Cancellations & Appeals
Insurance companies can no longer cancel your coverage just because you or your employer made a mistake on your insurance application. Previously, insurance companies could take away your coverage, declare your policy invalid, and ask you to pay back any money they had spent on your medical care.
These protections apply to all health plans, including grandfathered plans, whether you get coverage through your employer or buy it yourself.
- Your insurance company can cancel your coverage if you intentionally put false or incomplete information on your insurance application.
- Your insurance company can cancel your coverage if you fail to pay your premiums on time.
- Your insurance company notify you at least 30 days before they can cancel your coverage, giving you time to appeal the decision or find new coverage.
Appealing Health Plan Decisions
If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party.
You can ask that your insurance company reconsider its decision. Insurers have to tell you why they’ve denied your claim or ended your coverage. And they must let you know how you can dispute their decisions.
Two Ways to Appeal
There are two ways to appeal a health plan decision:
- Internal appeal: If your claim is denied or your health insurance coverage canceled, you have the right to an internal appeal. You may ask your insurance company to conduct a full and fair review of its decision. If the case is urgent, your insurance company must speed up this process.
- External review: You have the right to take your appeal to an independent third party for review. This is called external review. External review means that the insurance company no longer gets the final say over whether to pay a claim.
- Your state may have a Consumer Assistance Program that can help you file an appeal or request a review of your health insurance company’s decision if you are not sure what steps to take.
- If you have questions about internal appeals and external reviews, call your health plan or state insurance regulator.
