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Questions tagged [health-insurance]

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Has, or could, a state or city become a group insurer under federal law?

If a city or state, more likely a state, as part of an insurer being licensed to do business within said state, were required to insure the citizens of a state as a "single group", perhaps ...
paulj's user avatar
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1 vote
1 answer
98 views

Am I required to disclose that my injury happened on someone else's property?

I recently injured my hand and needed surgery. The injury happened on my father-in-law’s boat. There was no negligence on his part; I simply banged my hand on a railing while jumping in the water with ...
NotARobot's user avatar
1 vote
1 answer
44 views

Why is Medicare not included in the entities of policy change for CMS?

See this link. https://www.medicaid.gov/federal-policy-guidance/index.html Why is Medicare not included in this list? The Centers for Medicare & Medicaid Services (CMS) is responsible for ...
JustBeingHelpful's user avatar
1 vote
1 answer
58 views

Does Jimmo Settlement Agreement of 2013 also apply to Medicaid?

The Jimmo Settlement Agreement was passed in 2013. This is under the Center for Medicare & Medicaid. In laymen's terms, this allows a patient to receive help with skilled therapy/nursing ...
JustBeingHelpful's user avatar
1 vote
1 answer
87 views

Questionable arrangement with a dentist

I saw an ad on a classifieds site that was something like 'Free AirPods if you let me clean your teeth!' Turns out its a dentist who does your yearly checkup, bills your insurance say $450, and then ...
Kovy Jacob's user avatar
1 vote
1 answer
136 views

Lapse in Coverage By Becoming Disabled From a Pre-Existing Condition at a New Job?

In the US, most job-based health insurance plans include a stipulation which references the pre-existing condition exclusion period: The time period during which a health plan won't pay for care ...
Yos233's user avatar
  • 113
2 votes
0 answers
628 views

Does a Dental Office have an obligation to tell you they are going out of network when you have been a patient for four years in-network?

I had been going to a dentist from 2018-2022. I had work done in the summer and fall of 2022. They treated these appointments as normal - collected my copay, did the work, filed with the insurance, ...
Kara S.'s user avatar
  • 21
1 vote
3 answers
108 views

Germany: insurance for newborn but change of insurance end of the same month

A child is born to parents (german citizens, german clinic) who are insured by an international private health insurance until the end of the month. The birth certificate was available at 25th of this ...
Allerleirauh's user avatar
0 votes
0 answers
52 views

What are requirements to determine options for statutory or private health insurance after moving back from abroad (in the EU)?

When a person moves back to Germany after being abroad in the EU (e.g. Netherlands) long enough to have to insure themselves there and not be insured in Germany anymore, what determines if you can be ...
xuiqzy's user avatar
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1 vote
0 answers
67 views

For non-emergency treatment in California: Can hospital/surgery center deny service/treatment because of lack of co-payment when client has insurance?

For non-emergency treatment in California: Can hospital/surgery center deny service/treatment because of lack of co-payment when a client has insurance? In other words, can a provider refuse to render ...
COOKIES's user avatar
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2 votes
0 answers
33 views

Does the Anti-Kickback Statute apply to remunerations when a patient has private insurance?

The Stark Law (42 U.S.C. § 1395nn) and the Anti-Kickback Statute (AKS) (42 U.S.C. § 1320a-7b) are pretty clear that they only apply to federal/state-funded insurance plans. Under these plans, a doctor ...
amz-sea's user avatar
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0 votes
0 answers
41 views

How to keep medical coverage for pre-existing conditions when changing jobs in California

I'm sorry for this question being so strange. I'm shaking while I write it. This is very hard. My mom has really bad cancer. She is in remission, but there is a relatively high chance it will be back ...
137's user avatar
  • 101
1 vote
1 answer
137 views

Qualifying Life Event changes in Employer Sponsored Health Insurance

Is my understanding correct that HIPAA in the US defines the concept of Qualifying Life Events as a means to ensure employer sponsored health programs provide a Special Enrollment Period upon being ...
maple_shaft's user avatar
1 vote
1 answer
197 views

Do high-asset / low-income people qualify for free medical care in California?

Can people with low incomes qualify for free medical care (Medi-Cal) in California regardless of their liquid assets? A document on the Department of Health Care Services site (pdf) notes off-hand: ...
MWB's user avatar
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0 votes
2 answers
51 views

How to interpret illinois SB 3242 'covered services' definition?

Background: I did a dental procedure during the waiting period of a new dental plan. My dentist contest that contracted prices do not apply during this period despite the fact that the insurance ...
Aelian's user avatar
  • 101
2 votes
2 answers
172 views

Lab work and laws regarding price-gouging

A patient goes to doctor. Doctor orders two tests, TestA and TestB. The insurance company only covers one. The EOB shows that the two tests were billed at $500 each. TestA is not covered, TestB is ...
paulj's user avatar
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2 votes
0 answers
87 views

Can my healthcare provider deny me a free annual wellness visit just because one of their doctors left the practice?

I called to make an appointment for my free annual wellness visit.* They said because my primary care physician (PCP) left the practice, they would not be able to give me the free annual wellness ...
user3358338's user avatar
0 votes
2 answers
75 views

Must all COVID-19 tests be fully reimbursed by health insurances in California, United States?

I read on one of the COVID-19 testing websites (https://www.sccgov.org/sites/covid19/Pages/covid19-testing.aspx but the following text can only be viewed but booking an appointment) [emphasis is mine]:...
Franck Dernoncourt's user avatar
2 votes
2 answers
262 views

Can an employer ask an employee about personal health matters (HIPAA) and COBRA decision in public?

Hypothetical Scenario (in the US): Susan's employer, MoneySavers, offers COBRA to employees who separate from the company. Susan has given her two weeks' notice (she has quit her job) and will soon ...
ninja star's user avatar
0 votes
1 answer
43 views

Is it ever doctor's responsibility to ensure insurance coverage for services received? California

If patient before appointment gives explicit instructions to doctor to proceed with appointment only if patient's insurance would fully cover appointment; and then doctor in writing confirms that ...
user2138912's user avatar
1 vote
0 answers
455 views

Lab provider says I owe them money, insurance company says I don't. Who is right?

tl/dr: My doctor told me some lab work would be fully covered, but the doctor didn't do the work themselves. They sent it off to a 3rd party lab service. Turns out that one particular test wasn't ...
conman's user avatar
  • 581
8 votes
4 answers
1k views

Can the law limit what heath care providers I see if I have commercial and medicaid?

There's a bit of story to this: We had been trying to find a therapist for my son. We wanted one that we felt comfortable with. We didn't care if the provider was out of network or if we'd have to pay ...
Kyle's user avatar
  • 203
1 vote
3 answers
288 views

Are US doctors allowed to charge insured clients more than uninsured clients?

Is a U.S. doctor allowed to charge a client with insurance more than a client without insurance? I was told the cost for my visit was $40 if no insurance but $60 co-pay if I have insurance. I called ...
Pryscilla H Stam's user avatar
3 votes
0 answers
58 views

Termination letter marked 1 day early

Someone I know was let go from their job on 4/1, he was using the insurance provided by his employer. In his employment contract it states insurance will remain active through the rest of the month ...
wearebob's user avatar
  • 141
3 votes
2 answers
280 views

Does Justice Roberts Obamacare opinion contradict itself?

Chief Justice Roberts' opinion in National Federation of Independent Business v. Sebelius upheld the ACA individual mandate as a tax. Disagreeing with the joint dissenters (Alito, Thomas, Kennedy, and ...
Naftali Tzvi's user avatar
2 votes
1 answer
190 views

Can insurance companies increase the monthly cost to the point that it becomes unaffordable?

Let's say Unlucky Joe is a very accident-prone young man. He keeps getting into costly accidents all the time, but it can never be proved that he does it by mistake, and it doesn't benefit him ...
Philip Evans's user avatar
1 vote
1 answer
81 views

What portion of a medical bill does the insurance has to pay?

In a car accident, not at fault, what portion of a medical bill does the insurance company of the other driver has to pay? The hospital will most probably bill my health insurance, and there is the ...
KingsInnerSoul's user avatar
0 votes
1 answer
139 views

Do I have a case to challenge a private medical invoice that wasn't covered by insurance?

I had private medical insurance as part of my employer, I rang up in October for an appointment and one was "authorised" for January. I then left my job in December and still attended in January. (I ...
Adam's user avatar
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1 vote
0 answers
27 views

Is there a legal professional who can be hired to assist with insurance for patients with complicated medical needs?

Is there a specific category of legal professional that could be hired specifically to assist with the filing of the paperwork and management of insurance claims on behalf of an individual? I am not ...
Freiheit's user avatar
  • 269
2 votes
1 answer
681 views

being forced to use Express Scripts (mail order delivery) on perscriptions

Insurance policy set up by the workplace requires us to fill prescriptions through a specific mail order vendor and denies coverage of prescriptions through other retail vendors (Walgreens, CVS, etc) ...
hellyale's user avatar
  • 315
1 vote
1 answer
60 views

Should I settle with a car insurer (Uber) and reimburse a medical insurer after car accident? (subrogation) [closed]

I was a passenger in an Uber ride, and there was an accident. I had medical treatment, paid with my medical insurance from work, and now they want to get a reimbursement (subrogation). This is totally ...
Elabore's user avatar
  • 111
2 votes
2 answers
297 views

Employer Added Wife to Insurance, Now They Retroactively Voided Her Coverage

My employer "accidentally" included my wife in my health insurance plan. (They are now saying that they don't cover spouses). They retroactively voided the plan without informing us. We thought she ...
Mark's user avatar
  • 21
5 votes
1 answer
331 views

How much privacy about my health am I giving up if I participate in my employer's wellness screening program?

My employer is having a "Wellness Screening Fair" where you can receive free testing for things like cholesterol and insulin, and I imagine advice about how to interpret the results. Sounds good.. But ...
cxrodgers's user avatar
  • 219
0 votes
1 answer
47 views

Is there a fine for no health insurance 2017

I'm referring to the 2017 tax year (Jan 17-dec17 filed April 18) My CPA for 10 years is telling me there is a fine this year for not having health coverage. Multiple other people i know who used h&...
Cade's user avatar
  • 11
3 votes
1 answer
1k views

Are parents allowed to not pay for their children's surgery?

Through public internet group chats, I was able to meet a teenage girl that suffers from a medical condition. According to her, she lives in the US, but in a neglectful household where her parents pay ...
Sam's user avatar
  • 133
0 votes
1 answer
149 views

Can an employer pay less in benefits to employees on a 'Family' healthcare plan than employees on an 'Individual' healthcare plan?

I work at a community college in California. About a decade ago, my union negotiated for the district to pay 100% of all healthcare premiums for single employees, and a fixed dollar amount towards the ...
Relativity's user avatar
1 vote
1 answer
120 views

Secular Health Care Sharing

My goal is to provide the most affordable health insurance plan or health insurance alternative for freelance workers nationwide. The Affordable Care Act made members of Health Care Sharing ...
SmallHadronCollider's user avatar
1 vote
1 answer
72 views

What is the motivation behind the "rules for coordination of benefits"?

I am looking at a law which motivation I don't understand: WAC 284-51-205 Rules for coordination of benefits. (1) When a person is covered by two or more plans, the rules for determining the order of ...
Igor Soloydenko's user avatar
1 vote
1 answer
43 views

Health Insurance Usage for Employers

Do employers look at health insurance usage, and use that data to possibly lay people off for incurring too much usage? 1) Would such a practice be legal 2) Even if it were illegal, could employers ...
Sir Fartsalot's user avatar
3 votes
2 answers
607 views

Can residential/custodial parent change our kids health insurance unilaterally?

We have a parenting plan that designates all health decisions as "jointly made." The other parent previously had our child on their employer insurance plan. They just changed jobs and hence insurance ...
Max Savishinsky's user avatar
2 votes
1 answer
250 views

What would happen to Hobby Lobby under Medicare For All?

The Hobby Lobby SCOTUS case, if I'm not mistaken, says a company can manipulate the nature of their employees' health insurance, justifying it by the idea that since they're providing it, they should ...
Tirous's user avatar
  • 489
4 votes
0 answers
224 views

What happens if I accept work contracts in two EU countries at the same time?

I am going to accept a job in Dublin, Irealnd but I also have an opportunity of getting a work contract in the Czech Republic. The latter job would be mostly remote (it would require me to visit the ...
user512365's user avatar
1 vote
1 answer
79 views

Interpreting an ambiguous definition in an insurance policy

My wife has a travel insurance policy where "dependent" is defined as follows: Dependent means your spouse and your or your spouse’s unmarried natural, adopted or step-child of the participant ...
Eugene's user avatar
  • 203
1 vote
3 answers
8k views

Is it legal for "in-network" dentist to send me a bill when insurance company denied claim?

A couple months ago I went to the dentist for a crown, he noticed my jaw clicking and he said that I would need a "occlusal adjustment" to help fix this. Based on what I was told, I was under the ...
olimits7's user avatar
  • 111
1 vote
1 answer
366 views

Is it legal for employer to require portions of an IRS form 1040 for verification of dependent eligibility?

Is it legal (California, USA) for an employer to require an employee provide a copy of the first two pages of their most recent form 1040 as part of demonstrating the eligibility of the dependents for ...
eponymous's user avatar
3 votes
4 answers
8k views

Can a medical practitioner legally charge health insurances a different amount from what it would charge a non-insured patient?

In the United States, can a medical practitioner legally charge health insurances a different amount from what it would charge a non-insured patient? I am mostly interested in the states of ...
Franck Dernoncourt's user avatar
1 vote
1 answer
82 views

Pre-existing issue (medical)

I have a sub-dermal haemangioma on the side of my face, its barely visible, and its been there since I was young. We had it looked at by a professional when I was child and it was never officially ...
Alex's user avatar
  • 189
2 votes
1 answer
5k views

What is the difference between "controlled substance" and "needing a prescription"?

I was prescribed a medication. The doctor said it was not a controlled substance. Why did he write a prescription? If it's not controlled couldn't I just go to the pharmacist and ask for the ...
user8705's user avatar
3 votes
1 answer
106 views

Health insurance just for a particular gender?

Can a company provide health insurance just for a particular gender? For example by giving different premiums for different genders. I think they can give different premiums for different age groups. ...
user avatar
0 votes
1 answer
725 views

Is an asylee applicant exempt from buying a health coverage?

According to Obamacare non residents are exempt from mandatory health coverage. Based on the Marketplace regulation: Applicants for asylum are eligible for Marketplace coverage only if they’ve been ...
Ravichandra Namburi's user avatar