New Law Requires Health Insurance Plan to Pay Co-Pay & Restricts Abuse

Posted on Sep 23, 2010

We are pleased to report the following important update & information regarding major changes in our nation's health insurance industry and patient-consumer rights.  September 23, 2010 represents a new and significant day for American consumers in our health care system.  Under the new law, the Affordable Care Act, American citizens are given a series of new rights, benefits, and protections as consumers; and health insurance companies are subject to new restrictions to prevent further abuse of the insurance industry.

Health Insurance Companies Cannot:
•    Deny coverage to kids with pre-existing conditions. Health plans cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a pre-existing condition like asthma.
•    Put lifetime limits on benefits. Health plans can no longer put a lifetime dollar limit on the benefits of people with costly conditions like cancer
•    Cancel your policy without proving fraud. Health plans can’t retroactively cancel insurance coverage – often at the time you need it most - solely because you or your employer made an honest mistake on your insurance application.
•    Deny claims without a chance for appeal. In new health plans, you now have the right to demand that your health plan reconsider a decision to deny payment for a test or treatment. That also includes an external appeal to an independent reviewer.

Patient-Consumers in New Health Plans Now Have the Right to:
•    Receive cost-free preventive services. New health plans must give you access to recommended preventive services such as screenings, vaccinations and counseling without any out-of-pocket costs to you.
•    Keep young adults on a parent’s plan until age 26. If your health plan covers children, you can now most likely add or keep your children on your health insurance policy until they turn 26 years old if they don’t have coverage on the job.
•    Choose a primary care doctor, ob/gyn and pediatrician. New health plans must let you choose the primary care doctor or pediatrician you want from your health plan’s provider network and let you see an OB-GYN doctor without needing a referral from another doctor.
•    Use the nearest emergency room without penalty. New health plans can’t require you to get prior approval before seeking emergency room services from a provider or hospital outside your plan’s network – and they can’t require higher copayments or co-insurance for out-of-network emergency room services.

Gray and White Law has helped many Kentucky families whose loved ones suffered from injuries that could have been prevented or injuries that resulted from negligent medical care provided by a doctor, specialist, nurse or orderly.  Please contact us today for a FREE CONSULTATION via confidential e-mail or toll-free phone call at 1-888-450-4456.

The source of the information provided above was brought to you by healthcare.gov, a federal government website managed by the U.S. Department of Health & Human Services.

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