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Can a health insurance company try to increase patient payments?

On Behalf of | Nov 14, 2023 | Bad Faith Denial Of Patient's Claim For Medical Insurance

Health insurance exists primarily as a means of limiting personal liability. Someone who has a major medical issue can rely on health insurance to cover the cost of their care. Many different people buy into group plans and policies, which means that there is a large pool of people helping to cover those costs in the event that someone has a catastrophic medical issue.

Health insurance companies should uphold their policies so that individuals can receive the care they need even in situations where they cannot otherwise afford treatment. Most health insurance policies include some degree of patient responsibility, and those financial obligations can be a challenge during a major medical issue.

What are patient responsibility costs?

There are three main ways in which health insurance companies pass expenses back to the people undergoing treatment. The first is through a deductible. Individual patients have to pay a certain amount for their care using their own resources before their insurance policy will cover the rest. The second is through co-pays. Co-pays involve patients paying a flat rate for certain types of care. They may have a co-pay that applies for certain medical appointments and another co-pay for medication. Finally, there is coinsurance. Coinsurance makes a patient responsible for a certain portion of their treatment costs.

When can insurance companies change patient costs?

Every year, individuals or their employers will need to renew insurance coverage. That time is when the company can implement changes to policy premiums, patient responsibility costs and the benefits that people receive. Those who are unhappy with the proposed changes have the option of seeking coverage with a different company. After renewing the policy for the next year, the terms are essentially set. The insurance company cannot retroactively go back and change what it will cover or how much the policyholder must pay because someone makes a large claim. Doing so may constitute bad faith insurance practices.

Insurance companies have an obligation to operate in good faith, which means that they uphold the contracts that they signed with their customers. Refusing to pay for covered treatment or attempting to manipulate people into paying more than their policy requires are both examples of bad-faith insurance practices. When an insurance company has made it clear it wants to put profits ahead of the well-being of policyholders, it may be necessary to take the issue to court.

Filing a bad faith insurance lawsuit can potentially help people get the coverage they need and have paid for since they started carrying a specific policy. Those who may have grounds for such a suit can benefit from exploring their rights and options under the law with the assistance of a skilled attorney.