Health Insurance/Costs: Consumer Protections

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A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan
Helps consumers navigate their employer or private health plan's internal grievance procedure and external review programs of specific states.

The COBRA Subsidy and Health Insurance for the Unemployed
This issue brief written by Kaiser staff examines the potential impact and limitations of new temporary subsidies to help people maintain their employer-sponsored health coverage after a layoff created by the American Recovery and Reinvestment Act of 2009.

Recent Documents: (132 results)

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The COBRA Subsidy and Health Insurance for the Unemployed -- October 2009

This issue brief written by Kaiser staff examines the potential impact and limitations of new temporary subsidies created by the American Recovery and Reinvestment Act of 2009 to help people maintain their employer-sponsored health coverage after a layoff.

Health Reform: Lessons From Massachusetts -- September 2009

Two reports and an updated fact sheet examine state-level health reform in Massachusetts and the lessons it offers for policymakers in Washington.

Pulling it Together: Last Week's Health Reform "Shocker" -- June 2009
In the latest column from "Pulling It Together, From Drew Altman," the Kaiser Family Foundation’s President and CEO

Explaining Health Care Reform: What is Health Insurance? -- May 2009
This brief explains the ways in which coverage might be defined under a health reform plan, and some of the policy issues raised by those determinations.

Explaining Health Care Reform: What Is An Employer “Pay-or-Play” Requirement? -- May 2009
The brief examines the concept of employer pay-or-play provisions in health reform proposals and some of the policy implications surrounding the level of coverage required, the penalty to employers who do not offer coverage, and whether small firms are exempt from the requirements.

Explaining Health Care Reform: What Are Health Insurance Exchanges? -- May 2009
This brief explains the purpose and function of health insurance exchanges, which are a key element on many recent health care reform plans.

Health Care Costs: A Primer -- March 2009
This primer on health care costs examines the rapid growth in the nation’s health care costs since 1970, when the average growth in health spending exceeded the growth of the economy as a whole by an average of 2.5 percentage points. It also examines the impact of health care costs on families, with insurance premiums rising 87% between 2000 and 2006, more than four times the growth in wages.

Video: "The Cost of Cancer" -- February 2009

This Kaiser Family Foundation documentary explores the financial consequences faced by three people, all privately insured, after being diagnosed with cancer. It was released in conjunction with a joint Kaiser/American Cancer Society report, "Spending To Survive: Cancer Patients Confront Holes in the Health Insurance System."

Spending To Survive: Cancer Patients Confront Holes in the Health Insurance System -- February 2009

This report examines the severe challenges cancer patients can face in paying for their health care even when they have private health insurance. It is authored jointly by the Kaiser Family Foundation and the American Cancer Society.

Cost Sharing for Health Care: France, Germany, and Switzerland -- January 2009
This background brief examines how three European countries – France, Germany, and Switzerland – have dealt with cost sharing in their health systems, including specific policies that limit the impact on people and families with significant health care needs and low incomes.

This issue brief written by Kaiser staff examines the potential impact and limitations of new temporary subsidies created by the American Recovery and Reinvestment Act of 2009 to help people maintain their employer-sponsored health coverage after a layoff.

Two reports and an updated fact sheet examine state-level health reform in Massachusetts and the lessons it offers for policymakers in Washington.

In the latest column from "Pulling It Together, From Drew Altman," the Kaiser Family Foundation’s President and CEO

This brief explains the ways in which coverage might be defined under a health reform plan, and some of the policy issues raised by those determinations.

The brief examines the concept of employer pay-or-play provisions in health reform proposals and some of the policy implications surrounding the level of coverage required, the penalty to employers who do not offer coverage, and whether small firms are exempt from the requirements.

This brief explains the purpose and function of health insurance exchanges, which are a key element on many recent health care reform plans.

This primer on health care costs examines the rapid growth in the nation’s health care costs since 1970, when the average growth in health spending exceeded the growth of the economy as a whole by an average of 2.5 percentage points. It also examines the impact of health care costs on families, with insurance premiums rising 87% between 2000 and 2006, more than four times the growth in wages.

This Kaiser Family Foundation documentary explores the financial consequences faced by three people, all privately insured, after being diagnosed with cancer. It was released in conjunction with a joint Kaiser/American Cancer Society report, "Spending To Survive: Cancer Patients Confront Holes in the Health Insurance System."

This report examines the severe challenges cancer patients can face in paying for their health care even when they have private health insurance. It is authored jointly by the Kaiser Family Foundation and the American Cancer Society.

This background brief examines how three European countries – France, Germany, and Switzerland – have dealt with cost sharing in their health systems, including specific policies that limit the impact on people and families with significant health care needs and low incomes.

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Health Insurance/Costs: Consumer Protections

Most people now get their health care through some form of managed care plan – a health maintenance organization (HMO), preferred provider organization (PPO), or point-of-service option (POS). And most of the time these people receive the care they need. But when a health plan decides that the care a patient or their doctor wants is not medically necessary, or limits the care in some way, or denies payment for the care, the potential for a dispute with the plan arises. The health plan may be justified in refusing to provide or pay for treatment if it is generally not considered medically necessary, or not necessary in the particular situation, or not covered by the policy. The cases most likely to end up in dispute are often not clear-cut, such as treatments that may be new and experimental, whose value is unproven.

Consumers have certain rights under state and federal laws that they can exercise if they disagree with a decision their plan makes about medical coverage. These rights apply to both the “internal review” process and “external review.” The rights depend on the type of health plan the person has and which state they live in.