Are there dangers in cancelling health insurance?There can be potential serious adverse consequences associated with canceling health. If you cancel health insurance before replacement health insurance coverage is confirmed and already available, there may be a gap in your health insurance coverage.
First, there is no assurance that you will be able to obtain new health insurance. You might be denied coverage due to health conditions that developed prior to applying for the new insurance or plan, or go completely uncovered during the underwriting process. Second, even if you are accepted for subsequent health insurance coverage you could face a situation in which certain medical conditions that developed during the prior health insurance coverage are excluded from coverage under the new insurance as "preexisting conditions."
These problems may not exist if you are moving from one group insurance plan to another, as many group policies ignore pre-existing conditions if you move from a similar group health coverage within 30 days of prior coverage. A second exception will probably result in the same continuation of coverage mandated by HIPAA on and after January 1, 1998.
What will happen to our health insurance for my dependent children and I after the divorce from their father?
Your husband may keep the children on his policy. However, as you are no longer married you are no longer eligible for coverage on his policy. However most plans offer a conversion package to individual coverage under COBRA, a federal law. The cost of insurance is usually the responsibility of the separate parties after a divorce. However, coverage for the children may be available.
What are typical problems that arise in getting health care benefits provided or paid?
Coverage and benefit disputes in health care insurance and health care service plans that frequently arise include the following:
(1) The insurer or plan contends that care was not "medically necessary," which is often defined as care which is reasonably required according to accepted norms within the medical community.
(2) The insurer or plan contends that the charges were not "usual, customary and reasonable" for the services rendered.
(3) The insurer or plan contends that the treatment was "experimental" or "investigational," which generally means that the care has not been accepted in the medical community as normal treatment or treatment that has not been proven to be effective medically.
(4) The insurer or plan contends that medical care was received outside a specified geographical service area and was not emergency care.
(5) The insurer or plan contends, with respect to extended care especially, that the care constituted "custodial care" or "long-term rehabilitation" which are usually excluded from coverage. This issue often arises in the context of persons confined to skilled nursing facilities or persons requiring home health care.
(6) Coverage in a replacement policy that is substantially and impermissibly different (more limited) than that in a group policy it replaced.
(7) Substantial differences between descriptions or terms in the evidence of coverage (member handbook, disclosure form or summary) and the insurance policy or health plan contract in the circumstance where the denial of coverage or benefit is based on the evidence of coverage, not the contract.
(8) Substantial ambiguity in a particular term, definition, benefit or coverage description, exclusion or limitation, or an ambiguity created by an interplay between or among the different provisions.
(9) The insurer or plan attempts to effect a reduction in or elimination of a benefit or coverage contrary to a provision in the policy or plan, or without adequate notice.
(10) The insurer or plan seeks recession or cancellation of the policy or plan alleging that an insured or member had a preexisting condition not revealed in the application.
Check here for a helpful article on dealing with insurance companies when you have a high risk illness.
My father who has conjestive heart failure and type 2 diabetes recently underwent a quintuple heart bypass. His medical bills are staggering and he has no health insurance. Short of filing bankruptcy, what are his options in getting these amounts reduced?
You could offer to pay immediately at the same discounted level those bills would have been paid by a health insurer (Blue Cross and HMO have agreements with the hospital and medical/surgical providers to substantially discount bills). That's a very substantial discount from the full "list price".
If that offer is not accepted, when he is sued, he might be more successful by saying the discounted price is the "reasonable and customary" price, rather than the list price they are seeking to collect. This approach is based on the fact that the discounted rates are what they receive on the majority of payments. He could do extensive pre-trial discovery to make them disclose their actual reimbursement rates (they would likely settle rather than disclose).
This whole process could be handled far better with the help of an attorney. If you don't have the money and fear bankruptcy is his only recourse, see a bankruptcy lawyer soon as Congress is about to change the bankruptcy laws and make it very difficult to wipe out bills.
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