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Back to the Future: A New Kind of Health Plan

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Under the Microscope: Health Insurance Applications

As a child of the '80s, I remember a line from a song that goes something like this: "It always feels like, somebody's wa-tching me-e-e. I've got no privacy." Well, most Americans apparently felt the same way, so in 2004, the second provision of HIPAA went into effect that protected most Americans' right to privacy of their medical information. I say "most," because in certain circumstances, you voluntarily waive your right to keep your medical information private from specific individuals and/or companies. One of those instances is when you apply for health insurance.

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Looking Good on Paper: The Art of Filling Out Insurance Forms

Getting insurance in the individual/family market if you aren't entitled to guaranteed coverage can be a tough task (see my column "HIPAA, COBRA and PHI, oh my!" for more on how guaranteed-issue individual plans work). Even if the insurance companies accept you, it may not be on the best terms. They may raise the rate you pay (called rated-up), exclude coverage for certain conditions (called a waiver), or both.

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Surviving Summer: I Scream, You Scream (Let’s Hope it’s for Ice Cream)

We've all been there, either as a kid or as a parent. Everybody's having fun at the summer picnic and then we hear a loud yell. If we're lucky, it's usually followed by the tinkling bells of the ice cream truck as it's making its rounds. We reach in our pocket for some change, anticipating the inevitable, breathless rush as our kids run up with outstretched hands. Unfortunately, sometimes that initial yell is followed by the even louder, "Mo-o-om!" Summer has struck again.

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Man or Machine? How Best to Obtain Health Insurance

When I was a child I used to read quite a bit. It was my way of escaping into worlds wondrous and unknown. I was particularly partial to sci-fi (as little boys often are) and of course wanted to be an astronaut. Alas, it wasn't to be so I took the next best thing of course...I became an insurance man. In reading those stories, I often came across the theme of human vs. machine.

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When Your Claims Are Denied

Last week we talked about the forms insurance companies send you that illustrates how they paid your claim. We touched upon some reasons why claims are denied initially. This week, we'll share some quick fixes as well as what to do when you're flat-out denied a claim.

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As Easy as EOB

If you've ever had a claim with a health insurance company, you typically get a statement in the mail showing what and how something has been paid (or not paid). These statements are called Explanations of Benefits or EOBs for short. Most of them say, "This is Not a Bill". Then why do they cause so many headaches? Sure seems like a bill to me. In my practice, I have found that these "Explanations" are anything but clear and need explaining. In other words, the "Explanation" part needs explaining.

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To Tax or Not to Tax…Are There Any Questions ?

It has been said that the only two things that are certain in life are death and taxes. While nobody has figured out how to currently avoid death, we can do things currently that minimize our taxes. Our last couple of columns dealt with health insurance concepts that individuals purchasing direct as well as employees receiving employer-based coverages could benefit from. This column deals with the taxation of benefits received ONLY through an employer with the implementation of the Section 125 of the IRS code, (more commonly called a cafeteria plan).

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We Got You Covered!... (or Do We ?)

Over the last two months or so, we've looked at the health insurance industry from a number of perspectives, from choosing a health plan, to getting yourself insured. One thing we haven't touched upon is the language insurance companies speak. Just as Eskimos have over a dozen words for snow, an insurance company has different meanings for the word "covered" when used in different instances. "Covered" has to be the most misunderstood word in an insurance companies lexicon.

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A Cure for What Ails You —Or— Take Two Aspirin and Call Me in the Morning

If you're a fan of the older medical-themed TV shows, you've heard this phrase a few times. Two aspirin and a good night's sleep was the treatment most often prescribed. Times and television shows sure have changed. Now we have TV shows where the treatments and diseases are so cutting edge and advanced they border on futuristic. The doctors have transformed from kindly, old Dr. Marcus Welby-types to acerbic, acid-tongued physicians like Dr. House.