Discrimination

Did you know that if you meet the eligibility requirements to be covered by a group health insurance, it is unlawful for the insurance company to establish separate rules for eligibility for enrollment under the terms of the plan based on any of the factors for yourself or family members that you want to enroll?  These would include but may not be limited to:

            Health Status

            Medical condition (physical and/or mental)

            Past claims

            Receipt of health care

            Medical history

            Genetic information                     

            Evidence of insurability

            Disability

If you work the minimum hours required to qualify for your employer’s group health insurance, you or your eligible family members cannot be excluded or charged a higher premium than the rest of the participants.

http://www.understandingyourmedicalclaims.com/

EBook Release

I’ve almost finished my EBook.  It should be completed by April 1, 2011.    As soon as it's finished, I'll post updates on how to order it.  Hooray for me!!!

HIPAA LAWS

A couple days ago I blogged about a denied insurance claim on my husband.  As stated earlier, I called our insurance company to get to the bottom of this.  First and foremost, I wanted to verify that my husband’s physician was a preferred provider.  “Tina” asked for all the appropriate information; patient name, date-of-birth, ID #, etc.  But when she realized that I was not the patient, THE BRAKES WENT ON.  Due to HIPAA laws, she could go no further with our call.  I had to get my husband on the phone, and he had to verbally give her permission to speak with me (which he did).  I know this can sometimes be a pain in the you-know-what, but HIPAA is ultimately for our own protection.  “Tina” went on and discussed the claim with me, but also indicated if I needed to call again about him, she would again have to get verbal permission.  To side step this for future calls, she is going to mail him a permission form to fill out and mail back.

HIPAA

HIPPA stands for The Health Insurance Portability and Accountability Act, a Federal law that passed in 1996, that allows persons to qualify immediately for comparable health insurance coverage when they change their employment or relationships. It also creates the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care. It also ensures patients have access to their own medical records while adding new responsibilities to those charged with protecting this information.  Many refer to HIPPA as a privacy protection law.

Choosing Your Health Plan

Choosing between health plans can be a very confusing and daunting endeavor.  There are many plans to select from and it’s best to weigh your options to see which one will fit your individual or families needs.  Plans can differ greatly.  While one plans premiums may be low, the services may cost you quite of bit of money once you utilize the providers.  Other plans may have a high monthly premium, yet you may owe little or nothing to your providers after you see them. Although insurance companies seldom cover 100% of all the medical costs, some will cover more than others.  Some factors that you will need to consider are ~

*Do you need insurance for just yourself or your family?

* Do you need to make adjustments to your current plan?

*Do you want to be able to have access to a large number of providers that you can see without getting permission from your insurance company?

*How much will it cost me?

* How affordable are the different plans?

*Do you want to have a high deductible so that you’re monthly premiums will be lower?

*How do I pick a health plan?

*Do I need to pick a primary care physician?

*Am I able to see my current doctor on the plan?

*What do the plans cover?

*Are there any limits on how much I will have to pay in case of a major illness?

*Does it cover hospitalizations for elective services?

*Does is cover pre-existing conditions, chronic illnesses and preventative care?

*Do I need referrals to see specialists?

*What will my insurance company cover if I need attention for an emergency of when I’m out of town?

*Are there any wellness incentives?

*Will it coordinate benefits with my spouses insurance?

Make sure you discuss any questions or concerns about your insurance with your insurance broker.  If you’re not sure who to contact, talk to the Human Resources Manager where you are employed.

I Need to Change My Mind-set

We’ve had an HMO (through a Health Maintenance Organization) insurance plan for several years.  With a HMO, you choose your Primary Care Provider (doctor) who acts like a “gatekeeper” for all your healthcare needs.  This means that you must get permission from your PCP before you can see any specialists.  (Of course there are always a few exceptions to the rules.)  For example, if you feel you need a dermatologist, you either have to see your PCP, or you may be able to call his or her office and he or she will agree to set up a referral without seeing you first.  Either way, you just can’t just make an appointment with the dermatologist before following the correct steps.  The first of this year we changed from an HMO to a PPO (Preferred Plan Organization). We don’t need our PCP to refer us anymore.  If something urgent comes up that we feel we need to see a specialist about, we can call the specialist ourselves and make our own appointment.  No longer do we need to get “permission” from our PCP.  Now here’s where I need to change my mind-set.  My husband noticed a lump where it didn’t belong.  We automatically resorted to our “old way of thinking” and called his PCP to be seen.  Originally he didn’t have anything for a couple weeks out, but he did eventually get him in within a day.  Had he not been able to see him for a couple of weeks, we could have just bypassed his PCP altogether and called a specialist for an appointment.  Now granted with our PPO, we can refer ourselves and make our own appointments, but there are still specialists that won’t see you without a referral or recommendation from your PCP.  This has nothing to do with the way your PPO insurance works; it just has to do with the specialist’s policies and procedures.  We’re still working on my husband’s condition, and now if we feel if we aren’t satisfied with his PCP’s treatment, we can self-refer him elsewhere.  Important Note: When self-referring, make sure the specialist is a PPO Plan Provider with your insurance.