Suspending your policy can be beneficial in instances of financial hardship or an extended trip overseas; provided your health fund allows it, this period does not count towards your maximum of 1,094 absence days.
Active and retired federal workers paying both an FEHB premium and commercial Medicare Advantage premium can save significant money by opting to suspend both.
Temporary suspension
Temporary suspension involves several steps. It is crucial that this process remains transparent, working closely with all stakeholders involved, while at the same time keeping its reason confidential to avoid potential conflicts of interest and ensure proper handling. Furthermore, any modifications or additions to trial protocols or paperwork must be effectively communicated as this ensures trial sites can accommodate additional workload.
Establishing an account as suspended helps prevent payment requestors from conducting financial transactions on it, but allows it to still process transaction authorizations and perform other account maintenance functions. Alternately, placing it into active or invalid status can prevent further activity until any lingering issues have been addressed.
Temporarily suspending coverage allows policyholders to remain insured until a specific date and can help them remain covered while they resolve their problem; once resolved, their policy may be reinstated – though beware: insurance companies usually require clients to keep paying until at least 12 months have passed before considering reinstating them.
Suspension can create much anxiety for retirees who are already struggling to pay their health premiums, especially as higher premiums may eat up an expected worker pay raise or cost of living adjustment, prompting them to downsize to less costly plans or even consider leaving the FEHB program altogether.
One option would be to drop their FEHB enrollment and enroll in a commercial Medicare Advantage (Part C) plan, saving both their Part B premiums as well as an extra premium charge from that plan (usually only few hundred dollars annually or often nothing). Furthermore, this would eliminate the Medicare Levy Surcharge which otherwise applies.
Permanent suspension
In cases of suspected fraud and/or misrepresentation, AHCCCS may permanently suspend providers and suppliers from payment. Such action would only occur after consulting OIG and DOJ and finding credible information or evidence supporting permanent suspension. Providers do have due process rights when this action is taken by AHCCCS as described in the Provider Due Process Flyer; though an account which has been permanently suspended cannot carry out monetary transactions but account maintenance (such as authorizing services) can still function normally.
Cancellation
Health insurance companies sometimes cancel policies without due cause; in such instances, you have the ability to file an appeal if an error occurred with regard to your coverage. Typically, an appeal request will be reviewed within four months from when it was sent; expedited reviews may occur if required due to urgent situations. You may also request external reviews if internal ones don’t satisfy you sufficiently.
Cancelling individual major medical policies can vary between companies, so contact your insurance provider and request specific instructions. Some providers will give you a form to complete, while others require more extensive paperwork or even provide you with a checklist – make sure you read all fine print carefully, and check your bank statements regularly for charges associated with the cancellation of this policy.
Active and retired Federal employees alike often struggle to afford FEHB premiums that increase by double digits each year. This strain on finances may eat into worker pay increases and any retiree cost-of-living adjustments – prompting people to assess whether or not they qualify for Special Enrollment Periods whereby they could sign up with another Medicare Advantage Plan or supplement coverage through an outside provider.
Terminating an individual or family plan may seem straightforward, but there are a few key considerations you must keep in mind before doing so. For instance, cancelling during open enrollment means not being eligible for new coverage until next year; and any gaps between old and new coverage could incur substantial medical costs.
As soon as you purchase a plan through the Marketplace, it can be cancelled at any time without incurring a cancellation fee or penalty. Furthermore, changes may also be made during Special Enrollment Periods such as changing jobs, getting married, having a baby or experiencing other qualifying life events.
Appeal
If your health insurance company denies a service or claim, you have options available to you to overturn their decision. Consult your policy documents for details of how and when you can appeal; call your health plan’s customer service for further guidance; ask doctors and hospitals not to send bills until after your appeal decision has been rendered; contact state consumer assistance programs for advocacy assistance if needed.
Your first step in appealing a decision by your insurance company should be writing them a letter outlining why their decision was unjust, providing any supporting documentation such as test results or statements from doctors. Most health plans take at least 30 days to review an internal appeal request but this timeframe can vary based on policy; expedited appeals can sometimes be done if medical needs require it.
External review provides another level of appeals; professionals from outside your health insurance provider reassess original decisions that affect you based on an independent perspective. You may access this service if an internal appeal fails or the decision jeopardizes your health in some way.
State and individual health plans often offer their own external review processes, while federal law mandates that insurers provide access to an independent review organization contracted by the government for all insured individuals.
As part of your appeals process, be sure to save copies of letters and emails sent to the health insurance provider, along with any correspondence. It is also crucial that your appeals efforts include your doctor – they need to be involved so as to ensure that medical necessity of your claim is fulfilled.
No matter whether you have an individual or group plan, any decision by your health insurer or the Marketplace to reject payments, deny coverage, reduce benefits or reject benefits is subject to appeal. Furthermore, for Small Business Health Options Program (SHOP) plans you can appeal any decisions by the SHOP Marketplace which reduce coverage or cancel accounts.
