Over half of all Americans receive health insurance benefits through their jobs. While employer-based health insurance offers an affordable and convenient alternative to private payer options, it also leaves workers and their families without any options when it comes to choosing an insurance company. Unfortunately, some health insurance companies deny benefits to workers even when they should be covered, creating not just hassles but also new and often overwhelming financial burdens for working-class families.
For families and individuals who have recently lost employer-provided insurance benefits or have been denied coverage, the idea of paying out-of-pocket for medical expenses can be incredibly scary. Don’t panic, though, because there are ways to recover lost insurance benefits, whether those benefits have been denied by a current employer’s health insurance program or lost due to job termination. Read on to find out how to deal with any type of health insurance coverage loss.
How to Deal With a Denied Claim
ERISA, short for the Employee Retirement Income Security Act, regulates not just retirement and pension funds, but also employer-based health and disability insurance plans. It regulates the provision of employer-sponsored benefits and explicitly states that employees have a right to sue the plan carrier if they have been erroneously or unfairly denied coverage. If a claim gets denied or a worker is unfairly refused coverage, the first step is always to visit jpricemcnamara.com to find a lawyer who can help.
ERISA makes it possible to file a lawsuit against the employer’s health insurance company if a claim gets unfairly denied. More often than not, though, there’s no need to take the issue to court. A lawyer can also help clients navigate the appeal process, dealing with plan carriers and advocating for clients to ensure that the insurance carrier has properly applied its approval or denial criteria to the situation.
How to Deal With Lost Coverage After Losing a Job
Losing a job is already stressful. When it involves losing health insurance coverage for the entire family, too, the situation can get even worse. No matter how overwhelmed ex-employees may feel after being terminated, they need to take action quickly because some options are only available for 30 to 60 days after a worker loses employer-provided coverage.
People who have been laid off may be able to continue receiving insurance through COBRA. Short for the Consolidated Omnibus Budget Reconciliation Act, COBRA allows workers and their families to continue to receive health insurance coverage under their previous employers’ group health insurance plan for up to 18 months after losing a job. Under COBRA, ex-employees pay for both their share of coverage and the former employer’s, with premiums set at 108% of what they were originally.
Signing Up for Medicaid, if Possible
Medicaid is a health insurance program run jointly by the federal government and individual states. It’s designed to provide insurance to low-income Americans, which means not everyone will be eligible. Eligibility requirements vary by state, so check with the State Medicaid Agency to find out whether this is a viable option.
Options Are Available
No matter how scary it is dealing with lost insurance coverage or a denied claim, there’s help available. If a worker or a covered family member believes that coverage or a claim has been denied unfairly, the best solution is always to speak with a lawyer. Otherwise, check out the options for public and private health insurance described above.