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What Should I Do if My Short-Term Health Insurance Claim is Denied?

Dealing with a health insurance company during a claim can be difficult, especially while you are simultaneously coping with a medical condition. Insurance companies often do not make the claims process easy for clients. They may deny valid claims, unreasonably delay payouts, or use other tactics to save their investors money. If you receive a denial on a short-term health insurance claim, do not give up. Contact an Arizona insurance bad faith lawyer to discuss your options.

How to Qualify for Short-Term Insurance

Short-term health insurance is a type of policy that provides temporary coverage. It is not a typical health plan that will last until the policyholder decides to cancel. Instead, it provides short-term coverage, typically for up to 12 months at a time, with the option of renewing for up to 36 months. The maximum length of a short-term insurance policy will depend on the laws in your state.

Short-term insurance plans are typically more affordable than traditional coverage. The average price in 2018 was $113 per individual and $277 for a family plan. You will need to fill out and submit a health questionnaire from the insurance company to see if you qualify for coverage. Most questionnaires will ask basic questions about your health and medical history, such as if a doctor has diagnosed you with an illness.

Disqualifications and Limitations

You might not qualify for short-term health insurance if you have certain conditions or do not meet the company’s eligibility requirements. An insurance company might automatically disqualify you, for example, if you exceed 250 pounds as a female or 300 pounds as a male. Other common disqualifications are pregnancy, HIV, AIDS, a non-citizen of the US, being insured under another policy, or qualifying for Medicaid.

Insurance companies have the right to deny short-term health insurance coverage based on one of your pre-existing conditions. Although the Affordable Care Act prohibits insurance companies from denying coverage based on pre-existing conditions, short-term health plans do not offer the minimum essential benefits. Coverage, therefore, is not guaranteed-issue. The government also does not provide subsidy programs for low-income individuals to help them pay for short-term insurance as they do for long-term policies.

Consult an Arizona Insurance Bad Faith Attorney

If you have short-term health insurance and submit a claim for a recent doctor’s appointment or procedure, the company might deny you for several reasons. The first step in appealing a claim denial is understanding the reason for the decision. Your insurance company should explain why it could not offer coverage in the denial letter. Common reasons include lack of related coverage, a gap in payments and insufficient information.

Next, contact a lawyer for help appealing the denial. Your insurance company might have acted in bad faith, allowing you to appeal the denial as well as file a new civil suit against the provider. Examples of insurance bad faith include automatically denying coverage and failing to explain the denial. Hiring an attorney will show the insurance company you are serious about protecting your rights. It could be enough to get the company to respond more favorably to your claim.

If the insurance company stands by its claim denial, your lawyer may be able to request an internal review or file an official appeal. An internal review gives your case back to the insurance company for another look. A review of the decision could lead to a change in the status of your case. An appeal submits your claim for review by a third party. The third party might side with you and believe you are eligible for coverage, forcing the insurer to pay benefits according to your short-term plan. An insurance bad faith lawyer can help you appeal a denial on a short-term health insurance claim.