Rules That Apply to Health Insurance Companies – Know Your Rights!
In this video, Scott Glovsky talks about the rules that apply to health insurance companies. Health insurance is different than other things we buy like cars and food. As such, there are special rules to make sure health insurers live up to their promises. In other words, in exchange for paying premiums, health insurers promise to cover medically necessary care when we need it.
Health Insurance companies are required to provide a thorough investigation, a fair investigation, a full investigation, and a prompt investigation. California law says there is a relationship akin to a fiduciary relationship between a health insurance company and a member. Health insurers have a duty to help you. They have a duty to find coverage. They have a duty to find facts to justify coverage. Health insurers cannot put their interests above your interests. They cannot put their motive to make a profit above your need for medical care.
The law in California says health insurers must give as much interest to your needs as to their own. Accordingly, and to learn more, you can visit the Califonia Department of Insurance.
That said, in reality health insurers act very differently.