Health Insurance Consumer Rights

If you are insured under any health insurance policy, then you must be aware of all the health insurance consumer rights to fully benefit from your policy. Here we have covered most of the common rights. In addition to this, there are state specific laws.

Information Disclosure

The insurance providers must disclose some information in their policy documentation and provide some on request.

  • Health coverage details
  • Financial responsibility
  • Procedure for filing grievance, for utilization review and to access care
  • Contact details related to your health plan
  • Details of the organization
  • Annual financial statements
  • Subscriber contracts
  • Consumer complaints information
  • Medical records’ confidentiality protection procedures
  • Drug formalities
  • Quality assurance description
  • Clinical trial decision-making procedures

And more.

Access to Healthcare

To ensure that you have proper access to essential healthcare, certain policies are in place. This opens up the following opportunities for you:

  • Choosing a specialist over a primary physician
  • Getting referred to out of network specialists at no extra cost
  • Continuing with your current provider, who is not part of your new insurer’s network for 60-days
  • Adequate choice of providers
  • Right to choose a primary care physician
  • Right to know all possible treatments for your medical condition

Emergency Care

If your policy covers in-hospital treatments, then emergency conditions (as defined by the prudent layperson standard) must be covered and for such emergencies, prior approval is not needed.

Women’s Healthcare

If you are a woman, depending on the policy you have, you have several special rights. Some of them are,

  • Two annual OB/GYN preventive and primary services
  • Cover for bone mineral testing and measurements
  • Complete cover for breast cancer, cervical cancer screening, maternity care, and Inpatient and reconstructive surgery for mastectomy
  • Cover for contraceptive devices and drugs

Appealing Decisions

If you are denied a referral, policy or claim, it is within your rights to file a complaint. There are several clauses for denial and you can research further on that. If you cannot resolve the issue with your insurer, you can take up the case with your state insurance department.

More Health Insurance Consumer Rights

  • Your insurer must provide you a summary of your health coverage and benefits in an understandable manner.
  • You can find help at the Consumer Assistance Programs run by the state to sign up for health coverage, know your responsibilities and rights, and file appeals or grievances.
  • You might be entitled to free preventive care.
  • Children below 19 years of age cannot be denied or limited benefits because of pre-existing health conditions.
  • Your policy cannot be cancelled because of an honest oversight or mistake in your insurance application.

Health Insurance Related Articles

» Health Insurance Companies
» Health Insurance Agents
» Health Insurance Plan Types
» Affordable Health Insurance Policy
» Health Industry Market Companies
» Health Insurance Market Scenario
» Cheap Health Insurance
» Online Health Insurance Quote
» Short Term Health Insurance Policy Works
» Types of Health Insurance Plans
» Explain The Health Insurance Plans And Functions - I
» Types Of Health Insurance Plans And Functions
» Health Insurance Policy Judiciously
» Why One Go For Health Insurance?
» Cheap Health Insurance in Arkansas
» Cheap Health Insurance in Arizona
» Cheap Health Insurance in Alaska
» Cheap Health Insurance in Alabama
» Cheap Health Insurance in Georgia
» Cheap Health Insurance in California
» Health Insurance Plans
» Medical Billing
» Short Term Health Insurance
» Small Business Health Insurance
» Health Insurance Plans and Services
» Market Scenario Of Health Insurance
» Affordable Health Insurance
» Individual & Group Health Insurance Policies
» Texas & California Health Insurance
» Health Insurance Policies
» Personal Health Care
» Short Term Health Insurance Policy
» Small Business Health Insurance Policy
»Health Insurance for Cancer Survivors
» Cheap Health Insurance in Florida
» Cheap Health Insurance in Delaware
» Cheap Health Insurance in Connecticut
» Cheap Health Insurance in Colorado