 Should I report a preexisting condition to my health insurance company? |
| I was under my father's military health care until the age of 23. Knowing this, I sought out and purchased individual health insurance through a writing agent that filled out the necessary ... |
|
 What's the best place to purchase both auto and home insurance from? |
| I'm buying a new home and changing my auto insurance carrier, what insurance company can offer me the best deal when it comes to providing both home and auto insurance in a combo package?... |
|
 Should Insurance cover water heater damaged due to failed pressure reulator? |
The pressure regulator on my home's incoming water line failed, leading to community's incoming 160PSI pressure (rather than the regulators 60-70) bursting my hot water heater.
My ... |
|
 Family travel insurance? |
Im going to Egypt in june with my husband and two sons,We need to get travel insurance but when i get quotes on line the prices vary from 15 pounds to 100 or more.
Any one recommend where i can ... |
|
 Is anyone else experiencing this homeowner's insurance problem? |
| Our homeowners insurance doubled this year. The cost is really impacting our ability to pay the premium. Every company we have talked to insist that we insure to replacement cost which of course ... |
|
 Allience what does it mean ? |
| allience what does it mean exactly ? is that means cooperation as well ?... |
|
 Flood insurance? |
| I called GEICO, they told me that flood insurance is only available through FEMA ($180/yr - everybody pays the same). A "flood event" is defined as water that covers two acres; water that ... |
|
 If you pay cash for a car does the dealership still have to offer gap insurance? |
| I bought a van and paid with a check from another finacing company the deajership did not offer us gap insurance and they are saying that they did not have too because we basicaly paid cash which we ... |
|
 Can i use my car that i own to lease out to a company to make money? |
Additional Details
I have a car that I own and i dont need it because i own 2 other ones. Can i lease out my car to a company or have a company use my car and pay me for them using it ... |
|
 Term Insurance...help!? |
| Hey so I'm recently married and want to buy some level term insurance but am not sure which is a good company to buy from. Anyone have any suggestions as to where to buy this stuff and how much ... |
|
 Medicaid Question...? |
Okay I need someone who REALLY knows that they're talking about. Seriously.
Okay I am 3 months pregnant and going to apply for medicaid this wednesday (December 10th)...I am ... |
|
 Will homeowners insurance cover needed decking once roofing underway? |
| I am in the process of having roof replaced after hail damage. My insurance company (Travelers) adjustor had given me the verbal go ahead to do roof based on the estimate that we received. We have ... |
|
 Anyone ever heard of insurance paying your hospital MORE than what was billed? |
Our insurance company paid $500.00 dollars more than the actual bill plus they want us to pay a 20% copay! Anyone been through this before!!!!!!
Additional Details
I need to add to this ... |
|
 How important is insurance to you? |
| Insurance companies sell them in many different forms. Life , Critical illness, Pet etc... We never used to have so much insurance in good old days but nowawadays we seem to have an insurance ... |
|
 My husband lost his job and we have been out of medical insurance for 8 months now. My son is sick and in the |
| E.R. right now with health complications and we are running lots of medical bills. Do you know if it is possible, since it has been under a year without insurance, if we can file for Cobra coverage ... |
|
 Would I win if I sued this insurance company? |
| About 3 months ago I filled out a life insurance application, took the physical etc. The policy was for My wife, my child and I. My wife and I are both 21 years old with no medical problems etc. The ... |
|
 Universal life insurance a good idea for dev. disabled heir? |
| I have a developmentally disabled daughter. I would like to be sure leave her money when I do die. I have a 30 year term life insurance, I'm 35 now. I'm afraid that when I'm 65, I ... |
|
 Where can I get a good life insurance policy for my father? |
| He is already 63 years old, a smoker, and not so great health. I don't want a million dollar policy just enough to cover a funeral and his last debts as I will be the one to take care of this. A... |
|
|  |
fredo | Dad's insurance won't pay for needed treatment...? |
I'll make this as brief as possible...my father has a blood condition; he is missing a chemical in his blood that is essential for his immune system. He receives shots or "infusions" once a month, this has increased in frequency since he was diagnosed well over 20 years ago.
The problem is, his insurance company will not approve/pay for the treatments any more than once per month. They are very expensive. His condition has advanced to the point where he NEEDS the infusions every 3 weeks, or he starts getting very sick and can't fight off any infections. He was recently hospitalized as a result of one of these episodes. His doctors (three of them) agree that he needs the treatment once every 3 weeks. I am a graduating law student taking the bar exam in July. What can I do/what is the best method for ensuring he can get the treatment he needs? He is in California, where I will be also, he has good insurance, is 68 and otherwise in good health. ANY advice is greatly appreciated.
Additional Details
Thanks for all answers so far...some extra info. ship: He cannot do them himself because the supply of the chemical he's injected with is very limited and, I believe, restricted to health care providers. It's literally billed at over $10,000 per dose and even if it were available, it would be financially difficult for him to get them.
bud: he is retiring at the end of this year and will be enrolled in Medicare but is on another insurance policy through my mom's work. |
 |
 
stephenweinstein
 |
If his policy specifies that infusion is only covered for 1 treatment per week (or 12 per year), then he must either (a) pay for 5 treatments per year and have the insurance pay for the other 12, or (b) find other insurance.
If the policy does not explicitly limit the number of treatments that are covered, but the insurance company is claiming that the treatments are not medically necessary, then take these steps (in this order):
1. The insurance company's appeal process
2. The IMR (Independent medical review) process
3. Involve the state government
4. Binding arbitration
Most health insurance policies in CA now require binding arbitration rather than suing. Even if the policy does not specify, arbitration is less expensive than a lawsuit (except in small claims court), especially when either party is an insurance company. |
|
Phil
|
Without a policy to review, it is impossible to give an exact answer.
That said, in general, most policies will provide an appeal clause. If the previous dosage use to be enough, but his condition has worsened, the company needs to understand that this is now a medical necessity. File an appeal using his doctor's report that the dosage needs to be increased.
The appeal might fail. Regardless of whether it is necessary or not, the company will only pay for what is covered under the policy conditions.
Good luck. |
|
s351chic
|
See if you can appeal to have them paid as a medical necessity. Have you checked to see if Medicare will pay for this as often as he needs? Is he currently only under your moms policy or does he have his own as well?
If the poilcy is an ASO (meaning if the policy is thru a large company like verizon, target etc) Then the employer actually pays their own claims and therefore make their own rules and the insurance company simply administers the policy and pays the claims using the employers own money. If its a group like this you may be able to appeal directly thru HR.
(Did you hear about the brain damaged lady recently that walmart was suing for like $400k? Its because they are an ASO and technically paid it themselves.. and in the end it was their decision to let her keep the money).
For an appeal there is a process that needs to be followed. You appeal to the insurance with all the info you have. It may take a few steps to get to the top of the food chain there; then you can request it be sent to an independent review board. If they deny it too, then you can appeal to the DOI (Dept of Ins) in your state but you have to do the legwork first, you cant just go right to the State.
Also, see if the shot itself can be paid for under his drug plan and not major medical. Then you'd only have to pay for the actually admin of the shot thru the medical coverage. |
|
bud68
 |
If he is 68, he should be enrolled in Medicare. What are the coverage options there? |
|
ebmid2
 |
I'd talk to a lawyer. |
|
mbrcatz
|
OK, you've left out the most important part - WHY is the insurance company refusing the additional treatments? They have to give a reason when they deny coverage.
If the reason complies with the policy terms and conditions, there's not much you can do. If it doesn't, you need to appeal. Even if it does, I'd appeal, or else you'll be paying out of pocket. The way I see it, it's not EVERY treatmetn they're denying, right? Only the ones that come more often than once every 30 days.
Anyway. You can also complain to your state insurance commissioner. Keep a couple things in mind: appeal requests and complaints MUST be in writing. Obviously, keep a copy of the appeal request and complaint. AND, an insurance policy is a CONTRACT. You're only going to win the appeal/complaint, if they are in violation of your CONTRACT. The contract has terms and conditions and LIMITATIONS. I've never seen an insurance policy that "covers anything they need, no matter what". Ever.
As an aspiring lawyer, you can probably appreciate what that means. |
|
shiprepairwoman
|
Can he do his own infusions? That might be cheaper than going in to have them done.
My cousins get infusions at home for hemophilia because they may not have time to make it to the hospital. |
|
| |
|
| | |
| Questions List |
Answers | Last Post
| | | |
5 | 13 minutes(s) ago
| | | |
6 | 32 minutes(s) ago
| | | |
7 | 49 minutes(s) ago
| | | |
7 | 2 hour(s) ago
| | | |
7 | 7 hour(s) ago
| | | |
7 | 9 hour(s) ago
| | | |
7 | 1 day(s) ago
| | | |
7 | 5 day(s) ago
| | | |
7 | 2 week(s) ago
| | | |
7 | 2 month(s) ago
| |
|
Homepage 
Financial
Forum 
Insurance 
No Spam
Adult 
Gambling
Unfinished
Deception
Plagiarism
Not English
