Key Health Insurance Terms: Key Terms – Community Health Advocates
Coverage Denials
If your health plan refused to pay for a medical service or denied a prior authorization request, you have the right to fight the denial through your plan’s appeal process. Here are some Do-it-Yourself appeal guides to help you:
- Medical Necessity DIY: (English) (Spanish)
- Not a Covered Benefit DIY: (English) (Spanish) (Mandarin)
- Out-of-Network Reimbursement DIY: (English) (Spanish) (Mandarin)
- Emergency Services Denial DIY: (English) (Spanish)
For more information, please see: How to Fight a Denial
Resources for Dealing with Medical Bills
If it is determined a bill is your responsibility, the following resources can help reduce the amount owed if you cannot pay:
- Do-It-Yourself Debt Negotiation Packet: (English) (Spanish)
- Fair Medical Debt and Reporting Act: (English) (Spanish) (Mandarin)
- Medical Debt Lawsuit DIY:(English) (Spanish) (Mandarin)
As of November, 2022, a default judgment in a medical debt lawsuit cannot result in your wages being garnished (i.e., taken out of your paycheck) or a lien being placed on your home (i.e., the court cannot take any property you own to repay medical debt). See CHA’s one-pager on the Ban on Liens Wage Garnishments for more information.
For more information on resolving medical bills, click here.
Hospital Financial Assistance
- Hospital Financial Assistance Frequently Asked Questions (English) (Spanish)
- NYS Uniform Hospital Financial Assistance Application (English) (Spanish) (Chinese)
For more information on hospital financial assistance and debt negotiation, click here.
Surprise Bills
Not all bills that come as a surprise are surprise bills! Read more about the Federal NO SURPRISES ACT and New York State’s Surprise Bill and Emergency Services law, their protections for certain out-of-network emergency- and non-emergency care situations, and how to dispute surprise bills:
What to do if you get a Surprise Bill (English) (Spanish) (Mandarin)
Information your plan must give you under the No Surprises Act
Information providers must give you under the No Surprises Act