Recent Blog Posts
Who Needs Long-Term Disability Insurance?
Long-term disability insurance (LTDI) provides replacement income for policyholders who become unable to work because of an illness or injury. In theory, any worker could benefit from LTDI, but these policies are most often held by company executives and professionals who specialize in a particular field and cannot easily transition to another line of work should they become disabled from performing their specific job. For this reason, LTDI is especially attractive to doctors in general and specialists such as surgeons in particular.
Is Artificial Disc Replacement “Experimental and Investigational”?
If you ever see the phrase “experimental and investigational,” it’s likely to be in the context of a letter from the insurance company refusing to cover your requested surgery or other medical procedure. “Experimental and investigational” is a favorite phrase of the insurance industry. Carriers create internal memos, called Policy Bulletins, that label a particular procedure or medical device as experimental and investigational, and then they rely on that memo to issue blanket denials of all requests for the treatment, without conducting an individualized assessment of the patient’s condition and whether the requested procedure might be appropriate. These blanket denials could be seen as an abdication of the insurer’s duty to investigate each claim individually and make a decision based on the specific facts of the case. Denials like these might even be considered insurance bad faith. Additionally, lawyers who represent patients have found that insurance companies label some treatments as “experimental and investigational” despite abundant evidence demonstrating the procedure is neither experimental nor investigational. Artificial disc replacement is one such example.
What You Need to Know About Independent Medical Review
In a previous post, we talked about using an insurance company’s internal appeals/review process if the insurer denies your claim or request for treatment when you think they should have approved it (see Why an Internal Appeal is a Really Big Deal). There, we noted how a federal law (ERISA) that governs employer-sponsored health plans requires that insurers have such a procedure in place and further requires policyholders to use that procedure before they can file a lawsuit. We also noted how important those appeals are because if you later go to court, the arguments you want to make or evidence you intend to give can be limited by the record you created at the administrative level.
Why an Internal Appeal is a Really Big Deal
If your insurance company denies your claim for coverage, this denial could mean you don’t get the medicine or procedure you need, or you have to go into your own pocket to pay for costly medical treatment that you can’t afford (medical bills are the number one reason families file for bankruptcy). Some people don’t know there is anything they can do about a denial, and they simply give up, either paying for medical care on credit or going without. Others who read their policy and letters from the insurer carefully do realize there are ways to fight a denial, but even then, they don’t always go about it correctly.
Accidental Death & Dismemberment: A Substitute for Life Insurance?
You might be covered under an Accidental Death & Dismemberment (AD&D) policy as a fringe benefit through your employer or as a benefit of joining a professional association. Now that you are covered by an insurance policy in case of accidental death, you might be wondering if you really need to have a separate life insurance policy as well. After all, life insurance isn’t cheap, especially if you buy a whole life policy to take advantage of the investment it offers over term life. It’s crucial to understand what an AD&D policy covers and what it doesn’t.
What if the Insurance Company Makes a Mistake in Calculating My Deductible?
Your deductible is the yearly amount you have to pay out-of-pocket for medical costs before your insurance benefits really start to kick in. The deductible is a key feature of a health insurance policy, and generally speaking, the lower deductible you choose, the higher your premiums, and vice versa. When you go to the doctor’s office, you typically only pay a very small amount, like ten or fifteen dollars. This amount is known as a co-pay. While co-pays don’t count toward your deductible, they are a great cost savings to you.
Does My Health Insurance Cover Non-Drug Treatment for Pain?
Pain management is a necessary component of treatment after an orthopedic trauma or surgery. Pain is a disability that inhibits rehabilitation and limits one’s ability to return to the activities of daily living. Most health plans cover the treatment of pain resulting from illness or injury, but how they choose to cover it is… Read More »
Billing Problems: Who’s to Blame? Your Healthcare Provider or Your Insurer?
It would be nice if insurance paperwork were simple, if doctor bills were simple and easy to understand, and if questions or concerns could be cleared up with a phone call. It would also be nice if everyone had a robot maid to do the dishes, but we shouldn’t expect any of those things… Read More »
What is the time limit for filing a medical insurance claim?
The time limit to file a claim differs from insurance company to insurance company as well as among different policies sold by the same insurer. Medical providers generally have up to a year from the date of service to forward the claim to the insurance company, but insurers can shorten this time limit to… Read More »
What Is the Statute of Limitations for Filing a Claim Against an Insurance Company?
A statute of limitations is a law that provides a window for filing a civil lawsuit or criminal charges. Once that window has closed, courts will dismiss any lawsuits or prosecutions which are filed late. Different types of cases have different statutes of limitations set out in state or federal law, and determining the… Read More »
