Category Archives: When Insurers Say No

Flu shot covered, office visit co-pay still charged?

I took my kids to the doctor’s office for their flu shots.  They told me that the flu shots were covered because of Obamacare, but I still owed the $25 co-pay.  Is that allowed? Feeling Gipped Dear Feeling Gipped, It is allowed, however if the only purpose of the visit was the flu shot, the […]

Obamacare: alternative medicine is “covered”

Why hasn’t anyone thought of a health insurance plan to cover alternative medicine?  An insurance that goes outside the current health system, a separate insurance for people looking for these complementary and alternative medicine treatments? Other Path Seeker Dear Other Path Seeker, Your current health insurance may cover it already.  The Affordable Care Act (“Obamacare”) […]

Extra lab tests likely to be covered, after deductible

Do insurance companies cover the cost of more accurate tests, such as ultrasound or blood tests, if a patient can provide evidence that he/she has one or more cancer marker genes? Informed Patient Dear Informed Patient, The insurer will pay for medically necessary tests.  So, if the doctor believes that the ultrasound or blood test […]

Medicare covers wheelchairs; you pay 20%

What is it like to have Medicare as your primary insurance, in particular for durable medical equipment, such as prostheses or wheelchairs? Shifting Forward Dear Shifting Forward, Medicare Part B does cover durable medical equipment, including prostheses and wheelchairs.  See Medicare.gov’s list.  “Part B” is Medicare’s coverage for physician services and other out-of-hospital items.  It […]

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 […]