Health Insurance Discrimination Laws

Where You Need a Lawyer:

(This may not be the same place you live)

At No Cost! 

 What Discrimination Laws Cover Health Insurance Plans?

The Affordable Care Act (often known as the ACA or “Obamacare”) introduced enormous improvements to the United States’ healthcare system—including significant anti-discrimination provisions. Make sure you understand your ACA and other legal rights.

The anti-discrimination provisions of the ACA match those of other federal statutes, such as the Civil Rights Act and the Age Discrimination in Employment Act. Discrimination based on race, color, national origin, gender, age, or disability is prohibited under Section 1557 of the Affordable Care Act. A health insurance or medical provider may not additionally employ neutral policies that discriminate against members of a protected class.

Section 1557 addresses a wide range of health-related initiatives and activities, including:

  • Any HHS-funded program or institution (including Medicare or Medicaid)
  • Any HHS-managed program
  • Health Insurance Marketplace
  • Insurers that participate in the Marketplaces

In other words, it applies to most insurance plans, medical providers, hospitals, and retail pharmacies. However, some job-based health insurance policies are “grandfathered” and are not covered by the ACA.

Other insurance laws, rules, and regulations, such as the following, may also apply.

The Employee Retirement Income Security Act (ERISA) and the Health Insurance Portability and Accountability Act (HIPAA) are both federal laws (HIPAA).

These laws provide additional safeguards and may necessitate distinct complaint procedures. If you have been discriminated against, you should seek legal counsel. A health insurance attorney can assist you in identifying all of your causes of action and filing the necessary paperwork and claims.

A pre-existing ailment, often known as a pre-existing condition, is any illness that a person had previous to applying for a health care plan.

Chronic or long-term conditions are examples of pre-existing conditions. Pregnancy can also be deemed a pre-existing condition for health policy purposes in specific situations.

People with pre-existing diseases are frequently denied coverage or charged a higher coverage rate by healthcare providers and insurance companies.

According to the logic, people with pre-existing illnesses are more expensive to cover and demand greater health benefits. As a result, those with such ailments frequently require the greatest coverage but have a more difficult time acquiring it.

When a health insurance company denies a person coverage because of a condition they had before applying for health care coverage, this is known as pre-existing illness discrimination.

Prior to the implementation of the Affordable Care Act, insurance companies routinely denied coverage to such individuals. As a result, the individual receives subpar medical care and is forced to incur additional out-of-pocket expenses.

Can Health Insurance Companies Legally Refuse to Insure a Patient?

According to federal law, you cannot be denied insurance because of pre-existing medical conditions or health status, race or color, national origin, gender, age, or disability.

Gender identity is also protected, according to HHS. Transgender patients have been at the vanguard of Section 1557 lawsuits.

Furthermore, an insurance provider cannot decline vital health benefits, coverage, or cancel a policy for discriminatory reasons. You have the right to appeal a refusal of coverage under the ACA.

You can file an internal appeal with the insurance company or an external appeal with a state or federal regulator.

Consider contacting a health insurance lawyer if you need assistance filing an appeal. A lawyer can assist you in filing the proper appeal and constructing a compelling case for coverage.

Health insurance firms used to be able to cancel subscribers’ health insurance plans for inadvertently leaving out information unrelated to their medical history and committing clerical errors.

However, these activities are now considered prohibited. A health insurance provider cannot also cancel a person’s policy for illegal reasons, such as those that violate state and federal anti-discrimination laws.

Furthermore, several jurisdictions have laws prohibiting health insurance companies from canceling policyholders’ healthcare coverage because of the presence or diagnosis of specific medical disorders, such as HIV, Alzheimer’s disease, and a few other ailments.

A health insurance firm cannot cancel a policyholder’s health insurance coverage just because they do not wish to pay their medical bills.

A health insurance company cannot discontinue health insurance at any time, according to the Affordable Care Act. It is now actually against the law. This is especially true if a policyholder omitted medical facts or documentation when applying for health insurance coverage.

On the other hand, a health insurance firm can cancel a policyholder’s health insurance plan if they fail to make monthly premium payments, willfully omit or misrepresent information while applying, or commit health insurance fraud.

Even in the instance of health insurance fraud, a health insurance company may be unable to cancel a policyholder’s health insurance plan if they file an appeal and win their case.

Can Health Insurance Companies Charge Patients Different Premiums or Rates?

Insurance companies cannot charge you more because of your race, national origin, gender, or a pre-existing ailment. However, premiums may be raised as a result of the following:

  • Age: Older policyholders may be charged three times as much as younger policyholders.
  • Tobacco use: smokers may face a 50% surcharge over non-smokers.
  • Geography: When determining rates, insurance companies may consider the healthcare expenditures in your community.

Health insurers must also justify certain rate increases. Consider contacting an insurance benefits lawyer if you have issues with the legality of your insurance premiums.

How Can I File a Health Insurance Discrimination Claim?

If you are the victim of illegal discrimination, you may file a lawsuit against the insurance company or file a complaint with the Office for Civil Rights of the U.S. Department of Health and Human Services. You must usually file your complaint within 180 days of the discriminatory act.

Health insurance discrimination legislation is still being developed. The Affordable Care Act was passed in 2010, and the HHS formalized its anti-discrimination policies in 2016. Because the federal courts have yet to hear many ACA discrimination claims, there is some uncertainty about how the law should be applied.

People sue their insurance providers for a variety of reasons. It is necessary to explain the relationship between the individual who purchases insurance and their insurance company in order to understand why it is feasible to sue an insurance company. The person who buys insurance is known as the insured, and the insurance business is known as the insurer.

The insurance policy is a contract in which one party agrees to pay a premium in exchange for the insurer providing coverage to the insured. If a loss occurs as a result of an insured occurrence, the insurance company will protect the insured against any losses, damages, or responsibility. As a result, the insured and an insurer have a legal, contractual relationship.

Suits are frequently filed when an insurance company fails to indemnify or defend an insured against a covered act under their policy. They also occur when an insurance firm fails to meet its contractual obligations, such as erroneously denying a lawful insurance claim.

It is vital to know that if you disagree with your health insurance provider, a health insurance lawsuit is not normally your first option. You must first go through numerous formal steps to resolve the insurance dispute outside of court. You may have to sue your insurance carrier if no settlement is reached.

Can a Lawyer Help My Health Insurance Discrimination Case?

Yes. Because of the uncertainty in this developing field, it may be best to consult with an insurance attorney. A lawyer can assist you in understanding your rights, filing the necessary paperwork and claims, and keeping you up to date on legal developments.

Law Library Disclaimer


16 people have successfully posted their cases

Find a Lawyer