Alabama Health Insurance Frequently Asked Questions

Health Insurance FAQ's

Q. My health insurance company is non-renewing my policy. Can they do this?

A. If your policy is not guaranteed renewable, the company may exercise their right to non-renew your policy. It is important that you very carefully read the section of your contract concerning cancellation.

Q. How long does a company have to pay a medical claim?

A. The insurance company has 45 days to either pay or deny a claim once proof of loss has been received, unless additional information is requested.

Q. I recently had open heart surgery, and the physician's bill was $20,000. I filed a claim with my insurance company, but they say that only $11,000 is reasonable and customary. I do not have $9,000. Can I do anything to get them to pay more on this claim?

A. Reasonable and customary rates, which vary between providers and hospitals and geographical areas, are not regulated by the Alabama Department of Insurance.

The physician can appeal to the company, if the surgery he/she performed was especially difficult or required unusual procedures. The insured can appeal by verifying the customary rates for other physicians in the area, and by asking the company to substantiate how they arrived at the reasonable and customary charges.

Q. The insurance company is delaying paying my hospital claim. They keep telling me they are checking for a pre-existing condition, and want information about all the physicians I have seen in the past five years. I know the condition was not pre-existing, and this is a waste of time. Can you assist in this matter?

A. If the policy is more than two years old, the company should not be conducting a pre-existing condition investigation. If the policy is less than two years old, the company has the right to conduct a pre-existing condition investigation. The consumer should complete a Consumer Complaint Form, and provide us with copies of any correspondence received from the company, as well as a copy of the insurance policy. We will contact the company to find out why they are delaying on paying the claim, and see what can be done to expedite it.