Health Care Attorney Answers Common Questions

Posted on: November 16, 2017

Here are answers to some common questions from Pennsylvania residents concerning a variety of health care law issues. The answers are intended to provide general information only. You should consult a lawyer with experience in healthcare law matters for advice regarding your specific situation.

Question: Can my health insurance company cancel my policy?

Answer: An insurance policy (including a group plan in which an individual participates) is a contract between the insurer and the insured. As with any contract, it cannot be canceled arbitrarily. If, however,  premiums are not paid, or if it is discovered that the insured made materially false statements when he or she enrolled, the carrier may have the right to cancel.

Also, if the policy or plan allows it, in some cases, the insurer may have the right to reduce or alter benefits. Claims submitted prior to the effective date of the change will ordinarily not be affected. 

Question: What is HIPAA and what does it do?

Answer: HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. It is a federal law that covers the privacy and safeguarding of individuals' private medical information.

Question: Are online reviews of doctors and other healthcare providers reliable?

Answer: These sites are controversial. Reviews found there, especially negative ones, should be taken with a large grain of salt. Most doctor ratings and reviews sites permit posters to remain anonymous. Even if a doctor is able to discern the poster's identity, he or she may ordinarily not respond through the site without violating both professional ethics, medical privacy and confidentiality laws.

Moreover, many websites also disavow any responsibility for negative posts and refuse to remove them, even if the physician can show that the criticism is unfounded. 

Question: What can I do if my health insurance provider refuses to pay a claim?

Answer: Pennsylvania residents covered by health insurance policies and plans have the right to request the insurer to review and reconsider a denied claim. Generally, the Explanation of Benefits (EOB) related to the denied claim will include instructions on how to request this review. Insureds may also request an “external” (independent) review if the denial is confirmed.

They may also file a complaint with the Commonwealth Department of Insurance and, ultimately, bring suit. It is important to be aware of and observe all time limits for filing, as they are often quite short and are strictly enforced. 

Question: What is an advance healthcare directive?

Answer: An advance healthcare directive, sometimes called a “living will.” allows individuals to dictate how they are to be treated should they develop a life-threatening illness whose symptoms make it impossible for them to express those wishes. A directive typically includes instructions as to whether artificial life support is to be used to keep the individual alive.

While hospitals typically require admitted individuals to sign a directive, it is preferable to do so before it becomes necessary. Pennsylvania's law includes a simple form that, when properly completed and signed, health care providers are obligated by law to honor.

NOTE: This is for informational purposes only and does not constitute legal advice.