Your rights when your health plan changes — for any reason
State laws offer some protection
By Insure.com
Imagine this scenario: You get a great job offer at a nearby manufacturing company, complete with HMO coverage for you and your family. Six months later, when premiums rise, your employer changes health plans, and your family doctor isn't in the new HMO's network of approved health care providers. So you find a new doctor and a new pediatrician and begin to develop a relationship all over again.
The new HMO, aggressively bent on cost-cutting, plays hardball with the local hospital system when its contract is up for renewal a year later. But the hospital system refuses to do business with the HMO, and again, you lose the doctors you've grown attached to.
Wait a minute! you want to scream. Shouldn't you have some say here? Why should you be punished by losing your doctor just because your HMO or employer wants to save some money?
Depending on which state you live in and the type of health insurance you have, you do have some rights when your health plan or doctor changes without your consent — but not a lot. Your rights probably aren't going to be very broad, and they might apply only if you're pregnant, if you have a life-threatening illness, or if they're spelled out in a union contract. And if you have an individual health plan, as opposed to an employer-sponsored group managed care plan, you can expect even fewer, if any, rights to protest the changes to your coverage.
Here's a look at your rights — or lack of them — in a variety of situations, along with examples from various states. Click on the link to your problem in the box above.
To find your rights in your own state, contact your state's health insurance regulatory agency. You can find contact information by choosing your state from the "Insurance in Your State" pull-down menu at the top of this page.
Last updated July 20, 2003
|
British Citizens:
Canadian Citizens:
