3 Things your health care insurance is required to do

Published on March 17, 2015, by Matthew Sharp


3 Things your health care insurance is required to do

Health care insurance is designed to protect the policyholders in Nevada from the financial toll of medical care, particularly in the case of ongoing expenses due to a catastrophic illness or disability. The policy is a contract between the client and the insurance company, and all insurance companies must abide by the set of responsibilities outlined in the policy, comply with state and federal laws, and act without discriminating against a client due to race, disabilities, marital status, religion or sexual orientation.

A person may purchase individual health insurance or enroll in a group health insurance plan through a place of employment. Insurance companies issuing individual, church or state, and local government policies perform in much the same way when it comes to dealing with a claim. 

Policyholders deserve respect and fair dealings

Insurance policies contain specific details regarding coverage of medical events. When a claim is made and there is no question of policyholder liability, the company is contractually obligated to pay it in full, typically within 30 days of its receipt.

If there is any question about whether the claim is covered by the policy, the company must conduct a thorough and unbiased investigation. During this process, the policyholder is entitled to fair treatment without harassment, intimidation, or pressure.

In the event of a denied claim, an insurance company must provide all information about the investigation to the policyholder and answer any questions the policyholder may have. The policyholder is entitled to full transparency, including the factual and legal reasoning that led to the denial.

Policyholders have resources to fight unfair claim denial

According to Nevada state law, a policyholder has the right to expect the health care insurance company to deal honestly and fairly without considering its own interests over those of the insured. A bad faith insurance suit may be brought against an individual health insurance company that does not honor its duty to the policyholder.

Group health insurance companies are still subject to the duty of good faith and fair dealing, but policyholders do not have as many resources in the event of a claim denial. There will be an opportunity to appeal it, but the court typically only considers information provided to the insurance company during the process. Any flaw in the appeal, however slight, makes a successful attempt to get the claim paid unlikely. A policyholder filing an insurance dispute may benefit from the legal advice of a Nevada personal injury attorney who can help navigate the legal system for maximum benefits.