Affordable Care Act

Got a call from a patient yesterday who had been dropped from his parents insurance policy because he was 25 years old.  I suggested he try and fight it because under the new health care laws (that went into effect March 2010) adult children can be covered through age 26.  His family did call and were told that they (the insurance carrier) had opted out of that provision for one year, something I was unaware of that was an option for insurance carriers to even do. So unfortunately for him he is going to have to find new insurance coverage.

http://www.healthcare.gov/law/provisions/youngadult/index.html?gclid=CI6tjKez-6UCFSVe7AodFD13ow#

There are a lot of new regulations on insurance carriers...see how they might effect your policy...

http://www.healthcare.gov/law/provisions/index.html

A Little Insurance Sarcasm

Yes patients really owe co pays at every visit...even for follow up visits. (I'm going to go out on a limb here and assume that unless you're a medical professional you don't know how to read your own MRI and that even if you had the written report from the radiologist it wouldn't mean much to you without your doctor explaining it to you...that's what the appointment is for, and that's what your copay pays for.)

No your old insurance carrier will not continue to pay for medical care on an injury that occurred while covered under that policy if your coverage termed during treatment (with the exception of COBRA coverage).  (This means if you schedule surgery it might be nice if you informed your surgeon's office of the change, rather than have them spend 30 minutes pre authorizing surgery with the insurance information they do have only to discover it isn't valid.)

Yes patients are responsible for providing accurate insurance information to their doctor's office.  While the billing and insurance staff are amazingly awesome people they are not capable of telepathy.  (See previous sarcastic comment...it applies here too.)

Yes patients are responsible for getting referrals from their PCP to a specialists office, not the other way around. (This can lead to angry phone calls from patients who got a huge doctor bill because their insurance carrier denied payment...not super fun.)

Yes doctor's offices really do need the policy holder's social security number in order to file the insurance claims, not just the last 4 digits. (The last 4 digits are worthless, you might as well draw a picture of <insert something you find funny here> because it would be just as useful.)

Yes it is the patients responsibility to provide correct mailing addresses for both the person who will get the bills and the person who carries the insurance policy, as mentioned previously billing and insurance staff are not telepathic. (Guessing usually leads to angry phone calls from divorced couples.)


Just Sayin'  :)



Questions? Comments?

deargabbyinsurance@yahoo.com

Referrals & PCP's

I prefer not to mention commercial insurance carriers by name, so it's going to make today's post a challenge.  Many insurance carriers require you to "declare" a primary care physician (PCP) and any time you need to be seen by a specialist you have to have your PCP refer you to the specialist.  That sounds simple enough, but it can get complicated really fast if you don't know your policy well, because as with any set of rules, there's always an exception to them.  Just because you have insurance coverage doesn't mean you can see any doctor you want either...well you can, but it will all go to your out of network benefits, and depending on what those are one trip to the doctor can become very costly. Another problem we run into is situations where a patient didn't realize that their insurance carrier required them to declare a PCP and then when they needed to see a specialist a referral couldn't be done.  



This picture has absolutely nothing to do with today's topic, it just made me laugh...

Questions? Comments?
deargabbyinsurance@yahoo.com