Can having one drink cause your health insurance claim to be denied?

Medical treatment can be expensive, and that’s why it’s important to have medical insurance. Medical treatments for emergencies are one expense that most people would not be able to afford without health insurance of some kind. But what if you’ve had just one drink or a beer and there’s an accident where you were injured and required emergency medical treatment, would you be surprise if your health insurance refused to help?

Most people expect their health insurance to help if they need emergency medical treatment regardless of whether they’ve had a drink or not. But denial of coverage due to the presence of alcohol in the body although rare, has happened.

Insurance companies can deny claims because of alcohol in the body based on the 1947 National Association of Insurance Commissioners model law. The law states that insurance companies should be allowed to deny claims for patients if they were injured while under the influence of alcohol. But the law does not state the amount of alcohol that must be present, only that there is alcohol. This means that you could be denied, even if you’ve had only one drink.

In reality however, most of the time your blood won’t be tested for alcohol if you wind up in the hospital for treatment.

Whether an insurance company is authorized or prohibited from enforcing this law is left up to the individual states. As of January 2011, 26 states permit denial of insurance claims if alcohol is present in your system, while 17 states explicitly prohibit those denials, this according to the National Institute on Alcohol Abuse and Alcoholism.

There seems to be no end to the problems that may arise through the use of alcohol. It most likely won’t happen to you, but just know that it is possible for your health insurance company to deny your claim if you’ve had only one drink.