Some Important Facts About Health Insurance in Alabama

With the rising cost of health and medical services, it really makes sense for residents in Alabama to have health insurance policies to prepare for any unexpected health or medical expenditures. The easiest way to enjoy health coverage would be to enroll in the group health insurance offered by most companies in the state. Even small sized companies with less than 50 employees have health insurance policies designed to address the needs of its employees and their families.

One important thing to know is that the state of Alabama requires insurance companies to pay for medical claims within 45 days of receiving proof of loss. However, if the insurance provider feels that further investigation is warranted, a written notice must be given to the policyholder explaining on the delay and need for additional time to settle the claim. The Alabama Department of Insurance also does not impose strict guidelines regarding the amount that a provider may pay to the policyholder. This is because insurance providers are allowed to pay only the amount they deem reasonable and customary, thus leading to the possibility of paying less for what the insured has paid for. However, policyholders are also allowed to appeal and asked for detailed reasoning as to how the provider came about with the amount. If the policy has been imposed for less than two years, insurance providers are also allowed to delay making payments to investigate for pre-existing conditions. In the case that the settlement is proven to be associated with a pre-existing condition, no payments may be given for the claims. However, if the health insurance policy has been enforced for more than two years, insurance providers cannot conduct investigation for pre-existing conditions.

Policyholders should also verify that the health insurance policy they have purchased has already been approved and issued by the provider before they can be assured of coverage. If no such policy has been issued, coverage may not be guaranteed and there is still a chance a claim may be denied even if premium payments have already been made. If more than 60 days have passed and no insurance policy has been issued, consumers would need to follow up on the provider or ask the Alabama Department of Insurance for Assistance.

Compared to individual health insurance policies, employees covered under a group health plan have less control over the coverage they will get. This is because the contract is primarily between the employer, who is deemed the policyholder, and the insurance company. In this case, if the policyholder decides to switch to coverage with lesser benefits, employees normally cannot prevent it from happening. Subsequently, if the employer defaults on a payment, employees cannot force the insurance provider to provider coverage to them.

In the case when an employee finds himself not covered with group health plans, he can invoke the Health Insurance Portability and Accountability Act (HIPAA)of 1996. The state of Alabama has also taken steps for its constituents to deriver maximum benefits from the HIPAA, with the creation of the Alabama Health Insurance Plan (AHIP). Under AHIP, insurance providers are not allowed to imposed waiting periods for pre-existing conditions for continued health insurance coverage after an employee loses his or her job. However, there are several requirements for one to quality for AHIP, such as having lived in the state permanently and having at least 18 months of continuous coverage. An individual is also eligible after using up his or her COBRA coverage. Under state law, those who are covered under the health insurance coverage of their spouses or has insurance under Medicare or Medicaid does not qualify for AHIP.

We help our Alabama customers in Birmingham, Montgomery, Mobile, Huntsville, Tuscaloosa, Hoover, Dothan, Decatur, Auburn, AL and other cities in the Yellowhammer State lower their premiums and save money on all types of insurance. Use the form above to find low cost auto, homeowners, health, medical, life and long term care insurance. Using our Alabama insurance agent and broker network, you can easily compare rates from multiple insurers.

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