Health Insurance

Recently Answered

  • QWhen can my doctor share information about my health care?
    2 Answers
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    Office of the National Coordinator for Health IT
    A answered
    To make sure that your health information privacy is protected without interfering with your health care, the HIPAA Privacy Rule allows your information to be used and shared in the following ways:
    • For your treatment and care coordination. For example, your doctors can see what tests you have had and their results, so tests do not have to be repeated.
    • With doctors and hospitals that provide you care, to provide payment for their services
    • To make sure doctors and other health care professionals give good care
    • For protection of the public's health, such as to report when the flu is in your area
    Your health care provider or health plan does not have to ask you whether they can use or share your health information for these purposes.

     
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  • QWho can collect Supplemental Security Income (SSI)?
    2 Answers
    A
    PearlPoint Cancer Support
    A answered
    Supplemental Security Income (SSI) is a needs-based program. You must prove your income and assets are below the limit. You do not need work credits to qualify, but you must meet the Social Security Administration’s (SSA) definition of disability. SSI is also available for individuals over 65 without a disability who meet the financial need requirement. People approved for SSI automatically qualify for Medicaid. In some cases, you may qualify for both Social Security Disability Insurance (SSDI) and SSI. SSI is not health insurance.
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  • QHow does a consumer select a health insurance policy?
    1 Answer
    A
    Discovery Health
    A answered
    Think about your needs and ask:
    Do you want a plan that covers preventive care like annual check-ups? Most fee-for-service plans don't cover these visits, but managed care plans do. This aspect is particularly important if you have or are planning to have children. 
    How healthy are you? If you need a low premium and are healthy, consider a high-deductible plan. Understand, though, that accidents happen, and a single hospital stay could wipe out your savings and plunge you into debt. Think about how much money you'd be able to apply to medical expenses if necessary.
    Do you have a specific doctor or hospital in mind? Managed care plans use networks of doctors, and if your doctor isn't in that network you'll pay some or all of the bills if you see him or her. If specific providers are necessary, consider a fee-for-service plan.
    How important is easy access to specialists? Many managed care plans require a referral from a primary care physician before you see a specialist. If they don't feel it's necessary, you'll pay for the visit out-of-pocket.
  • QWhat do I do if my health insurance claim for cancer treatment is denied?
    1 Answer
    A
    LIVESTRONG
    A answered
    If an insurance claim that has been submitted to the insurer to cover medical expenses is denied, consider appealing the decision. Many insurance denials are the result of errors, such as a miscoded item on the claim form or a bill sent late to the insurer. An insurance company may reverse a denial decision and pay some portion or the full claim amount if the appropriate information is provided and the error corrected. 
  • QWill it cost more to include older children on my health insurance policy?
    1 Answer
    A
    AARP Health Education
    A answered
    If you currently include your children on your health insurance, the Affordable Care Act allows you to keep them on your family policy until they reach age 26. Your insurance company will not be able to charge you more to insure your older children than it charges for younger children. It also will not be able to provide them fewer benefits. 
  • QWhat are the basics of government insurance plans?
    1 Answer
    A
    Discovery Health
    A answered
    For those eligible, the government also has health insurance programs: Medicare, Medicaid, SCHIP, high-risk pools, and Military Health Insurance. Additionally, the law requires employers to cover some people who are between jobs.
    Medicare is insurance for people age 65 and up, as well as younger people with certain disabilities, and people of all ages who have permanent kidney failure requiring dialysis or a transplant.
    Medicaid is a state-administered insurance program available to certain low-income people and families. Participants must meet specific requirements on age, pregnancy, disability, blindness, income, resources, and U.S. residency status. Rules vary by state. 
    Families that earn too much to qualify for Medicaid may still qualify for State Children's Health Insurance, or SCHIP. Also state-administered, it covers uninsured children no older than 18 whose families earn up to $36,200 annually. For little or no cost to the participant, SCHIP pays for doctor visits, immunizations, hospitalizations and emergency room visits.
    High-risk insurance pools exist for those who don't qualify for the above programs and are in relatively poor health. They're state-mandated programs designed to provide coverage to those unable to buy private insurance because of pre-existing conditions. By placing the uninsurables into a single group, the state can emulate private insurers' plans and offer health care (though at a higher cost) to those who'd been denied coverage.
    Military Health Care is available to those serving in or retired from the U.S. armed services. The main system, Tricare, is available to all active military employees, to retired members of the uniformed services, and their families. For military retirees, the Department of Veterans Affairs offers additional medical help. One such service, CHAMPVA, helps veterans, their dependents and their survivors pay for medical services. The VA is a plan that offers the same services but to veterans only.
    Finally, the Consolidated Omnibus Budget Reconciliation Act of 1985 requires employers to continue health coverage to laid-off workers for a limited time. COBRA coverage depends on the circumstances of the job separation. (For example, a person fired after being caught stealing would not continue to get coverage through COBRA.) Though the participant receives the company's insurance, he or she has to pay the full cost.
  • QWhat is a pre-existing condition in relation to health insurance?
    2 Answers
    A
    Dr. Michael Roizen, MD - Cleveland, OH - Internal Medicine
    A , Internal Medicine, answered
    From a health insurance standpoint, a pre-existing condition is a health problem you have been diagnosed with, advised about, or given treatment for prior to enrolling in a new health insurance plan.
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  • QIs ambulance transportation covered under insurance?
    1 Answer
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    Betty Long, RN, MHA - Bala Cynwyd, PA - Nursing
    A , Nursing, answered

    Funding for ambulance service varies in different parts of the country. Depending on the community, it may be a mix of tax dollars, donations and private pay. Generally, municipal or county Emergency Medical Services (EMS) or fire departments will handle emergency 911 transports and private companies handle non-emergency transports. While insurers may contract with EMS, private companies may charge much more and leave the patient with an unexpected bill to pay.

    Take some time to check into any local volunteer ambulance services that might be able to provide transportation services in a non-emergent situation. Often times, if you are a member of the company (by making an annual gift), your transport to the local hospital is often covered. 

    And while you're at it, check into your health insurance coverage for ambulance transportation and find out if there are co-pays or deductibles when used. 

    You certainly don't want any surprises, like a big bill from the ambulance company, when you come home from a hospital. Do your homework ahead of time to understand your benefits.

  • QWhy should insurance companies pay for an allergy specialist?
    1 Answer
    A
    Dr. Paul M. Ehrlich, MD - New York, NY - Allergy & Immunology
    A , Allergy & Immunology, answered
    Our insurance system is penny-wise and pound-foolish. A visit to an allergist is more expensive than one to a gatekeeper physician, but when you add up the serial costs of follow-ups to the gatekeeper, the payment to the allergist starts to look cheaper. When you throw in unnecessary tests and mistaken treatments, the costs are higher still. Legislators complain about unnecessary testing and the high cost of medical care. Allergy is a case in point -- a lot of money gets spent that might not have to be. Add in the question of patient misery, which can't be measured. "Series of scratch tests -- $1,000. Emergency hospitalization -- $7,000. Childhood saved from perpetual coughing, wheezing, sneezing, and overall discomfort -- priceless." A good allergist will test 10 percent of the time.

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    Asthma Allergies Children: A Parent's Guide
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  • QWhat is long-term medical disability insurance?
    1 Answer
    A
    Dr. Michael Roizen, MD - Cleveland, OH - Internal Medicine
    A , Internal Medicine, answered

    Insurance for long-term medical disability (LTD) replaces lost income if you are disabled for a long period of time. It kicks in after short-term medical disability insurance runs out and you still can’t go back to work. It pays you a monthly benefit just like short-term medical disability did.

    Keep in mind that there are other options for LTD and that LTD insurance runs out on your 65th birthday no matter what.