Archive for the ‘Health Insurance’ category

Cosmetic Reconstructive Surgery – When Will Your Health Insurance Cover You?

December 14th, 2010
J. Stewart asked:




Improving the facial structure or other parts of the body as an enhancement is not generally considered cosmetic reconstructive surgery. This typically falls into the elective surgery category. This article will discuss reconstructive surgery and the reasons it is performed. The basis for this surgery involves abnormal development, congenital defects, tumors, disease, infections and trauma.

By its very name, cosmetic reconstructive surgery denotes the fact that it is necessary to improve the quality of the patient’s life. It can improve function and in severe cases give the patient a more normal appearance. Because this surgery is not always done for beauty’s sake, it may be covered by health insurance companies. However, because insurance water’s can be murky, not every procedure will be covered as they can vary from company to company.

One area that could be considered primarily a cosmetic only procedure would be eyelid surgery. However, if the patient’s eyelids are drooping so badly that they cannot see properly it may be looked at in a different light. This procedure could indeed become cosmetic reconstructive surgery because the vision is impaired. A patient’s insurance company could decide that this surgery falls under the correct category and handle the costs.

Cosmetic reconstruction surgery on the hand would be another area that is necessary for functioning in life. If through an injury or automobile accident a patient has broken bones in the wrist then hand surgery may be the only option for that patient to lead a normal life. Nerve compression, Dupuytren’s disease or carpal tunnel syndrome are all valid procedures to improve the quality of life and thus would be considered cosmetic reconstruction surgery.

Breast cancer that results in a mastectomy causes a deformity that cosmetic reconstructive surgery could help produce a normal appearance for. The surgeon can use the tissues from the patient, and use implants or other prosthetics to achieve the shape, size and appearance of the breast. All of the aforementioned surgeries could be considered cosmetic reconstruction surgery as they help the patient lead a better life because they have functioning limbs and a normal appearance.

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What to Do if You Don’t Have Health Insurance – You Might Not Beat the Odds

December 13th, 2010
Jennie Heckel asked:




Have you been working hard and paying your bills on time your whole life? Saving your money and trying to get ahead, looking forward to retiring some day? You read in the paper and hear on the news about so many people that are uninsured. Uninsured, and don’t have health insurance because they can’t afford it. Are you one of the uninsured people like I am? Are you worried about having a health care emergency and not knowing how you would pay your medical bills? You know you really can’t switch jobs. You feel you’re getting too old or under skilled to be hired by anyone else. You might even be self-employed too. You know you can’t or don’t want to learn a new skill to get a new job at a bigger company that has group health insurance. Your present employer really can’t afford health insurance for his employees and you don’t see that changing where you work.

You have gotten by this long without health insurance and you know that you should do something about it. But health insurance is expensive and getting health insurance is a good idea and something you have always been planning to do. But, we just keep putting it off, until it is too late. So what is a man with a family, or a single person do if you barely can find the money to pay for the necessities, like the rent, or a mortgage, the higher price of gas and food, much less expensive health insurance?

Do you think you can beat the odds? For men it is one in three, for women one in five that you will have a major health care emergency hospitalization and incur medical bills for surgery, hospital stay, outpatient medical care, therapy and prescription drugs. Do you worry and lay awake at night, wondering how you would pay for emergency care, if you needed it?

Ever wonder what you will do if the worst happens and you had to go to the hospital without health insurance? In a word. Bankruptcy. The retirement you worked your whole life for and dreamed about… the retirement you always envisioned is gone…taken away from you in an instant. And by a calamity you have tried to avoid. A calamity that broad sided you, and you had no warning and you never knew what hit you.

Imagine this scenario. You are 55, been in great shape your whole life, you work hard and live right, don’t smoke, eat healthy foods, watch your weight and have been taking care of yourself the best way you know how. But lately you have been getting a little short of breath. You shake your head and say “it’s just getting old” and keep right on working on the house, the car, the lawn, the crops or a new project you just have to get done. While working, all of a sudden you feel really short of breath. You stop, sit down and can’t breathe. You look down and your arm is feeling funny and tingly. All of a sudden you feel a shooting pain running up your arm into your shoulder, “ah…just overdoing it again” you say to yourself. I’ll just rest a spell and it will go away. But this time the pain does not go away like other times. You feel the numbness and worse, a stabbing pain goes into your shoulder. Quickly the pain intensifies and travels deeper and is shooting across your chest, a crushing pain and now you are really scared. “Wonder if this is a heart attack?” You know you waited too long and it’s too late…This time it’s for real. You are in the middle of a heart attack.

You are desperate and in stabbing pain. You know calling 911 might save you…if you can get to a phone. You call for your wife and she is inside the house and does not hear you. You try to get up and feel faint and you have no strength and your legs just can’t move. You holler louder, it hurts so bad and she hears you this time. She rushes to your side and you are so short of breath you can’t talk, the pain is too great. You point to your chest and she can see by the look on your face you are suffering and in great pain and something is terribly wrong. She runs to call 911, frantic about you and tells the ambulance to come right away and she thinks you are having a heart attack. She runs back to your side and you both are terribly scared and all you can do is wait.

The bad news has just begun…When the ambulance arrives, you find out the very worst has happened. You really are having a heart attack…they rush you away to the hospital, taking your vitals and giving you the drugs to save your life. Expensive surgery follows with angioplasty to open up your blocked arteries in your heart, and you get a stint to keep the worst blocked artery open. The doctors say that you should make a good recovery with adequate care, rest and therapy. You will have to take heart medications and high blood pressure drugs the rest of your life. Already the worry has started, and you think to yourself. “how am I going to pay for this”? The deep financial worry never leaves you. You have heard stories of financial disasters happening to good people with no insurance, Tragic consequences happening to people getting hit with huge medical bills for surgeries in the tens of thousands of dollars. You lost…you did not beat the odds.

Now what can you do? Your retirement dream is gone, now you will have to work the rest of your life to pay your medical bills off. The story, I shared is real, this medical tragedy happened to my brother, a farmer, a hard worker, a self-employed bulldozer operator in the prime of his life. No health insurance and he now faces a $45,000 medical bill he can’t pay. Not unless he wants to sell the beautiful log cabin home he built with his own hands and the farm he worked his whole life for. He is worried sick and tied to heart drugs for the rest of his life. Heart drugs and a stint that make him feel even more sick. He has decided to sell part of his land to pay the hospital and clinic bills. He hates to do this, but has no choice.

He tried to pay the hospital and clinic with agreed upon payments of a $1,000 a month each, paying every penny he could, but that was not fast enough or good enough. The hospital and the clinic still turned his account over to the collection agencies even though he was paying over $2,000.00 a month. He is an honest man who worked hard his whole life and did not deserve this. He can barely afford the heart drugs and makes just enough money so he does not qualify for state-assisted health care or prescription drug benefits.

One more thing is important…That is not the only calamity. He is not eligible for any type of health insurance for his heart, even if he could afford to pay $850.00 a month for health insurance coverage, plus his monthly medical bill payment to the collection agency. Why? Because now, he is uninsurable. In order to be covered under health insurance for his heart, he would have to not have any hospital care or treatment related to his pre-existing condition for seven years to quality for having that heart condition covered under any health insurance policy. For my brother, he will have to work harder than ever to pay this debt off, just when he should be taking it easier and not working so hard to prevent yet another heart attack. There will be no retirement for him, he is 59 and that is a terribly hard price to pay.

What does this mean for you? Don’t wait, don’t let a major health problem ruin your chances of retirement. Health care coverage can be purchased and can be budgeted for. If my brother knew what was going to happen, he would have budgeted the money for a health insurance policy. He could have spared a couple thousand a year for an inexpensive health care policy with a high deductible. This would have cut the medical bills he received by a significant amount, and he still would have health insurance to cover him in the future. When you’re lying in bed at night, think of the people you know that have had their lives turned up side down by a health calamity, lost their jobs, their homes, all their savings and their cherished retirement. This is too big a price to pay. Take care of yourself, and your family. Protect your retirement dream. Getting an online insurance quote, is easy, and safe and can help you take a step in the right direction. Help remove most of the worry, about “what if a medical emergency occurred to you or a loved one”. Would you be covered? Let’s hope the answer is “Yes.”

When I got laid off from a great job due to a large corporate company downsizing, at the age of 50, I lost my group health insurance. I went on the Internet and found the online insurance quote websites a real help. The easy to fill in forms “just fill in your zip code” got me started with my online quote. The websites were easy to use, and I enjoyed getting free insurance quotes. The websites connected me with top insurance agents who helped me figure out how to compare the quotes. The agents were friendly, easy to talk to, and I got a policy to protect me at a cost I could afford. Please click on the link above and get some health insurance that will protect you and your loved ones. Just knowing something really can happen and taking the right steps to protect yourself can help remove some of the worry. Don’t try to beat the odds, you may not win. Don’t let a small financial burden become an impossible one. Do it for yourself, do it now before it is too late.

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Is Cosmetic Surgery Covered By Health Insurance?

December 10th, 2010
Jason Perry asked:




Insurance Companies and What is Covered

Health insurance policies can vary on what is considered a covered medical procedure. Most insurance companies follow the definitions given by the AMA (American Medical Association) and the ASPS (American Society of Plastic Surgeons) which state that there are two types of surgery when discussing plastic surgery – reconstructive and cosmetic surgery. Luckily, there are guidelines insurance companies must follow when it comes to defining what is considered reconstructive and what is considered cosmetic.

Reconstructive Surgery

Reconstructive surgery refers to surgery performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. These typically include;



Abdominal Surgery: If performed to improve or eliminate health problems such as back pain, sores, hernia, rashes, or to help improve your ability to walk normally.

Breast Surgery: If performed to correct asymmetry, reduce large breasts causing health problems, reconstruction due to loss, congenital absence (born with only one breast), or to reduce large male breasts.

Ear Surgery: If performed to correct deformed ears by birth, disease, or injury.

Eyelid Surgery: If performed to correct drooping eyelids that are causing vision problems or correct eyelids that are turned in an abnormal way.

Facial Surgery: If performed to balance the appearance if caused by paralysis, or to treat deformities in the facial muscles, head, or neck.

Hand Surgery: If performed to treat carpal tunnel syndrome, Dupuytren’s contracture, nerve injuries, tendon injuries, fused fingers, or other deformities.

Nasal Surgery: If performed to correct deformities resulting from birth, disease, or problems with breathing.



Cosmetic Surgery

Cosmetic surgery is the reshaping of normal structures on the body to improve the self-esteem or appearance of a patient. These typically include physical improvements that are not medically necessary. Such as breast enlargement procedures, nose jobs (rhinoplasty), face lifts, hair transplants or laser hair removal, elimination of spider veins other such ‘appearance’ type medical procedures.

Researching Your Procedure

Read your health insurance plan booklet. You will likely find quick answers about surgeries covered, the appeals process and your expected deductible for the procedure.

Every health insurance company has a list of pre-approved medical procedures. So the direct method of contacting your health insurance provider will save you a lot of time when finding out if the exact procedure you need to have, or would like to have, is covered. Ask about exceptions, rule changes or special considerations. If possible, ask them to mail or fax you an approval letter or document outlining the coverage of the procedure you are asking about.

When speaking with your health insurance PPO or HMO provider, make sure you understand all details. Some insurance companies may cover the initial operation, but not the “post-op” complications or touch-ups. Some may not cover the surgery but will protect you in case of problems later on. Some may just cover prescriptions and short-term disability.

Before any type of surgery, discuss the procedure with your doctor and insurance carrier to determine what coverage, if any, you can expect.

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Health Insurance; COBRA; OBRA; HIPAA; Medicare; Definitions, Relationships

December 7th, 2010
Carolyn Magura asked:




Health Insurance; COBRA; OBRA; HIPAA; Medicare. If asked, could you state that you knew that all 5 of these topics had the same thing in common: medical insurance coverage for you and, perhaps, your family? Would you know the qualifications for each? Well, in this article, we will discuss them. For a timeline that depicts, graphically, the time relationship between them, please see the timeline in http://www.disabilitykey.com.

HEALTH INSURANCE Coverage from Work

If we are lucky, we, and/or our spouse, work for a company that provides, as a benefit, health insurance coverage for us and our family. If so, we are very lucky. Even if that is true, there are some key things that you might want to look at to see if you have ENOUGH coverage.

1) From your Human Resources Department (or wherever else you would go to get information about your health insurance) get what is called a “Summary Plan Description” (SPD). This document should be kept where you can always find it, as it contains all the information you will need about what your insurance covers and what it doesn’t.

2) Look up “Coverage” and “non-coverage” in your SPD.

These will tell you what your plan covers and doesn’t cover. You need to see if, perhaps, you or one of the covered members of your family has a condition or circumstance that might not be covered, where you need additional coverage. For example, let’s say that your family has a history of cancer; perhaps your plan restricts the number of hospitalization days for care; or, restricts the days per condition. In this case, (like my children) you might want to get additional “cancer insurance” (I think that AFLAC might provide this type of coverage).

It would be a good idea to contact a Health Insurance benefit Broker and ask him/her to read your SPD and see if you have any gaps in coverage. They then can help you supplement coverage BEFORE YOU NEED IT!

NO HEALTH INSURANCE COVERAGE

You might be one of the growing members of our society that, through one circumstance or another, does NOT have health insurance coverage for your family. In this case, I strongly encourage you to contact a Health Insurance Broker and get immediate coverage of what is called “catestrophic” (not sure if I spelled this correctly) coverage. In this type of coverage, you will generally have large deductibles, but will have coverage if, say, one of you has to go into the hospital.

CONTACTING A BENEFITS INSURANCE BROKER

Whenever you call or email a Health Insurance Broker, it is very important to prepare ahead of time. WHAT, specifically are you looking for; how much can you afford to pay every month; what circumstances do you want to make sure that your family is covered for. In this way, you can make sure to focus on your critical needs.

COBRA

COBRA is an acronym ( how can I spell acronym correctly, yet not be sure that I spelled catestrophic correctly?) that stands for: Consolidated Omnibus Budget Reconciliation Act. Basically, it is a federal law that allows you to pay for your Company-paid health insurance, as an active member, if you no longer work for that company for, generally 18 additional months.

1) COBRA is “triggered” (that is, you, or a covered member of your family, become eligible for COBRA) by events such as the following: resignation from the company; termination (FOR ANY REASON) from the company; divorce of a spouse; a covered chile’s birthday makes them ineligible for coverage. These are the main “triggering” events for COBRA.

2) Now, when eligible for COBRA, you will be asked to pay for 100% to 105% of the company’s employee/employee and family coverage amount. You should get a letter from your company explaining what that amount will be. BEFORE YOU DECIDE TO TAKE COBRA, there are some important things for you to consider.

What will be your cost, and what will be the coverage for that cost?
Sometimes the cost is too much for the coverage. In these cases, you might want to select HIPAA coverage, instead (see HIPAA below).

Or, you might just want to get catestrophic coverage as was mentioned earlier, and wait for full coverage under your next job.

Part of this decision should be whether or not you or a member of your family has what is called a “pre-exisitng coverage” condition.

Here again, before automatically taking COBRA, it would be wise to contact a Benefits Insurance Broker and give him/her all of your options, and get their input. I have worked extensively with a Benefits Insurance Broker, and he is absolutely fantastic!

OBRA

What, you ask, is OBRA? I’ve never heard of it, you say, and no one I know has heard of it either! Well, that’s because, 99% of Human Resource or Benefit folks that I know have never heard of it! OBRA is a federal law that was passed that extends COBRA for an additional 11 months FOR DISABILITY PURPOSES ONLY!! Why, you ask, is this important? Thanks for asking, let’s see if I can explain.

If you are as nieve (did I spell this wrong too? sorry!) as I was when I first started looking to bridge my health insurance from working to Medicare, I assumed that when I got through all of the hoops to qualify for SSDI (Social Security Disabililty Insurance) I’d IMMEDIATELY be eligible for Medicare, RIGHT??? WRONG!!!!

When you FINALLY qualify for SSDI, you have to wait for 5 months before you get your first check. AND, the rules state that, you are eligible for Medicare 2 years (24 months) FROM THE DATE OF YOUR FIRST SSDI PAYMENT. Well, if you add 24 + 5 you get, 29 months between qualifying for SSDI, and Medicare coverage.

OK, I said earlier that COBRA is for 18 months of coverage. Well guess what 18 months of COBRA + 11 months of OBRA equal – 29 months!

BUT, there are two catches to OBRA; first of all, you have a small window of 30 – 60 days to apply ( this window opens the date of your SSDI approval); and, it can cost up to 150% of your plan coverage amount. BUT, if you have a “previously existing condition” this might be the best way for you to proceed.

Again, it is important to contact a Health Insurance Broker to help you with the risk/cost ratio of all of these situations.

It is also improtant to know all of these deadlines as you plan to ensure that you and your family have important health insurance coverage.

HIPAA

HIPAA is a federal law that is called, briefly, the “portability” law for health insurance. What that means is that when you leave a group (read company-paid plan), the carrier that provided that plan, must offer to you, another plan, different from COBRA, when you leave the group coverage. Generally this will be what is called a “bare bones” plan. Again, the best thing for you to do is to call/email a Health Insurance/Benefits Broker with all of your information: SPD, COBRA info, HIPAA info, needs, cost limits, and let him/her help you find the optimum plan coverage for you.

MEDICARE

OK, now, finally, we’ve reached Medicare! BUT (you really didn’t think it would be that easy, did you?) if you have qualified for Medicare because of disability, there are RESTRICTIONS (of COURSE there are!).

First of all, if you are qualifying for Medicare because of disability, you are probably under the age of 65 – normal retirement age.

Medicare coverage does NOT cover prescription drugs, which, those of us with disabilities probably need, and which cost lots.

But, Congress prescribed that states (all but 11) offer what is called “Medicare supplement” plans, some of which do offer prescription coverages.
BUT, these plans ARE NOT REQUIRED TO, and do not, offer these medicare supplement plans that offer prescription coverages to folks who qualify under age 65! So, if you are qualifying because of disability, your medical insurance plan doesn’t cover one of your primary cost expenditures!

Here again is where you need to contact a health insurance/benefit broker. Again, he/she can work with you, and your specific circumstances, to get you the coverage you need.

Hope that this information was helpful to you. If you have any questions, please feel to ask them by commenting on this blog, and I’ll be happy to get you an answer.

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Surfing the Waves of Health Insurance in California

November 29th, 2010
Paul Stewart asked:




For people in California, health insurance is a constant topic of debate. Universal California health insurance programs have been introduced in the state legislature twice in the past three years. Unfortunately for California, health insurance legislation like this has not yet been passed. However, San Francisco has implemented a program for universal health insurance. California has one of the largest economies in the world, but the individual is still mostly responsible for acquiring California health insurance coverage. The Los Angeles Times reports that 7 million people in the state do not have health insurance. Californians are very concerned about California health insurance programs. Luckily, Business Health Insurance has information on the best health insurance California has to offer.

The good news is that there are many options available for health insurance. California boasts the fifth largest economy in the world and the California health insurance industry helped place the state in this position. Many providers first began providing health insurance in California before expanding to other states.

Because of this California health insurance programs are well developed. For example, in California, health insurance programs offered by Blue Cross Blue Shield are divided into two separate companies. Consumers can choose between Blue Cross of California health insurance and Blue Shield of California health insurance. California health insurance plans offered by these two companies differ considerably. Blue Cross of California health insurance is geared more toward customization, while Blue Shield of California health insurance offers a system of set plans with adjustable premiums and deductibles.

Following the latest trend in health insurance, California health insurance providers now offer Health Savings Accounts (HSA) to their customers. The benefit of HSAs is that, unlike their precursors for financing health insurance, California Flexible Spending Accounts (FSA), money deposited into an HSA is tax deductible and unused portions roll over to subsequent years.

When searching for health insurance, Californians also have an added benefit. Dental coverage is often covered by basic health insurance. California health insurance plans seem to be more inclusive other state’s plans. Finding good California health insurance coverage can be labor intensive because of the abundance of plans. Business Health insurance is dedicated to connecting you to the best health insurance in California.

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