Prior to healthcare reform, if your insurance company found a mistake or missing information in your insurance application, they could cancel your policy. Even if it was an honest mistake, you could be at fault and would no longer have insurance for future visits. The insurance company could also make this cancellation retroactive, meaning that they could refuse payment for services already performed. In this case, you would also have to pay back medical expenses the insurance company had previously paid on your behalf.
Under the Affordable Healthcare Act, if a patient mistakenly misses information or provides inaccurate information, the insurance company cannot cancel benefits as long as it is found to be done done unintentionally.
This provision is applicable to all healthcare plans, whether through an employer or an individual plan. However, an insurance company can cancel coverage if the patient intentionally provided false or incomplete information on their insurance application, as well as if the patient fails to pay their premiums on time.
As a medical administrative assistant, you may explain this legislation to patients but it is very important that you do not advise patients on how to answer questions on their insurance applications as this put both you and your employer at risk if you inadvertently advise someone to write something untrue.