What are Your Rights to Health Care?
Because an employer is not legally required to offer employment benefits, those employers that do offer an employee benefits package often customize a benefits package. An employment benefit package, which is governed by the Employee Retirement Income Security Act (ERISA), can include the following:
Short and long-term disability insurance,
Life and accidental death (AD&D) insurance,
Pension benefits, and
At the Law Office of Nancy L. Cavey, we handle ERISA Section 502 claims against group health insurance carriers and administrators for wrongfully denied health care or bills and breaches of fiduciary duty based on misrepresentations made by the employer or the health insurance carrier.
If your employer offered you group health insurance benefits, those benefits are generally governed by the ERISA statute, unless you work for a municipal or church employer.
ERISA is a federal statute that was enacted after the Jimmy Hoffa pension scandals when Jimmy Hoffa stole all the Teamster’s pension money.
ERISA was enacted by Congress to make sure that plans or policies that provide pension, medical, disability and life benefits are actuarial sound, have a claims process that is full and fair and provides for an appeal process if a claim is denied.
ERISA provides the minimum standards that a plan or policy must follow:
Plan information disclosure requirements for plan or policy participants that allows you to get a copy of the Summary Plan Description (SPD) that describes how the plan or policy works and a copy of the group health plan or health insurance policy,
Fiduciary responsibilities that administrators, managers and claims personnel owe to you as the beneficiary of the plan or policy, and
The internal grievance process that must be followed for denied claims.
The ERISA statute also gives you the legal right to sue for a breach of fiduciary duty the plan or policy administrator owes to you and your family and the legal right to sue for wrongful delay or denial of benefits or payment of your medical bills.
The plan or policy administrator may:
• Deny coverage for treatment, such as surgery, based on cost or an alleged policy exclusion,
• Deny post-operative treatment based on an allegation that the recommended treatment falls into a policy exclusion, or
• Deny payment for treatment it authorized, leaving you with the unpaid doctor and hospital expenses.
This bad and illegal behavior should not be ignored or excused, and you should not be liable for the payment of bills that are rightfully the responsibility of the group health plan or group health insurance company. Understand your rights and your benefits!
Call us your Health Insurance Disability Attorneys at 727-894-3188 or fill out the contact form on the right side of this page.
You don’t want needed treatment to be denied! You don’t want to be sued! You don’t want to be left holding the bag!
The ERISA statute requires immediate action by you, the policyholder, and if you delay you can destroy your claim by missing appeal deadlines and the right to sue.
At the Law Office of Nancy Cavey, we know that you rely on your health insurance benefits to provide you and your family medical care and that delayed or denied care can result in injury and even death.
If you have paid for surgeries, procedures or other treatment we can help you get the reimbursement that should be covered by the health plan or policy.
We also know that denied medical bills can destroy your family finances and can even lead to bankruptcy. One of the leading causes for filing for bankruptcy is unpaid medical bills. Don’t let your credit and financial history be destroyed.
That is why we are here for you with your health insurance benefit claim!
Health insurance benefits are invaluable but the details in a health insurance plan or policy can be confusing and overwhelming. Your employer or your group health plan or health carrier can leave you and your family in a vulnerable position when you seek quality health care and the full use of your insurance coverage.
You can help you with your health insurance claim and, if necessary, short and long- term disability coverage issues that may have led to your need for health care. We offer:
Employee health plan or health insurance aid by reviewing your employee benefit package so you know exactly what your coverage provides and what benefits your coverage excluded. We hold employers and group health plans and carriers to the promises they made when they sold to your health insurance coverage,
Assistance in COBRA issues so that you can temporarily continue your employer-provided health care despite the loss of your job, a reduction in hours, a change in your job, death of the spouse the provided benefits, divorce or disability. We help you take advantage, if you are eligible, for an extension of your COBRA benefits in the event of disability until Medicare eligibility begins.
Appealing Denied Claims for: Surgery | Medications | State of the art therapies and treatments | and Emergency Room Claims.
Complete health care representation by helping you navigate your health insurance claims, including analysis of your policy or plan, filing an appeal of wrongfully delayed or denied care, suing your employer of the plan or policy administrator for wrongful delay or denial of care, breach of fiduciary duty or misrepresentations made to you, and negotiating a resolution of your health care claim issues,
Mental Health Claim Assistance by making sure that you are provided with all the care you are entitled to under the federal mental health parity provisions, and
Eating Disorder Claim Assistance.
o Pre-existing conditions,
o Denial of care on the basis that the treatment is “experimental or investigational,”
o Medical necessity,
o Patient ineligibility,
o Pre-authorization and pre-certification issues,
o Outpatient claims,
o Policy exclusions such as custodial care or maintenance care,
o Payor misquotes of available coverage,
o Claim processing or coding errors,
o COBRA continuation issues, and
o Improper withdrawal of your health insurance coverage or portability of health insurance coverage under HIPAA,
o Appealing the wrongful denial of treatment and bills.
The reality is that you can’t rely on your employer or your group health plan or policy!
We are experts in ERISA health, life, disability, and pension claims. If you have questions about your healthcare or have been wrongfully denied your healthcare, you have come to the right place. We are all about protecting your rights under the ERISA law.
You need the advice of a knowledgeable employee benefits attorney whose sole mission to protect you and to maximize the health, disability, life and pension benefits you are owed. Let me be your guide!
If you believe that your employer or the group health plan manager or administrator have violated your rights, it is time to call the Law Office of Nancy L. Cavey to see if we can help you with your ERISA health insurance claim.
Health insurance litigation can be complicated, and you need experienced advice and representation from experienced Health Care Disability Claim lawyers like us!
Our goal is to answer your questions, explain your rights and stand up for you so you get the health insurance benefits you and your family were promised. If your health care claim was denied, call us at 727-894-3188 for a free consultation.