Ask MetaFilter questions tagged with insurance and healthcare

Need minor surgery but I'm just about to change jobs (and health plans). Disaster?

Anonymous — Fri, 18 Dec 2009 09:16:38 -0800

I have a small health issue which will probably require minor surgery. Pretty routine and low-risk kind of thing. I'm employed and have a good health plan through my job. But here's the problem: I might be changing jobs (and therefore health plans) very soon. Will this create problems getting the procedure paid for? I won't find out for sure if I need the surgery for a couple of weeks. And I'm sure that if I do, it will be even longer before I'm able to get the surgery. I might be in a new job much sooner than all that gets resolved. Questions:

1) Will I be able to sign up for my new employer's plan quickly enough to help with this?
2) Will that insurer decline to pay for my surgery because "it was a preexisting condition?"

Nothing's done yet. What should I be considering? Suggestions for a plan?

If it was COBRA...it would've bitten me AND my family!

littleredwagon — Fri, 11 Sep 2009 05:59:49 -0800

Since being fired last month, I'm in the process of getting health insurance for my family. But, I'm kind of confused with this COBRA '65/35 for nine months' deal with the government. I'm awaiting to hear from our local Blue Cross provider for a 9/15 effective date, but, our calculations show that the COBRA discounted price for nine months would be roughly $150 less than the Blue Cross premium. Now, it is my understanding that you have to elect COBRA AND send in your request for the 65/35 subsidy at the same time. If I don't get the subsidy, I want to go with Blue Cross. How do I do this properly? Is there any way I can apply for the subsidy without requesting COBRA at the same time?

Health care rationing in the US?

Wood — Fri, 07 Aug 2009 17:09:30 -0800

There is much talk about health care rationing in Britain, for example. How do I find out more about the status of rationing in the United States, my health care (nice employer based) and Medicare in particular. Is it the case that with health care in the US, private or Medicare, cost is never a reason to deny a procedure? That people under Medicare, for example, get all of those 50,000$ drugs that give you 6 months of life? How can I find out if my plan covers every possible procedure or not? I'm less concerned with the issue of rescision as a roundabout way of denying care versus explicit denial of care based on cost.

Help with Health Care!

odayoday — Wed, 15 Jul 2009 12:07:15 -0800

How can I show support for the new health care reform bill? My mom is a cancer survivor who is currently without health insurance, so the health care reform bill that just came out of the House (America's Affordable Health Choices Act) gives me a lot of hope. I've written to my representatives and senators, and am looking for other ways I can support this bill.

I'm considering sending an email to friends/posting on facebook a short note giving background about my mom and why I think this is a good bill, and asking them to write their reps if they feel the same. Is that something that would be worthwhile? Is there something else I should be doing?

My mom's health and lack of insurance has been a huge source of stress for my family, and while I probably shouldn't be looking at this bill as a lifesaver, I feel I need to do what I can to help it pass.

Health Insurance for an unemployed recent college graduate.

leybman — Wed, 01 Jul 2009 18:29:54 -0800

What should a recent (unemployed) college graduate do to get health insurance in Indiana? ` I need some desperate help. I just graduated from college, but am now officially uninsured. My parents' plan covered me only until I was a student in college. After that, I'm all on my own. I have tried to get prior insurance but none have given it to me. What I need is some advice on where I can go to get insurance in Indiana for someone like myself, unemployed, living at home, without any money to my name. Does anybody know if I even qualify for medicaid in Indiana? What should I do?

And oh yeah, my parent's COBRA plan is simply too expensive to afford. It would wind up costing something like 300 dollars per month alone. Simply unfeasible. any advice is welcome.

Health Insurance Without Employer Support

snsranch — Sat, 06 Jun 2009 19:06:17 -0800

Please help me find medical coverage/insurance for a five year old. A close friend of mine can't get insurance through his employer. He has a five year old son who he really wants/needs to have covered and will have to pay out of pocket.

He can afford about $100 a month which is much less than what he's found so far.

I would really appreciate any help or ideas.

Many thanks in advance!

Health insurance question

JamesWilson123 — Thu, 21 May 2009 12:13:38 -0800

Health insurance question: my insurance benefit ran out for a recurring doctor's visit. The doctor knew this - I didn't - and they kept accepting my copay as if nothing had changed. How do I proceed? My maximum benefit for physical therapy was reached in early July of 2008. I was not aware of this, but clearly should have been. The medical center was aware of this, as confirmed by my insurance company at the time (I just found out someone from the doctor's office called to check on my benefits in late June 2008).

I continued to go and pay my copay until August of that year. Early this year I started getting bills for the uncovered amount (2 grand). How should I proceed?

Again, I know I am responsible, but it seems unfair that they didn't let me know and continued taking my $10 every week as if insurance was still covering. Should I just ask for some kind of payment plan or do I have grounds to question the whole thing? Does anyone have experience with this? Many thanks for any help.

Is my company's wellness program legal?

Anonymous — Wed, 25 Mar 2009 15:31:05 -0800

Is my company's new, highly Orwellian, wellness program legal? How can I get them to stop? Posting anonymously to avoid employer retribution if I end my making a complaint.

My spouse and I are insured by her employer's health care plan. Recently, she was informed about a new wellness program they are implementing. The plan is called voluntary but it seems anything but. If you refuse to enroll, $90/month is deducted from your paycheck. If you enroll, you have two choices: the "no monitoring" plan which costs $65/month and the "monthly monitoring" plan with costs $30/month. Under terms of the monthly monitoring plan, you agree to health screenings of weight, cholesterol, diabetes, smoking, etc. every 30 days. If you have a negative screening, such as your weight going up instead of down, your rate climbs to $65/month until corrected.

In general, I have no problem with wellness programs, and all for healthy living. However, I don't like the fact that they are penalizing people who don't want to participate, and I don't like the idea of anyone being forced to pay "fat fees." I did a little research on the EEOC site and came up with this:

"The Equal Employment Opportunity Commission (EEOC) has offered employers some guidance with regard to the ADA's restrictions on medical inquiries and examinations. Under the guidelines, an employer may conduct medical examinations and activities that are part of a voluntary wellness and health screening program. Therefore, offering employees the opportunity to voluntarily participate in health screening programs for high blood pressure and cholesterol monitoring are not likely to violate the ADA, as long as there is no penalty (economic or otherwise) for not participating. Employers must treat any information acquired as a confidential medical record. (source: http://hr.blr.com/whitepapers.aspx?id=19254)"

We have no other access to health insurance, so switching plans isn't an option. I know you're not a lawyer, and you're not my lawyer. But I'd be interested in opinions as to whether this program is legal. And if not, I would also appreciate any tips people may have for how to get the employer to change the program. We live in Georgia, if that helps.

Throw away email address: illegalprogrammefi@gmail.com

Get tested?

Anonymous — Sun, 22 Mar 2009 14:31:30 -0800

Individual health insurance and sti. What to do? I've read through this question, which is kind of related, but it doesn't really seem to answer the question. Anyways, I have an annoying rash that's popped up on my inner-leg, don't know what it is. Never had anything like it before. I want to have it checked out, and get checked for an sti, but I do worry about insurance ramifications if a test comes back positive.

Should I go to my primary care physician, or a health clinic type place to get checked out and tested? What would the difference be, would it matter? I'm assuming my insurance will know about how the test comes back either way, yes? Will I be dropped from my insurance, or premiums increased? Will it be near impossible to get insurance in the future if a positive test comes back? Also, hypothetical question, I'm not seeing anyone, don't really plan on it for the near future, is it a terrible idea to just ignore it? I have individual insurance, and I know insurance differs greatly across the country, but some general advice on not freaking out would be very much appreciated.

Paying for cancer

Anonymous — Mon, 16 Mar 2009 12:25:47 -0800

I may have breast cancer. I do not have health insurance. What now? I am in my late thirties and the sole support of two teenagers. We live in California, and our closest family is in Florida. I am a long-term contractor at my current job, but no longer think they are going to hire me on, and so I have started looking for permanent work elsewhere. I don't have health insurance, and open enrollment has passed on my agency's health plan.

A hereditary breast/ovarian cancer risk factor, a BRCA1 deletion mutation, runs in my family. According to the literature, women with this particular mutation have an 80% chance of developing breast or ovarian cancer. My sister, my mother, my mother's sister, my grandmother's sister, and my grandmother's sister's daughter have have had breast or ovarian cancer. My mother, my mother's sister, and my grandmother's sister died from it. My sister was diagnosed stage 1/2 borderline, and had chemo and a bilateral mastectomy less than a year ago.

Well, yesterday I felt a lump in my breast. It was about the size of my fingertip to the first knuckle.

It could be nothing, but it could be cancer. If it were cancer, the treatment would probably be very aggressive -- meaning I may not be able to work.

If I got a diagnosis before securing insurance -- would that be a 'pre-existing condition' the company would not like to pay for?
And how do I get health insurance? Is 'Emergency Medi-Cal' or medicare an option?
If I had to go out on disability, I could not pay my rent. What if I moved to Florida to live with my dad -- how would that affect my state insurance and/or disability benefits? Would I apply here, then go there? Go there, then apply?

I don't mean to be hysterical. I know that it could very well be nothing at all. But it does seem like the timing of the diagnosis wrt insurance could be important, so I need to be smart about this. Hope for the best and plan for the worst, as they say.

Thanks for any advice you can give me.

Please help me filter out the good from my list of NYC doctors covered by my insurance.

scazza — Mon, 09 Mar 2009 12:04:27 -0800

Please help me filter out the good from my list of NYC doctors covered by my insurance. This is my last resort after days over months of searching trying to connect the dots and find doctors. Maybe you guys can help. I have searched on yelp, zocdoc, and all kinds of lists of good doctors (nymag) on google for ways to filter the list of doctors my insurance covers and have come up empty. I can't believe after days and hours online I've come up empty.

1. I am looking for a really awesome family practice doctor who can do it all OR a coop-type office that has multiple doctors (gyn, internal medicine, ortho or DO, etc.) I could see on my visit that takes my obscure crappy insurance First Health/Coventry Health Care.

2. Or techniques to filter out the good from the bad in an insurance's list of doctors.

I live in Brooklyn 11220, am often in 11215 and don't mind going to Midtown or below. I'd prefer a female or very nice male. I would really appreciate anyone who has wisdom about this or is willing to help. I'm at my wits end. Thank you.

What questions do you have about healthcare?

jeff1010 — Sun, 01 Mar 2009 19:06:36 -0800

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 :)

How do I even start to fill out these short-term health care applications?

Skwirl — Fri, 29 Aug 2008 19:37:42 -0800

How do I fill out an application for short-term health care if I barely even remember which doctors/clinics I've been seen at, let alone why? So, now that I'm all unemployed and without healthcare, it seems like a good idea to sign up for a short term or catastrophic plan. Michael Moore's Sicko has me all freaked out that if I don't disclose every last hangnail, the insurance won't even matter in a pinch because they'll go all Private Investigator on me and drop me for some minor misrememberence.

So, I probably need to collect all of these disparate records into one place. Google Health seems to be ready to serve this function, but it seems like a Bad (!) Idea (!) to put that kind of stuff up on the web behind a wimpy password when it has no good reason to be there. Is there another service where they'll go from a list of clinics you've been at, then have you sign some release forms and send you the stuff without doing your own legwork? Is this what health care brokers do? Are health care brokers a good idea or a rip off?

Uninsured and unfocused

zoomorphic — Thu, 03 Jul 2008 10:02:42 -0800

I'm a typical ADD adult, and I don't have health insurance until at least September. I'm down to my last few Ritalin tablets, and I need a new Rx. How much does Ritalin (or Concerta, Adderall, etc) typically cost without insurance, and can I minimize these costs without having to sign up for an interim insurance plan? What are the best generic varieties of the big name psychostimulants? Will getting an Rx while uninsured just kick up my fees when I am finally covered by a health plan because my condition is pre-existing? I've been on Ritalin since I was in fifth grade, where I escalated from a back-of-the-class, disorganized goof-off into a straight-A, ambitious student. Maybe that's a red flag for dependency, but I don't care--Ritalin does right by me.

When I graduated college and no longer had insurance I went off of the pills for two years and floundered, had a string of bad jobs, and I kept a filled bottle around Just In Case. Finally I started using the pills again, and my career is on track. Now I'm down to the last few tablets. I'm now a writer/editor, so in addition to keeping me focused and on task throughout the day (I'm naturally hardwired to work at night, 7pm-3am), Ritalin gives me a sustained sense of well-being that vastly improves my vocabulary and mental acrobatics. I don't want to give it up and see what happens.

I'm currently uninsured, though by September I'll officially be on staff and thusly on a plan. I have medical records stating a pre-existing history with Ritalin.

Then I came across this question that puzzled me. Can my new insurance plan opt to not cover my ADD meds because I have a pre-existing condition? I managed to last without Ritalin for over two years, so will I be shooting myself in the foot if I get another Rx two months before my health insurance kicks in?

Am I overthinking or misinterpreting this? Obviously I don't understand the health insurance maze at all, but I do understand that I can't afford $270/bottle of Ritalin every month (I assume generics are my best bet), nor do I want to face the repercussions of being the scatterbrained, where-did-I-put-that-manuscript trainwreck I can be when left to my own unmedicated devices.

I'm in NYC/Brooklyn, a 25 year old woman, and survive on the minimal bounties of a writer's salary.

Cobra termination

TigerCrane — Fri, 18 Apr 2008 09:41:22 -0800

I missed a Cobra Payment and they terminated me. How can I appeal their decision? I screwed up, got confused and missed a COBRA payment. They have terminated me as of Feb 29. They tell me that I can write an appeal letter. This will take fourteen days. Can anybody give me some advise as to what to say int the appeal letter?

If it makes a difference, I have bipolar disorder, and have recieved disability. I believe I am still officially disabled.

If I cannot get COBRA back, do I have any other options? My pre-existing condition (bipolar disorder) makes it impossible to buy regular insurance. Now that I have been cancelled due to non-payment, I no longer qualify for HIPAA. What are my options?

Managing medical bils?

daniboi1977 — Tue, 12 Feb 2008 20:09:56 -0800

What is a good way to manage numerous medical bills and insurance EOBs? I've recently starting requiring more medical care than I have been used to. Every visit to the doctor generates 2-3 statements being sent to me (depending on what gets done), then I get the "explanation of benefits" from my insurance company, then another bill from the doctor for what is not covered. I'm feeling like I should be managing this information more carefully, but am feeling swamped by the sheer amount of paperwork coming in. Does anyone have a good system that they use for managing these bills, statements, EOBs, and making sure that you are not paying more than you need to?

Individual Health Insurance with Bipolar? Help!

DetonatedManiac — Wed, 06 Feb 2008 17:34:27 -0800

I am in the process of switching jobs. I need health insurance (likely individual health insurance) but I am Bipolar... help I Have bipolar. Medications are not a huge concern since mine are (fortunately) all cheap to purchase out of pocket and/or I have a huge stockpile. Main concerns for medical coverage is my Therapy Sessions, my psychiatrist and MOST OF ALL the nightmare scenario if I go Manic again and end up in a hospital (last time the bill for 5 days was $28k, fortunately I was covered at the time)

Old job and prior coverage: Never had a gap in coverage and my old job was a group (I think?). In any case, I am covered by them without any "pre-existing conditions"... until I quit. I have not decided when I am quitting but within the next month or so.

New Job: Is a low paying, experience building position until I go back to school in a year or two. As such the employer does not have a group plan (though I am *possibly* in a situation to convince them to get Assurant Group Health, if that would drastically change the situation). He has offered to pay 50% of whatever Individual plan I choose.

I live near Raleigh NC.

What should I do? If I need individual medical who is trustworthy to talk to and how do I broach the subject of my Mental Health? How do I get mental health covered without breaking the bank? What else should I consider given my situation?

Best insurance in the Bay Area?

Anonymous — Wed, 23 Jan 2008 03:10:48 -0800

I'm a mid-20s male in the East Bay. I don't have health insurance, but am thinking about getting some. None is available through work. What are my best options? I make about ~32k/year before taxes, and i am provided an extra ~150/month for health insurance. I have been pocketing the difference thus far, but going without insurance seems foolish; on the other hand, so does spending money unnecessarily. What options are available to me, what are the best for the lowest price, what would you recommend or stay away from? Optometry/Dental information would be helpful too.

HIPAA and a gap in coverage - help me decipher the law?

CrayDrygu — Tue, 22 Jan 2008 14:27:41 -0800

YANMLFilter: You're not my lawyer, but I'm going to ask you for help deciphering part of the HIPAA anyway. Specifically, the bits regarding pre-existing conditions. The Background:
I had (and was treated for) testicular cancer back in August. So, congratulations to me, I'm in danger of being denied coverage for a pre-existing condition if something wonky happens with my health insurance.

I should be pretty healthy according to the tests I've had since, but of course there's a few more follow-up CT scans and other tests to be done, just to be certain nothing has spread (and to kill it if it has). My employer, however, has closed it doors, and my health insurance ends on the 31st of this month.

I start my new job on the 28th. Assuming the common 90-day wait before I can get in on the new employer's group plan, that means I'll be without insurance for about 80 days. HIPAA says my new insurer can deny coverage for pre-existing conditions if there's a gap greater than 63 days.

The Question:
But! According to USC 1181(c)(2)(b), that waiting period should not be considered to be a "break in coverage." If I'm right, this means I wouldn't have any gap in coverage (since the waiting period would begin before my current insurance runs out), and thus I could not be denied coverage for pre-existing conditions.

Am I interpreting that correctly? Should I talk to a lawyer, and if so, what kind of lawyer? Any recommendations in the central NJ area?

Thanks in advance, everyone!

Can a person taking a break from college get health insurance?

Braeog — Sat, 19 Jan 2008 15:41:47 -0800

Health insurance for someone taking a break from college? My girlfriend is taking a few months off from college and so won't be eligible for her parents' health insurance. She doesn't have a job that provides benefits, either. She's in her early 20s and is pretty healthy, but has really awful luck when it comes to random health issues popping up and so it would be a good idea for her to have insurance in the next few months. She's off her parents' policy in the next week or two. What can she do? Would COBRA apply in this case? What other temporary insurance providers are there?

Have insurance, so how do I deal with out-of-network charges from the ER?

Anonymous — Thu, 08 Nov 2007 14:52:22 -0800

I am insured through a PPO. I was taken to an out-of-network hospital following an accident with major trauma. Am I out of luck for the charges above and beyond the dreaded "usual, customary, and reasonable" charges? I was basically unconscious and not in any shape to dictate what insurance I had and where to take me, not that I would have figured the only Level I trauma center in the area wouldn't take my PPO. Whoops.

Now the bills are coming in and while I am certainly not poor, I don't have tens of thousands of liquid dollars to pay off the excessive charges from the hospital. I will likely be at the top of the sliding scale, or off it, since I figure it's based around the poverty line and I make around six figures.

I want to know if I have a legitimate gripe and what my best path of resolution is in order to avoid paying the excess charges. Is the hospital (it's public) likely to chop the charges down if I simply ask? Will I absolutely need to show proof of (lack of) assets, etc.? I am under no impression that the insurance company will be compassionate in this case, so I believe focusing on dealing with the hospital is the best bet.

My best idea at this point is to take the excess (balance) charges after the insurance payments, divide by some number, and offer it in cash upfront. I figure that will end up being 50-100% more than they would have received from me if I had simply paid the 10% copay I would at an in-network facility - rather than 1000% more than I am being billed now. Is that fair, rational, and possible?

Side question: The ER scheduled followup appointments for me at the same out-of-network hospital. My PCP was out of town and his backup was not helpful, nor did the PPO customer service advise me not to have my followups at the same hospital. I feel I was not negligent in trying to avoid out-of-network charges. Do I have a leg to stand on when it comes to protesting the followup appointment benefits?

Doctor, doctor...how do I choose?

BitterOldPunk — Fri, 27 Jul 2007 22:26:38 -0800

How do I choose a primary care physician? For the first time in a decade, I have good health insurance (I'm in the US), and at age 41 it's time to take advantage of it and have all that unpleasant probing done that I've been putting off for far too long. I've googled extensively, I've contacted my insurance carrier for a list of approved providers, and I live in a city with a world-class medical center. So I should be set, right? But just picking a name at random from the list doesn't seem like the best way to go about it. I know there are sites that purport to give doctor ratings, for a fee. Has anyone used them, and are they worth it? I want a doc for more than a check-up: I want to find a genuine health-care provider who'll be my doctor for the next thirty years. Is that even possible these days? How'd you pick your doctor, what questions did you ask them, and what were your criteria? (If it matters, I'm a lifelong heavy smoker who'd like to quit, a moderate drinker, and I've never been seriously ill or even hospitalized, except for breaking my jaw in a bicycle wreck as a teenager.)

Corporate Do-Gooder!

thinkpiece — Sun, 03 Jun 2007 07:13:29 -0800

How can I help my fellow employees get the most out of their benefits program via efficient, lively, multi-platform communications? I'm in a terrific new Communications job in the very progressive HR department of a global business information company. My initial mandate is to improve Benefits communications which are currently complex, and myriad.

I have a wide-open opportunity to shape how a large employee population accesses healthcare and financial planning information -- and acts on it to get the most they can from their benefits program -- from a company that really wants to do the right thing.

I'm interested in any and all ideas, from program gripes or praise to content to delivery, that would keep your eyes from glazing over everytime you heard from HR about Benefits! Creativity, technology and simplicity (or at least, pitch-ability for budget allocation) will be extremely appreciated.

Dealing with the no-health-insurance lifestyle?

YoungAmerican — Sun, 07 Jan 2007 11:21:13 -0800

Have any tips for living (in the US) without health insurance? I'm 25, reasonably healthy, don't do anything particularly risky, and I don't have any health insurance. Does anyone have any tips for the health-insurance-less? For those with very limited resources, what's the best way to spend health care money, or get free or low-cost care that isn't awful? Is there care I absolutely need to get regularly?

If it matters, I live in LA, and my income is below $15K/yr.

Affordable independent health insurance?

blueplasticfish — Tue, 21 Nov 2006 12:03:36 -0800

How do I get affordable personal health insurance? I work at a small business that doesn't offer any health insurance. I can probably afford $60-$80 a month for payments. Is it possible to get decent health insurance for this? Something with roughly a $25 copay and a reasonable deductible.

I am young, 26, and don't have any health problems, but would like to keep it that way. I am not married, and just need coverage for me.

I have looked through old Mefi posts and none of them seem to answer this specific questions.

Any ideas?