How do I make sure the health insurance company is paying for everything they are supposed to?
613405
Insurance companies provide a plan document that explains what they will cover.  Most people look at what their copays are, but few read into the limitations and exclusions.  What the doctor says (via medical records and ICD-9 & CPT coding) DOES determine whether the insurance company will cover the service, but the physician (or his staff) is legally obligated to code for the exact service provided.\n\nFor example, if your insurance company does not cover a routine eye exam per plan exclusions, and the doctor codes the visit as a routine exam, your claim is DENIED.  If the doctor codes the visit as something was medically wrong with your eyes, it might be covered.  But, it would be unethical to change a diagnosis just so your insurance company would pay if you were really only there for a routine exam.\n\nBottom line ... understand what your insurance company will cover, and be prepared to follow the rules.\n\nPS, it isn't your doctor's job to know what your insurance pays for, it is yours.
94108
Different companies charge different amounts. It will also depend on how your health is, if you smoke, if you are over weight, etc. Start calling insurance agencies and ask for quotes. That is the only way to know who is going to be the cheapest.
271363
Your insurance company sent you the checks instead of sending them to the dentist... occasionally insurance companies will do that and you are suppose to sign those over and give them to the dentist.  They are meant to go to the dentist... not you.  Also, I am sure you signed something when you filled out paperwork stating that you would be responsible for any balance you insurance company did not cover as the dentist only gave you an 'estimate' of what the insurance company would pay.... because your insurance company only gave your dentist an 'estimate' of what they pay... the insurance company even has a disclaimer before they give a break-down of benefits stating it is an estimate only and payment is not guaranteed.  Therefore, there is nothing you can do but pay the bill.\n\nIn the future, if you want a guarantee of how much your insurance will pay for your treatment, then have your dentist send in a pretreatment estimate to your insurance company before you have treatment done.  Your dentist will do this for you as a courtesy.  The insurance company will then send, in writing, something to the dentist stating how much they will pay and then this is a definite.  The insurnace company will be bound to this and if they do not pay what they state at that time then you go after the insurance company.
156212
The insurance company has what they call "Allowed amounts" or "usual and customary", which is the amount that they will pay on a service. Your copay or percentage/ded is part of that amount. The health care providers who are contracted as In Network Providers sign a contract with the health insurance to become part of the network. Those providers agree to take the allowed amount as payment in full for the services. Any amount they charge that is over that allowed amount is a write off for them. If the providers are not contracted with that insurance company, they can legally bill you for the amount over the allowed amount. The providers who are contracted get the advantage of advertising from the insurance company because they will be listed in your provider booklet or on your insurance company's provider directory on the website. They will get more patients from those searches than if they were not contracted, so the amount they have to write off is not a problem.
836902
No insurance is 'worth what you pay for it' until it's time to collect benefits.  Most lines of health insurance only pay about 60% of the total premiums toward benefits.  The rest goes to expenses and profits.
1185310
You sound like you already know a bit about health insurance, but here’s a couple of general ideas, although it’s always best to talk with a qualified insurance agent who can help you get the right coverage. When you talk about $200-250, is that total costs for a month or for premiums and copays? It sounds like you might like a PPO over a HMO, although you might also be interested in a more traditional fee-for-service type of insurance. The PPOs will give you more freedom, but you’ll also have to fill out more paperwork. However, if you already have a doctor you like, you might want a PPO since your doctor might not be part of a HMO (PPOs usually don’t require you to have a primary care physician). \n\nLast year, Consumer Reports conducted a national reader survey of about 35,000 people and asked them about how they liked their health insurance and quality of health care (click here). Sixty-four percent said they were happy with their health plan. People were generally happier with HMOs than PPOs, but the Consumer Reports writers said that this was probably more a function of the lower prices. As a group, more PPO members felt they had adequate access to health care than HMO members. As I mentioned before, though, the rate of billing errors was three times higher among PPO members than HMO members.\n\nKaiser of course has a major presence in California, and Blue Cross Blue Shield is also a popular choice among Californians (they had by far the most PPO plans in the top 10 of the CR survey). You might want to write down all your concerns and then rank them in order of importance. It’s simple, I know, but I’ve always found it a useful way to make a tough choice.\n\nIf you’re still looking for answers, visit MostChoice.com. It’s a Web site that makes finding health insurance answers easy and makes shopping for health insurance quick and painless. You’ll be able to view online quotes from California health plans, and local area insurance agents will help you compare a range of competing health plans from companies like BCBS. There’s no cost or obligation to you, and your personal information is used only to match you with local health plans and insurance agents. You can find it here: http://www.mostchoice.com/health-insurance.cfm.\n\nBarnes@MostChoice.com
255965
there is really no best plan. i would recommend a discount plan that coincides with your prescriptions. ex: pays 100 percent on bloodpressure but must only get generic brands of everything else.  so surf the net for a discount plan that way your only charged for the prescription instead of the monthly cost plus co-pay and/or diff. of what the insurance company payed for the medicine.  Sorry no specific company GOOD LUCK
34056
Despite some efforts to create a national system, healthcare is still funded largely by joint employer/employee contributions, with the employer typically picking up 70-80% of the cost.  \n\nMore and more options involve HMO's, or health maintainence organizations.  They trade a low-cost co-pay (or insured share of medical cost) for managing practically every decision involving your care.  HMO's often make decisions based on financial considerations.  Other insurance plans are available, but at substantially higher prices.\n\nWith healthcare costs skyrocketing, largely due to vastly increased malpractice insurance premiums, a better solution is needed.  There has been continued talk of "tort reform" which reduces the liablility of a doctor or hospital in a suit.  Other "consumer-driven" insurance plans have been developed that put the insured in more of a position to determine how much his health care will cost.  My wife and I have such a plan, and it offers us some incentive to choose our doctor visits more carefully.
813684
I'm not sure what you're looking for ... If you mean comparisons of your company's plans, there won't be any.\n\nTry to remember that your employer, NOT the insurance carrier, determines what each plan will offer.  In almost every case, insurance companies are ASO (administrative services only) now.  This means that your company holds an account that all claims are paid from.  All the insurance company does is administer the plan your company specifies and then they pay claims out of your company's account.\n\nThus, your company's benefits will likely be different from every other company out there.  I'm sorry if this is disappointing news.  The best suggestion I can give you is to read through all your options and decide what's best for your level of health.
1015341
You can't possibly find that out unless you come across the paperwork for the policies or payments made to an insurance company. Good luck.
394636
check and see if your job has  insurance.If you make that much a week they want you to pay your own bills.Unless you go to a free clinic and don't tell them you have a job.
328928
It always depends on what kind of policy you have. You really do get what you pay for. You should always read your policy in it's entirety. If the insurance is paid by the employer and you don't have a choice, you can always purchase additional insurance. If this person is low income, she can apply for medical assistance through the state and they will pay any bills 3 months prior to the application. She may want to give that a try. You would be surprised at who they qualify for medical assistance.
1153851
First off,  I would not worry about the what the insurance company feels.  I would do whatever it took to get myself treated.  If it makes you feel any better, think about the $125 million a year compensation the CEO of United Health Care makes.  \n\nhttp://hcrenewal.blogspot.com/2005/05/how-can-1248-million-year-ceo-make.html\n\nSecond, you do not have a pre-existing condition based upon that definition.  Nothing has been diagnosed, treated, or cared for so therefore it is a new condition and not a pre-existing one.  Lets take an easy example,  you see a doctor and he finds that you have high blood pressure.  You probably have had high blood pressure for a while already and is only being diagnosed now.  This is a newly diagnosed condition not a pre-existing one even though you had high blood pressure before seeing the doctor.  Just because you have pain before seeing the doctor doesn't mean it is a pre-existing condition because the cause of the pain has never been diagnosed.\n\nThird,  sorry to say that your insurance sounds like a PPO  or POS.  (since you can directly go see an orthropedic doctor.)   Don't forget that even with insurance especially a PPO you have a deductable (its like car insurance).  You are responsible for the first $250,500,1000 or whatever you deductable is.  Once your deductable is met, the insurance picks up a percentage of the cost (90%/10%, 80%/20%, 70%/30% etc your share being the later percentage.\n\nSo good luck
1019574
If you go to an insurance company without doing your homework, they will sell you something that is profitable for them not you. You need to understand what you want it for. there is going to be a financial balance between 3 factors\n\n1. monthly premium\n2. copayment\n3. deductiable\n\nthese factors will vary based on the type of insureance you buy.\nyou need to determine based on marital status, children, health, age, job dangers, family history and any other specific factors in your life.\n\nyou need to think about how often you will use the insurance. \nif the answer is rarely then think about low premiums and high copay and deduct. If you will be a heavy user then the opposite will apply.\n\nDON"T let an insurance company decide for you.\n\nother considerations would be existing doctors. If you have ones that you like you need to choose a policy that includes them.\n\nas was mentioned above, consult HR at work and do more research. What you've done here is an important first step
1109182
they should pay your medical bills
110800
Check with your insurance company - it should be covered.
720315
You can also throw the insurance company's into the mix, they have a good thing going and would hate to lose it to socialized medicine. They essentually set the rates that uninsured have to pay and it is wrong. I as an uninsured person have to pay full price for everything and the insurance companys set their own price as to what they will pay. In effect I am subsudizing the insurance companys low rates. This is wrong and I would like to see somebody do something about it, maybe as more become uninsured I will see it happen if I live long enough with substandard health care because I can not afford to pay full price.