Rights and Regulations
ACA protections, No Surprises Act, mental health parity, and state-specific consumer protections for insurance disputes.
120 articles in this topic
ACA Patient Protections Overview
Key Affordable Care Act protections for insured Americans.
ACA Essential Health Benefits: What Must Be Covered
The 10 categories of care your ACA plan must cover.
ACA Preventive Care Mandate
Free preventive services required under the ACA.
ACA Pre-Existing Condition Protections
How the ACA prevents discrimination based on health history.
ACA Annual and Lifetime Limit Ban
Your protection against coverage caps.
ACA Appeal Rights for All Health Plans
The appeal rights the ACA guarantees every patient.
ACA External Review Mandate
The federal requirement for external review of denials.
ACA Dependent Coverage to Age 26
Your child's right to stay on your plan.
ACA Mental Health and Substance Abuse Coverage Requirements
Behavioral health as an essential health benefit.
ACA Maternity Care Coverage Requirements
Pregnancy and newborn care coverage under the ACA.
No Surprises Act Overview
Complete guide to the No Surprises Act protections.
No Surprises Act: Emergency Services Protections
How the law protects you from surprise ER bills.
No Surprises Act: Ancillary Provider Protections
Protection from surprise bills by out-of-network providers at in-network facilities.
No Surprises Act: Air Ambulance Protections
Air ambulance balance billing protections.
No Surprises Act: Independent Dispute Resolution
The IDR process for provider-insurer payment disputes.
No Surprises Act: Good Faith Estimate Requirements
Your right to upfront cost information.
Filing a No Surprises Act Complaint
How to report violations of the No Surprises Act.
Mental Health Parity and Addiction Equity Act Explained
How MHPAEA requires equal coverage for mental health.
Common Mental Health Parity Act Violations
How insurers break parity rules and what to do about it.
Quantitative Treatment Limits Under Parity
When visit limits and cost-sharing violate parity.
Non-Quantitative Treatment Limits Under Parity
Prior auth, step therapy, and other hidden parity violations.
Using Parity Laws in Your Mental Health Appeal
How to invoke MHPAEA in your appeal letter.
Mental Health Parity Compliance Analysis Requests
Your right to request your insurer's parity analysis.
Women's Health and Cancer Rights Act
WHCRA protections for breast cancer patients.
Newborns' and Mothers' Health Protection Act
Minimum hospital stay requirements after childbirth.
GINA: Genetic Information Nondiscrimination Act
Protections against genetic discrimination in insurance.
HIPAA Portability Protections
How HIPAA protects your coverage when changing plans.
HIPAA Special Enrollment Rights
When you can enroll outside of open enrollment.
COBRA Rights and Protections
Your right to continue employer coverage after job loss.
COBRA Election Period and Deadlines
Key timelines for electing COBRA coverage.
COBRA Qualifying Events Explained
Events that trigger COBRA eligibility.
EMTALA: Emergency Medical Treatment and Labor Act
Your right to emergency care regardless of insurance.
EMTALA Violations: When Hospitals Turn You Away
What to do if a hospital violates EMTALA.
The Prudent Layperson Standard Explained
The legal standard for emergency care coverage.
CMS Coverage Determination Process
How Medicare decides what to cover nationally.
National Coverage Determinations Explained
Understanding NCDs and how they affect your coverage.
Local Coverage Determinations Explained
How LCDs vary by Medicare region.
Medicare Patient Rights Overview
Your fundamental rights as a Medicare beneficiary.
Medicare Beneficiary Notices of Noncoverage
Understanding ABN and other coverage notices.
Medicare Advantage Consumer Protections
Special protections for MA plan members.
Medicaid Due Process Rights
Your constitutional rights in Medicaid coverage disputes.
Medicaid Managed Care Protections
Rights specific to Medicaid MCO members.
State Mandated Health Insurance Benefits
Benefits your state requires insurers to cover.
State Prompt Payment Laws for Insurance Claims
Deadlines insurers must meet for claim processing.
State External Review Laws by State
How external review rules vary across states.
Role of Your State Insurance Commissioner
How your state regulator oversees insurance companies.
State Consumer Protection Laws for Health Insurance
Additional state-level protections beyond federal law.
State Bad Faith Insurance Laws
When your insurer's denial constitutes bad faith.
State Independent Review Organizations (IROs)
How states select and regulate external reviewers.
Patient Bill of Rights: Federal and State
Your fundamental rights as a healthcare consumer.
Informed Consent and Insurance Coverage
How informed consent relates to insurance claims.
Your Right to a Second Medical Opinion
Laws that guarantee second opinion coverage.
Continuity of Care Laws by State
Protections when your provider leaves your network.
State Surprise Billing Laws
State-level protections beyond the No Surprises Act.
Network Adequacy Requirements
Laws requiring insurers to maintain sufficient provider networks.
Any Willing Provider Laws by State
When providers can join any insurer's network.
Provider Directory Accuracy Requirements
Your rights when insurer directories are wrong.
Premium Grace Period Protections
How long you can keep coverage after missing a payment.
Laws Against Retroactive Coverage Denials
Protections against post-payment denials.
Timely Claims Processing Laws
How quickly insurers must process your claim.
Utilization Review Regulations
Laws governing how insurers conduct UR.
Clinical Review Criteria Transparency Laws
Your right to see the criteria used to deny your claim.
Independent Medical Review Laws by State
State IMR requirements and procedures.
Balance Billing Protections by State
State laws that prevent balance billing.
Assignment of Benefits Laws
When providers can bill insurers directly on your behalf.
Out-of-Network Billing Regulations
Rules governing out-of-network charges.
Prescription Drug Coverage Laws
State and federal laws governing medication coverage.
Step Therapy Reform Laws by State
States that limit step therapy requirements.
Prior Authorization Reform Laws
New laws streamlining and limiting prior auth.
Gold Card Prior Authorization Laws
Laws that exempt high-performing providers from prior auth.
Telehealth Parity Laws by State
Laws requiring equal coverage for virtual and in-person care.
Fertility Coverage Mandates by State
States that require fertility treatment coverage.
Autism Coverage Mandates by State
State laws requiring autism therapy coverage.
Hearing Aid Coverage Mandates by State
States that require hearing aid coverage.
Contraceptive Coverage Mandate
ACA requirements for birth control coverage.
Preventive Care Coverage Rules
Which screenings and services must be covered at no cost.
Experimental Treatment Coverage Rules
When insurers can and cannot deny experimental care.
Clinical Trial Coverage Laws
Your right to routine care coverage during trials.
Reconstruction Surgery Coverage Laws
Laws requiring coverage for reconstructive procedures.
Mastectomy and Reconstruction Coverage Rights
Federal protections for breast cancer surgery patients.
Mental Health Emergency Coverage Rights
Your right to emergency psychiatric care.
Substance Abuse Treatment Coverage Rights
Laws requiring addiction treatment coverage.
Eating Disorder Coverage Laws
State mandates for eating disorder treatment.
Chronic Disease Management Coverage Rights
Laws ensuring ongoing coverage for chronic conditions.
Pediatric Coverage Requirements Under ACA
Children's coverage as an essential health benefit.
Children's Dental Coverage Requirements
Pediatric dental as an essential health benefit.
Emergency Services Coverage Rules
Federal requirements for ER coverage.
Out-of-State Treatment Coverage Rules
When your insurance must cover care in another state.
Cross-Border Healthcare Coverage
Coverage for treatment received in other countries.
Appeal Rights Timeline Summary: Federal and State
A quick reference for all appeal deadlines.
How to Cite Regulations in Your Appeal Letter
Referencing laws and rules that support your case.
Filing a Department of Labor Complaint
When and how to involve the DOL in your appeal.
Filing an HHS Complaint About Your Insurer
Reporting insurer violations to Health and Human Services.
Filing a State Attorney General Complaint
When to escalate to your state's attorney general.
Reporting Insurance Fraud
How to report fraudulent insurance practices.
Whistleblower Protections for Insurance Complaints
Legal protections when reporting insurer misconduct.
Class Action Lawsuits Against Insurance Companies
When individual denials become class action cases.
Small Claims Court for Insurance Disputes
Using small claims court for denied claims.
Mediation for Insurance Disputes
Alternative dispute resolution for claim disagreements.
Arbitration in Health Insurance Disputes
When your plan requires arbitration and what it means.
Insurance Regulatory Enforcement Actions
How regulators punish insurer violations.
Insurance Market Conduct Examinations
How states audit insurer practices.
Insurance Consumer Complaint Databases
Public databases tracking insurer complaints.
NAIC Consumer Resources for Insurance Disputes
National Association of Insurance Commissioners tools.
CMS Star Ratings and Insurer Quality
How quality ratings reflect insurer appeal practices.
Transparency in Coverage Rule
Requirements for insurers to disclose pricing.
Interoperability Rules for Health Plans
How data sharing requirements affect your rights.
Patient Access API: Your Right to Health Data
Accessing your claims data electronically.
Your Right to Request a Coverage Exception
When and how to ask for exceptions to plan rules.
Your Right to Independent Review of Denials
The legal basis for external review.
Your Right to Continued Coverage During Appeal
Laws protecting ongoing treatment during appeals.
Your Right to Expedited Review for Urgent Cases
When you can demand a fast-track decision.
Your Right to a Written Explanation of Denial
What your insurer must tell you in writing.
Your Right to Your Complete Claim File
Accessing every document used in your denial decision.
Anti-Retaliation Protections for Filing Appeals
Laws preventing insurers from punishing you for appealing.
Language Access Rights for Insurance Appeals
Your right to appeal materials in your language.
Disability Accommodations in the Appeals Process
ADA requirements for accessible appeal procedures.
Federal vs. State Surprise Billing Laws
How federal and state surprise billing protections overlap and differ.
Prior Authorization Patient Rights
Your legal rights during the prior authorization process.
Coverage Appeal vs. Payment Appeal
Understanding the two types of insurance appeals and when each applies.