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Advising Employees on their Rights to Health Insurance

The financial burden suffered by an individual with inadequate health insurance can be overwhelming. In fact, medical expenses are one of the leading causes of bankruptcy even for those who have some form of health insurance. At Hawks Quindel, we recognize that protecting your rights to health insurance – including coverage of medical procedures doctors deem necessary for your health and well-being – is of utmost importance to you and your loved ones. Our employee benefits attorneys have experience with the complicated web of laws governing your rights to health insurance and tirelessly advocate to protect those rights on your behalf.

General Overview of Health Care Law

There are a variety of laws governing your right to health insurance coverage, including the Employee Retirement Income Security Act (ERISA), the Consolidated Omnibus Budget Reconciliation Act (COBRA), and the Patient Protection and Affordable Care Act (PPACA). The Health Insurance Portability and Accountability Act (HIPAA) protects your privacy rights, among other things, and Wisconsin law further governs certain health insurance policies as well as your right to privacy of protected health information.

Our experienced Wisconsin employee benefits attorneys identify the proper laws governing your health insurance issue and make sure those laws are enforced in your situation. Some common health insurance legal issues are discussed further below.

Wrongfully Denied Health Insurance Claims

It can be frustrating to find yourself with a large medical bill when your health insurance company denies you coverage. Insurance companies commonly deny claims because they deem the medical procedure “experimental” or “not medically necessary.” If you have health insurance through your employer, then ERISA and the ACA afford you rights to appeal the insurance company’s decision. The plan administrator’s review must be full, fair and without bias. If you are unsatisfied with the final decision, you have rights to file a lawsuit. If your health insurance has denied you coverage for medical treatment, Hawks Quindel’s employee benefits attorneys can assist.

The Affordable Care Act

The Patient Protection and Affordable Care Act revamped the healthcare system, including setting minimum standards for health insurance plans. Among other things, the ACA prohibits health insurance plans from discriminating (including refusing to enroll or charging more for coverage) on the basis of sex, disability, race, genetic information, medical history, health status, and more. The ACA requires that certain insurers provide “essential health benefits” and it prevents insurers from imposing preexisting condition exclusions.

The ACA also prohibits retaliation for engaging in protected activity. Thus, employers cannot discipline, demote, harass, threaten or terminate employees for reporting violations of the ACA or for exercising employee rights to a tax credit or subsidy for use in the health care exchange. Further, you may have a claim if your employer reduces your work hours to avoid having to offer health insurance coverage.

Special Issues Involving Retiree Health Insurance Benefits

Employers are increasingly modifying their retiree healthcare benefit plans. Increasing costs, in tandem with the reforms provided by the ACA, have led many employers to reduce their retiree health benefits or eliminate them all together. Whether the reduction or termination of retiree health benefits is lawful depends on a number of factors including the plan language, your employment status and the law as it continues to develop in this area. If your retiree health benefits have been discontinued, Hawks Quindel’s employee benefits attorneys can assist.

If you have questions about your health insurance benefits, Hawks Quindel can help. The employee benefits lawyers will review your issue and employ innovative legal solutions to address your situation. Contact us today to discuss your rights.