Ask MetaFilter questions tagged with insurance and medical

Should I get these tests done now, and will insurance cover treatment in the future?

Anonymous — Wed, 02 Dec 2009 11:01:50 -0800

A complicated question about a specific medical condition, insurance, and pre-existing conditions. Hello,
I'll try to explain this clearly- apologies if it's a bit long, the background is necessary!
I live in New York. Three months ago I switched jobs, and the new job told me I had to wait three months for my insurance to kick in. I did not elect to take COBRA or any interim insurance because I recently had surgery and that knocked my premiums up past what I could afford.

About three weeks after starting the new job I got the results back from a pap smear and they said they'd found HPV of the "dangerous, may possibly cause cancer" variety, and that I had to go in for a colposcopy. I explained that I was waiting for my insurance to kick in and they said it should be ok to wait the two months till this happened.
So last week I got laid off. Now there isn't going to be any insurance till I don't know when.

Planned Parenthood will do the colposcopy on a sliding scale that I can just about afford, but my concern is: if I get this test while I have no insurance, and god forbid it turns out I have cervical cancer or pre-cancer that needs to be treated... when I get a job and get insurance, will this then count as a pre-existing condition and not be covered?

I'm really worried about this. The strange thing is that I already have a condition- ulcerative colitis- but whenever I've started a new job, the employer's insurance has covered it with no problem. So that's a pre-existing condition, right? But everyone is saying that this will be different and that I absolutely should wait to get the colposcopy till I already have insurance.

So, two questions. Is there, for some reason, a difference between things like ulcerative colitis and (knock wood) cervical cancer, that would mean that the former is covered while the latter is not? Is it true that if I test positive my new insurance wouldn't cover treatment?

Second question- I know you are not my doctor, but would it be all right to wait until I do get insurance to get tested? It's already been almost three months now and I'm getting really nervous, thinking that something awful and dangerous might be growing inside me and I just have to wait. I know that the earlier you catch these things, the better, but I also know that if it IS pre-cancer, this kind tends to move slowly- is it all right to wait a bit longer?

Thanks...I'm sorry if this is a bit disjointed but the whole subject makes me incredibly stressed out and nervous and I feel a bit helpless in this situation. I want to do what's best for my health without putting myself into years of debt.

Thanks in advance to all of you....

San Francisco insurance confusion

eschatfische — Fri, 02 Oct 2009 20:16:30 -0800

What's the deal with the Brown and Toland vs. Hill Physicians division in San Francisco medical care? Why must San Franciscans with HMOs be referred to specialists who not only accept your insurance plan, but are also part of the same medical group as the referring doctor? I've always found the demarcation of Brown and Toland vs. Hill Physicians doctors in San Francisco to be strange. Having to go to specialists who not only accept your insurance but who are also part of a specific medical group is certainly inconvenient and problematic for patients, and it doesn't seem to be so great for the doctors, either.

Is there a reason San Francisco medical care is divided into these sub-groups? Does this actually benefit anyone to add an additional layer of middlemen? Is it like this elsewhere? I can't recall experiencing this anywhere else, and Googling doesn't seem to help explain the origins of these groups.

Thanks!

How can I arrange for bulletproof independent health insurance?

rr — Mon, 22 Jun 2009 19:47:00 -0800

How can I arrange for bulletproof independent health insurance? It may be the case that very soon I will need an health insurance policy, not company specified, for me and my wife. In light of stories like this one, I am very concerned that even if I answer about my health history and my wife's history even to the extent possible, I will forget something and get hosed if I ever come down with anything.

Since the health insurance isn't likely to change in the US in the nearterm, I want to somehow insulate myself from this. Given that, is there any way to have the HI company pre-vet the policy in some way so that this isn't a risk later on? Or some other way to do this -- service or whatever?

I've lived with extremely active jobs for the last 15 years, so to be honest a lot of "I went to the doctor because I had a cough" kind of stuff doesn't readily come to mind even when I think about it. I would much prefer an active investigation.

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!

Insurance Settlement

cmh0150 — Sun, 12 Apr 2009 11:36:17 -0800

A friend, a 62 year old woman, was injured while driving in TN; her car was totalled. She is suffering back pain. She has been to an attorney who has retained an independent doctor to evaluate her. The doctor has assessed that she retains 5% PPI (permanent personal impairment?). The question she has - what is the likely dollar value of the settlement based on the 5%?

Source for Medical Malpractice Insurance Quotes for Doctors/Hospitals?

Quarter Pincher — Mon, 16 Mar 2009 18:28:59 -0800

Do you know of any reasonably credible sources that list the premiums and deductibles that hospitals/doctors (of any kind, but largely medical surgeons for intensive-care/emergency/surgical hospitals) pay for medical malpractice insurance? I'm researching figures for a malpractice reform idea. The idea is based on a rumor that medical malpractice insurance is an absurdly burdensome expense for hospitals/doctors who must pay it in order to legitimately practice. If there were a way to eliminate that particular burden, the massive periodic (monthly/etc) savings would gradually equal lesser medical expenses for Billy and Susie down the line.

My idea was to eliminate the need for malpractice insurance by enacting legislation requiring the hospital in question to add the malpracticed-against as simply a new employee, paid out of the standard payroll expenses, at a comfort-offering rate (variable according to terms of the suit and local standards of living) instead of having to lop over this giant sum (and pay insurance for the dark cloud of a giant sum to loom over them, waiting to be dished out). Does this idea hold much water?

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.

Getting medical insurance to cover dental procedures.

disaster77 — Sun, 08 Mar 2009 18:16:03 -0800

Getting medical insurance to cover dental procedures. I have a somewhat rare medical condition, amelogenesis imperfecta, meaning I was born with no enamel on my teeth. This has required a lot of dental work over the years. I have temporary crowns that are 15ish years old and need to be replaced with permanent crowns ASAP. This is going to be very expensive and my dental insurances really do not cover much at all (maybe 1-2 teeth/year).

My dentist suggested looking into getting my medical insurance to cover them since I have a medical condition. Surely he suggested this because he has seen someone do this successfully before. I was wondering if anyone here had been able to get medical insurance to cover dental work and if so how they went about it. Any advice appreciated.

Can i collect unemployment if my job only offers job options I can refuse?

TwilightKid — Wed, 28 Jan 2009 06:26:27 -0800

Due to cost saving measures, my company is about to remove health insurance and my bosses are basically looking for me to become an independent rep for them....Can I colect unemployment should I feel I was put in a position that I could no longer work under those conditions? (the full story (i think) inside... I am an advertising sales rep with my magazine for almost 10 years. I make salary and commission.
I am married with a 1 year old child living in NJ. I work though in NY.

I was told tonight that due to the economic climate, that the company is looking to restructure my position and is asking for me to brainstorm idea's on a suitable solution for both parties rather than them making it for me.

Option 1)
Salary cut, commission raise, work in office 2 days a week, no medical insurance.

Option 2)
I become an independent sales rep. No salary, high commission (industry standard for a rep is 20%), work from home, no medical.

I am not sure what the better option is, although I feel that Option 2 might be it.

Option 1 will give me at least a guaranteed bi-weekly paycheck in addition to my commission. Although the industry suffers, this is a niche magazine where there will always be business coming in...If it is a bad/week month, I know I would still get a paycheck of some sort. The bad...I still would have to commute into the city.

Option 2 gives me total independent freedom as an ad rep and will allow me to do my job for other magazines as well. I have toyed with the idea of starting an Independent Ad agency for my niche market for the last year anyway.

Having medical taken away seems to be a given. I don't really see any other scenarios. I certainly won't continue to work full time out of the office without medical.

If I decline these one of these two options presented to me, what happens? Can they let me go 'with reason'? Will I be able to collect unemployment? I think they are giving me a few weeks to decide...

I guess my question comes down to is unemployment....Since they are still giving me option to stay aboard and to keep the position in some capacity, are they protecting themselves from having to pay me unemployment should i decide not to accept either option?

I am not sure how it works....Since I have paid into it for all of my adult life, would this scenario constitute me being allowed to collect?

My biggest concern is medical for me and my family. I'd rather use all my time trying to find a new job (with medical) in this horrible climate.
I'd rather walk away from this job , but won't unless I know I can collect....Is this a simple matter of calling my state dept?

thsanks for your input..

Please hope me, President Obama

Anonymous — Tue, 27 Jan 2009 18:03:56 -0800

NoInsuranceFilter: I awoke New Years Day in the hospital. My clothes had been cut off, I had a catheter in and a wrist restraint on my left wrist. I had five stitches in my eyebrow. The bill has arrived. Out with a friend, drinking and apparently got ahead of myself. Said friend was concerned with other things and claims to have not noticed my state. He says that he recalls seeing someone steal my shoulder bag off my prone body after I was struck and fell to the sidewalk head first but claims to have been more concerned with the blood coming from my head. I lost a digital camera and my passport along with numerous objects and papers gathered during years living abroad. Despite his claim at having been concerned with my safety, I awoke six hours later alone in the hospital. He wasn't so concerned to have even gone to the hospital with me. I called him and asked him to please pick me up when the hospital indicated it was time for me to go and he called back and asked if I could find anyone else to get me.

Now, the bill has arrived.

Blood bank - $137.00
Emergency - $18,637.50
Pharmacy - $218.00
IV Solutions - $116.00
Pulm Func - $86.00
Drug/Detail Code - $682.00
CT Scan - $24,379.00
Speech Therapy - $307.00
Radiology - $1015.50
IV Therapy - $636.00
Clinical Labs - $2700.50
Clinic - $25.00
Total: $48,940

I was in the emergency room from ~0230 until ~1130. The UC hospital even sent a small blue envelope so I could send my remittance.

I've contacted the county and asked for assistance. I'm a late-30's full-time community college student preparing to transfer. I receive financial aid and pick up occasional daily work as a consultant. On paper, I don't have a job.

I meet with the California county tomorrow and wonder what they will be looking for on my bank statement? The depression I felt after taking a beating, losing personal and valuable possessions along with losing a friend was beat back a bit with the purchase of an LCD TV made before the bill arrived. While I spent less than $500 should I be concerned with the county representative line-itemizing my most recent expenses? I haven't made any withdrawals and am not hiding monies. Should I hide expenses? My checking and savings are less than $600, combined. I just received a $1000 financial aid check but it won't be on my current statement. It is earmarked for the next two months rent.

I own a car but it is registered non-op. My possessions worth noting are the car, my bike, a bed, the tv and my laptop.

Finally, a professor suggested writing to my representatives both locally and nationally regarding the ridiculousness of this bill. Should I bother?

If I've left anything relevant out, I can be emailed at fortyeightnineforty@gmail.com

How much should I put in my medical Flexible Spending Account?

grouse — Mon, 24 Nov 2008 15:35:27 -0800

How much should I put in my medical Flexible Spending Account for next year? I am in the 25 percent marginal tax bracket. The minimum is $240 for the year.

If I put $240 in and I spend at least $192, then I have broken even. Given that I have a $200 deductible on my medical insurance, that seems likely, as that is less than the cost of two visits to a general practitioner, or one visit to a specialist. On the other hand, now that I live in a country where I have to pay to visit the doctor, maybe I won't be assured of a couple of visits beyond an annual physical (free).

I don't have any expenses that I can definitely expect, such as ongoing drug prescriptions. Searching through previous AskMes reveals a wealth of things I could spend the money on rather than waste it. I've never done this before so I would welcome your thoughts.

Treatments deemed unnecessary after the fact, do we have to pay?

Sloben — Sun, 15 Jun 2008 16:12:43 -0800

Several months after her last visit to physical therapy, my fiancee was informed that her health insurance company won't pay for the last two months of it because they didn't think it was "medically necessary". Even if she upheld all her obligations, including co-pays every visit, is she liable for these charges? (more details inside) Some details:
- Jan: She was referred to an in-network physical therapist from her primary care physician due to pain from a back injury.
- June: Almost 5 months later the therapist stopped therapy as they felt they had done all they could do. She had paid her co-pay every visit and had even inquired about whether she needed additional referrals from her physician, to which she was answered no.
- Nov: Almost 6 months after the last visit, she was informed by the health insurance company that they weren't paying for the final two months of visits due to lack of "medical necessity".
- Feb: The physical therapist starts sending us bills for the final two months of treatment.

Since then we have appealed the "medical necessity" assessment with the health insurance company and were denied. They essentially said they had repeatedly asked for additional notes from the therapist regarding the final two months, and once they received them had deemed the treatment ineffective (and unnecessary) because she wasn't demonstrating the required improvement to prove the ongoing treatment medically beneficial.
We have also filed a complaint with the Illinois Dept. of Insurance, but they essentially said there is nothing they can do.

The therapist is getting aggressive and threatening to call a collections agency if we don't pay several thousand dollars.

We feel that at some point during those two months someone should have at least let us know these treatments might not have been covered instead of half a year later. We are mostly upset with the therapist because it seemed like they racked up 60 days worth of charges even while the insurance company was not paying them, all while my fiancee was never informed or given alternative options. We have researched things quite a bit, but short of getting a lawyer, haven't found any details in terms of legal obligations and obligated time frames that might help us out. Any help or suggestions from the hivemind?

GP for Chico

Pontifex — Sun, 04 May 2008 21:47:31 -0800

Recommend a General Practitioner in Chico California. I've done a bit of reading on Metafilter concerning finding a good practitioner. From the reading it seems asking about a specific location is the last step people take to "check around" about doctors in their area. I feel comfortable going out and doing the leg work of "interviewing" doctors, but I wouldn't be doing the due diligence for myself if I didn't post about it here.

So my question is twofold: Can anyone recommend a good doctor in the Chico Area (South of Redding north of Sacramento - for the curious) that I can use as a GP? And, related to that, if you were looking for a brand new doctor what characteristics would be most important for you?

The second questions required some explanation. During my reading I've found that the majority of the respondents recommended finding a doctor that was "right for you", but I have no idea what would be right for me. I haven't been to a doctor in at least 5-7 years due mainly to having shitty college health insurance and not having anything "seriously wrong" with me. Now I have some pretty nice insurance I want to exploit as much as humanly possible. But, I need some advice on what makes a good doctor. E.g. Good bed side manner, likes to throw around numbers, not a schmuck, etc. Hearing about what other people think is important for their own doctors would help me identify which traits I would like most.

Thanks in advance.

Dad needs help paying the bills

Koko — Thu, 01 May 2008 06:22:21 -0800

Health insurance options for 65-year-old diabetic in Massachusetts? My father's health has been failing for some time; he's 65, a type 1 diabetic and is constantly in and out of hospitals and care homes. He is, of course, permanently disabled; unfortunately, so is his wife, so neither of them have insurance through work.

His wife, J, is working on various ways to get him insured; he recently lost his state disability ("Mass Health", I think my brother called it), and Medicaid says that they make too much money from Social Security to qualify. J has applied for AARP Supplemental, but says that unfortunately, none of the insurance companies pay beyond the 120 days that Medicare will allow (I'm not sure what that means). She's working with a social worker at his current nursing home to reapply for state health programs, as a long-term nursing home stay seems likely in his future.

Are there any other options, state, federal or private, that she should be looking into? I realize, considering his pre-existing condition and the fact that he lives in the US, the answer's probably a resounding NO, but I figured it couldn't hurt to ask. Any Mass. residents with similar situations found solutions? Thanks in advance!

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?

Can I work as a writer or medical liaison at a corporation, and pursue freelance journalism, simultaneously? Or would this be a conflict of interest?

Anonymous — Fri, 08 Feb 2008 14:10:34 -0800

Can I work as a writer or medical liaison at a corporation, and pursue freelance journalism, simultaneously? Or would this be a conflict of interest? I recently finished a Ph.D. in biomedical research. I want to move into a career than involves more writing, as this is one of my stronger skills, and I find it more enjoyable than laboratory work. I am looking at corporate work as a medical writer or liason (pharma or medical writing,) versus mass media journalism.

I have already done some freelance journalism, and worked a short stint at a major news outlet, so I have some contacts in this field. However, due to a chronic medical issue which came up during grad school, my doctors have advised me to make sure I get solid group plan coverage. (It's mental health/depression, hence the need for *solid* (complete) coverage)
Thus, I'm hesitant to just become a freelancer now, especially I have little to no savings from being in school for so long.

Medical writing, for instance at a large pharmaceutical or medical devices co., seems to be a good solution in that I can combine writing with the benefit perks... but I also like creativity and investigation, hence the pull towards journalism.

So, can I work at a corporation and pursue freelance journalism, simultaneously, or would this be a conflict of interest?

Additionally, how would it look if I went to a corporate job for a while, then tried to change tracks to journalism? Would I be welcomed back into the fold, or looked upon suspiciously?

Thanks, and direct contact can be made at: anonymousnic@gmail.com

Mid twenties male with medical dilemma needs some collective advice.

debu — Tue, 22 Jan 2008 20:15:32 -0800

I'm a male in my mid-twenties, active, and have been for the most part healthy. A few months ago I started getting some strange symptoms, and pain in one of my testicles. I was uninsured so I went to the doctor anonymously and paid cash. His thoughts were it was probably just a standard infection, and gave me some antibiotics and told me to come back if the pain persisted. Around that time I also went to an anonymous city clinic to see if it could be an STD and everything up until then checked out OK. There was a test *Syphilis that I hadn't called back on for results, I did so today and they said the test was negative as well, but there was "something else was going on".. Apparently, the second part of the Syphilis test showed them this. I also asked again about the STD related stuff and they said all that was fine. Up until a couple weeks ago things were feeling better but since then, for some reason, I've been going downhill with symptoms quickly. So I have a few questions (3rd question is most important)

1. I'm not sure the specifics of the test that indicated "Something else" was going on, but I'm guessing it's because of a low blood cell count? If so, that could be anything compromising the immune system right? Or does the second part of a Syphilis test tell something more specific?

2. I'm self employed and thought I could only afford a high 5000.00 deductible plan. As of a week ago I now have insurance, but obviously picked the wrong plan. A few days ago I sent the form to change that to a O deductible higher monthly rate plan, but I have no clue how long this process takes? According to my series of doctor visits at 18 there was a chance I could at some point develop neurological problems (Parent and other family members died of) these "other issues" the clinic was referring to could be related to all this and be chronic. Should I sweat it out not seeing the doctor until my plan changes?

3. If I go in soon to a new doctor, I'm not going to mention the STD clinic visit (Rather not have that on my records, whether things were ok or not), and I can't go back to the first doctor because I went in anonymously and my new insurance will attack me if I disclose this. So what do I say if I go into a new doctor and he asks "Have you recently taken antibiotics for anything"? "Well doctor, now that you mention it I did take some I found lying around ten days in a row, and they didn't do anything for this pain that I hypothetically haven't been treated for". How do I convince him I know something else is going on without seeming like I'm trying to self diagnose?

I'd like some collective input on ANY of these before I pull the trigger. advice? thanks

Risks of forgoing health insurance?

Anonymous — Fri, 18 Jan 2008 06:14:28 -0800

Risks of forgoing health insurance when one has limited assets? I am in my final semester of graduate school. Students at my school are supposed to purchase the school's health insurance for $1,000/semester. The coverage is poor--extremely limited coverage with high copays. So far I have paid for coverage but haven't used it once. I am also lucky enough to meet the income requirements for state-sponsored (free) health care. (In my state you are eligible for this care even if you already have insurance.) I have to see the doctors at a specific hospital and so far the care has been excellent.

My tuition bills are already huge and I'm eager to cut corners wherever possible. I don't have any assets other than retirement savings in a Roth IRA from before I went back to school. Since the (bad) school coverage is so expensive, and I have (great) coverage that is free, I am considering forgoing the paid coverage. Technically, however, the state wants people with free care to purchase insurance (although they are able to retain the free care…go figure?!).

What are the risks of not purchasing the school health insurance? For example, I'm not sure what would happen if I were to suffer a serious injury and be brought to a hospital other than the one where I receive my care or worse, out of state (the risk is low since I don’t go out of state often). If something like this happened I would be protected by the fact that I have no real assets that could be seized to pay for medical bills, right? Or am I missing something?

Although it might be ethically “wrong” to not purchase the insurance my state wants residents to, both education and health care are insanely expensive and I’m just trying my best to get by without owing hundreds of thousands of dollars in the end. I also paid my fair share of taxes when I was working so I don't feel too bad about having free coverage now while my income is so low. Thank you.

Medical Malpractice Insurance Coverage

chriswarren — Sat, 05 Jan 2008 13:00:25 -0800

Does medical malpractice insurance typically cover all damages of injured patients? I'd like a citable source on this if at all possible, but searches so far haven't turned up anything worthwhile.

A minor fender bender. Will it ruin our lives?

TwilightKid — Tue, 03 Jul 2007 09:49:03 -0800

About a month ago, my pregnant wife and I were in a minor fender bender on Rt. 202 in NJ. The woman before us stopped short, and we hit her going about 20 mph. This wasn't our fault. Their wa sa police car who made an erratic turn at the merge of the road that cause a few cars in front of us to swerve and or strop short at the time. The mini-van had a minor scratch and bump. Our jeep had no damage..... I don't know the full details of the law, but NJ law seems to say that the person who hits from behind is automatically at fault. Period. We both get out of the car. While we are a bit shaken up, due to her being 6 months pregnant, she feels fine physically. The woman we bumped into said she was fine as well.

She didn't want to exchange insurance info initially, but we did so anyways. We pull over and call our insurance company right away to just get everything on record, just in case....

A few hours later, the woman had contacted the agency as well and filed a claim....Yadda Yadda. In the end, our insurance company paid out $700. Since my wifes insurance has been spotless, our rates are not going up and she remains on the preferred drivers list. case closed, so we thought.

Today, we get a call from our insurance company stating that the woman has gotten a lawyer and is now going after a medical payout....

Thats all we know so far....And we are a bit scared...The insurance guy gave us assurance that we are in good hands and that they will fully investigate every claim before paying out. He said that we do not need a lawyer at this point. And based on the minimal damage to her vehicle, they will heavily look at the amount of $$ she is looking to collect. Of course, our insurance agency will do the payout, but we are then not sure how it will affect us or our rates...Or, can she come after us, personally? We just bought a house? How bad can this get? It was a tiny scratch on her car...

We have been told to remain calm, but we are scared cause we don't know how bad it can possibly get.....Is the NJ law about people from behind being automatically at fault so air tight, that we couldn't consider a counter suit against this woman? Is there anything we can do in regards the pregnancy? Are we screwed and at the mercy of the insurance companies and the lawyers at this point?

Not sure what I'm really asking here..Just looking for some insight.....

much thanks....

Give Blue Cross the old heave-ho

parmanparman — Thu, 21 Jun 2007 06:59:08 -0800

How could a person learn about and find resources for starting - yes, starting - a medical insurance company or friendly society involved in medical insurance? I am really tired of the cost and consequences of a certain kind of specialist medical insurance and am thinking it's probably possible to find the financial backing and technical expertise to start a better kind of company.

Are there classes a person could take or an institute for people interested in starting or running medical insurance companies?

Insurance Pre-Existing Condition Woes

kmtiszen — Tue, 30 Jan 2007 06:41:19 -0800

My insurance provider wants me to fill out a pre-existing condition questionnaire! Help! After not being insured for about 18 months, I've finally started a job that offers me health insurance. Unfortunately, I have a chronic pre-existing condition (colitis) that requires regular medical care... including a colonoscopy every couple of years. Overjoyed with the possibility of not having to pay in full, first thing I do once I'm covered is run and get a colonoscopy.

But along comes a bill for $930 and a pre-existing condition questionnaire. My question is--is there anything I can do to get them to cover me? I'm in over my head here. I have a couple thousand dollars worth of bills that they're refusing to cover unless I return this questionnaire. But I know once I do, they'll probably refuse to cover me anyway. My only hope is you, hive mind, to help me do this an intelligently as possible.

I think my only glimmer of hope is that the GI that was treating me before being insured has completely quit his practice and has absconded with all my medical records. Nobody, myself and even his old hospital, knows where to find him or how to contact him. Would it be a bad idea to just leave him off the questionnaire entirely?

I don't know if it makes a difference, but I'm currently located in NYC.

Thanks for your help in advance!

Medical bill arrives with charges that I wasn't told about before treatment; can I argue against paying?

inatizzy — Sat, 20 Jan 2007 21:48:02 -0800

My dentist has sent me a bill for work done during two visits over the past couple of months; I thought that my insurance was covering everything, and my dentist's office never told me that I would be charged personally. I would like to dispute the charges; do I have a leg to stand on? The details: I went in for a regular appt in December and had the standard cleaning, xrays, and checkup by the dentist. The appointment had been scheduled by the office manager at the end of my last checkup 6 months prior. I assumed that it was all part of my dental coverage from my dental insurance. I didn't pay anything during the visit, which is normal, because in the past my insurance has covered the checkups.

I went back a week or so ago to get a cavity filled, and I was a little surprised at the end to learn that I had to pay a copay. But I let it roll off my back because the copay isn't very high and it wouldn't be worth arguing. I asked the office manager if I'd have to pay anything else and she said she didn't know, but if anything it'd probably be only a little more because of the way insurance companies usually treat fillings.

Today I come home to find a bill from my dentist for about $200, a combination of charges from both visits that apparently weren't covered by my insurance. (The vast majority is from the latter appointment, when I got the filling.)

I'm upset because I was never told that I would be charged for these services, and had I known, I would've thought differently about choosing which services to receive. For example, I would've turned down the Xrays at my checkup, since they took them last time and I know that you don't need to get them every visit. But the dental assistant had been ready to go with them and 1) never told me they'd cost extra, and 2) didn't even give me a choice to turn them down.

As for the latter appointment, if I'd known that my filling would cost $200 I would have looked into a less expensive solution, or at least a different dentist where I could pay less.

I'm quite upset because I feel like they took advantage of me by not being up front with these charges. I don't deny that I could've prevented this by asking them about it before I let them do anything, but I'd never been charged before and I trusted them to tell me if things would be different. I'd been given no reason to expect that I would be charged.

I'd like to write them a letter explaining my stance and asking them to strike the charges from my record, in addition to telling them that in the future I will require them to give me advance notice of all 'personal' charges that I may be subject to, so that I can make an informed decision about those services.

Do I have a leg to stand on here? Can I really hope that they will wipe the charges? Am I approaching this the right way? I'm new to all of this stuff and I'm not sure what I can really expect. Thank you in advance for your advice.

Typical contribution to med benefits in nonprofits?

desuetude — Mon, 18 Dec 2006 10:36:29 -0800

Where can I find statistics on what percentage of medical premiums are typically paid by employees of nonprofit organizations in the US? I'm in PA, if that's relevant. My employer has made some very significant changes in required employee contributions for coverage. In explaining/defending the new policy, they have been referring to industry standards.

However, the nonprofit pay scale is significantly lower than the for-profit industry standards, often for equivalent positions; traditionally in the non-profit world, this has been balanced by providing more generous benefits. While I understand that tradition has evolved as nonprofits move toward running a tighter ship, I'd like some numbers.

I'm not looking for inflammatory articles or spin to prove a point...I'd actually like some data so that I can discuss this knowledgeably and rationally later today. (Someone's gotta be the knowledgeable and rational one.)

Am I Getting Ripped Off?

gottabefunky — Fri, 27 Oct 2006 11:38:16 -0800

How can I make sure I'm not being overcharged for surgery and/or ripped off by my health insurance company? I recently had minor outpatient surgery and I'm trying to figure out how to make sure everything is on the up-and-up from both the hospital/doctors and the insurance company.

I don't have any specific reason to suspect getting ripped off, but I've heard so many horror stories about medical overcharging - and had personal experience getting shafted by health insurance companies - that I'd at least like to make sure nothing egregious is going on.

I've gotten itemized bills for the surgery, but a) many of the items might as well be Greek to me, and b) for the few that I've asked about, the response has been simply "That's what we charge for that." What other options are there? (Ideally low- or no-cost.)

With the insurance company, things are even more confusing: certain amounts allowed and other not, for no clear reason, and there are "discounts" they apparent get from, or negotiate out of, the hospital. There is very little effort put into making any of it comprehensible. I hesitate to file a challenge without good reason, so my rates don't go up. What else can I do?

Or should I just let it all go? Is $8,000 for an inguinal hernia repair reasonable?