11 votes

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

It is legal. Vermont tried it. They ended up abandoning the project because it would have required a tremendous tax increase.
Justin Cave's user avatar
  • 2,839
9 votes
Accepted

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

This is "Topic #601" in various ForwardHealth interpretative statements about BadgerCare Plus and Medicaid. The last 3 paragraphs say: When commercial health insurance plans require members ...
user6726's user avatar
  • 215k
7 votes

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

Analogous programs This is essentially how the the insurance policies offered on Obamacare (a.k.a. the Affordable Care Act) insurance exchanges for people seeking non-employer plans work. In Colorado, ...
ohwilleke's user avatar
  • 213k
6 votes
Accepted

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

Parents have a legal obligation to care for their minor children: it is illegal to harm a child through action or inaction. State law and associated welfare programs are complex: you can start here. ...
user6726's user avatar
  • 215k
6 votes

Health insurance just for a particular gender?

From healthcare.gov: How premiums are set Under the health care law, insurance companies can account for only 5 things when setting premiums. Age: Premiums can be up to 3 times higher for older ...
BobbyScon's user avatar
  • 161
5 votes

Does Justice Roberts Obamacare opinion contradict itself?

Isn't there tension between these two parts of the opinion? There is perhaps some tension, but the resolution of that tension is clear. There is certainly no self contradiction. The most obvious ...
phoog's user avatar
  • 37.2k
5 votes

Must a health insurance in the United States provide a listing of procedure and diagnosis codes that are covered upon request?

The health insurance contract should set forth what is and is not covered in detail (in addition, there would be a short summary version). They probably don't have to provide procedure codes that are ...
ohwilleke's user avatar
  • 213k
5 votes

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

It is legal for a dentist to bill you for services rendered. You have an obligation to pay the dentist (in exchange for services); the insurance company has an obligation to cover certain expenses of ...
user6726's user avatar
  • 215k
4 votes
Accepted

What would happen to Hobby Lobby under Medicare For All?

Your analysis is correct. Hobby Lobby would be irrelevant insofar as health benefits are concerned (although the general religious objection doctrine would still have relevance in other contexts, e....
ohwilleke's user avatar
  • 213k
4 votes

Is what the customer service of a health insurance company tells one of their customers legally binding?

If I may paraphrase the scenario: The customer has a contract with the insurer The customer is contemplating undergoing a certain procedure and is unsure if it is covered under the contract The ...
Dale M's user avatar
  • 209k
4 votes

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

Yes, the law can make such limits For another common example, an unlicensed person often cannot enforce payment if they carry out building work performed that requires a licence. It's worth being ...
Dale M's user avatar
  • 209k
4 votes

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

This practice is known as "rescission". It is legal under 45 CFR §147.128 in some circumstances. The regulation says (a) A group health plan, or a health insurance issuer offering group or ...
user6726's user avatar
  • 215k
4 votes

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 assets? For some programs, but not others. The main exception, discussed below, is the Medicaid ...
ohwilleke's user avatar
  • 213k
4 votes

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

Your father-in-law's liability isn't really your question to decide. If your injury is covered under his insurance policy -- and it may or may not be -- then your insurance company has a right to seek ...
bdb484's user avatar
  • 59.1k
3 votes

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

In the US, people are generally allowed to charge arbitrary amounts for services, as long as they do not violate various anti-discrimination laws in doing for. For example it would be illegal to ...
user6726's user avatar
  • 215k
3 votes
Accepted

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

It is legal and quite common. Your choice as consumer is at the point of selecting insurance company. If you dislike ES enough, that would be a reason to select a different insurance company. It would ...
user6726's user avatar
  • 215k
3 votes

Is what the customer service of a health insurance company tells one of their customers legally binding?

I'm going to go out on a limb somewhat and say that claims made by a customer service representative are not binding, and are only advisory. The reason is that the company is only bound by the terms ...
user6726's user avatar
  • 215k
3 votes

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

The concept of "controlled substances" has a special meaning, and stems from the Comprehensive Drug Abuse Prevention and Control Act of 1970, resulting in Chapter 13 of Title 21. Ordinary ...
user6726's user avatar
  • 215k
3 votes

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

They're not actually billing people different amounts because they have insurance or not. Doctors can pretty much bill a patient whatever they want for their service, similar to how a grocery store ...
animuson's user avatar
  • 4,295
3 votes
Accepted

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

It's probably not unlawful to ask, but an answer cannot be required immediately. Per the Department of Labor, Susan has 60 days to elect COBRA coverage (the qualifying event here being the termination ...
Ryan M's user avatar
  • 10.3k
2 votes
Accepted

Pre-existing issue (medical)

As they say, a pre-existing condition is one that was existing at the time you applied for and were given insurance. A pre-existing condition may be known or unknown: insurance will generally cover ...
Dale M's user avatar
  • 209k
2 votes

Health Insurance Usage for Employers

The "Privacy Rule" of HIPAA would prohibit this from happening. §164.504(f)(2)(ii) imposes requirements on group health plan documents (agreements), which must Provide that the group health plan ...
user6726's user avatar
  • 215k
2 votes

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

It isn't obvious on the face of it whether health decisions means "treatment decisions in non-emergency situations" or also includes choices of health insurance plans. Both of these could be fair ...
ohwilleke's user avatar
  • 213k
2 votes
Accepted

Secular Health Care Sharing

Setting up any health insurance plan is subject to myriad state and federal regulations and is not something anyone should embark upon without a lawyer. There are private for profit and non-profit ...
ohwilleke's user avatar
  • 213k
2 votes

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

Insurance law varies from state to state and policies have widely varying language. What your insurance company is bound to [as it refers to their obligations to you to cover charges] is the language ...
Wendy P's user avatar
  • 47
2 votes

Is there a fine for no health insurance 2017

The "shared responsibility payment" is a tax and not a fine, at least according to parts of the Supreme Court ruling on the matter (National Federation of Independent Business v. Sebelius, 567 U.S. ...
user6726's user avatar
  • 215k
2 votes

Possibly a stupid question, but do insurance companies HAVE to have somebody as a customer?

The general answer in the US is that insurance is a state-regulated business, so insurance companies cannot just do whatever they want. Here is a central resource for Washington state. In general, if ...
user6726's user avatar
  • 215k
2 votes

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

The at fault driver (in a state that is not a "no fault" state) has a legal obligation to pay all of your medical bills and all other economic and non-economic harm to you caused by the accident in ...
ohwilleke's user avatar
  • 213k
2 votes

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

To piggy-back off of user6726, I found some supporting materials regarding what's going on: Topic #213 - Sanctions for Collecting Payment From Members Under state and federal laws, if a provider ...
Kyle's user avatar
  • 203

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