insurance question

[Guest guest]

,what I've seen happen is that if they know you have another policy, they will start pointing fingers at each other saying the other is responsible for the bills. Personally, I would wait until you're officially covered by your partner's insurance before terminating the one you already have.Happy New Year, .LarryOn Dec 29, 2009, at 12:18 PM, Barrow wrote:

Dear all,

I have an insurance question, one that I need to resolve quickly. Over the last few years my health insurance premiums have skyrocketed to the point that they are a serious burden. I'm not exactly sure that my "insurance" is more than a payment plan for meds.

I am eligible, and now subscribed, to my partner's insurance, starting January 1 via American Airlines. I could play safe, and make a final quarterly payment now on my confiscatory policy, and cancel it after the new policy is definitely in play......but I have no idea what happens with duplicate coverages, etc.

Any thoughts?

Thanks

JB

[Guest guest]

" It depends " .

Probably one or both policies are covered under " Coordination of Benefits " .

Those rules state the order of priority of which policy pays first, and which

policy is secondary. It's perfectly OK to have 2 policies in effect, but it's

not OK to try to get both of them to pay for the ENTIRE CHARGE on the same claim

without the other policy knowing about it. The idea with C.O.B. is that the

primary policy pays first, then the secondary policy (possibly) covers some or

all of what the primary policy didn't pay.

NOTE--It is not necessarily true that C.O.B. will result in 100% of the charges

being paid. For example, say your primary policy covers pay 80% on a procedure,

and the secondary policy would pay 90%. Submitting the unpaid charges to the

secondary policy will probably result in paying only the additional 10% they

would have paid. BUT, if you're keeping both policies, you should always submit

the unpaid charges to the secondary carrier, because even if they don't pay

anything at all it, they may apply the entire charges to your deductible (if you

have one).

YOU HAVE TO CHECK THE COORDINATION OF BENEFITS RULES IN YOUR POLICY BOOK(s) for

specifics on your policies...so this is general information--However, usually it

says the primary is the policy in effect the longest. BUT, if one is " retiree "

coverage and another is from an active employer, the active employer coverage

pays first. The C.O.B. section will have very specific rules on it,and they'll

be spelled out.

If your coverage on the A.A. policy begins on Jan 1st and it's generally good

coverage (I suspect it's very good), I wouldn't pay one more payment (for 2010)

on your old insurance, unless it's to cover claims for the end of 2009.

>

> Dear all,

>

> I have an insurance question, one that I need to resolve quickly. Over the

last few years my health insurance premiums have skyrocketed to the point that

they are a serious burden. I'm not exactly sure that my " insurance " is more

than a payment plan for meds.

>

> I am eligible, and now subscribed, to my partner's insurance, starting January

1 via American Airlines. I could play safe, and make a final quarterly

payment now on my confiscatory policy, and cancel it after the new policy is

definitely in play......but I have no idea what happens with duplicate

coverages, etc.

>

> Any thoughts?

>

> Thanks

>

> JB

>

[Guest guest]

The pointing of fingers only happens because people don't understand their

responsibilities under Coordination of Benefits, and they haven't notified both

carriers that there's another policy. You must tell both carriers about the

existence of the other. Specific Coordination of Benefits rules will help both

carriers spell out who becomes primary and who is secondary. Those rules

prevent finger-pointing or denying of coverage. But if you don't tell them

both, you will run the risk of having them BOTH deny coverage, because in the

absence of info telling them the contrary, each will assume the other to be

Primary. And they will probably think you're trying to pull one over on them

and get double paid, which does not happen under C.O.B. (usually).

And simply paying for the old policy for another month or another quarter will

not clear up that mess-- I.E. somebody still has to be Primary and somebody

Secondary at the same time. In fact, doing that may make it worse, because

you'd probably still be treating them both as Primary at the same time, and you

can't do that. And they might both deny your claim.

>

> > Dear all,

> >

> > I have an insurance question, one that I need to resolve quickly. Over the

last few years my health insurance premiums have skyrocketed to the point that

they are a serious burden. I'm not exactly sure that my " insurance " is more than

a payment plan for meds.

> >

> > I am eligible, and now subscribed, to my partner's insurance, starting

January 1 via American Airlines. I could play safe, and make a final quarterly

payment now on my confiscatory policy, and cancel it after the new policy is

definitely in play......but I have no idea what happens with duplicate

coverages, etc.

> >

> > Any thoughts?

> >

> > Thanks

> >

> > JB

> >

>

[Guest guest]

I have Blue Cross Blue Shield of ND, so it isn't the same as your provider.  But

since we are administrators of our health insurance (we renogiate our contracts

with this provider every two years, there are a few things to watch out for:

Since insurance cost is on the rise, employers are changing their policies (what

their insurance will cover) to reduce their cost.  However, with that said, if

there is a provision in your policy that covers any type of implant (pace

makers, prothesis, hip replacements, knee replacements, etc.), there should be,

if cochlear implants is not stated specifically (as is isn't in my insurance

policy), by inference that the prothesis is needed to improve quality of life,

therefore it should be covered by insurance.  I'm probably not wording this

correctly, but I don't have the time to look this up.  I would scour your policy

to look for anything that refers to implants, and see just what is covered under

your policy. 

Secondly, from my own experience, dealing with our member services at our

insurance company, not all of the insurance staff who handle phone calls from

members regarding what is covered under your policy, or why your Explanation of

Benefits shows denial of a service, or those staff who process the insurance

claims, understands that cochlear implants are not the same as hearing

aids.  Therefore, while batteries for hearing aids (and hearing aids) are not

covered by insurance, batteries to operate your cochlear implants should be

covered, because without that power, your implant is inoperable.  The same can

be said for a pacemaker.  If the battery goes dead on that, well, the pacemaker

does you no good.  So, I've had to explain this to my insurance, and upon review

of my claim denial they reversed their decision once they understood what the

batteries were for.

So, either your insurance company has new people who are processing your claims

and isn't fully knowledgeable about your implants, or, your employer changed the

level of coverage on your insurance policy to save money, and thus these items

are no longer covered.  But, I wouldn't take it at face value.  I would appeal,

and appeal and appeal until you've exhausted all resources.

Best of luck!  I would be interested in learning the outcome, if you don't mind

sharing.

________________________________

From: Lottiebond <lottiebond@...>

undisclosed-recipients@...

Sent: Wed, March 10, 2010 5:21:15 PM

Subject: Insurance Question

Hi,

I would like to ask the group if anyone has The Bledsoe Health Trust (Blue

Cross/ Blue Shield)?

I have had this insurance for over 32 years and all of a sudden I am told

they do not over batteries or Cochlear accessories. Does anyone have the

plan and still receiving payments for any of this?

Please send reply so I can check into more info on it.

Loretta Hoopes

Totally Deaf 3/14/1984

Cochlear Implant Nov. 2002

Received processor 12/2002

[Guest guest]

Hi everyone,

My daughter gets her helmet tomorrow. Our insurance company denied our claim,

stating the helmet is under their " exclusion policy " . We had to pay for it

ourselves ($3500!). I was wondering if anyone else had their claim denied and if

anyone appealed the claim and won. We are definitely going to appeal.

Thanks!

Cori

[Guest guest]

First, read the insurance advice in the Files section of this site. Also, make

sure to get a copy of the exclusion and read it for yourself. You want to be

sure you were given correct information. Exclusions can be tough to fight, but

it can be done. You basically have two options. 1. Get the exclusion removed

from the policy through your employer. This involves complaining to your (or

whoever carries the insurance's) human resources about the exclusion and asking

that they have the insurer change the policy to remove the exclusion. I've heard

that this has worked for some people. OR 2. Appeal on grounds that the exclusion

is illegal. For this, you need to find out what laws govern your insurance

policy. Many are governed by the state they are sold in, but that's not always

the case. Ask your insurance company. Then look up the laws and try to find

something about disallowing exclusions for birth defects, congenital deformity,

craniofacial deformity, etc. Most states have some law along this line. Site the

law in the appeal letter. Don't give up! Remember, you may be making it easier

for someone else down the line to get proper coverage. Let me know if I can do

anything else to help.

>

> Hi everyone,

> My daughter gets her helmet tomorrow. Our insurance company denied our claim,

stating the helmet is under their " exclusion policy " . We had to pay for it

ourselves ($3500!). I was wondering if anyone else had their claim denied and if

anyone appealed the claim and won. We are definitely going to appeal.

> Thanks!

> Cori

>

[Guest guest]

We were denied as it was deemed "cosmetic". We did get a discount for not using insurance. Could you call the place and ask for a deal since you are paying upfront cash? We got 700$ off.kim

>

> Hi everyone,

> My daughter gets her helmet tomorrow. Our insurance company denied our claim, stating the helmet is under their "exclusion policy". We had to pay for it ourselves ($3500!). I was wondering if anyone else had their claim denied and if anyone appealed the claim and won. We are definitely going to appeal.

> Thanks!

> Cori

>

[Guest guest]

My son has BCBS and Virginia Medicaid. THis works well in-state, because

most of the time, Medicaid will cover our copays. We had to go

out-of-state (to Atlanta) for testing last year, and the Medicaid didn't

cover any of it. If you are going to a " border " city, the hospital may

take your out-of-state Medicaid benefits, but you would have to actually

ask the providers if they will take it. Sorry...

Mindy, mom to , 9, CVID+

> I have a random insurance question...andra (CVID, FG Syndrome) is

> under

> my husband's health insurance plan, since she is also a Regional client

> she

> qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any

> of

> you have both private insurance and state insurance. I am wondering if

> Medi-Cal would be more willing to finance referrals " outside of the

> system " ....I have no idea about any of this but we are desperately trying

> to get a referral to Cincinnati Children's. This has been dragging on

> for

> well over a year (maybe longer....I've lost track) now and we really

> cannot

> afford to finance the visit ourselves. Just wonder if anyone else has had

> experience with this.

>

> Thanks,

>

> Jeane

> Mom to andra 15

>

>

>