Legal Question in Health Care Law in California

Patients with life-threatening diseases who are cancelled by their healthcare in

When a person is diagnosed with a life-threatening disease (Crohms) and will need life-long treatment under a doctor's care, can a healthcare insurance provider simply cancel that person's membership because of costs?


Asked on 3/23/00, 10:38 pm

1 Answer from Attorneys

Roger Renfro Renfro & Associates Law Corporation

Re: Patients with life-threatening diseases who are cancelled by their healthcar

This response assumes you are a California resident. There is no easy way to structure an answer to your question. Generally, rights to "coverage" under an insured healthcare benefit program are contractual in nature. That is, the express terms of the insurance contract will determine when and if the insurer has the right to unilaterally cancel your insurance coverage. If the healthcare insurance provider has retained the right to cancel your coverage as you indicate, it must be stated in the contract. Thus, reading the insurance contract would be a good way start to answer your question. You'll soon discover that understanding the legalease set forth in the insurance contract is a different story, however. If you obtained insurance coverage through your employer, the rights retained by the healthcare insurer may be easier to understand since the employer is required to provide you with a Summary Plan Description. The Summary must be designed in such a way as to be readily understandable. Irrespective of how your insurance coverage was acquired, you should consult with a local attorney familiar with individual and group insurance coverage immediately. Any delay in doing so may significantly jeopardize available rights under the terms of the insurance contract.

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Answered on 3/28/00, 11:16 am


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