What questions do you have about healthcare?

March 1, 2009 7:06 PM

What types of questions would you like to see answered about healthcare / health insurance?

I'm working on a project to help other people better understand their healthcare. I'd like to know what 'how-to' questions you think should be answered.

This is mostly about private, not employer-sponsored healthcare.

Here are a few examples of what we have:

-I got laid off, what do I do?
-I have a pre-existing condition, how do I get insurance?
-How do I negotiate a rejected claim?

Things we won't cover:
-How do we fix broken healthcare? (Or anything policy-related)
-Why are they such crooks?!
-Anything Medicare-related or for seniors

Thanks :)

posted by jeff1010 to health & fitness (12 comments total)

How can the severely mentally ill, who so often cannot arrange the complexities, get medical care? For their general health, and for their mental health, please.
posted by anadem at 7:17 PM on March 1

I have to pay for my own health insurance, and I'd like to know why preventive care isn't covered for a year and/or WHY wasn't that prominently noted? I recently went to the dr's office for my yearly girl-parts checkup, and it wasn't covered. GRRRAGH!

Is it bad to change health insurance providers after only 3 months? The above issue is abusrd. Those checkups are the ONLY time I've been to the dr's office in the past 5 years.

Is there some service or website that can help decipher these plans? I thought I had a good grasp of what mine covered, but I was wrong.

I've love to see the results of your research - please follow up! :)
posted by WowLookStars at 7:20 PM on March 1

What resources are there to find private healthcare as an individual?
What can I do if I hit my maximum benefits?
What are my privacy rights? What can the insurer disclose and to whom?
If my insurer goes bankrupt, am I liable to pay my doctor bills that have been submitted but not yet paid?
What are the different types of private insurance? What is the difference between a PPO and an HMO?
Why would my doctor stop accepting an insurance carrier other than reimbursement rates?
What if I disagree with the treatment codes my doctor lists for reimbursement from carrier?
posted by JohnnyGunn at 7:25 PM on March 1

case management is what anadem is talking about.

i used to do some HR work and was working on choosing a new healthcare carrier/benefit package. the one we chose (for many reasons) also offered case management for everyone free of charge.

this meant that you could have a confidential rep thru the healthcare provider to help you manage all the paperwork etc for your ongoing case, be it cancer, pregnancy, or mental health. they wouldn't make the appts for you, but they could help you figure out what your deductibles/copays were, what pharmacies participated, finding doctors in the network etc.

i would like to second that this is a good question.

"is there someone to help me figure this out all when i am confused?"

also, "i am confused by prescription coverage. my prescription does not have a generic form."
posted by sio42 at 7:25 PM on March 1

Here's my question:

"When I go to a doctor, I sign a release form that states the doctor will keep my record confidential, but will provide information to the insurance company. How is this information stored, how long is it kept, and what is done with it? For example, if I take a test for the BRCA gene -- and so obviously consider myself at risk for breast cancer -- will the insurance company at a much later date up my premiums or deny me coverage based on my perceived risk?"
posted by Houstonian at 7:48 PM on March 1

My insurance is good, and has no pre-conditions clause. My doctor has indicated that I have several risk factors which would indicate that I should pre-screen for certain types of genes which are indicative for certain cancers. This is not a standard test, but would be covered by my insurance; however, if I found out that I am predisposed to cancer, and I lost my insurance carrier at some point (change of jobs, layoff, etc) I may not have such good and understanding insurance.

Is it better to have an expensive screening under my current coverage which would only difinitively say that I have a predisposition for cancer, only to find out that I may someday change my healthcare coverage and not have as good a pre-conditions clause, thereby potentially placing any future cancer diagnosises(?) at risk of violating a future pre-conditions clause?
posted by Nanukthedog at 7:52 PM on March 1

Don't know how much your audience knows about medical insurance, but it might be a good idea to explain what a deductible is, what a copay is, what %80/%20 (or whatever) means, how to figure out whether a plan covers particular things like preventative care, durable medical equipment, etc.

Might be a good idea to run over what the real costs are for particular varieties of insurance, maybe do a comparative analysis for a couple different kinds of plans and for a couple different scenarios (traumatic injury, major illness, totally healthy year, etc).

Otherwise, I recently had to figure out about temporary insurance, and wish I'd had more info about which plans made sense for me. I kinda guessed, and didn't get injured or sick, so I never found out if I'd guessed right.
posted by nat at 7:53 PM on March 1

Some questions:

If I have been clinically diagnosed to have a gene that increases my risk for certain cancers, will that be considered a "pre-existing condition?"

In which US states can I be denied insurance or charged higher rates on genetic grounds?

My doctor wants me to take an expensive medication. My insurance company refuses to pay for the medicine and insists I take a cheaper drug that I've already tried and that didn't work. What can I do?

I've heard of "patient advocates" that help guide people through complex situations, such as sorting out medical bills and coordinating care among specialists. How can I find one?

If I leave the US for several months, can I put my domestic health insurance "on hold" (stop paying premiums, since they won't cover me while abroad) and then reinstate it when I get back?

If I have a rare condition, how do I educate my insurance company about it so they don't deny treatment that my doctor thinks is necessary?

If I fail to report a condition when I apply for insurance, what could happen if the insurance company finds out?

What is the medical equivalent of the credit bureaus? Can I check the accuracy of my records? What can I do if an error in the record results in me being denied insurance?

I know of some doctors who don't report every detail to insurance providers because they don't want patients to lose their insurance or be denied treatment. What are the risks to doctors and patients of this practice?
posted by PatoPata at 8:31 PM on March 1

Here are some that have come up around my household lately:

1. I got laid off a while ago and am on COBRA. What happens if/when my former employer goes out of business?

2. I'm a freelancer. What organizations can I join that will give me access to cheaper insurance?

3. Is an HSA a good idea for me? How much should I put into it?
posted by adamrice at 9:19 PM on March 1

I had to get my own insurance recently and was confused by all the terms like deductibles, coinsurance, copays, etc. As a recent college grad who was always covered by my parent's insurance and never had to deal with the money side of going to the doctor, all of this was a bit mind-boggling. So definitions of common insurance terms would be a good resource.

Plus, I'm still confused about what I have to pay for exactly. I know I have to pay a flat fee (copay) to go see the doctor and then some amount of whatever the tests cost. But I have no way of anticipating what those amounts are. I think. Maybe I should read the dense, confusing policy again?
posted by wsquared at 10:18 PM on March 1

I am X years old, of Y sex, and Z race/socioeconomic status/marital status/health situation. How much will it cost me to undertake procedure XX which occurs to many people with the same X, Y, and Z as me.


Yeah, its a question that has TONS of variables and even more answers. If you setup a database/spreadsheet or something like that, it would answer most questions. eg. What if I broke a leg, how much would it cost? How much would it cost to have a tonsillectomy done? Just the more likely ones.

Good luck.
posted by hal_c_on at 1:26 AM on March 2

How do lapses affect health insurance? ie - if I'm not covered for 30 days, or 60 days, what will be excluded from my new policy? Does it matter if it's a group company policy or an individual one?
posted by a robot made out of meat at 10:02 AM on March 2