Saturday, August 27, 2011

Question about health insurance copayments?

My insurance company has raised my prescription copayments to approximately 80% of the total cost. I think that this is ridiculous. Especially since I used to pay much less in the recent past. I'd like to hear from people who are knowledgeable about prescriptions and insurance companies who may have suggestions as to how I can go about getting my copayment reduced, if that is possible. Polite, sincere, constructive, relevant answers only please.
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Is it private insurance or through an employer? If it is through an employer, I would speak to the Human Resource Dept or whichever department is in charge of health care benefits at your company. They would be able to offer you an explanation to the increase in copays as well as information on how you can go about changing it if it is possible. If it is a private insurance company, I would call the company directly and also ask for an explanation. They will also be able to tell you how to go about changing your policy to lower the copays. Is it Medicare Part D? If so, you can check http://www.medicare.gov which will help you find prescription drug coverage that will better meet your needs. You can also call 1-800-MEDICARE . Open enrollment ends soon, so you only have a few more weeks to switch your plan if you have Medicare Part D.
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Any luck with health insurance lead programs?

What has been the most successful lead programs you have used? I have tried web leads, but for the most part the companies do not tell them an agent will call until after they have put in all their information. This just makes the people mad! I have tried some direct mail, but not a lot. Any suggestions with either web leads or tangible leads?
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As with most insurance-related topics that "make people mad," it is the consuming public that is to blame. People have determined that the internet makes them all-powerful and privy to all of the information and understanding they need to make just about every life decision. The need for professional advice is apparently obsolete. The only way for the industry to combat the trend is lure the websurfing insurance prospect into the insidious agent-lead lair. If the general public would just concede that they haven't a clue about their insurance needs, or at least that there's a possibility that there's an expert who knows more than they do and is willing to benefit them with that expertise, there would be no need to play these stupid games. Sorry for the rant. In answer to your question, other than referrals (the best source), about the only reliable leads are direct mail systems that make it clear to the consumer that they are requesting contact with an agent.
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Am a student and need health insurance? Any suggestions?

Am a college student, no insurance. Want to get some insurance adn want to get something thing checked out like I get frequent headaches, and have dizziness, & need a physical. Any suggestions?
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health-quotes.talk4fun.net - my family have this health insurance. It is affordable and has good coverage for dental issues.
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does your health insurance go up when you get pregnant?

i'm 18 and under my parents insurance will the know by the insurance company if i see an OBGYN, even i f I pay the co-pays myself?
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health-quotes.talk4fun.net - try this one. My sister had no problem with her insurance coverage while being pregnant.
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What health insurance is better, Aetna or Bluecross Blueshield?

I have BCBS and thinking about switching to Aetna. Just want to know what is the best choice. Thanks!
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I'm an insider (supervisor at a big health ins co). Here's what most people don't know. The carrier has little to do with anything. Most accounts are ASO now (administrative services only). This means that your company has a bank account that claims are paid out of. They set the benefits, etc. Then they pay a company like one of the above (and no, I don't work for any of these) to process claims, provide customer service, contract providers, etc. The insurance company doesn't make decisions... they just implement the rules specified by the company who has contracted them. Thus, read the plans for all three. Determine what you need, how much you will use it, what you'll use it for, etc. Realize that for people with major illnesses, often managed care (copay-based plans) end up costing more than PPO-type plans (deductible-based) because, as soon as the out-of-pocket is met, you don't pay for any more services. As I said, this varies by plan. So, do your homework and you'll make the right decision and save money. Anyone who says premiums are cheaper with one company or another is speaking from their experience at their company. Insurance companies managing ASO accounts don't collect premiums. When you pay a premium, you're making a deposit into the account that your company has its claims paid from. Thus, you're paying your employer, not your health insurance company.
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Does health insurance cover the cost of autism treatments?

And if it doesn't, should it?
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Can you get your health insurance to cover the costs of autism treatment? The chances are better than you might think. These step by step instructions, provided by expert Christina Peck CPC, may save you thousands of dollars per year. Difficulty: Average Time Required: varies Here's How: 1. Call your health insurance provider and ask these critical questions: 1) What are my individual and family out-of-pocket deductibles? What are my out-of-pocket maximums before 100% reimbursement begins? 2) How many visits per specialty (ie PT, OT, Speech) does my insurance plan allow per year for out-of-network providers? 3) Are there any limitations on diagnosis codes? 4) Does my plan have mental health coverage? 2. Ideally, you will receive positive and helpful answers to the questions you pose in Step One. If you don't, it may be time to change insurance providers. According to Christina Peck, the ideal type of health insurance for the parent of a child with autism is a PPO or Preferred Provider Organization. If you are covered under an HMO and can make a switch through your employer or on your own, Peck recommends you do so. 3. Get the details on coverage of specific therapies. Most children with autism will need physical, occupational and speech therapy. They may also need psychological, feeding, social and behavioral (ABA) therapy. Does your insurance company cover these therapies? If so, what are the deductibles? How much therapy is covered per year? 4. Get the details on coverage of supplies and equipment. If your child with autism needs an augmentative speech device or other equipment, the cost may be covered. 5. Know your insurance codes and units. Peck notes that all insurance companies use the same codes for the same diagnoses and therapies -- but there are different codes for different units of time spent on those therapies. For example, 92507 is the code for one hour of speech therapy, but 97112 is the code for just 15 minutes of physical therapy. Be sure your therapists know which code is appropriate for their service, and how many units to charge for. Your physical therapist, for example, might need to charge for four units of therapy to cover the costs of a one-hour session. 6. Get creative in your insurance claims. Most insurance companies limit therapies as they relate to autism per se, but Peck suggests that parents think outside the "autism box" when making their claims. For example, she says, "Is your child getting Occupational or Physical Therapy because they have autism? Or is it because of hypertonia (low muscle tone)? Why should your therapist use the code for autism instead of coding for the actual issue involved?" 7. Organize your paperwork. Christina Peck, in her book Blessed with Autism, includes a set of worksheets you can use organize information about claims you've made, claims that are pending, and grievances you may have filed. 8. If you feel you have the right to insurance coverage based on your policy, and you are running into problems getting that coverage, consider resubmitting, following up on your claim and even filing a grievance. Through a combination of knowledge and assertive follow-up, you may be able to save a great deal of money over time. 9. Once you have a solid understanding of what your health insurance will cover, research your state's offerings. Some states require that insurance companies cover autism-related claims; others offer services through the Department of Mental Health and Retardation. By mixing and matching insurance and state-funded coverage, you may find that many of your child's services are covered. Lisa Jo Rudy Autism Guide 4/19
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Employer taking out health insurance premiums, but no coverage yet -- legal?

My friend's employer swapped them to a new health insurance plan and has already started charging them the premiums even though there's no coverage yet. Some kind of "paperwork problems." He's about to get charged for the second nonexistent month of coverage. So that's $600 in the hole in return for... nothing. Is there any way this could possibly be legal? Of course he's already planning to talk to the local Labor department if he doesn't get a refund, but I thought I'd toss it out here too.
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Group health insurance premiums are "pre-paid". Premiums that are taken out of your check in Feb. will pay March premiums, etc. There is usually only a two week (or one payroll cycle) advance payment though. I have seen it go as far as one entire month in advance, but this is somewhat rare. Anything beyond that and there is probably an issue with the enrollment paperwork. If the effective date of the benefits are changed, then he would be entitled to a refund of the premiums already paid for months there was no coverage. The employer usually will have an Insurance Agent that helps with the benefits. Find out who that is and they may be able to help. I hope it works out....
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Would you hire a person that just did 5 years in prison for not paying for health insurance?

We going to have a new breed of convicts on the street's coming in the future, im scared : )
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I wonder how many violent criminals we are going to have to release just to make room for those evil health insurance dodgers?
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What percent of illegal immigrant children don't have health insurance?

If you know the percent who don't have health care in California that would be even better. California is proposing an initiative that would raise cigarette taxes to $3.47/pack in part to pay for health, dental and vision benefits for illegal immigrant children.
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The current figure is 7.5% of all immigrants. I'm all for the tax increase. You, like everyone else, got bombarded with information at a young age about how smoking is bad. But you wanted to be cool, so you did anyway. You should have listened to your parents and school. I'd rather have you paying for this healthcare than me. Yes!!!
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what are some extreme examples of the measures people take when they don't have health insurance?

I read about the case of the man throwing his wife off the balcony because he couldn't pay her medical bills any longer and wondered what other extremes people have gone to....... anyone know of similar cases?
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Growing up we were really poor. My sister had terrible teeth. Long story short- my siblings and I went to foster homes, my parents to prison. My younger sister went to a home that took her to the dentist. She got braces. But over time her foster parents would not take her back to the dentist to get them removed. My sister waited two years longer than she should have and finally when she was 17yrs. old (I had my own apartment by then) I found her in my bathroom with a fork, pulling her braces off..one by one. All I could do was cry. To me, this was extreme. Could you imagine how much that hurt her? Oh, and once when I was a kid...I fell on a rock and made my front tooth turn black so my father laid me down on the ground and held me there while pulling the tooth out with a pair of pliers. Yeah..people do strange things when they feel they need it done and there are no means to pay for it. I believe that everyone should be entitled to health care!
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Anyone else here chronically or critically ill without health insurance?

I'd move to Canada if I could afford to but instead ... most of us uninsured Americans stay here to die unable to afford healthcare. I had it for 2 months but still spent $1600 just on bloodwork & ultrasounds, I ended up canceling it because I can't afford treatment even IF I could afford the time off from work. What is with this country? Is it a population control method?? What are your thoughts? And how do you receive treatment when you need extensive work as in cancer with no ins. & unable to not work?
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Try a discount health benefit plan. Very affordable, about $40 a month. Pre-existing conditions don't matter. check it out for yourself.
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What are the major problems health care insurance companies face?

insurance companies face problems too. what are they and what causes those problems?!?
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Major problems...We are older and live longer...Therefore We require more medications and more hospitalizations...Not even including the Younger and the babies that are now being born with problems caused by parents
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Why wouldn't employers pay the 8% penalty instead of paying for health insurance?

It would be cheaper to have your employees be covered by the government and pay the 8% penalty.
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These employers probably do not pay much any way so their employees would be forced to come to work sick just to make the rent .
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What are these presidental canadates gonna do to help the health insurance crisis and help hunger in the US???

I mean we have people starving over in america and people with no insurance and without healthcare. And they worry about straving children in africa. WHY?????....We have problem right here is the USA!!!!!!
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You hit the nail on the head, that is what I have been saying for the longest of time , but, it is not going to get better , it will get worse , with all the Mexicans coming into the United States , we are over populated.
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i am a uk citizen flying to the states to have a boob job, do i need to get health insurance?

i am flying to las vegas to have a boob job. i am a uk citizen so we don't have health insurance anyway but if anything was to go wrong after the operation and i had to go to hospital do i need to get health insurance?
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I am sure you are paying for your own procedure for breast augmentation and have already budgeted for it. However, if you suffer complications you would then have an issue. If I were you I would check into Travel Insurance--you might be able to find a really good one that would provide protection for any unforeseen complications. You would of course list the Travel Insurance for your trip originating in the UK to cover travel to Las Vegas. Many of the Travel Policies cover medical on a primary or secondary basis--some exclude coverage for pre-existing conditions, etc. The Policy would not cover the cost of the surgery itself but you might be able to find one of these that will cover any complications--no guarantees of course! Hopefully Travel Insurance on your side of the pond would be more comprehensive in this situation since England has National Health Service and not traditional health insurance. Google Travel Insurance and then make sure you ask a lot of questions before you buy since this trip would obviously not be your run of the mill tourist trip! I hope this helps. Good Luck!
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how can i get legal advice regarding a pet health insurance company who denied a claim. I appealed to the co.?

i have had the same pet insurance for 8 years. ln feb 2004 my lab had a smal nosebleed. took him to the vet and was told dogs can get nosebleeds and appeared healthy. Had a couple of episodes of reverse sneezing. called the vet and was told most likely allergies. his insurance policy is from july to july. In september he had a large nosebleed and after many tests was diagnosed with nasal cancer. the insurance company refused to pay stating his iinitial symptoms began in the previous policy period and therefore not covered. No where in his medical record does it state he had cancer. I feel as if I've always done the best for my lab, securing lhealth insurance and taking him to the vet for any unusual symptoms and I feel i've been let down by both. Could the vet have diagnosed him earlier or should the pet health insurance co take responsibilty and pay the medical cost i have incurred for his treatment. Who can i go to for advice. Is there time limitation in persuing action. thanks
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Talk to your vet. He should write a letter to the insurance company and give them a time-line for the cancer diganosis. You should also have the records of your dogs vet exams. You can make copies and send them to the insurance co., highlighting the dates of exams. Have the vet office make you a copy. If they refuse call the Veterinary Medical Board in your state. By law they are required to make you a copy or a written summary of the records. The only other thing is go to an attorney....but that will probably cost you more that the vet bill. Good Luck and God Bless
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Does anyone know if Vision works or lenscrafter accepts United Health Care insurance?

I was wanting to go to a place like lenscrafters or visionworks instead of an optometrist because i work from 8-5 and i need to go somewhere open on the weekends. i have united health care insurance and wanted to know if either of those places accept it. My copay for an eyedoctor is 20 dollars and i can get free contact lenses if they are in the network, would it still be the same price at a place like that as it would be at a doctors office? Thanks!
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Your best option is to call the phone number on your card. They can tell you based specifically on the plan your employer purchased and what requirements (if any) that you must meet (pre-certification or pre-authorization).
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Do rich people generally bother buying health insurance?

Or do they simply prefer to pay their doctors out of their own pockets?
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Rich Democrats always expect someone else to pay for their Doctor Bills. Well...... I guess All Democrats expect that, eh?
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What's the average price of a Doctor's visit without health insurance?

My eyes are yellow.
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~~This varies so much by area (State and county). If it's a specialist, very hard to guess. If it's a physical maybe in the area of $120.00- $160.00 -and that would not include any of the tests needed for a physical. If it's a family physician the initial visit is always higher because the billing code is for more extensive time, in the area of $120. to $160. When it's just for routine care after being established, approx $60 to $80. I'm quoting from rates in my area which is Southern California.~~
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How much did you pay for Health Insurance 10-15 years ago?

How much do you pay now? Clarification: What you paid now and then, Not your parents.
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Back then my employer paid the whole thing. Now I am uninsured, and pay nothing. ?°)
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Hoe do I pass my Life accident and Health Insurance Exam?

I am studying for Life Accident and Health insurance Exams and I am wondering whether I can learn lessons from any of you who have taken the license exams passed or failed, what you did or did not do.
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Know the study materials inside out. Practice tests! Find a free one here. http://www.insurance-schools.com/free_in… Also, be very well rested. On test day, read the entire question - many seem tricky, and end in "BUT" or "EXCEPT". This is why practice tests are such a good idea. Read every possible answer before picking one.
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Is there a place that i can get health insurance comparisons for an employee of 1 (me)?

I have just started an online business through a familiar auction site and am looking for health insurance...any help will be appreciated
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Go to your local, independent agent. They'll be able to get comparative quotes for you, and help you compare coverages and deductibles, as well. SHOP LOCAL. Buy through your local agent. Fake insurance policy scams are on the rise, as are "health plans" that are sold as huge discounts, which are NOT INSURANCE. You won't get taken if you buy local. If you try shopping over the internet, you're more likely to be taken.
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Why is it that16% of Americans have no health insurance & of those who do, 40% have such inadequate insurance?

That they can't even afford their co-payments, deductibles or drugs? (unless they're generic). And FYI, yes, I'm including those who have medicaid & medicare in the numbers of those that are insured. I am NOT including illegals in the numbers that are not insured, as they are not citizens or even legal residents. Nor have I included people that choose not to be insured because they don't feel they need it. I am just talking about legal Americans that need it.
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Because so many people have bought into the insurance companies propaganda that service would be even worse under a federalized system. We currently have people dying in hospital beds while waiting for service, we have wait lists for service, we have people being denied life saving procedures. How could it get worse? We're smart enough to learn from other countries.
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I dont want people abusing the system, yet I dont want to mandate health insurance?

GOT A BETTER IDEA BESIDE COMPLAINING ABOUT NOTHING?
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I don't think I will live to see a civil health care system in this country. At this time a lot of people have heart disease, or cancer. both of which can be linked to diet. what diet? maybe corn/wheat/soy/gmo/wasteland... and who benefits? A small group of people with very large shipments of pharmaceuticals, and some insurance and banking investors and some paid of left and right wing politicians. and kellogs. and wonder bread. Way to go America.
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