Dear Stan7a,
Usually the pharmacist should do the math to process and fill your prescriptions in a prudent way. The difference however are not significant; in short, if the cost of your medication turns out to be greater than your deductible plus your copay (for that tier), then you will not only have to pay your deductible but also the copay for that 1 pr...
Dear jdemma,
Whether your provider can charge you a higher price that his contracted (negotiated) rate depends on the terms and conditions of his contract with your insurer.
The only way you can find out about this particular term is to contact your insurer and ask them that question directly. This will get you the information you need & inform the...
Dear uninsuredNewYorker,
As for your hospital and (air) ambulance bills, I am not aware of any provisions in PPACA (ObamaCare) that can help you with bills incurred while in-insured. I am also not aware of any state assistance programs (CA or NY) that help pay bills while un-insured. It is typically those providers (such as the hospital & air-ambulance...
Dear jb111o,
I cannot speak to legality of your question but it seems like your provider may have not used correct codes to submit their claim. Your insurer pays claims based on what your provider submits to them.
I recommend you check with your provider to make sure your provider is submitting accurate codes for services rendered. If that is not the i...
Dear Jmo366,
My heart goes out to your family for what you are going through; I am not aware of any regulations that mandates health insurance coverage to a suicidal person but there are provisions that may help provide coverage to her if she is deemed "disabled"!
What constitutes disability?
For Social Security disability or SSI purposes, t...
Dear jaime310,
Generally speaking, a health plan consists of a number benefits such as office visit, lab work, medications, etc. Some may be subject to a deductible & co-insurance (the portion of t he bills covered after deductible) and others at a flat co-pay; but with most short term plans, you will have to pay for all covered benefits until your ded...
Dear Mogo12,
You can file out a complaint with your state's department of insurance. I was unable to identify your state of residence from your profile so I am unable to provide you the specific link. Each state has a separate department of insurance. This agency is responsible for handling complaints against insurance companies. When submitting a com...
Dear madisoninkley,
Plan deductibles don't necessary apply to every benefit of a plan; but depending on the plan structure, they could be. There are plans that cover your day to day doctor visit or medication for just a copay ($30-$40) but will require you to meet your deductible for procedures or hospital stays.
If this is your first time shoppin...
Dear wisertime,
It is true that most employer sponsored group (and retiree) plans don't qualify as credible coverage that can help waive your Part B penalty; however you stated "I can't afford it" which makes me wonder if you can qualify for subsidy or financial help. I recommend you looking into that with your local county authorities ...
Dear greengarden7,
Terms of employer sponsored group plans vary based on the agreement between the insurer and the policy holder (the employer). Some policies require spouse and dependents to get their coverage through their own employer when and where available. This could especially be an issue if both yours and your husband's employers offer covera...
