If you have filed a claim with your health insurance only to have it denied, you know just how frustrating it is to face this situation. There is a myriad of reasons this might occur, but the result may leave you feeling as though you have hit a dead end. Many people do not realize that the Employee Retirement Income Security Act covers certain health care-related claims.
ERISA, also known as the Employee Retirement Income Security Act, is a law passed in the 1970s that dictates administration of employee pensions and insurance. It exists to protect employees who receive such benefits through private companies facilitated by employers. If this applies to you, you should know the following three facts about ERISA.
1. ERISA entitles you to information
Misinformation is perhaps the greatest threat facing individuals trying to take advantage of health insurance and other employee benefits. You may receive conflicting advice from your employer and insurance provider, or you may have no information at all. ERISA mandates that plan providers must provide insureds with information regarding its funding and the features it extends to beneficiaries.
2. Private health insurance is covered
If you receive private health insurance through your employer, you may feel frustrated by the care you receive or the coverage that it includes. Sometimes the insurance company may deny your claims, as in the aforementioned scenario, and it may seem there is little recourse. ERISA applies to employer-provided health insurance, though, which means that protections extend to the coverage you get through work.
3. Claims must be compliant
If you suspect that your insurer is acting in a way that violates the standards established by ERISA, you can file a claim. Doing so is not necessarily a simple process, though. Typically, you must check with your provider to learn the claims procedure and then file accordingly. Your claim is more likely to receive an approval if it adheres to the compliance standards of your insurer, and an attorney can assist with this.