2010 Affordable Care Act
- Coverage for seniors who hit the Medicare Prescription Drug "Donut Hole," including a rebate for those who reach the gap in drug coverage;
- Expanded coverage for young adults, allowing them to stay on their parents' plan until they turn 26 years old;
- Small-business tax credits to help these companies provide insurance coverage to their workers; and
- Providing access to insurance for uninsured Americans with pre-existing conditions.
- Traditional fee-for-service health insurance plans are usually the most expensive choice. But they offer you the most flexibility when choosing healthcare providers.
- Health Maintenance Organizations (HMOs) offer lower co-payments and cover the costs of more preventative care, but your choice of healthcare providers is limited. The National Committee for Quality Assurance evaluates and accredits HMOs. You can find out whether one is accredited in your state by calling 1-888-275-7585. You can also get this information as well as report cards on HMOs.
- Preferred Provider Organizations (PPOs) offer lower co-payments like HMOs but give you more flexibility when selecting a provider. A PPO gives you a list of providers you can choose from.
- Do I have the right to go to any doctor, hospital, clinic or pharmacy I choose?
- Are specialists such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care and physical therapy?
- Does the plan cover home care or nursing home care?
- Will the plan cover all medications my physician might prescribe?
- What are the deductibles? Are there any co-payments?
- What is the most I will have to pay out of my own pocket to cover expenses?
- If there is a dispute about a bill or service, how is it handled? In some plans, you may be required to have a third-party decide how to settle the problem.
Appealing Health Insurance Claims
Step 2: Contact your insurer and keep detailed records of your contacts (copies of letters, time and date of conversations).
Step 3: Request documentation from your doctor or employer to support your case.
Step 4: Write a formal complaint letter explaining what care was denied and why you are appealing through use of the company's internal review process.
Step 5: If the internal appeal is not granted through step 4, file a claim with your state's insurance department.