Health care law covers many areas of the health care industries and health care insurance issues. Health care law issues may include:
- Elder Care Lawyers;
- Health Insurance Lawyers;
- Medicare and Medicaid Lawyers; and
- Nursing Home Lawyers.
There are many subcategories of the categories mentioned above. Elder care law includes numerous issues, such as:
- Long-term housing for the elderly;
- Nursing homes and assisted living;
- Medical benefits and subsidies, including Medicare and Medicaid; and
- Elder abuse and neglect, which may include:
- physical abuse;
- mental abuse;
- financial scams; and
Health insurance laws govern the different types of health insurance available. There are many different types of health insurance plants that are available, including:
Medicare and Medicaid are government provided healthcare programs for certain groups of individuals. Medicare is for elderly and disabled individuals over the age of 65. Medicaid is for disabled individuals, low-income individuals, and families with children.
Nursing homes are subject to federal and state laws, including healthcare laws. A nursing home is a long-term care facility for elderly individuals to reside and receive the necessary medical supervision for their health. Nursing homes typically provide care to individuals with chronic illness who cannot care for themselves, such as individuals in wheelchairs who cannot use the restroom themselves, feed themselves, or take their medication.
What are Some Examples of Health Care Law Disputes?
One of the most common types of health care law disputes involves an individual’s health care plan. These disputes may involve a number of factors, including:
- The denial of medical coverage for services or benefits;
- The refusal to authorize the insured invidiual’s hospital visit or medical procedure;
- Excessive or Incorrect charges for medical services;
- Cancellation of health insurance policies without providing proper notice; and
- The refusal to carry over a policy when an individual changes jobs.
Disputes involving health coverage and policies can involve multiple parties. This may include:
- The individual who is insured;
- The policy provider;
- Their employer;
- Medical parties; and
- Other relevant parties.
Most health care plan disputes, however, involve claims between the insured and the policy provider.
Another type of health care dispute may arise if elder abuse or nursing home abuse occurs. Nursing homes may violate the Nursing Home Reform Act or subject elderly residents to abuse. There are some signs that point to nursing home and elder abuse, which include:
- Bruises, bedsores, or other injuries;
- Excessive weight loss;
- Dehydration; and
- Unclean conditions.
If an individual’s loved one is a victim of nursing home abuse, they should contact the nursing home administrator and file a complaint. They may also contact their state agency regarding the violation. Additionally, the individual may obtain the assistance of a lawyer to sue the nursing home for damages.
What Types of Laws Govern Health Care Issues?
There are a wide range of laws that govern health care issues. These laws may also vary by state. Because of this, it is important to have the assistance of an attorney with any health care law issue to advise an individual what laws apply to their claim.
As noted above, the Nursing Home Reform Act was enacted to ensure residents receive quality care, certain services, and have a Residents’ Bill of Rights. This act applies to nursing homes that participate in Medicare and Medicaid.
Another important law governing health care issues that is familiar to many individuals is HIPAA, or the Health Insurance Portability and Accountability Act. The section of HIPAA most individuals are familiar with is the privacy section which regulates the use and disclosure of patient health information, including:
- Health status;
- Health insurance; and
- Health related payments.
Entities that are covered by the HIPAA are not permitted to disclose patient information except for certain reasons and only under certain conditions. These entities include:
- Health insurers;
- Medical service providers;
- Employer sponsored plans;
- Health care facilities; and
- Independent contractors employed by the entities listed.
What if I Have a Health Care Dispute or Claim?
The first step to take if an individual has a health care dispute or claim is to seek the advice of an attorney. An attorney can provide invaluable guidance regarding what laws apply, how to make a claim, and what the possible outcomes may be.
There are steps an individual can take if they are involved in a dispute regarding their health care plan. Filing a health care plan dispute may be handled using the following steps:
- Obtain notice. If an individual is denied coverage or their policy is cancelled, they should obtain the reason in writing;
- An internal review. A claim may be filed through the mechanisms of the health care organization itself, called a consumer complaint. The health care company may provide the individual with a remedy for their losses;
- External review, where an outside agency reviews the complaint. These may be necessary when the internal review cannot resolve the dispute. These are not available for all claims and are usually reserved for individuals who are self-insured or who are insured through an employer-sponsorship program;
- Arbitration or Mediation. Many insurance contracts contain clauses requiring disputes to be resolved through arbitration or mediation; and
- Civil Lawsuit: If the insured individual and the health insurance company cannot reach a settlement through an internal or external review, they may file a lawsuit in a civil court. In certain severe cases, a lawsuit may be filed before a review is filed.
No matter what option an individual chooses to try and resolve their dispute, a health care lawyer will be an invaluable asset. A lawyer will review the individual’s case as well as their policy, determine what may be the best path to resolution, and assist them every step of the way.
It is important to note that the Affordable Care Act, or Obamacare, made it illegal for insurance companies to deny an individual insurance coverage based on pre-existing conditions. Pre-existing conditions, or pre-existing illnesses, are any illness that the individual has prior to applying for their health care plan. Pre-existing conditions can include long-term or chronic conditions.
In addition, federal laws prohibit insurances companies from denying coverage based on an individual’s race, national origin, sex, age, or disability. A lawyer can review an individual’s case to determine if their insurance company has violated federal law.
What are Some Typical Remedies for a Health Care Law Claim?
The type of remedy an individual will receive for their health care law claim will depend on the type of case or issue they are facing. An attorney will be able to provide the individual with the most up-to-date information regarding available remedies.
For example, if an individual commits elder abuse, they may be liable for activities prohibited by civil laws, including:
- Intentional infliction of emotional distress;
- Other prohibited activities.
In some cases, elder abuse may be prosecuted as a criminal offense. A large number of state criminal codes define crimes against elderly individuals, including elder abandonment and fraud committed against an elderly person. These offenses may be classified as a misdemeanor, which is punishable by up to a year in jail, or as a felony, which is punishable by more than a year in prison.
If an individual or nursing home is sued in civil court, the plaintiff, or individual filing the lawsuit, will be seeking damages. Damages are monetary payments that are made by the defendant in order to compensate the victim for their injuries, losses, and pain and suffering. Punitive damages may be added in certain types of tort claims. For example, damages in an elder abuse claim may include compensation for medical bills, rehabilitation, and pain and suffering.
Do I Need to Hire a Lawyer for my Health Care Law Issue?
Yes, it is essential to have the assistance of an experienced personal injury attorney or a health care lawyer for any legal issue involving health care. An attorney can review your claim, advise you regarding what laws apply and how to proceed, and represent you during any court proceedings, if necessary.
It is important to note that many cases have a statute of limitations, or a time limit on filing your claim. Because of this, it is essential to contact an attorney as soon as possible.