Category Archives: When Insurers Say No

Find out whether local hospital is in network

How do I know whether care from my local hospital will be covered by my health insurance plan?  I got my plan from the exchange and am having a hard time figuring out what is what. Puzzled Dear Puzzled, Your best bet is to ask the insurance plan directly.  You can call them; there should […]

How much you pay before the plan pays

Does the coinsurance on health insurance apply to the total medical charge or the discounted charge after the health plan’s discount?  For example, my insurance company says I owe 20% coinsurance on laboratory visits. The lab charged $200, and the insurance company disallowed $175, which means we have $25 left over. The insurance company says […]

Health coverage different for employee than for dependent

Is anyone else aware that the benefits of a health plan can be different for the enrolled employee versus the dependent?  How is this even legal in any state?  And disclosure is not required either.  This was a work-related injury. Fuming and Hurt Dear Fuming and Hurt, I  think what you have found is that […]

Obamacare: can specialists refuse to treat me?

Do uniquely qualified specialists have the right to refuse to treat a patient who has name brand private sector insurance, just because the policy was purchased on the health insurance exchange? Special Case Dear Special Case, If the specialist accepts patients with insurance from that insurer, he or she would not be able to reject […]

Employer missed health insurance payments – what to do

I just found out that my employer has not been paying for my health insurance for the past seven months.  Should I try to get the $1,400 they “saved” or just be glad that they put me back on the plan? Unpleasantly Surprised Dear Unpleasantly Surprised, If you think this was a simple clerical error, […]

Test for toxins might be covered

What toxins can I get a blood test for, that health insurance will cover?  I know that lead is usually covered, but what else? Chem-Free Dear Chem-Free, As long as the test is medically necessary, it would generally be covered by health insurance.  The test would need to be related to symptoms you were having, […]

Obamacare: DNA tests not required

Should insurance companies be allowed to use DNA tests to decide how much to charge someone?  Insurance companies currently use such information as sex, age, preexisting medical conditions, BMI, smoking, and other factors to set rates for individuals on the basis that these factors effect the likelihood of payouts. DNA information can show genetic likelihood […]

Who is watching the bills?

Whose responsibility is it to monitor accurate procedure coding for a patient’s billing and account? Can the patient reasonably be expected to audit and enforce correct coding?  Is there a source of transparent codes/procedures (along with what is covered by an individual’s policy) that consumers can access? Watchful Wonderer Dear Watchful Wonderer, The patient cannot […]