Exclusion buried in definitions section
Many policy exclusions are hidden in the definitions section rather than the exclusions section.
Policy interpretation rules
Prior authorization requirement
Failing to get prior auth can result in denied claims — but emergency exceptions exist.
ACA §2719 / MHPAEA
Coordination of benefits trap
When covered by multiple policies, insurers fight over who pays — you shouldn't be in the middle.
COB regulations
Short claims filing window
Many policies have 30-60 day windows to file claims — easily missed and hard to extend.
Policy claim filing requirements
Depreciation-based replacement value
"Actual cash value" coverage pays depreciated value — not what replacement actually costs.
ACV vs. RCV policy terms
Appeal rights not disclosed
You have the right to appeal denied claims — insurers are required to tell you this.
ACA §2719 internal appeals