectomy, maternity care and treatment of infertility.
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Appeal unfair decisions by insurance companies and HMOs. You have a right to file a grievance if you do not agree with decisions made by your insurance company about covered benefits. For example, you can file a grievance about a shortened hospital stay, denial of a referral to a specialist or denied coverage for a drug. You can also challenge the company if it decides that a medical treatment is not necessary.
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File a complaint with your local office for consumer affairs if your insurance provider will not honor your medical insurance consumer rights (see Resources below).
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Tips & Warnings
Insurance companies offer several different plans with variable deductibles. Shop around for the best rates when you are looking for health insurance.
The amount of money you will have to pay for your health coverage will vary according to the plan you choose, the number of people you wish to enroll, their ages and the state of their health.
