Most Common Health Insurance Questions

Here are a sample of recently asked questions. This information will be updated routinely
Ask a general health insurance question, click here

Question	Response	Added
"My physician wanted to give me a medication called Sporanox to treat a problem related to my feet. However, my doctor said that my health plan would not pay for this prescription and that I would have to pay for it myself. Can you help?"	If your health plan denies payment or coverage on a prescription medication, then request a copy of your health plan's formulary. A formulary is the list of the medications covered by your health plan. If the medication is listed, then the medication should be covered. If the medication is not listed, then submit a letter of medical necessity and reasons why the medication should be included to the Medical Director of your health plan for consideration. In this case, Sporanox was included in the formulary and the health plan quickly approved the claim for payment.	Today
"Husband possibly switching jobs. I am 14 weeks pregnant. Will this be considered pre-existing or does it depend on the new plan? New insurance would not be effective for 90 days, during which time we would be on COBRA."	There are a few things you must verify. First, whether the new plan offers maternity coverage. Second, whether there is a pre-existing limitation or requirement to satisfy. And third, whether there is a waiting period until benefits, including maternity benefits, will be eligible for you to use. It appears that the third question may have been answered by your statement of "90 days". And, in the meantime, you have COBRA coverage so that your health insurance coverage does not lapse. But, the questions on whether there is a pre-existing limitation and whether the new plan has maternity benefits has not been answered. You need to find the answers to these additional questions, but if you don't want your employer or new health plan to know about your pregnancy, then ask anonymously or refer to the new plan's policy booklet to investigate on your own. Other issues: if you and your husband are moving from one group plan to another group plan, then HIPAA may come into effect, because it enables you to apply the time earned from your previous group plan towards satisfying the pre-existing requirements of the new health plan. If you find that the new plan has a pre-existing limitation then consider looking into HIPAA or continue with COBRA. For additional information see our articles on HIPAA and COBRA. Be prepared and know the benefits, eligibility and any limitations of the new health plan before making decisions on switching jobs. Also consider contacting your state insurance department for more details on laws applicable in your state. Your state's insurance department's website can be found here.	1 day ago
"My company changed insurance plans during the year. Am I required to fulfill the deductible twice?"	If you are under a group plan, then your new group plan should "carry-over" the amount of the deductible you fulfilled under your previous plan if there was no break in coverage. Please review your policy booklet or contact your new health plan and ask them about carrying over your deductible that was satisfied.	1 day ago
"What is guaranteed issue in regards to obtaining a health insurance plan?"	"Guaranteed-Issue Laws" mandate the offering of a health plan to any individual, regardless of their current health status. Not all states have this mandate. The law assists individuals in finding a health plan, but the law does not set the rate of the premium. Many residents in states that have mandated coverage experience a high premium because the state is requiring a health plan to accept all individuals, even those with high medical costs and treatment. This results in these high costs being shared among all state residents by paying a higher rate of premium for their health plan. To determine if your state offers "Guaranteed-Issue" health plans and to whom the law applies, please visit our website at http://www.healthsymphony.com/stateinsurancedepts.htm for a link to your State's Department of Insurance and ask for additional information.	1 day ago
I am looking for an insurance company's definition of "preventive medicine".	"Preventive medicine deals with the prevention of disease and the maintenance of good health practices. Preventive medicine includes activities, such as vaccination against those diseases for which causes are known, research into causes of disease, studies of environmental deterrents to health, and instruction in public health and hygiene."...thanks to infoplease.com	2 days ago
My wife is covered by my insurance and she also has insurance through the University which employs her. So, which insurance company should I submit claims for her? The insurance bought by her University is not as good as mine, it has a high deductible and pays less for out of network service? How can these two insurance coordinate?	Review both of your policy booklets and look for the area concerning "Coordination of Benefits". If both are group policies, then they may coordinate, such as having your wife use her policy initially, and then having those claims submitted to your insurance to cover the portions her initial plan did not cover, such as the deductibles and high coinsurance. If both plans were Individual plans, then they may not coordinate, and it may be possible to submit claims to both plans to pay for the entire expense of the medical care your wife received. However, all health plans are different and different states have different regulations. Please look at your policy booklets and review both of these plans' rules before making a decision on how to utilize them.	2 days ago
I believe I am pregnant and have no insurance. I cannot seem to find a company to cover me. Are their any insurance companies that cover pregnant women?	Unfortunately, due to pre-existing limitations by health plans, this is a tough task. You could however look for health insurance offered by trade unions, alumni programs, or other associations that have group health policies where pre-existing may not apply. Contact your local chamber of commerce also. Or, you could contact your State Department of Insurance to see if your state has any options for you and if your state mandates that health insurance coverage must be offered to an individual regardless of pre-existing.. A list of websites for Departments of Insurance can be found at http://www.healthsymphony.com/stateinsurancedepts.htm . You may also search for a local health insurance agent and ask them for any additional advice or suggestions. Good luck to you.	2 days ago
What is the controversy over prescription drug coverage for the elderly?	You have asked a good question. The controversy is money. Currently, Medicare does not offer prescription drug coverage to beneficiaries and the Drug Companies benefit because these individuals must pay full charge for the cost of the prescription. However, if Medicare would offer Prescription Coverage, then the drug companies would have to accept the payment that the government would set to pay for Prescriptions. This is essentially the problem, a reduction in revenues for pharmaceuticals. Drug Companies feel if their reimbursements are reduced, then they will have less money for Research and Development, but they don't mention that they are currently the top industry with the highest profits.	3 days ago
How are the country's elected officials proposing to solve the health problem?	It does not appear that they are focused on accomplishing very much due to the corporate interests involved. Health insurance companies are opposed to patients' rights and expanding patients' ability to sue or change profoundly the health insurance system, the drug companies are making too much money to allow Medicare to offer prescription drugs which means they would accept less money for their pharmaceuticals than what is currently paid for them, and American citizens are opposed to nationalizing the health insurance industry. With all of these factors against any significant change, the more definitive things that will happen will be, health care costs will rise, premiums will rise, pharmaceutical companies and health insurance companies will continue to keep their profits and less people will ultimately afford health insurance. Now with the focus on domestic terrorist attacks, the issue of the health care system will take a backseat for some time. The prospects don't look too good for the near future.	3 days ago