In general, if you buy your health plan entirely on your own, then the laws governing your coverage are those in the state in which you live. However, if you obtain coverage through your employer, then the laws governing your coverage are the state in which you work. There is one important exception. By federal law, such company health benefit plans are exempt from state laws affecting health insurance. Where You Are States also regulate health plans differently.
Some states also are more active in overseeing health plans than others.
This may affect your ability to get results when you appeal a decision by your plan to deny treatment or payment. If you are a Medicare beneficiary in a managed care plan, you have specific rights guaranteed by federal law. This means the managed care plan may not create unreasonable delays to your ability to get care. This delay can be caused by repeated busy signals, excessive waits for appointments, provider hours or days that are too limited, or the use of review or approval mechanisms in arranging for surgery, hospitalization or other services. The right to appeal denials, terminations, or reductions in service.