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Medical Insurance

Medical insurance is an insurance against loss by bodily injury or illness. It covers doctor’s fee, hospital fee, medicine and other medical expenses. It may be purchased individually or on a group basis. It may also be provided universally by the government.

11,526 Questions
Life Insurance
Medical Insurance
Healthcare Coverage While Pregnant

How do you find out if someone has a life insurance policy on you?

Discuss it with them while they are alive. While that may sound like a flippant response it isn't intended that way.

Insurance policies can serve many purposes. Consider permanent insurance. Depending on circumstances, these policies may act as a very effective tool for estate planning. Let's go full circle. Considering that one is attempting to do plan, they would certainly want to communicate to the beneficiaries the tools in place. A smart-aleck statement? No. But it was an attempt to grab your attention and consider the question in another way.

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Conditions and Diseases
Medical Insurance
Travel Insurance

What is considered a preexisting condition?

A pre-existing condition is a medical condition that existed before you obtained health insurance. It is significant because the insurer may not cover the pre-existing condition for the duration of the pre-existing condition period. The policy will provide for a stated time period within which it will not provide benefits for the condition.

The pre-existing condition exclusion period varies by insurance company, and also by the State in which the policy is issued. Currently, State law regulates the terms and conditions of insurance policies. For example, some States have disallowed certain types of provisions, including mcertain medical conditions to which they might otherwise apply.

All of that may change if there occurs greater Federal involvement in the regulation of health insurance, but the odds are that new laws will apply only upon the expiration of existing insurance contracts and for the issuance of new contracts after such laws are implemented.

The rationale for pre-existing condition exclusions is that medical insurance works the same way other insurances do: that insurance covers fortuitous occurrences, nor ones that are planned, intentional, or predictable. Stated otherwise, you need to have coverage in place before something adverse happens. An analogy is that just like you can't buy auto insurance after an accident to cover the cost of the accident, medical insurance only covers issues that arise unexpectedly after coverage has begun.

Pre-existing conditions are usually chronic and often costly conditions such as:

  • diabetes
  • heart problems
  • mental illness
  • asthma
  • COPD
  • Hemophilia
  • Epilepsy
  • Chronic Infections
  • a pregnancy prior to coverage
  • an injury which occurred prior to coverage.
  • multiple sclerosis, etc.
  • certain allergies
  • certain skin conditions

If you think you may have a condition that might be pre-existing you can ask the insurance company if there are exceptions and if your physician can confirm you have not suffered or been treated for the problem during the time period designated by the insurance company. Some companies may decide they cannot cover you if you are seeking individual coverage (rather than group coverage).

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Medical Insurance

Does NJ Medicaid covers circumcision?

No.

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Medical Insurance
Pet Insurance

Does Blue Cross Blue Shield cover glasses?

Blue Cross/Blue Shield has many different plans and types of coverage. Yes, it will cover the cost of glasses, if this coverage is included in your plan. To get a specific answer , you would have to call either your plan administrator or Blue Cross directly to see if you are covered under your plan.

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Oral Health and Dental Care
Dental Insurance and Financing Dental Care
Medical Insurance

Where can you get braces that wellcare covers?

It depends on what area you are in. Call wellcare and give them your zip code they will give you a few names and numbers in your area. You may have to travel to destinations that are far. If you are in the area of Georgia : Medical College of Georgia offer it but you have to be on a waiting list.

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Insurance
Life Insurance
Medical Insurance

Are life insurance benefits taxable.?

In Canada, the death benefit from a life insurance policy is typically not taxable. However, if you do not name a beneficiary in the policy, the proceeds will go to the estate of the owner. That amount may be subject to probate fees which can be quite substantial depending on the province you reside in.

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Medical Insurance
Medical Billing and Coding

What does the medical abbreviation UCR mean?

Usual, customary, and reasonable.
Usual, Customary & Reasonable The fee that an insurance company establishes as a standard fee for a procedure. Check your insurance plan -- your insurance company will pay up to this amount for a particular procedure.
It can mean different things in medical terminology and, typically, the context is needed to be sure that the acronym is correctly decoded in the situation at hand. Since this question was placed in the medical billing and coding category, I'd suggest that you are looking for UCR meaning "Usual, Customary and Reasonable". This is a term from the health insurance industry that is used to explain how the insurer payment amount was determined that was given to a provider for fee-for-service claim billings.

The US insurance industry organization shares information among the carriers about the typical (usual, customary and reasonable) charges, payments, and final amounts providers accepted for their services, from reports of all claims paid nationally by member insurance companies. This is a huge amount of data that is then crunched to come up with the UCR for each particular service. Most insurer contracts with providers will specify UCR as the method of determining reimbursement amounts for many services, unless flat fees, capitation or other specified reimbursement methods or systems are negotiated. These UCR amounts for each provider service code (ICD-9-CM, CPT, HCPCS, etc.) are annually adjusted, based on the data of the prior year, and distributed among the insurers for use in renegotiating contracts with providers. The complex computations of the UCR in each contracting situation can, however, vary from insurer to insurer and contract to contract.

Other meanings of UCR you may be looking for might be:

Uniform Case Record (used in the medical information management fields to define documentation requirements, etc.)

Unit Carcinogenic Risk (probability, per dose unit of a chemical or compound, for producing cancer).

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Medical Insurance

Is US Health Group a scam?

It is not a Job bit an opportunity for you to give them money...they will buy leads with that money...then they will use the fresh leads and give you their old leads. You will sell a few on the scraps...then they will blame you for not doing well with no leads.....Left there and now I make 4K-6k a week.

Doesn't this site use names? I registered with my real name. I've been with the company two years. I've been provided with free leads since day one. never once been asked to pay for them. They are an awesome company, I've had nothing but good experience with clients claims, etc. I've had the policy myself for 2 years.

athena la roux- austin, TX

A policy holder had a heart attack and knee surgery and the US Health Advisors plan he had paid for everything. I am a policy holder and an agent in Florida. We make a good living and are 100% supported by the company and other agents.

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Medical Insurance

What is a variable copay?

== == According to one insurance company, the term "variable copay" has to do more with where services are rendered rather than by whom. Many doctors are able to practice at more than one hospital or more than one type of facility. The contracts each particular doctor has with each insurance company and with each facility affects the copay. Therefore the term "variable." Let me give an example to illustrate. Dr. Jones can practice at both Baptist and at Centennial Hospitals. If, let's say, your scheduled procedure was performed at Baptist, your copay is $100. Whereas the same procedure costs $500 at Centennial because of the agreements and "contractual amounts" agreed upon between the facility and the insurance company. To avoid unexpected costs with variable co-pays: 1. Find out where your doctor can practice. 2. Call your insurance company and see if there are any variations in payments and in the amounts you will have to pay. 3. If the fee schedules are the same at all of your doctor's locations, ask if when this might change in the future, if at all. 4. Also ask what type of facilities these variable rates, if any, apply. For example, would your rates ever vary for procedures performed in your doctor's office. "Variable co-pays" seem to only pertain to hospitals, outpatient centers, specialized facilities such as rehab centers, and surgery centers, but it never hurts to be sure you have all of the information. Personally, I would avoid these types of plans because it seems to me that it gives a provider/insurance company a possible loophole. While you could appeal an insurance company's partial payment or outright denial of payment and can prove what the actual schedule fees were at the time services were rendered, I wouldn't want to go through that hassle especially at a time when I need insurance the most. The difference in savings between a variable copay and non-variable copay policies would have to be very substantial and the insurance company would have to be reputable at servicing its claims.

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Medical Insurance
Retirement Planning
Medicare and Medicaid

When you turn 65 must you take medicare?

Answer
You can decline part B but part A is free so I can't imagine why you wouldn't take it ... In either case you'll have tons of trouble with your secondary.
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Insurance
Medical Insurance
Medicare and Medicaid

How do you make medicaid your primary insurance?

You don't. Because it is a form of public assistance, Medicaid is always the payor of last resort.

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Insurance
Medical Insurance

What decade did group health insurance begin?

The concept of health insurance was proposed in 1694 by Hugh the Elder Chamberlen from the Peter Chamberlen family. In the late 19th century, "accident insurance" began to be available. Health insurance was first offered in the United States by the Franklin Health Insurance Company of Massachusetts. This fim founded in 1850, offered insurance against injuries arising from railroad and steamboat accidents. By 1866, sixty organizations were offering accident insurance, but the industry consolidated rapidly soon thereafter. While there were earlier experiments, the origins of sickness coverage in the US effectively dated from 1890. The first employer-sponsored group disability policy was issued in 1911. Hospitals and medical expense policies were introduced during the first half of the 20th century. During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations. The predecessors of today's Health Maintenance Organizations (HMOs) orginated beginning in 1929, through the 1930s and on during World War II.

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Medical Insurance
Medical Billing and Coding

What does the ICD9 code 272.0 mean?

ICD 9 Cm Code 272.0 - Pure hypercholesterolemia

Familial hypercholesterolemia

Fredrickson Type IIa hyperlipoproteinemia

Hyperbetalipoproteinemia

Hyperlipidemia, Group A

Low-density-lipoid-type [LDL] hyperlipoproteinemia
pure hypercholesterolemia

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Medical Insurance
Ambulances

How much does ambulance service cost?

The total cost of the ambulance service will depend on the level of service provided according to the persons needs. A fee of 400$ is required for basic life support and this fee can increese depending on the mileage, the use of oxygen, EKG, IV and immobilization.

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Medical Insurance
Labor and Birth
Premature Birth

Is premature birth a preexisting condition?

No, premature birth is not at all a preexisting condition. Premature birth becomes imminent when the doctor thinks the condition of both mother and child would be safe to allow premature birth. In this way it will not be considered as a preexisting condition while applying for Medical insurance.

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Medical Insurance
Ultrasounds
Healthcare Coverage While Pregnant

What is Benefit coding?

Process of converting the Healthcare Benefit coverage terms into computer understanble language to reduce the memory space and time and paper work.

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Insurance
Medical Insurance

Can you designate the primary and secondary insurance coverage yourself?

Primary and Secondary CoverageIt may depend on your local regulations but typically which policy is primary is dictated by law and by the terms of your insuring contracts. The default is as follows. Exact Same coverages on both policies / Duplicate coverageThe policy with the earliest effective date is Primary unless the second policy was intended to replace the first. Policies with different coverages.The Policy which has the broadest coverage will be considered primary.

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Designating Primary and Secondary Insurance CoverageHere are opinions and answers from Wiki s Contributors:
  • Since it was court ordered for their mother to provide health insurance, I believe that that insurance would be considered primary...yours would be secondary. I had a similar problem before and a few people told me the same...so sorry their mother's health insurance would become their primary coverage.
  • Would your ex-wife be willing to pay for the kids' coverage directly to your insurance company? By paying directly to the company, this avoids "power plays," and she might not feel as resentful about the situation. Plus, you could let her know that you would pick up a rider policy that she can use when she has the kids. That way, you both have 100% coverage on your children. If the insurance is paid through your employer, talk to your lawyer first and see what creative options he/she's seen done in these type of cases. If you're going to pay for insurance regardless of her converage, maybe she can pay you a slightly higher child support payment (assuming she has to make one) and you would then be responsible for insurance as long as you are capable of working. In my personal experience, all it takes is an addendum page drawn up by your lawyer, and then submitted to both her and the courts. The courts will accept almost any agreement within reason as long as it is beneficial for all parties including and especially the children. I wouldn't give up on this especially if both of you are making insurance payments. If your ex-wife is able to speak coherently to you at all, you should be able to resolve this by using the reasoning that you are trying to get the most coverage for the children while maintaining current, established medical relationships with their medical personnel, namely their pediatricians and their staffs. If she can understand that a divorce is hard enough without adding one more change, she will be willing to work something out especially if you are willing to pay for insurance regardless of what she does. That shows her that you are serious about this and that it's not a power play. Good luck to you. I know how hard divorce can be on everyone. Luckily with time, it does get better and easier.
  • If you are married, both have medical insurance and have children, you would follow the "birthday rule". The parent with the birthday that falls earliest in the calender year (no matter what the birthyear is) would be the primary insurance. For example. Mrs. Smith was born May 3, 1945 and has Blue Cross that she has carried for 15 years. Mr. Smith was born June 10, 1939 and has had Aetna for 20 years. The primary insurance would be Mrs. Smith's policy as she was born on May 3rd which comes before June 10th. If both parents have the same birthday (it does happen), then you defer to the policy that has been in place the longest. So, if Mr. And Mrs. Smith had the same birthday month and day, then Mr. Smith who has had insurance for 5 more years than Mrs. Smith, would have the primary insurance policy.
  • The birthday rule above does exist, but court orders supercede the birthday rule. Only use the birthday rule if there is not a court order involved, like a current husband and wife both cover their children under their employer's insurance. The idea about dropping one of the insurances and just having her pay the cost is a good one. Most court orders just say who has to pay for the insurance, not how it is provided.
  • No. Here's the rules from Delta Dental's Web site: What is dual coverage? If you're fortunate enough to be covered by two dental plans, you have what is called dual coverage. Dual coverage doesn't mean that your benefits are doubled. What it does mean is that you will likely enjoy lower out-of-pocket costs for your dental care. Dual coverage works the same way whether you are covered by two Delta Dental plans or by Delta and another carrier. Delta Dental simply works with the other dental carrier to coordinate your benefits. Who is the primary carrier? The first or primary carrier is the one that covers you as a primary enrollee (e.g., your employer rather than your spouse's employer). If you have two jobs, the plan that has covered you longer is considered primary. For your children's coverage, the primary carrier is generally determined by the birthday rule: coverage of the parent whose birthday (month and day, not year) comes first in the year is considered to be your children's primary coverage. The birthday rule may be superseded by a divorce agreement or other court ruling. How does dual coverage work? Suppose, for example, that both of your plans provide two cleanings a year, each with 80 percent coverage. The primary carrier pays 80 percent, and the secondary carrier usually covers up to the remaining 20 percent that you would have had to pay out-of-pocket if covered by only one plan. You would not, however, be entitled to four cleanings per year. Why not twice as many benefits? Why don't you receive double the benefits when you have two dental programs, especially if your dentist recommends that you receive more than two cleanings per year? Dual coverage limitations, like all other program limitations, are built into your group's contract and into the rates your group pays for your coverage. These contracts are set up to provide affordable dental care to a maximum number of people. Given the choice between doubling one individual's benefits or providing a greater scope of benefits to more people in the group, most group purchasers choose to spread their benefit dollars more evenly. What if you have non-duplication of benefits? For groups with a non-duplication of benefits rule in their plan, the secondary carrier pays only the difference between what the primary carrier actually paid and what the secondary carrier would have paid if it had been the primary carrier. For example, if the primary carrier paid 80 percent and the secondary carrier normally covers 80 percent as well, the secondary carrier would not make any additional payment. However, if the primary carrier had only paid 50 percent, the secondary carrier would pay up to the remaining 30 percent. Dual coverage saves money for you and your group by sharing the total cost of dental benefits between two carriers. Containing costs is an important part of Delta's plan to keep you smiling. Sample coordination of benefits: Procedure Primary carrier pays 80%, Cleaning $80 $64 $16 $0.
  • When it comes to children, it falls under the "Birthday Rule". The parent whose birthday comes first is primary. For example if mom is January 1,1952 and dad is February 2, 1951, then mom would be primary. The primary plan is responsible for paying covered expenses up to the limits of the policy. If any unpaid costs are left over, the secondary coverage kicks in. The birthday rule is often used to determine which plan is primary and which is secondary. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor-not the year-so it doesn't matter which spouse is older. Like most rules, the birthday rule has exceptions: If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children; If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer (e.g., through COBRA), the plan belonging to the currently employed spouse would be primary; and In the event of divorce or separation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new spouse's coverage becomes secondary. And finally, the non-custodial parent's plan would provide a third layer of insurance protection. This order of payment can be altered by a court-issued divorce decree or by agreement, but the insurance companies must be notified. Keep in mind that these practices are common among insurance companies, but they are not governed by law. Practices may vary from one insurer to another. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. If the policy language is unclear, ask for help from your employer's benefit specialist or your insurer's customer service department.
  • Here's the 43 page booklet from Medicare http://www.medicare.gov/Publications/Pubs/pdf/02179.pdf.
  • The answer simply put is no. the order of liability is determined by general rules (such as the birthday rule) or by a court order. In the case of dual coverage through a single individual (someone with two jobs) the effective date determines which is primary - I've never come across a situation where someone could choose themselves.
  • The question is not specific enough. Coverage for yourself or for your children? This can get really tricky and no you cannot designate coverage - it's dictated by the insurance coordination of benefits rule written in the employer's contract when they sign up for coverage. Here are a few scenarios: 1. If you are the insured and have coverage through 2 different employers rule is the employer that you have been with the longest will be primary. 2. If you have coverage through your work and your spouse's work then yours will be primary - ALWAYS...NO EXCEPTION. 3. If you have government coverage like Medicare or Medicaid and also have private insurance from work then again your work insurance will be primary and government insurance secondary. 4. If children have coverage through both parents and they are not divorced the birthday rule takes effect. Whoever birthday comes first that's primary. 5. If children have coverage through both divorced parents then primary is the parent with whom they reside. If they have 50/50 custody then the birthday rule applies again. These terms are usually dictated in the contract between the insured and the specific insurance company. Hope it helps.
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Insurance
Life Insurance
Medical Insurance

Who pays for group insurance?

"Group insurance" is to be distinguished from individual insurance. In that sense, a group policy provides coverage for multiple people (usually a fairly large group) who have an element of commonality defined by the risk-bearing entity (such as an insurer). The commonality might be the same employer, a union, a profession, or any one of a multitude of other factors that bind the participants together.

The sponsor of the group may pay all or some of the premium for the coverage. However, it is more likely that each participant in the group plan will pay a premium. Group coverage is usually less costly than individual insurance because the insurer is able to enroll many persons without the need for advertising, individual commissions and related back-office expenses, and the other elements of overhead that it would otherwise incur.

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Medical Insurance
Retirement Planning
Medicare and Medicaid

Does Medicaid cover braces in Nebraska?

This will probably require prior approval, which will likely depend on whether the patient has the required Salzmann Index score.

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Medical Insurance
Public Health and Safety
Retirement Planning
Medicare and Medicaid

Does Medicaid cover eye glasses?

Yes, if medically necessary.

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Medical Insurance

Does ohip cover circumcision on kids?

No.

305306307
Medical Insurance
Surgery and Hospitalization

Do any insurance companies cover plastic surgery?

Cosmetic Surgery and InsuranceTypically, Cosmetic surgery and all other "elective" surgery is NOT covered under Medical Insurance policies unless the procedure is of a medical necessity. Corrective Cosmetic SurgeryIn general, for an insurance company to cover a plastic surgery, the surgery needs to be deemed medically necessary. Reconstructive surgery is considered medically necessary by many insurance companies if you are receiving reconstructive surgery after an accident or an additional medically necessary surgery (for example, breast reconstruction after a mastectomy).

Nasal surgery performed with a diagnosis of deviated septum are considered medically necessary and normally some cosmetic repair is performed at the same time.

Breast reduction can be medically necessary in certain circumstances.

What is typically not medically necessary is breast implants (no previous mastectomy), face lifts, liposuction, abdominoplasty to remove excess skin around the abdomen, etc.

Plan provisions vary widely. Even one insurance carrier can have 20 different plans available, each with variances regarding covered/non covered services. It is always best to contact your insurance company directly.

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Medical Insurance
Retirement Planning
Medicare and Medicaid
Medical Billing and Coding

What is medicare cpt code for anorectal manometry?

90911

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Insurance
Medical Insurance

How can you get your insurance provider to sign up doctors as in-network?

The "In-network Doctors" heading herein has some great tips on getting your doctor enrolled.

In-network doctors I actually contract with Physicians for an insurance company and quite often I get requests to go recruit a particular doctor. First of all, there are Department of Health requirements which state there must be a participating doctor of each specialty within a certain mile radius of each zip code in each county in order to actually sell insurance into that county. I would check to see what that mile radius is in your county, because if you have to travel that far, perhaps you can get an exception to see a non participating provider at the in-network benefit level since the access requirements aren't being met.

In order to get your doctor to participate, I would contact your member services area. Have the customer service representative forward your doctor's information to PROVIDER RELATIONS. Provider relations will then contact your provider to see if he would like to become participating. Usually there is an application that needs to be submitted by the doctor. Then, each doc must be credentialed..that is their information must be verified and approved by a board of medical professionals who are employed by the Insurance Company. Once approved, the doctor can be added.

One tip, however. Many doctors get approached to participate in various plans on a regular basic. This is not normally a high priority for a physician, especially if they are not aware that they have patients who may have that insurance. If you want your doctor to participate, call him or her and advised them of what insurance you would like them to join. Explain why and ask them if you can do anything to help the process along. Sometimes the biggest motivator for the physician is a vocal patient!

279280281
Medical Insurance
Diabetes
Definitions

How do you determine if you have a 'preexisting condition'?

== == According to BCBS, if you are still under a doctor's care for a condition and have not been released, it counts as a pre-existing condition. That is what I have found out during my search. What insurance company do you go through? Most places won't cover pre-existing conditions for 12 months! More accurately, look at the definition of pre-existing conditions in the policy disclousures. Typical language will say some like: any condition for which you received care or treatment for the past (generally 6 or 12 months) will not be covered for the first (generally 6 or 12 months). So if you had cancer but have been treatment free for several years, in many cases it will not be considered a pre-ex. The language in most plans is pretty specific so please read it carefully.

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