Questions tagged [health-insurance]
The health-insurance tag has no usage guidance.
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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 ...
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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, ...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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:
...
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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 ...
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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 ...
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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 ...
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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]:...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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Possibly a stupid question, but do insurance companies HAVE to have somebody as a customer?
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 ...
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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 ...
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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 ...
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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 ...
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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)
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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 ...
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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 ...
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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 ...
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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&...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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
...
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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 ...
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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 ...
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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 ...
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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 ...
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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 ...
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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.
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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 ...
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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 ...
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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 ...
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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-...
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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 ...
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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 ...
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