Employers typically present group healthcare plans as important employee benefits during the hiring and contract negotiation processes. Unfortunately, Texas insurers are not always enthusiastic about paying up — even when the people make claims for benefits that are well within the scope of the policies.
For those who come up against resistance while filing a claim, it is often important to realize that an important federal law protects the rights of employees. This often helps relieve some of the stress that comes from going against large, powerful institutions, such as insurance providers and employers.
The Employee Retirement Income Security Act, despite the name, governs health benefit plans in addition to retirement accounts. ERISA would give you the right to fair processing of your health claim, among other rights. According to the Department of Labor, the law grants the following rights regarding health plans:
- Access to information about health protections
- Documents proving coverage
- Provisionary coverage after losing the policy
Employees also have the right to recover benefits. The process of obtaining appropriate benefits is not always as quick or simple as employees might like, but ERISA does grant health plan participants the right to a timely and fair processing of claims, as mentioned above. The DOL website also provides an introduction to making a health claim from one of the following categories:
- Reimbursement claims
- Predictive claims
- Emergency claims
Of the categories above, the DOL states that claims falling into the post-service reimbursement definition are the most common. However, this does not mean they are the easiest or quickest to process. Those faced with a medical condition might do well to consider which type is in their best interest before making a decision to file.
