Questions tagged [health-insurance]
The health-insurance tag has no usage guidance.
0
votes
0answers
9 views
May an insurance change classifications after services have already been rendered?
A New Jersey Marketplace health insurance plan has a tiered benefit system where a member can choose providers from a two-tiered system. Tier One has the highest coverage level and is tied to a narrow ...
-1
votes
0answers
30 views
Malpractice lawsuit for seizure (potentially) caused by vaccination [on hold]
I am somebody who (due to a condition called a cavernous angioma) has suffered from epilepsy (mostly partial-onset seizures and, as of Tuesday, 4 grand-mal seizures) for all of my post-pubescent life (...
2
votes
1answer
62 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)
...
1
vote
1answer
47 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 ...
2
votes
2answers
170 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 ...
4
votes
0answers
70 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 ...
0
votes
1answer
41 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&...
0
votes
0answers
13 views
Health Insurance Company Denying Request for Table of Allowances
On the list of my plan benefits, it tells me that all services are to the Table of Allowances and that I'm responsible for fees in excess of the Table of Allowances.
My insurance company is refusing ...
0
votes
1answer
122 views
Are parents allowed to not pay for their children's surgery?
Through public internet group chats, I was able to meet a 16 year old girl that suffers from a medical condition on her feet. She lives in Washington, US, but in a neglectful household where her ...
0
votes
0answers
30 views
To what extent is it legal for health insurance companies to take into account cost when deciding whether to cover a particular treatment?
I'm trying to determine if insurers in the US are legally allowed to make a decision not to cover a treatment based on the high cost, even if the treatment is medically effective (and may even be life ...
0
votes
1answer
54 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 ...
1
vote
1answer
64 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 ...
0
votes
0answers
33 views
Can I offer a health insurance plan only to freelance workers?
My goal is to provide the most affordable health insurance plan or health insurance alternative for freelance workers nationwide in the USA.
The Affordable Care Act prohibits discrimination on the ...
0
votes
1answer
28 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 ...
1
vote
1answer
37 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 ...
3
votes
2answers
89 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 ...
0
votes
1answer
162 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 ...
2
votes
0answers
105 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 ...
0
votes
1answer
54 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
...
1
vote
1answer
420 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 ...
0
votes
0answers
42 views
Is part of my premium for my employer-provided heath insurance being used to pay for the ACA?
The title of the question sums it up pretty much. I'm curious if there is a money trail between what I pay in my employer offered healthcare plan and government funds used to subsidize the Patient ...
1
vote
1answer
112 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 ...
1
vote
2answers
1k 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 for in the states of ...
1
vote
1answer
43 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 ...
2
votes
1answer
2k 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 ...
0
votes
0answers
34 views
Long term disability denied
How can a insurance provider have their own doctors to override your doctors desicions for returning back to work?
2
votes
1answer
79 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.
...
1
vote
0answers
91 views
Can an employer charge employees more than 100% of group health insurance premiums?
Assume Company A is charged $100 per month from Health Insurer B for its group health plan offered to A's employees, can A charge it's employees $110 per month to enroll in this coverage, but still ...
0
votes
1answer
432 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 ...
3
votes
2answers
162 views
Is what the customer service of a health insurance company tells one of their customers legally binding?
In the United States, is what the customer service tells a customer legally binding?
Example: A customer calls their health insurance company, they say X is covered, 1 month later the customer ...
4
votes
1answer
161 views
Must a health insurance in the United States provide a listing of procedure and diagnosis codes that are covered upon request?
I wonder whether a health insurance in the United States must provide a listing of procedure and diagnosis codes that are covered, if requested by a policyholder?
In my opinion, the listing of ...
1
vote
0answers
86 views
Do doctors have the legal responsibility to inform the patient of services not covered by the insurance in the USA?
I wonder whether doctors have the legal responsibility to inform the patient of services not covered by the insurance in the USA.
https://craighospital.org/resources/you-and-your-doctor-rights-and-...
2
votes
1answer
78 views
The legal value of oral claims in the US
I went to the physician in California, United States. The secretary orally told me that the appointment was covered by my US health insurance, but it was not. Can I refuse to pay on the grounds that ...
2
votes
1answer
163 views
Is it illegal for a parent to refuse to pay medical expenses with child support in the USA?
I am asking one a friend's behalf.
My friend's parents are divorced, my friend (18, F) is living with her mother and her mother's boyfriend (not married to each other). The mother receives child ...
2
votes
1answer
102 views
dental clinic - horrible service overcharged [closed]
In May this year I went to a dental clinic to put a dental crown in Anchorage Alaska USA. The dental clinic told me that the total cost for the crown would be US$2300. US$1300 would come from my ...
8
votes
2answers
3k views
Is it legal for a company to offer a different insurance rate based on spouse's employer's offerings?
Is it legal for a company to offer a different insurance rate based on the spouse's employer's offerings?
My employer wants me to indicate to them whether my spouse can have insurance under her ...
1
vote
1answer
305 views
Can you sue minors only in America?
As I was reading the story below, I thought I must be reading The Onion, only to later see that it's The Guardian instead.
http://www.theguardian.com/us-news/2015/oct/13/woman-nephew-broken-wrist-hug-...
