About Experts Sitemap - Group 35 - Page 11 2015-08-25

Medicare, Medicaid, Life and Health Insurance: Medicare & Auto Accidents, auto accidents, auto injuries
auto accidents, auto injuries, court delays: Hi Richard Answer to first question is: True Answer to second question is to get auto insurance if you drive. Auto injuries are covered by auto insurance and are considered liability coverage, Therefor Medicare does not pay. However. is the liability...

Medicare, Medicaid, Life and Health Insurance: Medicare and Humana, humana insurance, rehab hospital
humana insurance, rehab hospital, copay: Hi Ellen Call 1-800-307-4444 and speak to my counterpart in NV. It sounds like she is in a Medicare Advantage HMO, and the co-pays add up. Ask to speak with a counselor and they will look at her situation and probably come up with better options. Joh...

Medicare, Medicaid, Life and Health Insurance: Medicare and Legal Immigrants, immigrant eligibility, legal immigrant
immigrant eligibility, legal immigrant, legal immigrants: Hi Stan It all depends on how reside continuously is defined in your State. I am in the Detroit area and the former Canadians go back on visits to Canada all the time. The Key is residence, short visits do not effect residence, This is a little...

Medicare, Medicaid, Life and Health Insurance: Medicare limit on rehab - switch to medicaid?, medicare savings program, medicaid regulations
medicare savings program, medicaid regulations, hospital rehab: Hi Beth What you need is a sit down face to face meeting with a counselor. You can reach my counterpart in Florida at 1-800-963-5337. Give them a call and request to speak with one of their counselors. They can review you situation and advise you of...

Medicare, Medicaid, Life and Health Insurance: Ms Medicaid, insurance carriers, medical records
insurance carriers, medical records, medicaid: Hi Angel! You do not get Medical records from insurance carriers/Medicaid but by the provider of services. So where ever your child received medical services from is where you would get his/her records. Medicaid is the payer not the keeper of medical...

Medicare, Medicaid, Life and Health Insurance: medicare part A, mail co, useful phone numbers
mail co, useful phone numbers, surgery tomorrow: Hi Nonette You can not expect the insurance to pay medical bills when you have not been paying premiums. He could have had Part A if he had paid the premium. This is too long and complicated to be done by e-mail, co I am referring you to my counterpart...

Medicare, Medicaid, Life and Health Insurance: medicare transfer between states, medicare number, coverage status
medicare number, coverage status, national prescription: Hi Jane Her Medicare number and benefits remain the same. Insurance coverage depends. If she has original Medicare with a national Prescription plan(PDP), she probable will need little change. If she has an Advantage plan, then===many changes. ...

Medicare, Medicaid, Life and Health Insurance: moving, health insurance assistance, state health insurance
health insurance assistance, state health insurance, state health insurance assistance program: Hi Cindy Medicare: Medicare coverage will remain regardless of the situation. Problem will be with the secondary coverage. If you have original Medicare and a Medigap policy that has national coverage no problem. If they do not have coverage , you simply...

Medicare, Medicaid, Life and Health Insurance: Protecting my home for my son's Inheritance, convalescent home, home expenses
convalescent home, home expenses, counseling service: Hi Richard Each State has it s own recovery law. Since I am in Michigan, I will refer you to my counterpart in California. Call 1-800-434-0222 and you will get the SHIP counseling service nearest you. Give them a call and make an appointment with one...

Medicare, Medicaid, Life and Health Insurance: 1,500 dollar premium bill from secure horizons, medicare savings program, secure horizons
medicare savings program, secure horizons, advantage plan: Hi Lisa It sounds like there is a problem with your Medicare Savings Program eligibility. However, this is too complicated to be done by e-mail/ So I am referring you to my counterpart in California. Call 1-800-434-0222 and you will get the nearest location...

Medicare, Medicaid, Life and Health Insurance: co-pay for mammogram, copay, insurance carrier
copay, insurance carrier, mammograms: Hi Karen! Your insurance company deems whether you have a copay or not. I have not heard of a government plan to make mammograms without a copay. If you are unsure or if you did not pay a copay prior to this year, call your insurance carrier directly...

Medicare, Medicaid, Life and Health Insurance: daughter on medicaid, primary insurance, private insurance
primary insurance, private insurance, medicaid: Assuming Medicaid was active at the time of service, Medicaid should pay for the remaining balance if any after your insurance pays. Here s what may be an issue, medicaid is considered to be the payer of last resource, if your primary insurance will deny...

Medicare, Medicaid, Life and Health Insurance: dnied coverage per preexisting, supportive documentation, own insurance
supportive documentation, own insurance, arthroscopy: Hi Linda! Since the issue is with the left knee not the right knee I would send an appeal. He did not have a pre- existing condition if the left knee had no issues prior to now. Just need to appeal and fight them.......they are hoping that the patient...

Medicare, Medicaid, Life and Health Insurance: Medicare and BCBS of Al, bcbs of al, medicare drug plan
bcbs of al, medicare drug plan, group health insurance: If you have the opportunity to have Group Health Insurance, you may be able to get good coverage at a better price. And if your plan includes drugs, then you would not need a Medicare drug plan. And you can make Medicare a secondary insurance which can pay...

Medicare, Medicaid, Life and Health Insurance: Medicare & Medicaid and Moving to another state., medicare savings program, medicare premiums
medicare savings program, medicare premiums, medicare medicaid: Hi Joe You are dealing with two entirely different systems. Each State has its own Medicaid program. As soon as you get to NJ apply for Medicaid there. They have 45 days to process the application, however it is retroactive for up to 2 months. You...

Medicare, Medicaid, Life and Health Insurance: medicaid discrimination, history of ovarian cancer, history of cervical cancer
history of ovarian cancer, history of cervical cancer, bladder cancer: Hi Teena! You may be right but hard to prove. Medicaid pays providers very little with alot of paperwork required so most Drs/providers do not want to participate with Medicaid. However if they chose to as in the Dr s you saw they should give you...

Medicare, Medicaid, Life and Health Insurance: Neulasta, social security office, white blood cells
social security office, white blood cells, person request: Hi Marshall A little out of my expertise. However, call 1-800-Medicare====as soon as it is answered say AGENT. You will be transferred to a live person. Request to speak with an appeals specialist. When you finally reach that person, request assistance...

Medicare, Medicaid, Life and Health Insurance: qmb, medicare recipients, health benefit
medicare recipients, health benefit, new health: http://www.peoples-law.org/health/gov-ben/qmb.htm Please see the above link. There is a place to call to find out more about this. It is for Medicare recipients that do not qualify for Medicaid and I have no clue why they took money out of her check. Please...

Medicare, Medicaid, Life and Health Insurance: SSD, Medicare & Medicaid, social security disability, medicare premiums
social security disability, medicare premiums, medicare medicaid: Since Medicaid is state specific, I am sorry that I cannot give you the information that you need. Start with Medicare and be sure that they have all of your information. They may be the best resource for you to be sure that your checks do not stop..but when...

Medicare, Medicaid, Life and Health Insurance: Collection of Denied Medicare Claim, medicare summary notice, social security office
medicare summary notice, social security office, medicare patient: Hi Lee I need the State you are in so I can give you the number to call. Have had trouble with computer, so do not know if you got the answer I sent yesterday. Too complicated to be done by e-mail, so I am referring you to my counterpart in your State....

Medicare, Medicaid, Life and Health Insurance: copayment, hardship waiver, copay
hardship waiver, copay, copayment: Hi Kathryn! Yes there is a financial hardship program that most providers use - If you make under a certain amount the provider can write off the entire copay or at least a portion. Call the provider and tell them you can not afford to pay the copay...

Medicare, Medicaid, Life and Health Insurance: Just out of curiosity, national abortion federation, medicaid payment
national abortion federation, medicaid payment, hotline operator: Hi Steve----- Medicaid may pay -- each state has different guidelines. Call the National Abortion Federation hotline at (800) 772-9100 to find out whether Medicaid covers abortion in your state. If it does, the hotline operator can give you the names...

Medicare, Medicaid, Life and Health Insurance: disability medicare supplemental ins. @63 yrs., social security disability, medicare supplemental ins
social security disability, medicare supplemental ins, benefits checkup: Hi Kate Sure do. Call my counterpart in Arizona at 1-800-432-4040 the nearest office to you. Contact them and they will get together with you and go on the computer to determine the best choices for you. They are part of the Medicare SHIP program. Best...

Medicare, Medicaid, Life and Health Insurance: Failure to buy Medicare part B retroactive, medicare hospital insurance, corba insurance
medicare hospital insurance, corba insurance, medical insurance benefits: Hi Billy Too complicated to be done by phone.Would take an hour session to explain in person. So I am referring you to my counterpart in NC. Call 1-800-443-9354 and request to speak to a SHIP counselor. They will get together with you and help you solve...

Medicare, Medicaid, Life and Health Insurance: gastric bypass, bluecross blueshield insurance, high cholestrol
bluecross blueshield insurance, high cholestrol, negative decision: Hi Darcel! Why did they refuse your surgery? Exclusions can not be fought since they are telling you up front what procedures they will not pay for. If they are denying for a specific reason, you need to prove they are wrong and do an appeal. You...

Medicare, Medicaid, Life and Health Insurance: Health Insurance, eob, insurance co
eob, insurance co, insurance company: Hi Keith! If the Doctor assured your sister that the insurance company would pay leaving her only her copayment, I would advise her to call the Dr s office to see why they are billing her for a balance they stated would be covered by insurance. You need...

Medicare, Medicaid, Life and Health Insurance: Humana Medicare PFFS/PPO, medicare pffs, family practice
medicare pffs, family practice, good sense: Hi Kathy This is out of my area of expertise. However I think you can get your answers by calling 1-800-Medicare. When it is answered, immediately say Agent==that will transfer you to a human being===when they answer request to speak to a provider specialist....

Medicare, Medicaid, Life and Health Insurance: MEDICAL ASSISTANCE, medicaid plan, patient need
medicaid plan, patient need, medical assistance: Hi Brenda! Each Medicaid plan is different in each state but in general they sort of follow Medicare s rules such as the waiver. You must notify a patient up front if you do not participate with their Medicaid plan and they usually have to sign a waiver...

Medicare, Medicaid, Life and Health Insurance: Medicaid Approval, charity care, emergency plan
charity care, emergency plan, stipulations: Hi Kathy! Medicaid is state specific so you would need to call them to see if they have any type of emergency plan. Most do. Or you can check with the hospital who will perform the surgery and see if they have any type of charity care which usually...

Medicare, Medicaid, Life and Health Insurance: Medicaid for Mom, medicaid regulations, old mom
medicaid regulations, old mom, counseling program: Hi Paul I do not recall which State uses MA. If it is: Maine===cam 1-877-353-3771 Maryland===1-800-243-3425 Massachusetts===1-800-243-4636 You will reach my counterpart in the SHIP Medicare Counseling program. The Medicaid regulations are different...

Medicare, Medicaid, Life and Health Insurance: Medicare/medicaid, demorest ga, medicare medicaid
demorest ga, medicare medicaid, medicaid regulations: Hi Carolyn Because the Medicaid regulations are different in each State, it gets a little complicated. Basically the information you received is correct. Georgia will not begin processing her application until she is in Georgia. However, there are probably...

Medicare, Medicaid, Life and Health Insurance: Medicare part B, coordination of benefits, enrollment period
coordination of benefits, enrollment period, employer plan: Hi Heather It appears he is OK with Part A, since it has been in effect since 86. I gather that he also had Part B, but cancelled it because he was on his working spouse s employer plan. There is no mention of when she stopped working. If she is still...

Medicare, Medicaid, Life and Health Insurance: Medicare, secondary insurance, and, denial letter, medicare patients
denial letter, medicare patients, medicare program: Jel, physicians that provide services to medicare patients should be enrolled in the medicare program, this does not automatically make them participating. At the time of enrollment, the physician will either opt-in (participate) or opt-out (non-participating)....

Medicare, Medicaid, Life and Health Insurance: medicare, copayment, medicare
copayment, medicare, collections: Hi Leah! It depends........if Medicare paid their portion and the balance per Medicare is patient s copayment or deductible then yes you can send patient to a collection agency if patient refuses to pay. If Medicare was billed but did not pay, you need...

Medicare, Medicaid, Life and Health Insurance: Procrit/Epogen, end stage renal failure, ship office
end stage renal failure, ship office, epogen: Hi Kathy You have to request a determination to get it covered, Call 1-800-701-0501 and you will et the nearest SHIP office to you. These Medicare trained counselors will meet with you and assist you in filing an appeal. Later, the Fall they will research...

Medicare, Medicaid, Life and Health Insurance: provider writeoffs, contracted providers, copay
contracted providers, copay, insurance carrier: Hi Sandra! Copays and deductibles are determined by the insurance carrier whether or not there is a contract. Usually deductibles and copayment percentage goes up if a patient goes to an non-participating provider. So if an insurance company pays let...

Medicare, Medicaid, Life and Health Insurance: OUT OF STATE MEDICAID ADDRESSES, state medicaid, medicaid
state medicaid, medicaid, poughkeepsie: Hey Cheryl...... The main website for Medicaid is: http://www.cms.gov/home/medicaid.asp Not sure if it will give you the information you need since so much on that site for Medicaid. If not just do a search for the state and Medicaid. And it should...

Medicare, Medicaid, Life and Health Insurance: Supplemental Insurance to Medicare, social security office, pathfinder search
social security office, pathfinder search, supplemental insurance: Hi Daphne Because of Stat Regulations, there is a listing of what is available in each State. It is in the Medicare and You manual Medicare sends out each October, You can get a copy at the local Social Security Office, if there are any of the 2010 issue...

Medicare, Medicaid, Life and Health Insurance: Where do I start?, medical billing program, massage therapy practice
medical billing program, massage therapy practice, billing programs: Hi Cassandra! I think I would suggest to find another therapy group as what you will start and call them to ask what program they are using. Call a few around your area. Most alike types of groups use the same medical program....you need to have your...

Medicare, Medicaid, Life and Health Insurance: Transfer benefits from Michigan to California, early onset dementia, medicare savings program
early onset dementia, medicare savings program, california medicaid: Hi Frieda Because each State have their own regulations for Medicaid, the benefits can not be transfered. Therefore, contact the California Medicaid office and find out their residence requirements, and other information. What really happens is that...

Medicare, Medicaid, Life and Health Insurance: transferring medicaid and SSD, social security office, retroactive coverage
social security office, retroactive coverage, information address: Hi again Each State has somewhat different regulations, Most say you have to be residing in the State before you can apply. Usually when someone moves into the State, they can sign a statement that they are going to reside in the State. So you wait...

Medicare, Medicaid, Life and Health Insurance: Breast reduction for cronic neck and shoulder pain, neck and shoulder pain, breast reduction
neck and shoulder pain, breast reduction, gravis: Medicare might cover breast reduction if you meet their criteria. A predetermination letter with photos and/or test results can help you achieve the ok for the surgery. It must be proven and medically coded as medically necessary or it won t be covered....

Medicare, Medicaid, Life and Health Insurance: balance billing, achilles tendon, achilles tendon surgery
achilles tendon, achilles tendon surgery, balance billing: Hi Ross! It happens all the time and it is not fair. Your surgeon knew that you were in a network and he should have asked for a surgical assistant in your network and if none were available he should have advised you prior to your surgery. So what...

Medicare, Medicaid, Life and Health Insurance: facing dental costs in retirement, teeth and gums, dental bill
teeth and gums, dental bill, informational packet: Hi Marta You will not find a doctor that takes Medicare because Medicare does not cover routine dental and dentures. You have an Advantage plan that has added dental coverage to their plan. What you need is to use one of those dentists. Ask the plan...

Medicare, Medicaid, Life and Health Insurance: Health Insurance, patient responsibility, explanation of benefits
patient responsibility, explanation of benefits, insurance carrier: Hi Douglas! It all depends -----some Dr s and insurance companies have contracts so their payment is reduced along with yours. If there is no agreement than your Dr can charge you for the balance unpaid by your insurance carrier. The only way to know...

Medicare, Medicaid, Life and Health Insurance: Health Insurance, harvard pilgrim health insurance, harvard pilgrim health
harvard pilgrim health insurance, harvard pilgrim health, referrel: Hi Kristy You did not mention the State you are in or if this HMO was a Medicare Advantage plan, or an employer plan When you first got the HMO, you also received a packet that explained the appeal process to you. It appears that you have been following...

Medicare, Medicaid, Life and Health Insurance: Issued a PPO Card instead of DMO, ppo plan, dmo
ppo plan, dmo, aetna: Hi Ty! You need to see what plan you signed up for.......under Cobra you continue on with the plan you had. So if you had the DMO plan then this would be the plan under the Cobra plan. If Aetna made a mistake, then they should be responsible for their...

Medicare, Medicaid, Life and Health Insurance: My lab work was sent out of network when I asked ahead of time. What are my options?, orthopedist, network providers
orthopedist, network providers, front desk: Hi Anthony! This happens alot and it is usually the error of the Dr s office. So call them and explain you asked them to use an in network provider and they did not. Ask them why they did not. Sometimes there are no in network providers for lab...

Medicare, Medicaid, Life and Health Insurance: Medicaid coverage of gastric bypass surgery, substantial weight loss, waist circumference
substantial weight loss, waist circumference, medicaid coverage: Your Doctor may be able to answer this better. Individual cases about Medicaid coverage of gastric bypass surgery generally involve proving that for a particular patient, the surgery is medically necessary and not cosmetic. Obviously, the surgery must be...

Medicare, Medicaid, Life and Health Insurance: Medicaid problems w/renewel, federal poverty level, medicaid policy
federal poverty level, medicaid policy, pay stubs: Indeed, it seems this worker was checked for accuracy and someone found those 2 things that need more clarification. As far as your life insurance - cash surrender value of life insurance which exceeds $1,500 in face value is counted towards your resources....

Medicare, Medicaid, Life and Health Insurance: Medicaid and relocation, gap coverage, medicare benefits
gap coverage, medicare benefits, moving to florida: Hi Alice Too complicated to be done by e-mail, so I am referring you to my counterparts. Calling from inside the State, the number in NY is 1-800-701-0501====In Florida, 1-800-963-5337. Call them and they will assist in the Medicare transfers. them...

Medicare, Medicaid, Life and Health Insurance: Medicaid as second ins., medicare supplement plan, mom lives
medicare supplement plan, mom lives, customer service number: Debbie, if you could please respond privately to me, I will be able to be more exact. Please tell me what state Mom lives in (zip code)and what Medicare Supplement Plan (letter) she has - C,F,G,J? This information should be on her ID card, or you can quickly...

Medicare, Medicaid, Life and Health Insurance: Medicaid vs Settlement, personal injury case, medicaid agency
personal injury case, medicaid agency, states supreme court: I m sorry to hear of your family s dilemma. This may depend on your State, but in 2006, the United States Supreme Court unanimously held that: (a) a State s Medicaid agency may recover against proceeds of a personal injury case only as to the party of the...

Medicare, Medicaid, Life and Health Insurance: Medicare Denial, psychiatric residential treatment, denial letter
psychiatric residential treatment, denial letter, pennsylivania: Hi Crystal There is not enough information for me to work with, and I do not use a providers manual. Also this is mostly outside of my expertise.I will recommend two things: Call 1-800-Medicare====as soon as it is answered, say AGENT===as soon as a...

Medicare, Medicaid, Life and Health Insurance: Medicare Only, medicare beneficiary, medicare patients
medicare beneficiary, medicare patients, collection effort: “yes” a provider’s collection effort may include a collection agency… •When a collection agency is used, CMS expects the provider to refer all uncollected patient charges of like amount(s) to the outside collection agency with regard to the same class...

Medicare, Medicaid, Life and Health Insurance: Medicare renewel problems, pay stubs, case worker
pay stubs, case worker, satisfactory answer: Hi Joe Talk with your case worker and see why the second request was made. It may very well be an administrative goof. If you do not get a satisfactory answer, the talk with the case Worker s supervisor. I hope you did not send the originals in the...

Medicare, Medicaid, Life and Health Insurance: Medicare vs Aetma, aetna insurance, aetma
aetna insurance, aetma, medicare card: Hi Loretta This is far to complicated to be done by e-mail. It would take almost an hour in person. Therefor I am recommending you contact my counterpart in your State. Your husband will receive a copy of MEDICARE AND YOU 2011 in a few weeks. In the...

Medicare, Medicaid, Life and Health Insurance: Outstanding Medical Balances, medicare medicaid, delinquent fee
medicare medicaid, delinquent fee, insurance carrier: Hey Luis! Yes they can if they advised you prior...usually it is written on their statements. Do they collect it? Usually not but it is mostly done to try to push a patient to pay on time. I would pay your bill but delete these charges...I doubt...

Medicare, Medicaid, Life and Health Insurance: No Pre-Authorization Required
Hi Maggie! Due to not requiring a pre-authorization they are leaving the door open to whether they pay or not. So you have a good reason to worry some however if your insurance company is a good one and your Dr feels that this surgery is 100% necessary...

Medicare, Medicaid, Life and Health Insurance: psychotherapy under medicare, social security office, pathfinder search
social security office, pathfinder search, secondary insurance: Hi Marian I would need more information and about 2 hours to explain this to you. You need to make an appointment with my counterpart in your State so they can get together with you and explain what is needed. Tell me what State you are in and I will...

Medicare, Medicaid, Life and Health Insurance: S.C.Medicaid, case worker, elder law
case worker, elder law, time limit: Hi Pauline The regulations are different in each State. So I am referring you to my counterpart in S.C,. Call 1-800-868-9095 and request to speak with a SHIP counselor. Your case worker should also know. Usually you can sell the house====put all...

Medicare, Medicaid, Life and Health Insurance: transfer of benefits, federal medicare program, medicare medicaid
federal medicare program, medicare medicaid, social security benefits: Hi Sheri. There s a few things I need to know here. She most probably has Medicare, (insurance for those over 65), but you need to find out if she has a white State of California card that would be MediCal (Medicaid). If she does, she would have to apply...

Medicare, Medicaid, Life and Health Insurance: COBRA rejecting past claims because I was Medicare eligible, group health insurance, cobra coverage
group health insurance, cobra coverage, primary insurance: Hi John There are too many factors to consider to do this by e-mail. so I am referring you to my counterpart in your State Their number is in the center of the back cover of MEDICARE AND YOU 2011 that you received in October. Call them and meet with a...

Medicare, Medicaid, Life and Health Insurance: choosing employer ins over Medicare part B, anthem health insurance, medicare supplement plan
anthem health insurance, medicare supplement plan, united health care: Hi Jenna Your friend was right. He should have got the Certificate and kept it for record. If they did not issue one, he should have requested it. There is a chance he had one and misplaced it. In October he should have received a copy of MEDICARE...

Medicare, Medicaid, Life and Health Insurance: How many days hospital does medicare pay for ?, medicare supplement, chest tube
medicare supplement, chest tube, plan states: Paula, it is up to your family and the doctors to decide where he will get the best care, not Medicare. If he only has Medicare and no other insurance, then he will be billed $1132 as a deductible. If his hospital stays comprise more than 60 days, then he...

Medicare, Medicaid, Life and Health Insurance: Emergency Dental with Medicaid, couple teeth, medicaid recipients
couple teeth, medicaid recipients, emergency dental: Erica, I searched for information and this is what I found: http://www.smilemichigan.com/FindaDentist/CommunityDentalPrograms.aspx Click on Counties N-W and go to Wayne County. You ll see half dozen different places you can go that will either treat...

Medicare, Medicaid, Life and Health Insurance: COBRA rejecting past claims because I was Medicare eligible, medicare, cobra
Medicare, Medicaid, Life and Health Insurance: COBRA rejecting past claims because I was Medicare eligible, medicare, cobra

Medicare, Medicaid, Life and Health Insurance: Insurance is not willing to pay, age restriction, insurance section
age restriction, insurance section, council person: Hi Ashlea! You can not force an insurance company to accept you. Not much more you can do then keep trying all the carriers. Texas is a state that backs up subscribers so perhaps go on their website to see if they have an insurance section that may...

Medicare, Medicaid, Life and Health Insurance: legal charging system from medical provider, ambulatory surgical center, copay
ambulatory surgical center, copay, medical provider: Hi Fonda! Provider s can charge an in network copay and deductible------should not do on a regular basis but once in awhile it is sort of accepted. Insurance companies don t really want providers to do so but as long it is not their regular business...

Medicare, Medicaid, Life and Health Insurance: MEDICARE AND MEDICAID COVERAGE, legg perthes, chronic myofascial pain
legg perthes, chronic myofascial pain, medicaid coverage: Hi Darryl This is far too complicated to be done by e-mail, so I am referring you to my counterpart in Wisconsin, Call 1-800-242-1060 and request to speak with a SHIP counselor. Make an appointment with them and they will review your situation in accordance...

Medicare, Medicaid, Life and Health Insurance: Does Medicaid cover Abdominoplasty/"Tummy Tucks, typical c, pubic area
typical c, pubic area, abdominoplasty: Medicaid usually will cover certain procedures that are medically necessary. This may be considered cosmetic surgery so I doubt if it would be covered but saying that, I would contact a plastic surgeon and see if you can get a consultation and have him/her...

Medicare, Medicaid, Life and Health Insurance: Medicaid Eligibility, medicaid eligibility, medicare eligibility
medicaid eligibility, medicare eligibility, dshs wa: Suzanne, everything I have read indicates paying off a debt would be a good thing. I believe the transfer of funds comes into play when it is to a family member, etc. They are allowed to keep their car, so that one may not need to be paid off unless it...

Medicare, Medicaid, Life and Health Insurance: Medicaid and primary insurance, maternity coverage, blue cross blue shield
maternity coverage, blue cross blue shield, primary insurance: Kathy, here s what I found: If you have medical insurance, they should pay for your care before Medicaid. In order for Medicaid to pay as secondary, you must follow the plan provisions of your primary insurance, which includes using your plan network of doctors,...

Medicare, Medicaid, Life and Health Insurance: Medicare after 24 months, medicare supplement insurance, social security benefits
medicare supplement insurance, social security benefits, medicaid office: Angela, income has nothing to do with Medicare, only Medicaid. Here s what I found though as far as continuing eligiblity: The Social Security Administration periodically reviews eligibility for SSDI. If your condition improves or you have a successful...

Medicare, Medicaid, Life and Health Insurance: Medicare, Medicaid Question, social security disability, medicare medicaid
social security disability, medicare medicaid, hospital expenses: Silvia, did you have employer group insurance? When did it end? There might be an opportunity for you to get Medicare Part B, medical coverage. This will not cover hospital expenses, which is Part A. This you must be on SSDI for 24 months to qualify for....

Medicare, Medicaid, Life and Health Insurance: Medicare Part D, langley wa, 4ppa
langley wa, 4ppa, prescription drug plan: Wendy, when he is able to join a Part D prescription drug plan, he will be penalized 1% of the national average for Part D plans every month, for each month he hasn t been enrolled. The penalty is not on the drug cost, rather on the plan cost. As I explained...

Medicare, Medicaid, Life and Health Insurance: Medicare Supplements for Dental and Psych?, medicare hmo, medicare supplements
medicare hmo, medicare supplements, free medicare: Surina. Please respond in private mode. I need to know your zip code. Do any of these apply to you? end-stage renal (kidney) disease? currently receiving dialysis? diagnosed with kidney disease that may require dialysis? admitted to the hospital as...

Medicare, Medicaid, Life and Health Insurance: when to go on medicare, social security office, medicare card
social security office, medicare card, medicare supplement: Hi Mary His insurance will be primary until he stops working. Then Medicare becomes primary If you are already on Social Security, sometime in February or March, you will receive your Medicare card. If you do not want part B, send it back and accept...

Medicare, Medicaid, Life and Health Insurance: medicare refund, medicare refund, social security check
medicare refund, social security check, account balance: Lynn, I would ask more questions of the nursing home. What part of Medicare needed to issue the refund? Why? Did S.S. miss an income payment to him? Keep his checking account balance under the allowed amount and you shouldn t run into trouble. Have a...

Medicare, Medicaid, Life and Health Insurance: Post-Service Denial of Radiology Test, time restraints, service denial
time restraints, service denial, cancer doctor: Hi Rose! Since there may be time restraints with your insurance carrier for appeals, I would first call the provider who called for the authorization and tell them that your carrier denied your bill stating not medically necessary. Ask if they could help...

Medicare, Medicaid, Life and Health Insurance: Who Is Primary Insurer?, social security office, certificate of creditable coverage
social security office, certificate of creditable coverage, medicare card: Hi Ken They told you right. Her coverage is considered Creditable Coverage in regard to both medical and prescription coverage. Ask them for a certificate of Creditable Coverage. You may need it when she quits work. You did not need to get Part B...

Medicare, Medicaid, Life and Health Insurance: possible move, medicaid qualification, medicaid program
medicaid qualification, medicaid program, regarding your situation: Tom, I wouldn t go through the cost of a move until you know where you ll be accepted. If HI or WA are your choices, here are the websites for you to contact to begin the Medicaid qualification process. You should talk with them regarding your situation...

Medicare, Medicaid, Life and Health Insurance: pre-authorized meds with Medicaid, suboxone treatment, pain meds
suboxone treatment, pain meds, 3 quarters: Hi Kelli! I do not really have that much knowledge on Medicaid since each state has different rules and guidelines that change all the time. You would have to call your state s Medicaid program to see why they are doing this or perhaps go on line for...

Medicare, Medicaid, Life and Health Insurance: straight medicaid, medicaid beneficiaries, brevard county fl
medicaid beneficiaries, brevard county fl, health care provider: Linda, here is the website I found that should help you find the providers you daughter needs in her area. http://ahca.myflorida.com/find_dentists.shtml Or - Medicaid Beneficiaries call (407) 420-2500 or (877) 254-1055, Press 2 for assistance to locate a...

Medicare, Medicaid, Life and Health Insurance: Disability, medicare medicaid, food stamps
medicare medicaid, food stamps, terminal cancer: Hi Lacy! I am not an expert on Medicaid/Medicare or SSI. However my brother is disabled and he had to be disabled for 24 months before he was eligible for Medicare. Medicaid is a bit different and each state has it s own rules. You must make under a...

Medicare, Medicaid, Life and Health Insurance: am i eligible for bariatrics? please help me, severe depression, diet pills
severe depression, diet pills, medicare part a and b: Jessi, you need to start with the right doctor who can assess your situation in order to get the approvals needed from Medicare and Medicaid. Here is a link to accredited places that I believe work with Medicare - http://www.surgicalreview.org/locate/asmbs/...

Medicare, Medicaid, Life and Health Insurance: Insurance pad tummy tuck, lupron injections, incisional hernia
lupron injections, incisional hernia, cosmetic surgeries: Hey Lei! Every insurance policy is specific to that subscriber.........what Blue Cross will pay for one patient they may not pay for another due to the specific limits on each policy. As long as they do not list this surgery under their exclusions ...

Medicare, Medicaid, Life and Health Insurance: medicaid recoupment, state medicaid office, state medicaid program
state medicaid office, state medicaid program, medicare savings program: HI Barbara It appears that you are not on the State Medicaid program, but in the Medicare Savings program which happens to be administered by the State Medicaid Office. Call the Coordinator of Benefits Contractor at 1-800-666-1118 and find out if they...

Medicare, Medicaid, Life and Health Insurance: Medicaid as Secondary, insurance cards, primary insurance
insurance cards, primary insurance, wellcare: Hi Greg Hard to do without having access to the EOMBs etc Plus a timeline might be needed to see what actions can be Made. You should be able to get the answers from your case worker Also I usually deal with persons having Medicare and so does my...

Medicare, Medicaid, Life and Health Insurance: medicare, medicare card, creditable coverage
medicare card, creditable coverage, health care plan: Dick, thank you for the question. Since you are still working and have a good health plan, here s what will happen and what you should do. Social Security will send you your Medicare card, but you should follow the directions to decline Part B. As long...

Medicare, Medicaid, Life and Health Insurance: medicare, social security office, medicare questions
social security office, medicare questions, letter in the mail: HI Rich or Dick ?? As you hit 65 you should have received a letter in the mail with your Medicare card. It would have said If you do not want Part B, send the card back . If this did not happen, go to the social Security office and apply for Part A....

Medicare, Medicaid, Life and Health Insurance: Medicare and Humana, pathfinder search, nj department of health and senior services
pathfinder search, nj department of health and senior services, supplemental insurance: Hi Amber tis a little complicated. Call 1-800-792-8820. the NJ Department of Health and Senior Services/ , and request an appointment with one of the counselors. They will sit down with you and review your options. Request the to do a Benefits Check...

Medicare, Medicaid, Life and Health Insurance: Medicare and VA, open enrollment period, social security disability
open enrollment period, social security disability, pathfinder system: Hi George Too much missing information to be done by e-mail. The open enrollment period for Medicare starts October 15th, so I advise going that route to get the best way to go. You should have just received the Medicare and You 2012. In the center...

Medicare, Medicaid, Life and Health Insurance: Medicare vs. Human, humana prescription coverage, supplemental policy
humana prescription coverage, supplemental policy, supplemental insurance: Donna, thank you for the question. A person on Medicare may choose between a supplemental insurance, (Plan F is everyone s favorite), or a Medicare Advantage plan, which takes the place of Medicare. These plans usually come in the form of HMOs or PPOs, which...

Medicare, Medicaid, Life and Health Insurance: Motor vehicle accident claims, motor vehicle accident, auto insurance company
motor vehicle accident, auto insurance company, medicare info: Hi Gayle! It depends on state laws and the auto policy that patient has. You can usually opt to have your health insurance primary or not. So I would suggest to call the Auto insurance company and ask them directly. They should know if they are listed...

Medicare, Medicaid, Life and Health Insurance: My son, intermediate care facility, medicaid regulations
intermediate care facility, medicaid regulations, medicaid office: Hi Don The regulations are different in each State and I am in Michigan, Contact the Medicaid office in your State for the information you are looking for. One thing that is common is the ability backdate the coverage for up to three months. Most group...

Medicare, Medicaid, Life and Health Insurance: My doctor's office sent my lab works to non-network provider, texas department of insurance, network provider
texas department of insurance, network provider, department of insurance: Hi Kun! Ask the Dr to provide you with something in writing stating that this lab was in network then appeal again to your insurance company. If they can not provide that then tell them that you should not be liable for their mistake and see if they can...

Medicare, Medicaid, Life and Health Insurance: gap insurance, nion-medicare, health insurance business, individual health insurance
health insurance business, individual health insurance, gap insurance: Wanda, I believe I need more information to best answer you. You are not on Medicare yet? Can you keep your Humana policy all by itself? What is lacking in the Humana policy that you needed a supplement? What did the Guardian supplement cover? Please...

Medicare, Medicaid, Life and Health Insurance: medical referrals, private insurance companies, medical referrals
private insurance companies, medical referrals, kidney stones: Medicaid is probably one of the worse........they are short staffed and take forever to do referrals and pay their bills. Medicare is not as bad but they still have their issues. I would say Medicaid and Medicare are much worse than private carriers......after...

Medicare, Medicaid, Life and Health Insurance: medicare/anthem, social security disability, martha martha
social security disability, martha martha, hmo network: Martha, it would be my pleasure to assist you and your husband. Please use this link and my dedicated team for Medicare insurance will call you to explain your options on my behalf. I m confident we will find what fits your budget and needs. https://www.joppel.com/QuickQuote.aspx?trackingID=UFAADEEH66YEGME...

Medicare, Medicaid, Life and Health Insurance: Medicare, BlueCross, and TMD, group health plan, jaw surgery
group health plan, jaw surgery, counseling program: Hi Joe One thing for sure, it can not be done by E-mail. Therefor I am recommending that you contact the SHIP counseling program in your State. Also, each State has some different coverage for treatments covered by Medicare for persons having Medicare...

Medicare, Medicaid, Life and Health Insurance: Medicare/Medicaid, ship counselors, medicare medicaid
ship counselors, medicare medicaid, medicare program: Hi Tim I am referring you to the SHIP Medicare program in your State. You can reach them: A: There phone number is on the back cover of the Medicare and You 2012 she should have just received. or B. go to Medicare.gov======scroll and click on how...

Medicare, Medicaid, Life and Health Insurance: Medicare and spindown, ssi income, medicaid
ssi income, medicaid, medicare: I think you mean Medicaid don t you? You need to use it for your medical care and that is the money that you have to pay out of pocket before Medicaid will pay for anything. Medicaid will not pay until you have spent your own money of $234. And that is monthly....

Medicare, Medicaid, Life and Health Insurance: referrals, drs office, kidney stones
drs office, kidney stones, medical company: Start pushing the Doctor -- usually the only reason they would delay is due to being backed up. I know at the medical company I work for sometimes it does takes us days to get a referral especially when we are short handed or backed up. Only way to push...

Medicare, Medicaid, Life and Health Insurance: Transffering medicaid between states, care doctor, state coverage
care doctor, state coverage, heart surgery: Hi Jessie Each State runs it s own program so their are some differences. Usually you make the move and establish an address, the make and application for Medicaid in Calf. They ave 45 days to process the application. however it can be approved for...

Medicare, Medicaid, Life and Health Insurance: collecting on medi and priviate pay, medicare medicaid, billing specialist
medicare medicaid, billing specialist, unpaid balance: Hi Teresa. What s medi ? Medicare? Medicaid? Medical? If it s Medicaid, then I believe private is primary and Medicaid may pick up the balance. It depends if your State has dental insurance as a benefit. Unfortunately, I m not a billing specialist....

Medicare, Medicaid, Life and Health Insurance: health Care Ins, social security office, retirement coverage
social security office, retirement coverage, sinus infections: Hi Richard Too complicated to be done by e-mail. Also some regulations are different in a given State. Since you are already on Medicare, you should have received a Medicare and you 2012 by mail in October. If not go to the local Social Security Office...

Medicare, Medicaid, Life and Health Insurance: health Care Ins, sinus infections, prescription drug plan
sinus infections, prescription drug plan, acid reflux: Hi Dick, thank you for the question. Your decision is relatively easy considering you are eligible for Medicare. The situation to be concerned about is how to insure your wife, since she is not yet 65. If you retire, you will need to check with your employer...

Medicare, Medicaid, Life and Health Insurance: health Care Ins, sinus infections, acid reflux
sinus infections, acid reflux, deductible plan: Hi Richard! You can op for a high deductible plan as long it is costing much less and being aware that you will have to pay up to that point before insurance comes into play. Yes in most states you are eligible for some type of cobra plan as long as...

Medicare, Medicaid, Life and Health Insurance: Health care in LA, dialisys, kidney function
dialisys, kidney function, kidney foundation: Hi. Have him contact the Kidney foundation in his area. They will assist him in many ways, including transportation if he needs it. Also contact the SHIP office at 1-800-434-0222 and they can explain what services and programs will be available once...

Medicare, Medicaid, Life and Health Insurance: heath care insurance, sinus infections, heath care
sinus infections, heath care, acid reflux: Hi Dick..there is no such thing as a high deductible if you are in Original Medicare. That means no HMO. We re you talking about a managed care plan for Medicare? I never recommend them as they really restrict you getting the care that you may need from the...

Medicare, Medicaid, Life and Health Insurance: Insurance denial, brain tumours, brain tumour
brain tumours, brain tumour, time guidelines: Hey Jeff! If you disagree with a denial you can appeal. On the denial paper it explains how to do an appeal. Every insurance company has different rules for appeals so read on form how to do one and do it within the proper time guidelines. Your appeal...

Medicare, Medicaid, Life and Health Insurance: Insurance Deny my appeal again., network provider, insurance card
network provider, insurance card, worth a shot: I think I would ask the Dr to write a letter or you write it and have them sign it stating they made the error by not using an in network provider then send the letter and another appeal to UHC to see if they will reconsider their denial due to error by Dr...

Medicare, Medicaid, Life and Health Insurance: lap band surgery, medicare hmo, lap band surgery
medicare hmo, lap band surgery, deteriorating spine: Hey Martha! Call your Dr and ask if they can call for you........there are strict requirements and each plan is different so only way to know 100% is to call the insurance company directly and ask. Usually need a prior approval and only the Dr can get...

Medicare, Medicaid, Life and Health Insurance: med i cal, medicaid program, latoya
medicaid program, latoya, dental work: Latoya, if you are referring to MediCal, the medicaid program in California - then dental services are currently excluded, but you may purchase your own dental plan for services. Here is a website that might help you find what you need: http://www.dentalforeveryone.com/?id=91028-0000...

Medicare, Medicaid, Life and Health Insurance: INSURANCE DOESN'T WANT TO APPROVE A DR. RECOMMENDATION, medical necessity, insurance company
medical necessity, insurance company, exclusions: Hi Mariska! You need to find the reason for the denial then try to prove their denial wrong. Every policy has exclusions and guidelines so she must find out why they would not cover and then review her policy to see if they are responsible to pay....

Medicare, Medicaid, Life and Health Insurance: inheritance for medicaid person, down syndrome, medicaid
down syndrome, medicaid, inheritance: Hi Pam It will count as income the month received, so he will probably lose a month s coverage. What is left of it will count as an asset starting the following month. He has to keep assets below $2000. Funeral cost is allowable, so he should make those...

Medicare, Medicaid, Life and Health Insurance: insuficcient medical care, hospital emergency room, radiation treatment
hospital emergency room, radiation treatment, genetalia: Jeanet, it sounds awful how the facility has treated him. Here are the patient s rights direct from Medicare. Resident Rights Nursing home residents have patient rights and certain protections under the law. The nursing home must list and give all new...

Medicare, Medicaid, Life and Health Insurance: Medicaid denied to dying daughter., dying of lung cancer, desperate need
dying of lung cancer, desperate need, lung cancer: HI Donna Call 1-800-243-5463 and request to speak with a SHIP counselor. You will reach their nearest office. Have them run a benefits check for you and they will also help you apply for any that she is eligible for. john Hi again Call that number...

Medicare, Medicaid, Life and Health Insurance: Medicare - Car Accident, hospital rehab, billing medicare
hospital rehab, billing medicare, bill medicare: Have all providers bill Medicare. The auto insurance is considered primary and Medicare will pay as a secondary carrier. Not to worry. You cannot bill Medicare, The providers such as the hospital, rehab, physicians must bill. Rehab is covered if it meets all...

Medicare, Medicaid, Life and Health Insurance: Moving information, social security check, advantage plan
social security check, advantage plan, waiting list: If you are in Original Medicare (not HMO) your Medicare will go with you. You will have to apply to Medicaid when you move. If you are in an Advantage Plan for Medicare (HMO) then you may have to find another plan if the one you have presently does not have...

Medicare, Medicaid, Life and Health Insurance: medicare, medicaid, medicaid qualifications, social security office
medicaid qualifications, social security office, medicare medicaid: Thanks Barbara. First, you will need to continue to qualify for your State Medicaid as required by their rules - I don t think you ll have a problem. Then, as of November 1st, your Medicare will be effective. Make sure you talk with your Social Security...

Medicare, Medicaid, Life and Health Insurance: Procrit injection coverage, procrit injections, medicare guidelines
procrit injections, medicare guidelines, physicians office: Mellony, I m not sure what rule you re asking about, but here s the link to the Procrit site applicable to your State. http://www.procritline.com/pages/guide/location_guidelines.jsp?location=AL&x=15&y=9 If you would like to receive the Medicare guidelines,...

Medicare, Medicaid, Life and Health Insurance: payment for therapy on hand., health medical center, private therapist
health medical center, private therapist, baptist health: Are you talking about physical therapy or occupational therapy on your hand? And is Baptist Health part of a hospital or did you go to a private therapist. I need to know this before I can answer. I am going to assume that they are part of the hospital...

Medicare, Medicaid, Life and Health Insurance: SWITCHING INSURANCE, humana medicare advantage plan, ship counselors
humana medicare advantage plan, ship counselors, prescription drug plan: Hi Blossom There is no such thing as Humana Medicaid. You probably have Medicaid and a Humana medicare Advantage Plan, probably a HMO or a PPO. Because you are a dual eligible, Medicare and Medicaid, you can usually switch. However, it depends on how...

Medicare, Medicaid, Life and Health Insurance: transportation, medicaid office, routine appointments
medicaid office, routine appointments, medicaid benefits: Beej, most states have Medicaid benefits for transportation to routine Dr. appointments. I would check with your Medicaid office to inquire. Also, some cities have private companies that transport the disabled for little or no fee. Again, ask your Medicaid...

Medicare, Medicaid, Life and Health Insurance: unfair bill, patient surgery, surgery room
patient surgery, surgery room, bad information: Hi Tom! Someone gave you bad information or sort of no information and they should be accountable. You did your homework up front but should have insisted to speak to your carrier before they did your surgery knowing that you were told that they would...

Medicare, Medicaid, Life and Health Insurance: ALMB ELIGIBILITY, magic number, medical bills
magic number, medical bills, medical expenses: Hi Millie Medical bills can be used for SPEND DOWN to qualify for Medicaid To come up with your magic number, total all your accountable income. Then subtract $20. Then if any of your income is earned income, take the total of earned income. divide...

Medicare, Medicaid, Life and Health Insurance: Bariatric Surgery, Medicare & Medicaid, medicare medicaid, medicaid regulations
medicare medicaid, medicaid regulations, medicaid office: Hi Lauren The Medicaid regulations are different in each State, and I am in Mi. call my counterpart in NH at 1-866-634-9412 and you reach the SHIP counseling service in NH.They will get together with you and help get this straightened out. They will...

Medicare, Medicaid, Life and Health Insurance: billing errors, ship counselors, social security office
ship counselors, social security office, coordination of benefits: Hi Lesie It sounds like the COB(coordination of benefits) computers have not been kept up to date. Give them a call at 1-800-999-1118 and see what information they have on the master files. Explain the situation to them and they will send you the proper...

Medicare, Medicaid, Life and Health Insurance: Cancellation of mom's insurance without notification, united health care, proper notifications
united health care, proper notifications, itt corp: Hi Kathleen It appears that proper notifications were not made. Did she and your father notify the Coordination of Benefits(COB) of the informational changes as they happened . Did she read the informational letters they received from their employers...

Medicare, Medicaid, Life and Health Insurance: cobra and medicare part b, cobra coverage, doctor bills
cobra coverage, doctor bills, medicare part b: Hi again Most likely. Look in his coverage packet to see any specific information concerning COBRA. Also the State you are in may have some specific regulations. Call the SHIP number that is located in the center of the back cover of Medicare and You...

Medicare, Medicaid, Life and Health Insurance: college student, tax refunds, medical insurance
tax refunds, medical insurance, insurance company: Hi Andrea! No they can not make you responsible to pay since he is legally an adult. However I would probably find out why the insurance company rejected his claims and see if you can get them to pay so your son will not get bad credit. Hospitals are...

Medicare, Medicaid, Life and Health Insurance: Dr. office call, billing unit, billing code
billing unit, billing code, medicare: Hi Abram One of four things. a. Doctor does not accept Medicare b. procedure is not covered by Medicare c. billing unit assigned wrong billing code. d. Since the service was in Jan, it was probably the first claim for you this year, and the deductible...

Medicare, Medicaid, Life and Health Insurance: denied claim, insurance company claims, dentist office
insurance company claims, dentist office, philadelphia children: Hi Andrea! I would do an appeal-------with every denial you can appeal. In your appeal explain the circumstance for the hospital visit vs the dentist office then explain that the preauth was not clear and both you and the Dentist took as the work was authorized....

Medicare, Medicaid, Life and Health Insurance: Filing Medicare when Provider doesn't participate, smp, medicare
smp, medicare, fraud: Hi Sunde Just does not sound right to me. Sounds like fraud and abuse. Medicare has a special section to look into things like this. Call the Senior Medicare Patrol(SMP) at 1-877-808-2468 and discuss this with them. Or check with www.smpresource.org...

Medicare, Medicaid, Life and Health Insurance: Filing Medicare when Provider doesn't participate, ecfr, div5
Medicare, Medicaid, Life and Health Insurance: Filing Medicare when Provider doesn't participate, ecfr, div5, private contract

Medicare, Medicaid, Life and Health Insurance: HMO Denied Referral, hmo coverage, orthopedic surgeon
hmo coverage, orthopedic surgeon, x rays: Pablo, unfortunately this is the downside of HMO s, having to stay in the network. I m not quite sure that the ability to see the same surgeon is OK by law . This would depend on your State and the HMO s rules. For you to better understand the Global...

Medicare, Medicaid, Life and Health Insurance: Getting insurance to pay for a mattress, 16th wedding anniversary, blue cross and blue shield
16th wedding anniversary, blue cross and blue shield, durable medical equipment: Hi Liz! I have never heard of any insurance company paying for a mattress from a furniture store. There are DME stores that do sell mattress for medical purposes and you may be eligible if you have DME coverage and if you can prove that it is a medical...

Medicare, Medicaid, Life and Health Insurance: Medi-cal repayment, medi cal, mail notice
medi cal, mail notice, mass mail: Charles, I ve searched for the answer to this, but just can t find it. You may have to talk with someone in authority at MediCal or you may try calling someone at this website: http://www.cahealthadvocates.org/low-income/medi-cal.html They will want you...

Medicare, Medicaid, Life and Health Insurance: Medicade, ship office, care source
ship office, care source, hmo: Hi Cindy you seem to be getting mixed up answers to your questions and to try to correct them by e-mail is pretty hard. So, I am referring you to my counterpart in your State. The phone number is in the center of the back page of MEDICARE AND YOU 2011...

Medicare, Medicaid, Life and Health Insurance: Medicare, medicare supplement insurance, open enrollment period
medicare supplement insurance, open enrollment period, social security office: Carol, you ve got a pretty good handle on how this works. But, upon turning 65, his employer sponsored insurance will still be your primary. As long as you both have this, you do not have to sign up for Part B of Medicare - saving you that premium. Therefore...

Medicare, Medicaid, Life and Health Insurance: Medicare Payments, medicare payments, medicare payment
medicare payments, medicare payment, coordination of benefits: Hi Joseph Call COB(the Coordination of Benefits contractor) at 1-800-999-1118 and explain the problem. They will examine the master files and see what information they have on file. If it does not match what you have or has items missing, they will send...

Medicare, Medicaid, Life and Health Insurance: ma advantage & non emergency transport, congestive heart failure, low blood pressure
congestive heart failure, low blood pressure, certificate of coverage: Hi Eileen When she accepted the MA plan, she should have received an informational packet, usually called Certificate of Coverage. If she does not have one, get one from the plan. part of the instructions in the packet show the exact instructions on making...

Medicare, Medicaid, Life and Health Insurance: medicare and secondary insurance, open heart surgery, secondary insurance
open heart surgery, secondary insurance, check ups: Jonathan, thanks for the good review. I wish I knew what more to tell you. Sounds like the typical bureaucracy of insurance vs. providers. HMOs always want your primary Dr. to be the gatekeeper. So if they are saying you should have seen him first, then...

Medicare, Medicaid, Life and Health Insurance: medicare/supplemental policy, prescription drug benefit, secondary insurance
prescription drug benefit, secondary insurance, secondary health: I am not familiar with what each state offers, sorry. You would have to search online. Secondary insurance usually does not include drugs..You would need a prescription drug benefit plan. I would suggest you contact the manufacturer of any drug that you take...

Medicare, Medicaid, Life and Health Insurance: payment recalled, weight loss surgery, help insurance
weight loss surgery, help insurance, first insurance: Hi Trena! Usually with 2 insurance plans you must get a denial from the first in order for the second to pay. Not sure why they recalled your payment but can you fight them on it? If they waited two years to take back the money they must give you ample...

Medicare, Medicaid, Life and Health Insurance: Secondary denies Primary copay for no Auth, medicaid hmo, customer service rep
medicaid hmo, customer service rep, hmo policy: Jake, I m not sure of your question. It seems odd to me that someone would have 2 insurance plans (HMOs). If the patient is on Medicaid, then the patient should owe nothing. The hospital should gets its payment from the primary insurer. If there is still...

Medicare, Medicaid, Life and Health Insurance: Copay Responsibility, explanation of benefits, eob
explanation of benefits, eob, patient responsibility: Hi Robin! It depends-----check your explanation of benefits to see if you are liable. Some insurance companies require the patient to make sure there is an authorization if needed prior to certain services. So hard to say what your plan requires. So...

Medicare, Medicaid, Life and Health Insurance: form, wheelchair batteries, provider john
wheelchair batteries, provider john, answer service: Call 1-800-Medicare=======you will get the automated answer service=====say agent to get a live person====when they answer tell them what you need. They will transfer you to the proper office where you will request the form. Hope this helps. Joh...

Medicare, Medicaid, Life and Health Insurance: information on switching into new IPA, hmo network, cancer specialist
hmo network, cancer specialist, abuse complaint: Hi Jennifer Your father should have received a packet of material when he joined the HMO. It is usually called the Certificate of Coverage, and explains what to do in this type of situation. Talk with the primary care doctor and see if he will give...

Medicare, Medicaid, Life and Health Insurance: Medicaid question, ohio medicaid, medicaid office
ohio medicaid, medicaid office, good sam: You need to check with your Medicaid office in the state that you are a resident of. Ohio Medicaid will only cover you in Ohio as is the same for Indiana unless you can find a doctor and hospital that handle both states as it sometimes the case when they border...

Medicare, Medicaid, Life and Health Insurance: Medicare And Blue Cross, medicare hmo, anthem blue cross
medicare hmo, anthem blue cross, blue cross of ca: Here is more info on coordination of benefits to help you understand a bit better since it is a bit confusing---------this is how we train our collectors......... COORDINATION OF BENEFITS When a member has other health insurance, whether it is Medicare,...

Medicare, Medicaid, Life and Health Insurance: medicaid collections, medicaid bill, medicaid managed care
medicaid bill, medicaid managed care, fidels: Hi Charles Since several of the regulations are different in each State, I am referring you to my counterpart in NY. Call 1-800-701-0501 and request to speak with a counselor. That call will get you the nearest office to you. They will assist you with...

Medicare, Medicaid, Life and Health Insurance: no pre-authorization, insurance company, insurance
insurance company, insurance: Yes a collection agency can sue you for the charges that your insurance company did not pay...you as the patient are liable and I am sure you signed some type of contract stating this. The provider is stating you are liable by sending you out to the agency...

Medicare, Medicaid, Life and Health Insurance: Question about how to provide, letter of approval, case worker
letter of approval, case worker, medicaid: Hi again Each State have their own set of regulations for Medicaid, and. I am in Michigan. Florida has a set of regulations that are far different than most States. Therefore, call 1-800-963-5337 and you will reach my counterpart in Florida. Make an...

Medicare, Medicaid, Life and Health Insurance: Copays from Secondary, secondary insurance, explanation of benefits
secondary insurance, explanation of benefits, deductible plan: Hi Connie! There is usually a copay amount under most policies then paid per contract rates. To be 100% sure call your primary carrier and ask them what you are liable for. Your insurance carrier deems what you owe not the Dr/provider. Always check...

Medicare, Medicaid, Life and Health Insurance: Doctor's office billing practices, office billing, explanation of benefits
office billing, explanation of benefits, billing practices: Hi Jill! It depends what you mean by negotiated rate --- if there is a contract between the Dr s office and your insurance company then no they can not charge you for that amount. Look on your explanation of benefits that you should have obtained from...

Medicare, Medicaid, Life and Health Insurance: Health insurance denied, united health care, college freshman
united health care, college freshman, high blood pressure: Hi Ann! I would try to clear it up if you can.....call UHC and ask how you go about disputing a misdiagnosed DX. All insurance companies are different and have different rules so you have to find out what they require for you to do then do it. It...

Medicare, Medicaid, Life and Health Insurance: Hmo, orthopedic surgeon, enrollment time
orthopedic surgeon, enrollment time, time doesn: You can only change insurance at the open enrollment time. Doesn t sound like you need to change providers as long as your surgeon is in the network of your HMO. I would go back to the orthopedic surgeon and have him/her contact the insurance company so that...

Medicare, Medicaid, Life and Health Insurance: out-of-network, liver cancer, liver transplant
liver cancer, liver transplant, hospital insurance: Hi Barb! It is worth a try....call the physician and explain what happened and ask him to write a letter to the insurance company explaining why your husband had to go to this hospital asking them to pay the claim as in network. Do it right away as sometimes...

Medicare, Medicaid, Life and Health Insurance: Oral surgeon, medigap plan, oral surgeon
medigap plan, oral surgeon, advantage plan: Hi Kathy This is really too complicated to be done by e-mail. There is not enough information to give you a good answer. I am guessing that you have Medicare and Medicaid mixed up and that he has Medicare and quite possibly has a Medicare Advantage...

Medicare, Medicaid, Life and Health Insurance: Prexisting or not?, menicus tear, charity care
menicus tear, charity care, new insurance: Hi Susie! Tough to do......and depends if there is a waiting time with your new insurance company. Our company makes an employee wait 90 days before they are covered. So if you can wait for a period of time without being in pain, I guess you could say...

Medicare, Medicaid, Life and Health Insurance: Reimbursement, fraud reports, psychopharmacologist
fraud reports, psychopharmacologist, antidepressent medication: Hi Anne Call our New York office at 1-800-701-0501 and make an appointment . They will get together with you and review the paperwork you have to see it it is fraud and Abuse. They can also help you with any fraud reports, or any appeals. John ...

Medicare, Medicaid, Life and Health Insurance: Tummy Tuck, insurance carrier, bosy
insurance carrier, bosy, medical procedure: Hi Tammy! Only way an insurance will pay for any procedure is to prove that it is medically necessary....if you can prove that most of the time they will pay. You really can not prove this, a Dr needs to. So you need to find a DR who is willing to help...

Medicare, Medicaid, Life and Health Insurance: Weightloss surgery, anthem blue cross blue shield, blue cross blue shield
anthem blue cross blue shield, blue cross blue shield, anthem blue cross: Hey Hargrove! Many insurance plans do not pay for weight lost surgery due to high cost and most patients reverting after a few years back to their original size. Companies do not have to pay for this type of surgery if they deem not to. There are many...

Medicare, Medicaid, Life and Health Insurance: billing codes, question thanks, code numbers
question thanks, code numbers, google: I checked code book and found following: E0370 - air pressure elevator for heel E0710 - restraints, any types Could not find anything under codes E0360 and E0361 - they could be miscellaneous codes specific to the provider/insurance company. So call...

Medicare, Medicaid, Life and Health Insurance: Elderly uncle on medicaid...no follow up with doctors, quality improvement organization, echo cardiogram
quality improvement organization, echo cardiogram, medicare number: Hi Jamie Not sure this will help. Each State has a Quality Improvement Organization(QIO) that handles this sort of thing that might be able to assist you. Call 1-800-MEDICARE and request their phone number in the State you are in. Also get the phone...

Medicare, Medicaid, Life and Health Insurance: HMO Insurance, lonni, lap band
lonni, lap band, hmos: Hi Lonni That is the problem with HMOs. If the doctor says that the Lap-Band is medically necessary, you might get it covered. It appears they do not have a provider that will take it, and since it is not medically necessary, they do not have to refer...

Medicare, Medicaid, Life and Health Insurance: member liability question - please help, family law attorney, patient responsibility
family law attorney, patient responsibility, judy judy: Judy, I am sorry for your loss. As I researched this, I found that the domestic partnership ends at death. Therefore, I don t believe these relationships without marriage have evolved far enough in the eyes of the law and lawmakers to make you responsible...

Medicare, Medicaid, Life and Health Insurance: Out of Network surgical center bill, social security office, medicare plan
social security office, medicare plan, advocacy program: Hi Again I was advised that the last answer I sent to you in fact never was sent. I had a computer problem because of a loose connection at the connection on the telephone pole outside. Sorry, but if you still have a question, I would be glad to answer,...

Medicare, Medicaid, Life and Health Insurance: ortho - claim filed wrong, customer service rep, time restraints
customer service rep, time restraints, insurance placement: The Dr s office can list a date if your son was in to start a procedure. If your son was not in at that time then they can not list a wrong date. Not sure why they would do that unless it was just an error up front. You need to try your best to resolve...

Medicare, Medicaid, Life and Health Insurance: SSD Medicare and supplemental health insurance, double lung transplant, supplemental health insurance
double lung transplant, supplemental health insurance, social security office: Hi Janice The reason I requested to know what State he is in is because each Stares some different regulations for this type of situation..Go to the Social Security office and get a copy of Medicare and you 2011. In the center of the back page is the number...

Medicare, Medicaid, Life and Health Insurance: Work Comp/Auto Accident, auto accident, auto company
auto accident, auto company, knee injury: Hi Chrissy! The patients knee injury is the Workers Comp claim--------during the auto accident did he hurt the same knee? If he did then it could be a game of who s responsible. Since his knee was not healed than W/C is still responsible however if...

Medicare, Medicaid, Life and Health Insurance: Eye surgery, mothers eyes, worse all the time
mothers eyes, worse all the time, legitimate question: You need to go to an eye surgeon who does these procedures and accepts Medicaid and have him or her send in for an authorization. Medicaid is state run so each state has their own requirements. The physician will know whether Medicaid will pay for the procedure....

Medicare, Medicaid, Life and Health Insurance: Insurance denied B12 Injections...., b12 injections, vitamin therapy
b12 injections, vitamin therapy, letter of decline: Hi Melissa! Every plan is different and has different guidelines. The only thing you can do is appeal their denial and you usually get a few appeals. Perhaps the Dr can come up with another way to get it through----sometimes it is the way it is...

Medicare, Medicaid, Life and Health Insurance: medicare replacement of implant, cape canaveral hospital, cape canaveral florida
cape canaveral hospital, cape canaveral florida, disability check: Hi F In Florida, the SHIP counseling service is known as SHINE. You can reach them at 1-800-963-5337, Give them a call and request a meeting with a counselor. They will meet with you, go over the situation, and recommend further actions. They can...

Medicare, Medicaid, Life and Health Insurance: myasthenia gravis treatment, best bet, uhc
best bet, uhc, blood products: Bill, I m not sure either. I couldn t possibly ascertain what this would fall under because every health plan is so different. Your best bet would be to call the Plan directly because you also might need prior approval or just to make sure you are using...

Medicare, Medicaid, Life and Health Insurance: qualifying for medicare, qualifying for medicare, applying for medicare
qualifying for medicare, applying for medicare, serious health: Hi Claudia i think you have Medicare and Medicaid mixed up. Medicare is health related, Medicaid financial.The regulations for Medicaid are different in each State, and I am in Mi. Therefore I am referring you to the the SHINE office in Fl. Call 1=800=963=5337...

Medicare, Medicaid, Life and Health Insurance: State no longer paying medicare premium, benefits checkup, hunch
benefits checkup, hunch, medicare: Hi Aurora Since each State has different regulations, I will refer you to the SHINE office in Florida. Call them at 1-800-963-5337 and request to speak to a counselor, and have them do a benefits checkup for your parents. I have a hunch that the income...

Medicare, Medicaid, Life and Health Insurance: denial of payment, medicaid office, evercare
medicaid office, evercare, health reform: Coleen, since Health Reform, most preventive services are no charge unless something is found during the procedure. If that is the case and Evercare paid their share, then there might be a deductible or co-insurance you are being billed for. Either way,...

Medicare, Medicaid, Life and Health Insurance: medicaid, medicaid, medicare
Medicare, Medicaid, Life and Health Insurance: medicaid, medicaid, medicare

Medicare, Medicaid, Life and Health Insurance: Individual Healthcare Insurance, high blood pressure, insurance commissioner
high blood pressure, insurance commissioner, healthcare insurance: Hi! There has been alot of changes in many states regarding pre-existing conditions.....as long as you have continuous coverage most insurance policies can not use this against you. Check with your Insurance commissioner for your state to see if there...

Medicare, Medicaid, Life and Health Insurance: Insurance vs treatment, tedious procedure, there some sort
tedious procedure, there some sort, medical necessity: Such a great question. Hospitals usually do not verify insurance until you show up for the procedure as people cancel, don t show and/or change insurance. It is a very tedious procedure to verify insurance coverage. There is no such thing as pre-bill. You...

Medicare, Medicaid, Life and Health Insurance: medicaid, medicaid program, benefits checkup
medicaid program, benefits checkup, kelps: Hi Geneva Let me now what State you are in and I will send you the phone number of the Medicare SHIP program. You can contact them and request a Benefits Checkup. You can also contact the local area on aging and request to speak with an I & E person....

Medicare, Medicaid, Life and Health Insurance: Medicaid Non-payment, health facility regulation, florida medicaid
health facility regulation, florida medicaid, laboratory licensure: Diane, it seems to me that the IN lab would ve done all things necessary to be able to accept out-of-state work and get paid. Also, vice-versa, FL clinics should know who they re sending their specimens to. Anyway, I found a page that might help. It s up...

Medicare, Medicaid, Life and Health Insurance: Medicare and Medicaid, advantage plan, insurance policy
advantage plan, insurance policy, medicaid: Hi Tim. When you say she has an insurance policy that works as her primary, it leads me to believe that it is a Medicare Advantage plan, either HMO or PPO. If this plan has worked well for her, then keep it - and Medicaid would be secondary. It might allow...

Medicare, Medicaid, Life and Health Insurance: medicare and medicaid copays, connecticut medicaid, routine foot care
connecticut medicaid, routine foot care, explanation of benefits: Sharon, the podiatrist will Medicare as the primary, then your mother will get the EOB explanation of benefits that will show you may be billed . I believe the answer is yes. Note that Medicare will not pay for routine foot care. I hope this helps...

Medicare, Medicaid, Life and Health Insurance: medicare/medicaid/medicare advantage, medicare medicaid, advantage plan
medicare medicaid, advantage plan, medicare: Tim, normally not, only for emergency. There are so many different medicare advantage plans - not knowing exactly which one she has, I would suggest you call their customer service because if there is coverage it may need to be pre-approved. I hope this...

Medicare, Medicaid, Life and Health Insurance: oral surgery, wisdom teeth, dental assistance
wisdom teeth, dental assistance, michigan gov: High Linda This is a little out of my area of expertise. You might call the local Area Agency on Aging and request a list of dentist in the area that might assist you. Your s would be in Oakland County. The Dental Association could also refer you. ...

Medicare, Medicaid, Life and Health Insurance: BCBS verses Medicare, medicare info, medicare card
medicare info, medicare card, bells whistles: Hi Bill Call 1-800-443-9354 and request to speak with a SHIP counselor. Make an appointment with them, and they will review your situation and make some recommendations.. In all probability you will end up with BC and a part D plan for prescriptions....

Medicare, Medicaid, Life and Health Insurance: Health Insurance, old wife, insurance plan
old wife, insurance plan, medical insurance: Hi Gerry! Your only choice would be to pay for a few months the Cobra plan..this way the insurance plan would be the same. To switch to another plan at the end of the month you may have some issues with pre-existing issues. And other choice is to see...

Medicare, Medicaid, Life and Health Insurance: medicaid recovery act, handicapped person, recovery act
handicapped person, recovery act, mmap program: Hi Shirley The Recovery Act in Michigan was put together in a hurry and is very confusing, Call the MMAP program at 1-800-803-7174 and you will reach the nearest office to you. Make an appointment with one of their Medicaid specialists, who will help...

Medicare, Medicaid, Life and Health Insurance: medicare, ship counselors, benefits checkup
ship counselors, benefits checkup, chore services: hi Cindy Not enough information. Need to know what State he resides in; has he Medicare and/or Medicaid, SS disability. time in Service etc. Too much to be done on the computer, so I would refer him to the SHIP counselors in his State. A SHIP counselor...

Medicare, Medicaid, Life and Health Insurance: multiple denials on claim, high school diploma, print outs
high school diploma, print outs, hr manager: Hi Teresa! If you were denied then you have a right to an appeal however you are only given a limited time to appeal. Check your denials and see what your insurance companies policy is. Most are about 90 days but some do give more time........ I doubt...

Medicare, Medicaid, Life and Health Insurance: Problems with Medicare supplement, thyroid growths, lung nodules
thyroid growths, lung nodules, medicare supplement: Patricia, not knowing exactly which Blue plan you have, I would start with your rep. This person receives commission from enrolling you, therefore should be available to offer customer service. Secondly, the billing dept. should be able to give you a breakdown...

Medicare, Medicaid, Life and Health Insurance: Problems with Medicare supplement, thyroid growths, lung nodules
thyroid growths, lung nodules, medicare supplement: Hi Patricia This is far too complicated to be done by e-mail. Plus the regulations regarding handicapped persons under 65 and Medicare are different in each State. Therefor I am referring you to the SHIP program in NC, The SHIP counselors are specially...

Medicare, Medicaid, Life and Health Insurance: Problems with Medicare supplement, thyroid growths, lung nodules
thyroid growths, lung nodules, medicare supplement: Hi Patricia! I would first call the Dr s office and ask for an itemized statement of your account. Tell them you want a list of all your charges, payments and contractual write offs. You have the right to get this to review. If you feel you can not call,...

Medicare, Medicaid, Life and Health Insurance: Selling Home and Medicare, medicare savings program, ship counselors
medicare savings program, ship counselors, coordination of benefits cob: Hi Scott Tough question. You are talking about Medicaid,not Medicare. With Medicare, it is a matter of keeping the Coordination of Benefits(COB 1-800-999-118) office aware of changes in her status. Problem with Medicaid is that each State has it s...

Medicare, Medicaid, Life and Health Insurance: WP/ GWP, reinsurance premiums, gross premiums
reinsurance premiums, gross premiums, gwp: Ekaterina, the amount of premiums customers are required to pay for insurance policies written during the year is written premium . This contrasts with premium earned which is the amount of premiums that a company has earned by providing insurance against...

Medicare, Medicaid, Life and Health Insurance: Coverage, radiation treatments, ears and eyes
radiation treatments, ears and eyes, death situations: I am so so sorrynto hear aboutnyournfamilynsituation. Your family should use the resources of the social worker where she is having treatment. They will let her know what is available to in the community. This is a very common issue with people under treatment....

Medicare, Medicaid, Life and Health Insurance: Dental Insurance denied wisdom tooth extraction, wisdom tooth extraction, dental insurance company
wisdom tooth extraction, dental insurance company, wisdom teeth: Hi Jan! Only way to fight them is to call them and appeal their decision. Usually the explanation of benefits show you what your next step is. All insurance companies have different policies so you need to find out what your company s requirements are....

Medicare, Medicaid, Life and Health Insurance: Insurance, responsible coverage, new insurance
responsible coverage, new insurance, health cost: Hey Susan----- Once your old insurance expires they are not responsible for any services beyond that date. Your new carrier would be responsible. Coverage is determined by date of service and period of contract with an insurance company. All insurance...

Medicare, Medicaid, Life and Health Insurance: insurance co-pays & deductibles, plan hmo, ppo plan
plan hmo, ppo plan, hmo plan: Hi James! An HMO plan usually has no copay to the patient and pays at 100% with some HMO s requiring a referral. Must stay in the network. There is no coverage for out of network providers. A PPO plan is a stronger plan where a patient can go in and...

Medicare, Medicaid, Life and Health Insurance: insurance question on breast augmentation and tummy tuck, anthem blue cross blue shield, anthem blue cross
anthem blue cross blue shield, anthem blue cross, blue cross blue shield: Hi Andrea! Unfortunately you have the two toughest insurance companies to deal with........Blue Crosses are very strict as so is Medicare on what they pay and what they do not pay for. As long as they do not exclude your type of surgery then you just...

Medicare, Medicaid, Life and Health Insurance: Medicare help, heart attact, advocate foundation
heart attact, advocate foundation, heart procedure: Hi Romeo Sorry about the delay, however I just got back out of the Hospital yesterday. But on to your problem. Contact the Health Insurance Counseling and Advocacy Program(HICAP) of California(SHIP) at 1-800-434-0222 and request to speak with a SHIP...

Medicare, Medicaid, Life and Health Insurance: medicare/medicaid/shar of cost, medicare medicaid, visual field test
medicare medicaid, visual field test, soc sec: Hi Barbara. I know, this can get quite confusing. First of all, the Part B deductible for 2012 is $140. This is what you ll be responsible for first. So Medicare is billed as the primary. Once you satisfy the deductible, you will be responsible for the...

Medicare, Medicaid, Life and Health Insurance: Tummy tuck, yeast infection, tummy tuck
yeast infection, tummy tuck, belly button: Hi Brenda! The only way to know 100% is to call your carrier directly........every policy is unique and no way to tell if you personally have coverage for a procedure. In general though most insurance companies do not pay for tummy tucks as it is considered...

Medicare, Medicaid, Life and Health Insurance: verbal denial, demand billing, advance beneficiary notice
demand billing, advance beneficiary notice, hi chris: Hi Chris Have the primary do a demand billing. It will go to Medicare, get denied, then bill BC. However, it probably will not be paid. If the primary or the doctor advised that the procedure was not covered, you will be responsible for the cost, ...

Medicare, Medicaid, Life and Health Insurance: Medicare secondary, medicare secondary payer, msp
medicare secondary payer, msp: Yes, you must accept the Medicare payment. As a participating Medicare provider, you have agreed to accept the Medicare allowable. This means you cannot bill the patient for more than the patient s Medicare deductible, copay or coinsurance amounts. Medicare...

Medicare, Medicaid, Life and Health Insurance: New Obama Care pre-existing conditions, blue cross blue sheild, bottom teeth
blue cross blue sheild, bottom teeth, initial policy: Hey Tina! You can go on whitehouse.com to see info on the reform...also links that further explain. Not 100% on reform so best to read from his site......pre-existing conditions are part of the reform but not sure what the exact rules are. I think...

Medicare, Medicaid, Life and Health Insurance: part B payments to physicians, medicare patients, approved charges
medicare patients, approved charges, physician visit: Loretta, I see your point, but my first thought is, who says the physical actually costs that much? and how much is profit? Everything must have a benchmark and these are normally called reasonable and customary charges. Think about HMOs - they negotiate...

Medicare, Medicaid, Life and Health Insurance: Pregnancy Medicaid, georgia medicaid, medicaid provider
georgia medicaid, medicaid provider, finding a new doctor: Hi Lou. The easiest solution would be to continue care with her preferred Dr. under your insurance. Obviously any expenses or copays are your responsibility. If you cannot continue this cost, then she would have to find a Medicaid OB/GYN. I found this...

Medicare, Medicaid, Life and Health Insurance: supplamental coverage for my mother, open enrollment period, medicaid program
open enrollment period, medicaid program, pathfinder program: Sorry for the delay, I was on vacation and forgot to inform to system Now for your Mother. Call 1-800-252-9240 and you will reach the Texas department of Aging. Make an appointment with them to have a Benefits Checkup done for her and also a Pathfinder...

Medicare, Medicaid, Life and Health Insurance: denials from insurances, medicaid, denials
medicaid, denials, third party billing: Hi Rebecca, Great question! When you receive a denial from Medicaid stating that the patient is covered by another insurance, this simply means that the other insurance is primary to Medicaid. You need to bill the Coventry first and if there is a patient...

Medicare, Medicaid, Life and Health Insurance: Medicaid supplimental, medicare supplement insurance, social security income
medicare supplement insurance, social security income, pocket expense: Jorjia, thank you for the question. If she will not qualify for Medicaid, then there are two ways for her to go. One is medicare supplement insurance, which does exactly that - supplements what Medicare doesn t pay for so that there is little or no out of...

Medicare, Medicaid, Life and Health Insurance: Medicare, social security office, extreme emergencies
social security office, extreme emergencies, medicare rights: HI Mike If you do not already have a copy of Medicare and You 2013 get a copy from the local Social Security office. In the center of the back cover is the phone number of the nearest SHIP office to you. Set up a 1 on 1 session with them and they will...

Medicare, Medicaid, Life and Health Insurance: MEDICARE LOOP HOLE, medicare, part d prescription plan
medicare, part d prescription plan: The correct term is Donut Hole coverage and yes there is such a thing. The donut hole is simply a gap in coverage which is the out of pocket portion for your drug benefit. You should review your coverage manual to find out the specifics for your own policy....

Medicare, Medicaid, Life and Health Insurance: Severance and Medicare, professional advice, medicare
Medicare, Medicaid, Life and Health Insurance: Severance and Medicare, professional advice, medicare, long time

Medicare, Medicaid, Life and Health Insurance: Humana, hmo plan, doctors visits
hmo plan, doctors visits, supplement insurance: The problem with the HMO is that you are restricted to your doctors. You cannot go out of network..and there are co-payments which may exceed the monthly payment to the supplement insurance. I never recommend anyone going to a Medicare HMO. It just restricts...

Medicare, Medicaid, Life and Health Insurance: Medicaid - how to reduce patient responsibility when on a spend down, patient responsibility, medical expense
patient responsibility, medical expense, caseworker: Hi Kathy, yes that s a horrific amount. In some states, you can erase or diminish the spend down amount by buying an insurance policy related to health, dental, etc. I guess the thinking is that you acquire a new medical expense to reduce a medical expense....

Medicare, Medicaid, Life and Health Insurance: Medicaid /sent to collections, state attorney general, eye dr
state attorney general, eye dr, residential placement: Hi Lynn You may need to take time to visit the doctor s office with your Medicaid card proving that your son had Medicaid at the time of the visit. Ask them to file the claim with Medicaid and once the claim pays you should not have receive any more calls...

Medicare, Medicaid, Life and Health Insurance: OPT OUT OF PART B, health insurance plan, ssa office
health insurance plan, ssa office, medicare part b: In order to opt out of Part B you would need to either go in person to the SSA office or call your local office for a personal interview. Once you speak to someone, they will mail you a form to complete that will dis-enroll you in Medicare Part B. Medicare...

Medicare, Medicaid, Life and Health Insurance: Severance and Medicare, extended health care, health care coverage
extended health care, health care coverage, social security office: Hi again You should have received a copy of Medicare and You 2013 in October. If not go to the local Social Security office ad pick on up. In the center of the back page is a phone number. Call the and make an appointment with a counselor. They will...

Medicare, Medicaid, Life and Health Insurance: insurance question, medicare deductibles, clearance letters
medicare deductibles, clearance letters, insurance question: Amy, sorry for the delay. In my search for your answer, I found Mississippi Medicaid excludes any sort of gastric surgery. Now Medicare will probably approve it if you have all the necessary doctor s documentation, but you would have to pay all the Medicare...

Medicare, Medicaid, Life and Health Insurance: Kaiser denied liver cancer surgery from out of network surgeon, liver cancer, cancer diagnoses
liver cancer, cancer diagnoses, benign tumors: Hi Jacklyn! Definitely appeal with any information you can come up with........usually the only way they will approve an out of network Dr is if there is no Dr in their network than can do the surgery. You might want to find out why Kaiser said she...

Medicare, Medicaid, Life and Health Insurance: Long Term Health Care, supplemental health insurance, health care insurance
supplemental health insurance, health care insurance, long term health care insurance: Hi John. It s good to see you have your thinking cap on. Unfortunately, Health Reform won t include LTC waiving pre-existing conditions, only health insurance. Due to political pressure, the CLASS program was dropped also, which would ve provided an LTC...

Medicare, Medicaid, Life and Health Insurance: medicaid, benign brain tumor, brain surgeries
benign brain tumor, brain surgeries, boston children: Hi Beth This is outside of my expertise, However, you might try the SHIP program at 1-877-353-3771. They do Medicare counseling and I believe also Medicaid in Maine. If not, go on the Medicaid site and hit Manuals. Then scroll to the PAMs and PAMs....

Medicare, Medicaid, Life and Health Insurance: Medicare Supplemental Insurance, medicare supplemental insurance, outpatient rehabilitation services
medicare supplemental insurance, outpatient rehabilitation services, skilled nursing facility: Sven, thank you for the question. First of all, you may be able to apply for them yourself for Medicaid through this website - http://www.dcf.state.fl.us/programs/access/medicaid.shtml#ad There may not be a need to hire lawyers unless they have an abundance...

Medicare, Medicaid, Life and Health Insurance: Selling house for medicare purposes, homesteads, pem
homesteads, pem, mother in law: Hi Robert since each state has their own regulations on Medicaid I can not answer you without knowing the State she resides in. Give me the State and I get the phone number for you to call for assistance. Call them and make an appointment with one of...

Medicare, Medicaid, Life and Health Insurance: Bariatric Surgery, dallas tx usa, texas medicaid
dallas tx usa, texas medicaid, amerigroup: Belinda, here are some things I found: On July 1, 2008, Texas Medicaid finally approved bariatric surgery (Lap Band and Roux-en-Y Gastric Bypass) for their patients, as long as it is provided by a Bariatric Surgery Center of Excellence surgeon and facility...

Medicare, Medicaid, Life and Health Insurance: billing for service, medicaid office, customer service rep
medicaid office, customer service rep, private insurance: Hi Bob Call Medicare at 1-900-633-4227. It will open in an automated call return. 1. say AGENT and it will transfer you to a customer service rep who in tern will transfer you to the Billing department or 2 as soon as the auto opens up say BILLING...

Medicare, Medicaid, Life and Health Insurance: medicare, social security office, medicare card
social security office, medicare card, pathfinder program: Hi Gerry Go to the Social Security Office and pick up a copy of the Medicare and You 2012 manual. It will contain most of the information you need. You should get Part A, as there is no cost to getting it, and it makes things easier later on. also...

Medicare, Medicaid, Life and Health Insurance: qmb, coordination of benefits, backlog
coordination of benefits, backlog, mouths: Hi Shelly When this happens, you have start and stop money actions going between 3 different agencies. There is a backlog at the first of the year because millions of actions are flowing between agencies. So three months is the norm during that period....

Medicare, Medicaid, Life and Health Insurance: Breast implants, stage 3 cancer, cancer of the uterus
stage 3 cancer, cancer of the uterus, breast implants: Good news about your wife s recovery. Medicare will pay if it is medically necessary. Be sure to mention the pain with the hardened implants. Leaking and hardening are reason for the surgery. It is very easy to recover from. Virtually no discomfort...

Medicare, Medicaid, Life and Health Insurance: doctor's appointments are being made at a later date for medicare patients, medicare patients, secondary insurance
medicare patients, secondary insurance, medicare: Hi Wanda! I never heard of this before.......perhaps due to low payments by Medicare they push appointments out. Does not seem right though..... I would call Medicare directly and complain....if they participate with Medicare there are certain guidelines....

Medicare, Medicaid, Life and Health Insurance: Health ins. pays ridiculous amount for surgery, medicare guidelines, laparoscopic surgery
medicare guidelines, laparoscopic surgery, network coverage: Hi Call 1-800-701-0501 and request to apeak with one of the SHIP counselor. Meet with one and they will look over you material and determine what can be done to solve it. I any appeals are necessary, they will assist you withe the appeal. Sorry for...

Medicare, Medicaid, Life and Health Insurance: Medical Coding and Medicare, insurance premiums, auto claim
insurance premiums, auto claim, auto policies: Hi Helen! Each state has different rules regarding their auto policies.....usually anything related to the car is considered an auto claim. To be sure just call your auto company and ask. And usually if someone falls in their own home it goes to...

Medicare, Medicaid, Life and Health Insurance: Medicare, long term health, local office
long term health, local office, health issues: Hi Susan It is possible for him to opt back in, but there will be a delay and also there will probably be a penalty. Call the local office of the MMAP program at 1-800-803-7174 and request to speak with a counselor. They will meet with you and see what...

Medicare, Medicaid, Life and Health Insurance: medicare advantage plan (MCAP), tufts health plan, mass general hospital
tufts health plan, mass general hospital, whipple surgery: Hi Teresa. Wow, big move from NV to Mass. It seems that Mass. Gen. will take most insurances, according to their website. I would suggest calling AARP UnitedHealthcare @ 800-547-5514 to inquire about their zero premium Medicare Complete plan. They should...

Medicare, Medicaid, Life and Health Insurance: medicare and medicaid, primary insurance, types of insurance
primary insurance, types of insurance, insurance plans: Hi Eddie! No your Dr does not need to accept Medicaid if he accepts Medicare. They are two different types of insurance plans/companies. A provider/Dr can be a participating provider with either one of them or both of them. It is not required for...

Medicare, Medicaid, Life and Health Insurance: insurance claims, insurance claims, insurance company
insurance claims, insurance company, insurance companies: Hi Mel! I would not think so----------your insurance company deems what DX they will pay for and as long as the DX is within their guidelines they will pay. No provider will just pick out a payable code to submit it to an insurance company as it is...

Medicare, Medicaid, Life and Health Insurance: MEDICARE/ QMB, medicare premiums, slmb
medicare premiums, slmb, low income subsidy: Hi Tara. I understand your frustration. You may want to inquire about SLMB and/or QDWI. These would be the next categories of help if your resources are too high. Also, to help with your prescriptions, call Social Security to apply for LIS, low income...

Medicare, Medicaid, Life and Health Insurance: refusal to authorize spine fusion surgery, spine fusion, fusion surgery
spine fusion, fusion surgery, medical necessity: Hey Bruce! If you have done all the appeals with no luck and they are still denying for lack of medical necessity I would get local politicians involved or perhaps even the local news. Insurance companies must pay for procedures that are medically necessary...

Medicare, Medicaid, Life and Health Insurance: AMA and Medicare, benefits checkup, home rehab
benefits checkup, home rehab, mmap program: HI Nancy TOO complicated to be done by email. Call the MMAP Program at 1-888-803-7174 and you will reach their nearest office They are Medicare trained counselors. Call them and request a meeting with them and they will help you with this problem. Also...

Medicare, Medicaid, Life and Health Insurance: billing Medicare part B for an expatriate retiree beneficiary, medicare consumer, social security benefits
medicare consumer, social security benefits, billing medicare: Susan..you have me stumped. Paper handwritten claims can always be sent for these exceptions. And if I were you, I would send the bill to Medicare as they will reimburse you. Download the 1490s from Medicare.gov/medicareonlineforms There is a form and...

Medicare, Medicaid, Life and Health Insurance: dispute dental bill, dentist office, dental bill
dentist office, dental bill, explanation of benefits: Denise, first of all, congratulations for continuing to have dental insurance. So many people don t have any at all. I would start by finding your EOB (explanation of benefits) for the claim date they are billing you for. Call the insurance company to...

Medicare, Medicaid, Life and Health Insurance: Never had health insurance. Need some., supreme court decision, professional agent
supreme court decision, professional agent, responsible decision: Kyle, sorry for the delay - was occupied with the Supreme Court decision on Health Care. Please use this link to have a qualified professional agent find you the best plan for the best price. https://www.healthcompare.com/QuickQuote.aspx?trackingID=UFAADEEH66YEGME...

Medicare, Medicaid, Life and Health Insurance: HMO / PPO Billing, rare brain condition, health care policies
rare brain condition, health care policies, coordination of benefits: Hi Beth! If you have a preauth from your PPO upon denial from the HMO I don t see why they would not pay if they have in the past. As long as you get preauth s for any test or procedure you should be fine however it does not guarantee you 100% that they...

Medicare, Medicaid, Life and Health Insurance: have medicaid need neurologist, counseling service, neurologist
counseling service, neurologist, randi: Hi Randi There are some different regulations in different States for Medicaid. Call the Florida counseling service in Florida at 1-800-963-5337 snd meet with them. They willreview the problem and provide you with assistance.Hope this helps. Joh...

Medicare, Medicaid, Life and Health Insurance: Part D, transition policy, maintenance changes
transition policy, maintenance changes, formularies: Hi Edwina - very good questions. I found a very thorough answer to your 1st Part D question: Formulary Changes Plans generally change their formularies each year (making it important to review one’s plan choice annually). Plans may also change their...

Medicare, Medicaid, Life and Health Insurance: surgery at duke medical center, duke medical center, hernia operation
duke medical center, hernia operation, no doubt: Wanda, I suggest you call Duke and tell them what insurance you have in addition to Medicare to see what will be covered and what you might be responsible for. If the hernia operation is medically necessary, no doubt that will be covered. If the plastic...

Medicare, Medicaid, Life and Health Insurance: Humana claim denial, going to the dentist, medical aspect
going to the dentist, medical aspect, delta dental: Hi Brian... Once an insurance company denies you can appeal.....your denial will tell you how to appeal since all insurance companies are different. I am not aware of such a law where the state determines coverage under a private insurance carrier. ...

Medicare, Medicaid, Life and Health Insurance: Humana Health Ins/Medicare/Medicaid, medicare health plan, nursing home administrator
medicare health plan, nursing home administrator, humana plan: Hi Gloria. This is a good question, one that can seem to be confusing. Why have so many insurances? Well, the nursing home would bill Humana first because this Medicare Advantage Plan takes the place of original Medicare. Of course, Humana does not pay...

Medicare, Medicaid, Life and Health Insurance: Medicaid Supplemental Insurance, social security disability, health care administration
social security disability, health care administration, florida medicaid: Hi Bray.. The regulations are different in Florida than in my State/ Therefore I am referring you to the Florida group. Call 1-800-963-5337 and you will get the nearest office of tee SHIP group in Florida. Call them and request to speak with one of the...

Medicare, Medicaid, Life and Health Insurance: Medicare Advantage PPO, coverage booklet, moop
coverage booklet, moop, s hospital: Hello, I must first commend you on your use of the computer. As to your question, the $3400 MOOP is a combined total for both in and out of network. So that is good. If you take a look at your packet from Anthem, there is a Evidence of Coverage booklet...

Medicare, Medicaid, Life and Health Insurance: penalty, social security administration, social security office
social security administration, social security office, medicare portion: Hi Barbara It is based on your premium for the previous year. I suggest you go to the nearest Social Security office and get a copy of Medicare and You 2012. After reading it, and if you have any questions, call the number in the center of the back cover...

Medicare, Medicaid, Life and Health Insurance: Refusal to File Medicare Claim for a single lab test, medicare claim, health care providers
medicare claim, health care providers, abuse complaint: Hi Bob What you are doing is a demand Billing. Their refusal is contrary to their contract with Medicare, therefore illegal. If they send in the bill, you will get an EOMB. The phone number I gave you has trained Medicare counselors to assist you. Same...

Medicare, Medicaid, Life and Health Insurance: SSDI - medicare or anthem primary??, health insurance assistance, state health insurance
health insurance assistance, state health insurance, state health insurance assistance program: Hi Aimee Call my counterpart in Kentucky at 1-877-293-7447 and you will get the nearest office for the State Health Insurance Assistance Program(SHIP). Have them run a benefits check up and also meet with them, They will go over your situation and show...

Medicare, Medicaid, Life and Health Insurance: Surgeon assistant bill, surgeon assistant, thanks in advance
surgeon assistant, thanks in advance, 5 months: Hi! I would call them and explain that you have been told that you are not liable by your Dr s and that you will not pay and if they have any questions they should call your Dr s. Then let them handle it. Hopefully that will work.... Good luck! ...

Medicare, Medicaid, Life and Health Insurance: Switching from Health first to HIP, corrective jaw surgery, benefits checkup
corrective jaw surgery, benefits checkup, hi mike: HI mike If you are not on Medicare, there is not much I can do to assist you. The information you received probably correct. HOWEVER if you are a dual eligible, have both Medicare and Medicaid, you can change your insurances almost any time you want....

Medicare, Medicaid, Life and Health Insurance: Billing a medicaid patient, medicare hmo, courtesy call
medicare hmo, courtesy call, medicaid: Hi Susan I AM NOT FAMILIAR WITH THE TEXAS REGULATIONS REGARDING THIS SO CALL THE Texas NUMBER, 1-800-252-9240 and a meeting with a counselor. Bring all the paperwork, and they will review the situation and help you get it worked out, computer acting...

Medicare, Medicaid, Life and Health Insurance: Health Insurance is Reversing Claim Payments, individual health coverage, medicare coverage
individual health coverage, medicare coverage, blue cross blue shield: Hi Marilyn! The Doctors should have called his insurance and if they did they would have found out that he had Medicare. So they are sort of fault also. When Blue Cross retracts their payment then they can legally charge your friend. However since...

Medicare, Medicaid, Life and Health Insurance: Out of Network Specialist, orthopedic specialists, orthopedic specialist
orthopedic specialists, orthopedic specialist, tommy john surgery: Hi Dena! Only way to reverse their denial is to prove 100% that no one in the network can do this surgery. If you can prove this then they will probably pay however this is a hard thing to prove. I have seen in my medical company where an insurance...

Medicare, Medicaid, Life and Health Insurance: Provider not covered., gallbladder surgery, sister hospital
gallbladder surgery, sister hospital, emergency reasons: Hi Emily! I would call the office again and explain that your insurance carrier will not pay for this bill since they are out of your network and ask them why they did not advise you. Then see if they can help you perhaps get an exception and get your...

Medicare, Medicaid, Life and Health Insurance: spindown/medicaid/medicare, medicare provider, medicaid provider
medicare provider, medicaid provider, medicaid: Hey Donna..... I do not answer questions regarding Medicaid since each state has its own laws and guidelines....best to check your states website for questions. Regarding Medicare you need to fill out an application and then meet their guidelines. They...

Medicare, Medicaid, Life and Health Insurance: Untimely manner, squeaky wheel, insurance commissioner
squeaky wheel, insurance commissioner, governor don: Hi Laurent! Call the office where you had the services done and tell them that you do not feel it is fair that you should have to pay for their mistake. Explained that they billed the incorrect insurance company and you were never advised until 3 years...

Medicare, Medicaid, Life and Health Insurance: Kaiser bill/ denied pre-authorization, kaiser bill, medical necessity
kaiser bill, medical necessity, better chance: Hi Kim! It depends on why they denied it. In order to appeal a denial you must prove their reason for the denial wrong. If you can do this then you have a chance for them to pay. So look at the specific denial then prove this is not correct. The more...

Medicare, Medicaid, Life and Health Insurance: medicaid billing, medicaid billing, medicaid provider
medicaid billing, medicaid provider, medicaid patients: Hi Melissa. It appears that a Dr. can opt out of both Medicare and Medicaid. For Indiana, I found this website that shows the opt out of Medicaid. http://provider.indianamedicaid.com/become-a-provider/disenroll-from-the-ihcp.aspx I do believe the Medicaid...

Medicare, Medicaid, Life and Health Insurance: medicare and share of cost, state medicaid office, medicare supplement insurance
state medicaid office, medicare supplement insurance, medicaid status: Hi Willard. Your question is a little confusing to me, but let me try. It sounds like you asked your State Medicaid for help. The fact that they say you have a share of cost is because you probably have income and assets higher than what s allowed for full...

Medicare, Medicaid, Life and Health Insurance: Worker's Compensation Authorization and Billing Medicare, health insurance carriers, health insurance company
health insurance carriers, health insurance company, billing medicare: Hi Ashley! Probably not since the injury is work related. Only W/C carriers are responsible for work related injuries not health insurance carriers. Only way to bill a health insurance company for something involved with a work injury is if the W/C carrier...

Medicare, Medicaid, Life and Health Insurance: claims, indemnity plan, eob
indemnity plan, eob, copay: Rosemary - my, I had to read this about 4 times to figure it out and it is still confusing. Not knowing what type of insurance your son has, I ll explain in normal terms. Normally, insurance states you have a copay for a certain visit or treatment,...

Medicare, Medicaid, Life and Health Insurance: health insurance, benefit, parents
Medicare, Medicaid, Life and Health Insurance: health insurance, benefit, parents, job

Medicare, Medicaid, Life and Health Insurance: health insurance, best health, health insurance
best health, health insurance, health plan: Hi Brittany. First of all, may I commend you on being diligent enough to know you should have health insurance. Many young people don t think they need it. One of the benefits of Obamacare is that children can stay on their parents policy until the age...

Medicare, Medicaid, Life and Health Insurance: Medical Bill Code, individual health insurance, correct billing
individual health insurance, correct billing, hi amy: Hi Amy Because your ultrasound is due to a history of cysts it is considered a follow up to an existing condition which is not eligible as a preventative test. The ultrasound for pain under your breasts is also not eligible because it is due to a symptom....

Medicare, Medicaid, Life and Health Insurance: Payment for surgical services, secondary insurance, insurance cards
secondary insurance, insurance cards, preauth: I Lonny A tough one, but, has possibilities. Carl 1-800-333-2433 and you will reach my counterparts in Minnesota. You will reach the nearest office of the SHIP Medicare trained counselors to you. Call them and make an appointment to meet with them and...

Medicare, Medicaid, Life and Health Insurance: Doctor office wrong about accepting medicaid
I am so sorry this is happening to you. If the neurologist does not accept Medicaid patients then they are obligated to have something in writing signed by you stating that you will be responsible for the bill. Contact your doctor s office and find out if...

Medicare, Medicaid, Life and Health Insurance: uninsured
I apologize for the confusion. Physician medical practices have no legal obligation to treat a patient. If a patient is uninsured and cannot pay for services upfront, a physician can refuse treatment. This is why ER s have become a default provider for...

Medicare, Medicaid, Life and Health Insurance: the uninsured
Hi David! I think that depends on each state.......some states have Charity Care and if you are not insured they will pay a portion of the bill if you qualify. It is heavily reduced though. Charity Care is funded by the government and our taxes. Trici...

Medicare, Medicaid, Life and Health Insurance: Inpatient Doctor Services
Hi Jack Medicare Part A is just for hospital services and Part B is for the doctor s fees. Medicare Part A is called the hospital insurance because it helps pay for the care a patient receives in a hospital inpatient setting, critical access hospital, skilled...

Medicare, Medicaid, Life and Health Insurance: Pre-op x-ray coding for Medicare submittal
I can t confirm the 76 modifier. There is still some information missing. Modifier use is supposed to be used with very specific variables. The lab is the only one who can accurately determine which modifier to use. There are too many if this, then use...

Medicare, Medicaid, Life and Health Insurance: Anything I can do?
Hi Amber.... You can always call them and try..... A good trick is to tell them that you are thinking about declaring bankruptcy....tell them you already went to any attorney and if they are not willing to negotiate with you then you will file this week....

Medicare, Medicaid, Life and Health Insurance: Medicaid supplimental insurance
It sounds like you re going to have to contact Medicaid and explain to them the situation and get a doctor s approval for skipping the medication steps they want you to go through again. Be persistent as sometimes the rules are unclear to doctors and Medicaid...

Medicare, Medicaid, Life and Health Insurance: medicare and humana
Hi Pamela Thanks for the question. Humana has a way for you to search for a doctor that accepts Humana Medicare Advantage plans on their website. Visit a href= http://pfp.humana.com/Pfp/FindNetwork.aspx http://pfp.humana.com/Pfp/FindNetwork.aspx /a ....

Medicare, Medicaid, Life and Health Insurance: obama care
Hi Tonie I am in Michigan, and because there are some different regulations in each State I am referring you to a Nevada expert. call 1-800-307-4444 and request to speak with a counselor. You will have reached the one nearest to you. Also ask for a benefits...

Medicare, Medicaid, Life and Health Insurance: veterans benefits
Hi William. I m not sure if you would qualify, but here s the website that might help you. http://www.va.gov/healtheligibility/Library/Tools/Quick_Eligibility_Check/index.asp If not, you should be able to get coverage through Cobra or healthcare.gov until...

Medicare, Medicaid, Life and Health Insurance: Medicare/Medicaide and Cost of share, high on the hog, medicaide
high on the hog, medicaide, living high on the hog: Hi Pattie Florida has a lot of State laws regarding your situation. Therefore I am referring you you to the SHINE Florida experts. Call them at 1-800-963-5337 and request an appointment with a counselor. The will meet with you. examine the situation and...

Medicare, Medicaid, Life and Health Insurance: medicare and uhc COB, uhc, cob
uhc, cob, medicare: Hi Aleta since there are some State regulations involved I am referring you to the Tennessee counseling group. You can reach them at 1-877-801-0044. You will get the nearest office to you. Contact them and get an appointment with a counselor. They will...

Medicare, Medicaid, Life and Health Insurance: Do i need additional health plan, personal health insurance, health insurance plan
personal health insurance, health insurance plan, ssi disability: Hi Angela This is too long to be done by e-mail, so I am referring you to the Georgia group of Medicare counselors. Call 1-800-669-8387 and you will get the nearest office of Georgia Cares. Give them a call and make an appointment with a counselor and request...

Medicare, Medicaid, Life and Health Insurance: Nursing Home Health Insurance, michigan health insurance, blue cross blue shield michigan
michigan health insurance, blue cross blue shield michigan, social security income: Hi Georgia. Too long to do by e-mail. Call the MMAP program in Michigan and request to speak to a counselor. Make an appointment with them and they review her material and do a benefits check. From that they will explain her options and you can then decide...

Medicare, Medicaid, Life and Health Insurance: medi/medi patient moving from CA to TX, medicare medical, medicaid program
medicare medical, medicaid program, abusive relationship: Hi Stacy! Each state has different laws regarding their Medicaid program so only thing to do is to either visit their website or call them to find out. She probably will have to requalify for Texas s Medicaid program. May be able to do on line not sure....

Medicare, Medicaid, Life and Health Insurance: Medicare and Cancer Insurance, cancer insurance, medigap plan
cancer insurance, medigap plan, advantage plan: One has nothing to do with the other. Medicare will still pay your bills. You still will have your copays and annual deductible with Medicare unless you have a secondary policy such as a Medigap plan. This info relates to Original Medicare and not a Medicare...

Medicare, Medicaid, Life and Health Insurance: medicare eligibilty, adult neurology, pediatric neurologist
adult neurology, pediatric neurologist, diagnosis of autism: Hi Andrea. You have to be on SSID for 24 mos. before you can become eligible for Medicare. If he is close to that, I would suggest calling Medicare for more answers. Also you might want to ask them about what they call compassion allowances . These are...

Medicare, Medicaid, Life and Health Insurance: Missouri Medicaid out of state coverage, missouri medicaid, emergency room visits
missouri medicaid, emergency room visits, billing guidelines: Out of state visits are covered by Medicaid in certain situations, including emergency room visits. However, it is important that the Nebraska provider contacts Missouri Medicaid to find out what the billing guidelines are. They may be required to enroll...

Medicare, Medicaid, Life and Health Insurance: Pharmacy Discount Cards, blue cross blue shield, discount cards
blue cross blue shield, discount cards, prescription costs: Hi Carl! Not sure what type of discount cards you are receiving since I do not get any here in NJ but I would assume they are for people who do not have a RX plan. Probably not worth the price to have if you have regular plan. However there are RX companies...

Medicare, Medicaid, Life and Health Insurance: medicaid, auto insurance policy, medicaid benefits
auto insurance policy, medicaid benefits, auto policies: Hi David! In most states if there is an auto accident the bills go through them first then to the health insurance. Every state is different though and some auto policies may act as primary where others are secondary to health. So no easy answers. ...

Medicare, Medicaid, Life and Health Insurance: Midwest Medicaid Coverage, glaxo kline smith, medicaid coverage
glaxo kline smith, medicaid coverage, treatment of lupus: Hi Jill----- Medicaid is a state funded government program that has guidelines.......you can always appeal their denial decision. Since each state has its own rules and guidelines you need to go on to their website or call them to see how they handle...

Medicare, Medicaid, Life and Health Insurance: Who pays first - Medicare or Kaiser, oxygen tanks, oxygen generator
oxygen tanks, oxygen generator, oxygen therapy: Hi Brenda There are some differences in regulations between States. I am in Michigan and therefore am referring you to the Maryland group of trained Medicare counselors. Call 1-800-243-3425 and you will get the nearest office to you. Make and appointment...

Medicare, Medicaid, Life and Health Insurance: hysteroctomy, medicare card, medicare supplement
medicare card, medicare supplement, advantage plan: You would have to call some of the companies that offer Medigap polices such as AARP for example. I have no way to tell you about hospital costs. You would need to call the hospital but you are definitely looking at thousands of dollars. Don t you have Medicare...

Medicare, Medicaid, Life and Health Insurance: medicaid for dependent parent, pathfinder program, medicaid regulations
pathfinder program, medicaid regulations, dependent parent: hI jOSE I am in Michigan and there is quite a difference in Medicaid regulations in Texas. So, call 1-800-252-9240 and you will reach the number to call in Texas. You will get the nearest office to you. Make an appointment with them and request them...

Medicare, Medicaid, Life and Health Insurance: Medicare deductible write off, hardship waivers, breathing medications
hardship waivers, breathing medications, medicare patients: Hi Tracy! Medicare patients are required to fill out hardship waivers and if it is a true hardship using current poverty hardship guidelines then Medicare will allow it. However a provider has to be careful on not making everyone a hardship. Hardship...

Medicare, Medicaid, Life and Health Insurance: Medicare supplement plan, medicare supplement plan, medicare supplements
medicare supplement plan, medicare supplements, annual enrollment: John, thank you for the question. I can certainly understand your frustration. In the slight chance that they are correct, I would pay an extra month while the audit is being done. The only other way out of this is to let me know when her birthday is -...

Medicare, Medicaid, Life and Health Insurance: Enrolling inMedicare part b, insurance documentation, pathfinder program
insurance documentation, pathfinder program, benefits checkup: Hi Call 1-800-686-1578 and you will reach the nearest office of the SHIP program in Ohio Call them and make an appointment with a counselor. Bring all the information, and they will, run a benefits checkup and a pathfinder program to determine your choices....

Medicare, Medicaid, Life and Health Insurance: How to Find The Right Facility, prescription pain killers, slide id
prescription pain killers, slide id, secondary insurance: Tracy, I ve not had this question before. Not knowing exactly what he has - supplement or Medicare Advantage plan - you might want to talk with the secondary company for help. In the meantime, here is a site I found that might help with what Medicare will...

Medicare, Medicaid, Life and Health Insurance: Insurance deductable, medicare billing, blood lab
medicare billing, blood lab, explanation of benefits eob: Medicare allows only a portion and then pays that amount minus copayment. Copayment is then the responsibility of the secondary carrier however if deductible has not been met then it is the patients portion to pay. I would go by what the Medicare EOB...

Medicare, Medicaid, Life and Health Insurance: Insurance deductable, medicare supplement, blood lab
medicare supplement, blood lab, doctor bills: Hi John. Sorry for the delay. Our first conversation, you typed she has a F+ Medicare Supplement. I took that to mean it was a high deductible F Plan. Now I m very confused based on the scenarios that you ve given me. The only way I can truly help is...

Medicare, Medicaid, Life and Health Insurance: insurance denies payment, blood pressure medication, short term memory
blood pressure medication, short term memory, heart medicine: Beth, FYI...Observation is considered as outpatient so if the insurance states the services could have been provided on an outpatient basis then it is likely that the original bill went out as in inpatient. But you will find out for sure once you contact...

Medicare, Medicaid, Life and Health Insurance: Medicare and Medicaid full dual coverage, medicaid programs, food stamps
medicaid programs, food stamps, insurance carrier: Hi Denise.... Before you pay anything you should call your insurance.carrier and be sure you owe. I do not know your specific policy and every state has their own rules for their Medicaid programs so only way to ensure you owe you need to call them. ...

Medicare, Medicaid, Life and Health Insurance: Medicare Part A deductable, inpatient hospital care, water in the lungs
inpatient hospital care, water in the lungs, benefit periods: Benefit period The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you re admitted as an inpatient in a hospital or SNF. The benefit period ends when you haven t received...

Medicare, Medicaid, Life and Health Insurance: Dental claim denied, consumer assistance program, tooth enamel
consumer assistance program, tooth enamel, dental experts: Hi Tina---- Medical insurance does not pay for dental procedures. They only pay for medical procedures. Clauses are in policies are made so that the customer is aware going in on what they pay or what they do not pay for. It is legal and all insurance...

Medicare, Medicaid, Life and Health Insurance: medicare card, medicare card, medicare benefits
medicare card, medicare benefits, application check: Hi Elizabeth Have you applied for your Medicare benefits? You have a 7 month window to apply for Medicare. You can apply up to 3 months before your 65th birthday and up to 4 months after. If you ve missed this window, you can apply as a late enrollment...

Medicare, Medicaid, Life and Health Insurance: Medicare Help, medicare open enrollment, lymph edema
medicare open enrollment, lymph edema, certificate of medical necessity: Ok, first of all - the pumps and hoses can be covered by Medicare or the health plan he might have that takes the place of Medicare, BUT he must get a Certificate of Medical Necessity from his doctor to show the need. Secondly, Medicare Open Enrollment...

Medicare, Medicaid, Life and Health Insurance: billing
I may not be right, but screening could be anything from a doctor simply asking questions to performing routine physical checks to rule out other problems. (Blood pressure, breathing checks, family history etc...) Diagnostics should usually be targeted testing...

Medicare, Medicaid, Life and Health Insurance: dual health coverage contractual adjustments
Primary carrier sort of makes the ruling when they are billed first. Secondary coverage only has to pay according to your contract on the balance after the primary deemed the charge. So the allowable was already deemed by your primary. If your primary...

Medicare, Medicaid, Life and Health Insurance: health care for expat
There are short-term plans available, even just the basic catastrophic ones. Get in touch with a broker that can help you. You would not be eligible for medicare as you are too young, but medicaid, maybe. It depends on your income and what state you plan...

Medicare, Medicaid, Life and Health Insurance: Insurance plan renewal dates, deductibles, insurance
deductibles, insurance, benefits: Hi Catherine You are correct. Most insurances including Medicare renew benefits on Jan 1st. Some BCBS plans have in the past had a July 1 renew date but I think most of them have abandoned this practice. As a rule of thumb, I would act as though all of...

Medicare, Medicaid, Life and Health Insurance: Medicare Supplement
Hi Pat - Happy New Year. You didn t mention what Plan of Medicare Supplement your husband has. For instance, if he has a J Plan, he can transfer to an F and have the same coverage. If he has an F Plan, he can transfer to a G, but then he would have an annual...

Medicare, Medicaid, Life and Health Insurance: Switching from "short term" high deductible plan to low deductible comprehensive plan just long enough for son to have surgery
Hello Andrew. As an insurance professional I have pause as to what you re suggesting. What if something else happens in April? June? October? Will you be waiting to take care of the malady until after Jan. 1, 2016? I suppose you can do as you wish, but...

Medicare, Medicaid, Life and Health Insurance: Medicare Part 2
Hi Marina The simple answer to your question is yes. However, Medicare Part B will only cover a limited set of ancillary Part B inpatient services specified in the Medicare Benefit Policy Manual . The hospital likely has access to the guidelines necessary...

Medicare, Medicaid, Life and Health Insurance: Medicare Replacement Plan
The nursing home is correct. Traditional Medicare works best with Medicaid especially for nursing facilities. Depending on their income, they could be eligible for full coverage. Medicare only covers certain services in a nursing facility and most replacement...

Medicare, Medicaid, Life and Health Insurance: Medicare Supplement
Hi Joyce You should have received a certificate of creditable coverage from your insurance company. That should prove that you were covered during that time. If you don t have one, you should be able to prove that you made your premiums. You should have...

Medicare, Medicaid, Life and Health Insurance: Starting to feel older now...
Haha! You re right - I am neither a Dr. or a guy! I know people younger than you who have more health problems and people older than you that can ride a bike 100 miles every weekend. So every one is different, we are mortal. Check with your doc to see...

Medicare, Medicaid, Life and Health Insurance: Having VA Medical Care and Medicare Savings Program
Sallie, if you are entitled to VA, you can also obtain any other sort of Medicare insurance to utilize medical care outside of the VA if needed. You would have to apply for the Medicare Savings Program to see which level of benefit you would qualify for....

Medicare, Medicaid, Life and Health Insurance: Veterans Medical Care and Medicare Part A
Sallie, as I tried to answer in your first question, I personally don t think it s enough. With all the vets coming home, etc., having the option to use traditional Drs. and facilities could be very beneficial. It probably would only cost you the price of...

Medicare, Medicaid, Life and Health Insurance: Veterans Medical Care And Medicare Part A
Oh, that s okay. This scenario is a little different. Part A only covers hospital admissions. It could be sufficient with VA benefits but I recommend that you don t seek treatment outside of the VA or VA authorized providers. If you do be prepared to pay out...

Medicare, Medicaid, Life and Health Insurance: hospital
Hi Joyce. When it comes to needing the emergency room, any hospital will do because the health plan has to cover it because it s an emergency. But she would need to be transferred as soon as possible to the hospital that WellCare works with. Also be sure...

Medicare, Medicaid, Life and Health Insurance: insurance approval
Isn t Wellcare a Medicare Advantage plan. I am not familiar with it but when I Googled that is what I found. If it is a Medical policy they won t pay if Medicare doesn t pay but I need more info to help you. Has she exceeded the Medicare cap of $1920 for...

Medicare, Medicaid, Life and Health Insurance: Labs & Referals
Hi Natalie, I am so sorry this has happened to you. This actually happens quite often. There may not be a resolution for this. You could try to file an appeal to your insurance company to see if they would reconsider paying for the labs. However, I suggest...

Medicare, Medicaid, Life and Health Insurance: Medicare/Medicaid
Hi Marianne. If she is on Social Security Disability for more than 24 months then she is eligible for early Medicare if she is not yet 65. If she has Medicare then you might want to see if she qualifies for Medicaid but you would have to use Medicaid doctors....

Medicare, Medicaid, Life and Health Insurance: Humana vs. Medicare
Hi Pamela. Medicare Advantage plans by law must cover at least what Medicare covers and usually will provide better benefits plus extras that Medicare doesn t cover. She cannot change her plan now unless she is on Medicaid. Otherwise, she will have to wait...

Medicare, Medicaid, Life and Health Insurance: Can a practice keep the co-pay collected for claims denied d/o untimely filing?
Hi Sue! It would depend if you have a contract with the insurance companies. When they deny a claim they will tell you on the EOB if you can bill the patient for anything and most of the time you can not under a contract. Most copays are based on what...

Medicare, Medicaid, Life and Health Insurance: my 2 1/2 yr old son is deaf
I am sorry this happened to you. My suggestions are: 1. Try to apply for your son for Medicaid. The financial guidelines for Medicaid are more flexible for children. 2. If you cannot get Medicaid approval, you can always apply for low cost insurance thru...

Medicare, Medicaid, Life and Health Insurance: medicare
It is too early to take social security. The lowest age they give out is 62. .The only way to get Medicare without social security is to be permanently disabled. Medicaid is for low-income people like you. Call your local DHS office to see if you qualify....

Medicare, Medicaid, Life and Health Insurance: Switching from Humana to Medicare
You need to call Medicare to see how to make the transition. Medicare does not cover the services that your mother needs. Humana is just a version of Medicare and has nothing to do with assets. Please call the Dept of Aging in your state to get some advice...

Medicare, Medicaid, Life and Health Insurance: Wondering
The only factor that will determine whether your friend is eligible for Medicaid is her household income. If she is under 18, by law her mother is still her legal guardian and considered her household unless she becomes emancipated by getting married. If...

Medicare, Medicaid, Life and Health Insurance: Inactive Insurance
Robin, assuming you are making your monthly insurance payments on time, then your Dr. should accept your ID card. All the insurance companies have been so swamped that it s been very difficult to verify things, but we are all hoping that they catch up. If...

Medicare, Medicaid, Life and Health Insurance: Medicare Supplemental Insurance
Dreter, I am not surprised that you are being bombarded, most people have that happen once you turn 65. It is true that Medicare only pays about 80% of your medical expenses. To answer your question: It is NOT required for you to purchase Medicare Supplement...

Medicare, Medicaid, Life and Health Insurance: Medigap Insurance
Dixie, when turning 65, this is a guaranteed issue time no matter the health of the applicant for Medicare supplement insurance. I always advise an F plan for the main reason you never know what may happen - therefore, get the best when you can because if...

Medicare, Medicaid, Life and Health Insurance: Non-participating provider
I definitely feel your pain. You need to ask if the drs are Medicare participating physicians or locate your Medicare contractor and download their MedPard directory which lists all participating providers. And there is no reason why you cannot contact...

Medicare, Medicaid, Life and Health Insurance: Is Supplemental Insurance Needed At All?
Hello Tal. Thank you for the question. In my experience I have found that people on a tight income don t go to see a Dr. often if at all. This may result in a faux feeling of good health and no medications. This is one of the reasons I advocate for getting...

Medicare, Medicaid, Life and Health Insurance: Cost for Medicare vs pre-medicare plan
Once you are 65, medicare becomes your primary insurance carrier. The cost is about $100 a month for Part B which are for your physician services. If you have worked 40 quarters or more in your lifetime and paid into Medicare with payroll deductions you...

Medicare, Medicaid, Life and Health Insurance: health insurance plan vs medicare
Lee, it s the retirement Social Security. If there isn t enough, then they will bill you quarterly for Part B. Both Part A and Part B of Medicare have gaps , ie - deductibles and coinsurance. This is what a supplement fills, these gaps. A few months before...

Medicare, Medicaid, Life and Health Insurance: ACA and Medicare
Thank you for the smile. CareMore is a Medicare Advantage plan. It takes the place of Medicare even though you must have both Parts A & B. The Federal Govt. pays CareMore to take care of its enrollees. As far as the smallest premium, I ve seen as little...

Medicare, Medicaid, Life and Health Insurance: dual benefits????
Hi Ben - sorry for the delay. Certain Medicare Advantage plans are designed to assist the Medi/Medi population. You still must use the doctors and facilities that are in their Medicaid network and they will cover everything that Medicare covers and more....

Medicare, Medicaid, Life and Health Insurance: denial letter
Hello Ann. I presume they sent you the letter, but you no longer have it. Probably calling Social Security at 1-800-772-1213 or calling your local office would be best. If you feel like the denial was wrong, you can use this form to appeal: http://www.socialsecurity.gov/forms/ssa-1021.pdf...

Medicare, Medicaid, Life and Health Insurance: Medicare when living in Canada
Hi Benni, in my opinion, if you will be filing taxes in the U.S., then you will need to provide proof of Canadian insurance so you won t be penalized under the Affordable Care Act. As far as Medicare, you will not need or be allowed to have Medicare if you...

Medicare, Medicaid, Life and Health Insurance: Humana
OK Kim, then please use this link that will connect you with a licensed agent in your area to pick a different plan that will best suit his needs. He ll have a Special Enrollment Period available to him. https://medicare.healthcompare.com/?trackingID=UFAADEEH66YEGME...

Medicare, Medicaid, Life and Health Insurance: lack of choices
Hi Sandy For services not covered by Medicare, you are not obligated to provide Medicare as an insurance. When you visit your outpatient mental health provider make sure you present your UHC insurance card to be filed. Contact your UHC insurance company...

Medicare, Medicaid, Life and Health Insurance: referral
Hi Joyce, I am just as confused as you are. My understanding is that the referral must come from the primary. However, it could be possible that they are requesting a referral from the neurologist since your daughter was previously under the care of a neurologist....

Medicare, Medicaid, Life and Health Insurance: Life Insurance
There are some life insurance companies that will insure him. Look up guaranteed life insurance. These policies do not require a doctors exam. Also, renal failure patients are automatically eligible for disability. In most cases, there is a 2 year waiting...

Medicare, Medicaid, Life and Health Insurance: Medicaid
You would need to check your state s medicaid guidelines. You would most likely have to have the patient sign an agreement that they have been informed that you do not accept Medicaid and they will be responsible for the charges incurred. However, certain...

Medicare, Medicaid, Life and Health Insurance: medicare
You should not be paying his supplement. Now that he has Medicare and Medicaid they ll cover it all. So sorry that you are going through this.Medicaid should ,also pick up his Medicare premium but Medicaid is state run so you really need to check with his...

Medicare, Medicaid, Life and Health Insurance: supplemental
Hi Bill, I tried to narrow down exactly what Michigan allows insurance companies to do. I believe if you ve seen a Dr. or had treatment within the prior 90 days to the start of your policy, then they can exclude services for that condition for the first 90...

Medicare, Medicaid, Life and Health Insurance: follow up on medicare supplemnt plan
Hi Nick, I reviewed the original question and answer, and I would suggest you find out exactly what your wife would cost as an employee. It may not be half as you calculated. If all in all getting your own insurance is not cost effective, then stay on her...

Medicare, Medicaid, Life and Health Insurance: medicare/medigap
Hi Nick, sorry for the delay. What you pay for your premium as a dependent on your wife s policy will help you make the decision. A Medicare Supplement Insurance policy would be typically $150/mo. more or less, depending on your State. Add to that your...

Medicare, Medicaid, Life and Health Insurance: Medicare question
Hi Mandy! Medicare does require you to pay your copay to a provider if they make payment however if it is a hardship for you and you can prove it Medicare also has a hardship waiver that could reduce or erase your copay. I don t think Medicare would...

Medicare, Medicaid, Insurance, HMO problems: my 23 yr old daughter is pregnant..., kidney failure, root canals
kidney failure, root canals, insurance food: Medicaid will kick in when kidney failure leads to the need for dialysis. In the meantime, check your handbook. There is an out of pocket limitation. After she has met that everything is covered at 100%. You may find that you are only responsible for the...

Medicare, Medicaid, Insurance, HMO problems: 3rd party liability, health insurance company, auto insurance company
health insurance company, auto insurance company, health insurance companies: Hi Toni, Thanks for your question. Since you were in an auto accident..your auto insurance should have been the primary payor for any medical bills that you incurred. Health insurance companies will not normally cover any expenses that are incurred as a...

Medicare, Medicaid, Life and Health Insurance: 48 yrs old w/Disability SS -, ford explorer 1992, doctor appt
ford explorer 1992, doctor appt, migraine headaches: Eileen, Based on what you have told me, I think you will have a difficult time qualifying for Medicaid. With your husband s income, which part of it will be deemed to your use, you would be over income for Medicaid programs in Florida. Because his income...

Medicare, Medicaid, Insurance, HMO problems: 75 year old male and Supplemental Insurance??, blue cross blue shield, medicare medicaid
blue cross blue shield, medicare medicaid, medicare plan: What he has is a Medigap policy. This picks up anything that Medicare Part A and B don t pay. If you are concerned about the premium check out AARP and their Medigap plan and see if that helps at all. The VA may supply him with his prescriptions for a minimal...

Medicare, Medicaid, Insurance, HMO problems: 85 year old mother's medicare, ppo plan, copay
ppo plan, copay, hmo plan: She pays Medicare for Part B. Does her doctor know that she has Keystone 65? Is it the PPO plan or the HMO plan? This will be the difference. There are office visit copays for some doctors and not for ohers. I think that you need to call Keystone...

Medicare, Medicaid, Insurance, HMO problems: Abdominoplasty, pubic area, abdominoplasty
pubic area, abdominoplasty, tummy tuck: You need to speak to your doctor first of all. Only he can determine if you indeed need a tummy tuck and if it would be considered medically necessary or not. If it is not medically necessary then chances are your medical insurance will not cover it. ...

Medicare, Medicaid, Life and Health Insurance: Adult disabled son, insulin infusion pump, cba program
insulin infusion pump, cba program, home caregiver: What brought Florida to mind is the number of older people who retire there who would have Medicare and Medicaid and would need specialists because of diabetes or other chronic diseases. Again, I can t tell you about the availability of doctors but you...

Medicare, Medicaid, Insurance, HMO problems: Advocating for an IUD, medicaid plan, mirena iud
medicaid plan, mirena iud, psychiatric evaluations: Amy, If your doctor accepts Medicaid, then they must agree to accept whatever Medicaid pays and cannot bill you for the balance. If your Medicaid plan has a deductible, which is less that $5.00 a day in most instances, you are responsible for the deductible...

Medicare, Medicaid, Life and Health Insurance: Aetna PPO & Medicaid as Secondary, aetna ppo, massive stroke
aetna ppo, massive stroke, secondary coverage: If you want to continue using her doctors then they will have to bill Aetna directly. Aetna will have to know that the doctors that she is seeing are not Medicaid providers. I would start by talking to Aetna. Let them know about her doctors and what needs...

Medicare, Medicaid, Insurance, HMO problems: Aetna's refusal to pay office visit, colorado medical center, university of colorado medical center
colorado medical center, university of colorado medical center, outpatient visit: Hi Diane! Most insurance companies have this guideline.........however if it was not clear to you or if someone told you different, you could appeal with Aetna. I would think when you had your appointment they collected a copay, was this amount your normal...

Medicare, Medicaid, Insurance, HMO problems: Alternatives to Medicaid, local health department, inexpensive insurance
local health department, inexpensive insurance, state websites: If someone is not permanently employed but in need of health insurance, as long as they can afford it, they can apply for individual medical coverage through an insurance company. It is not inexpensive but it will offer coverage. Some state websites will...

Medicare, Medicaid, Insurance, HMO problems: Alzheimers, spousal impoverishment, friends mother
spousal impoverishment, friends mother, homr: sherry What State are you in? The regulatiions vary in each State. IN GENERAL: sPOUSAL IMPOVERISHMENT MEANS THE SPOUSE NO IN THE NURSING HOME HAS PROTECTED ASSETS AND INCOME TO LIVE. As long as the spouse remains in the home it is considered not...

Medicare, Medicaid, Insurance, HMO problems: An American in Canada, canadian health insurance, health insurance questions
canadian health insurance, health insurance questions, health insurance program: Steven, I wish I was more of an expert on this than I am. But truthfully, I do not know if you can use Medicare in Canada. My guess is that Canada will not bill the U.S. government, but I really don t know. I do know that buying into the Canadian Health...

Medicare, Medicaid, Insurance, HMO problems: Appealing exclusions, broken cheek bone, oral maxillofacial surgeon
broken cheek bone, oral maxillofacial surgeon, blue shield california: Hi Jim! If your insurance denies any of the bills, then appeal them according to their denial. When an insurance company denies bills they always give a reason. Then you have to prove they are wrong..being very specific using their denial....so if they...

Medicare, Medicaid, Insurance, HMO problems: Getting Approved.., docotrs, gp surgery
docotrs, gp surgery, acceptable food: Kelli, I can t pretend to know all the elements of an evaluation, but I can tell some of the factors that will be weighed by a state adjudication. 1) Cost. They will not look just at the cost of the surgery itself, but will want to weigh the long term...

Medicare, Medicaid, Insurance, HMO problems: we are in Arizona, state websites, step daughter
state websites, step daughter, medical bills: Hi Heather! In most states, the answer is yes. Once she turns 18 years old, have all the bills sent to her instead of to you. Check with your state--------most state websites have alot of information regarding medical bills and minors. Good Luck!...

Medicare, Medicaid, Life and Health Insurance: Autistic Child, aetna hmo, medicaid hmo
aetna hmo, medicaid hmo, medi caid: I am still confused as to why this child s primary insurance is not Aetna. It could because she is a child with special needs. I would not drop the insurance that he carries for her as it is a court order and would have to probably go back to court to have...

Medicare, Medicaid, Life and Health Insurance: Avonex Injections, medicare supplement, avonex
medicare supplement, avonex, reimbursement rate: I wanted to follow up with you and let you know I recently received some information regarding Avonex injections and wanted to pass it on to you to see if these people could help you. Here is a link I was given. http://www.priorityhealthcare.com/content/patients/online_communities.aspx...

Medicare, Medicaid, Insurance, HMO problems: Avonex Payment, avonex, fee schedules
avonex, fee schedules, billing code: Hi Christine------ You need to know the billing code then look it up on Medicare s website----they have fee schedules listed for each region. Each state will be listed with the amount they will pay......remember it is after deductible and paid at 80%....

Medicare, Medicaid, Life and Health Insurance: Am I able to get Medicaid, state medicaid program, medicaid office
state medicaid program, medicaid office, emergency provisions: I believe you could apply for Medicaid under the Medically Needy program. This is not determined on income alone. If income were the only factor, you would be over income as the allotted income is only about $350.00 per month. But this is a spend down program....

Medicare, Medicaid, Insurance, HMO problems: accepting insurances, full service day spa, medicare office
full service day spa, medicare office, credentialling: Sandy, You need to apply through Medicaid and Medicare to be a licensed provider for them. Call your local Medicare office and ask about the process of becoming a provider. Once you are approved, you can accept their insurance. As an owner I don t know...

Medicare, Medicaid, Life and Health Insurance: adjustments, correct answer, deductibles
correct answer, deductibles, medical billing: Like I said I am not familiar with this. If the agreement is that the doctor accepts Medicare, then you wouldn t need to bill the secondary. However, you could just bill the secondary and see what they say. They won t pay if they are suppose to and then...

Medicare, Medicaid, Insurance, HMO problems: advantages of an HMO over a Medigap policy, medicare hmo, gap insurance
medicare hmo, gap insurance, medigap policy: Call 1-800-Medicare and request a copy of Medicare and You 2007. With an HMO you must use the providers in the HMO system or end up paying for the services yourself. Not a good option if you go a lot of traveling. There is less paperwork. However you...

Medicare, Medicaid, Life and Health Insurance: appauled by the treatment of oregons eldely and disabled, bone spurs, brother bobby
bone spurs, brother bobby, oregon right: Debb, There is a lot of red tape involved with applying for government assistance. But that is why there are people like me who are willing to help cut thru that red tape when possible. There was a reason I asked these questions, because, while red...

Medicare, Medicaid, Insurance, HMO problems: approved then denied after surgery, kidney stone, certified mail
kidney stone, certified mail, confirmation number: Hi Jonathan! Even though the hospital told you that it was pre approved, you as the patient are suppose to follow up with your insurance carrier to ensure it will be. Hospitals do call but they do it as a courtesy . If you appealed with the insurance...

Medicare, Medicaid, Insurance, HMO problems: BCBS HMO Blue Texas, hmo blue texas, weight loss surgery
hmo blue texas, weight loss surgery, certificate of coverage: Hi Tracy There is no way of knowing the answer to your question without having receiving the Certificate of Coverage packet from the Plan. So I do not know the answer. He will have to pick a primary care doctor. That is the person to ask. Joh...

Medicare, Medicaid, Insurance, HMO problems: Will BCBS (PPO) cover tubal ligation reversal?, second marriage, ligation reversal
second marriage, ligation reversal, tubal ligation: Chances are they will not. Get a copy of the booklet if you can and go to the section marked Exceptions and Limitations . In there they will say something to the effect of the reversal of tubal. Or you can just call his medical insurance. The...

Medicare, Medicaid, Insurance, HMO problems: Becoming a Medicare Provider, medicare provider, physicians office
medicare provider, physicians office, nighttrain: Unfortunately I don t know anyone who does this for a living. However you might want to call a local physicians office and talk to their office manager and see if that person might be willing to help. If you can t get their software to download, is it...

Medicare, Medicaid, Insurance, HMO problems: Benefit denial after being given preauthorization for a bariatric surgery, benefit denial, lap band procedure
benefit denial, lap band procedure, morbid obesity: Hi Lori! The next step is the appeal process......you need to know the specific reason why they denied the treatment. Once you know that then you can fight them. You need to prove the medical necessity.....it sounds to me it had something to do with your...

Medicare, Medicaid, Insurance, HMO problems: Benefit excluded, air ambulance company, empire blue cross
air ambulance company, empire blue cross, empire blue cross blue shield: I am sorry that you have had such an experience. It is common that air ambulance is not covered, or has a very limited benefit. I am not sure why it doesn t show it more clearly in your benefit plan. You have done all the right things so far. If you make...

Medicare, Medicaid, Insurance, HMO problems: Better Deal - HMO or Medicare, medicare card, home health care
medicare card, home health care, secure horizons: Hi Val You did not say if the HMO was a work related HMO or a Medicare Advantage Plan. I would guess a Medicare Advantage Plan. If it is a Medicare Advantage Plan there is no difference in the Medicare required converges than in original Medicare....

Medicare, Medicaid, Insurance, HMO problems: Being Bill Additional Charges & Dental PPO Aetna, aetna dental ppo, dentist office
aetna dental ppo, dentist office, mail: Hi Candice: It is not up to Aetna to advise employees of the change of coverage but the employer. Usually downgrades are made to reduce the premiums for the employer and employee. So the employer knew since they are the ones that had to pick the downgrade...

Medicare, Medicaid, Life and Health Insurance: Bill to Medicaid Patient?, ohio medicaid, patient question
ohio medicaid, patient question, explanation of benefits: Just to clarify this are you saying that Medicare paid their portion then via Medigap program sent copay portion to Medicaid for payment? If this is your question, no you can not bill the patient directly....you must call Medicaid and find out why they have...

Medicare, Medicaid, Insurance, HMO problems: Billed for Doctor's mistake, core biopsy, certified mail
core biopsy, certified mail, mammotone: Hi Kate! A lawyer would probably charge you more than the bill is. You need to work with the hospital since this is where the charges are coming from. Perhaps find someone in charge there, get their name and title, and send a detailed letter by way...

Medicare, Medicaid, Insurance, HMO problems: Billing by Anesthesiologist very late, getting insurance, hmo network
getting insurance, hmo network, patient surgery: Hi Laurie! If the HMO denied the claim due to not being billed in a timely manner, then yes it is the fault of the Dr who did not submit the claim in time and your daughter should not be responsible for their mistake. However if the HMO denied due to not...

Medicare, Medicaid, Insurance, HMO problems: Billing Medicare, certified pedorthist, billing medicare
certified pedorthist, billing medicare, bill medicare: Judy Just off hand I do not know the procedure. However. there are three ways to find out. Call the phone number for the Durable Equipment information listed in the back of the Medicare and You 2007 for the Mn area. Call 1-800 Medicare and request...

Medicare, Medicaid, Insurance, HMO problems: Bills sent to Collection Agency, care alot, charity care
care alot, charity care, worth a shot: Hi Theresa! You are not legally responsible to pay your mothers medical bills. So what I would do is to write on the bills again that they need to send the bills to your mother not you and ask that your address be removed from this account since you have...

Medicare, Medicaid, Insurance, HMO problems: Blue Cross, hmo plans, blue cross
hmo plans, blue cross, open access: Hi Nichole! Many Blue Cross s do pay but have some guidelines and requirements. Each Blue Cross Plan is different so you have to look at your policy to deem if they will pay. There are HMO plans, PPO plans, Open Access plans, etc As soon as you get...

Medicare, Medicaid, Life and Health Insurance: Blue Cross, humana plan, humana one
humana plan, humana one, outpatient therapies: CYD is Calendar Year Deductible. It sounds much better than the last one. I would call and ask very specific questions that pertain to your needs. You need to see a chiroprator. What will they pay exactly? Ask for examples. BCBS is a good insurer....

Medicare, Medicaid, Life and Health Insurance: Breast Reconstruction after Mastectomy, hmo providers, breast reconstruction
hmo providers, breast reconstruction, gold choice: Clyde All is not lost. The HMO is still Medicare, just s different way of paying. Still up to the doctor to advise if not covered. Only difference is the requirement for referrals and using the HMO providers, All the rights from original Medicare...

Medicare, Medicaid, Insurance, HMO problems: Breast Reduction, breast reduction, hmo plan
breast reduction, hmo plan, medical reason: You can appeal their decision and try again to get them to cover the surgery. Make sure that you have a medical reason to have the surgery. You need to show a history of the medical condition. Such as terrible back aches, you need to show that you had treatment...

Medicare, Medicaid, Insurance, HMO problems: Breast Reduction, breast reduction, plastic surgeon
breast reduction, plastic surgeon, chiropractor: The chiropractor is talking to another professional. It is not up to me to tell him how to word his concern and appeal for a breast reduction. Also your plastic surgeon will also have to speak to a doctor with your insurance company. It s not in the wording...

Medicare, Medicaid, Insurance, HMO problems: Breast Reduction using Medicaid, medicaid office, florida medicaid
medicaid office, florida medicaid, medicaid programs: Hi Emma! Breast reduction is usually done by a plastic surgeon and considered cosmetic so I doubt most state s Medicaid programs will pay. Perhaps if you prove that it is hindering your health and it is medically necessary, you may have a chance. ...

Medicare, Medicaid, Life and Health Insurance: Breast Reduction, breast doctor, breast surgeons
breast doctor, breast surgeons, breast reduction: What does your medical insurance pay towards chiropractic visits? Also, once you consult a chiropractor they may have a treatment plan that is set so that you go for three months. Did they recommend a chiropractor in your area? Make the appointment...

Medicare, Medicaid, Insurance, HMO problems: Breast reconstruction, breast cancer survivor, state insurance commissioners
breast cancer survivor, state insurance commissioners, saline implant: Contact your State Insurance Commissioners office and have them investigate this. They will be able to make a determination whether the insurance company should be paying for this or not. Did you get any sort of pre-authorization before you went in for surgery?...

Medicare, Medicaid, Insurance, HMO problems: Brother needs medical and prescription assistance, prescription assistance, debilitating stroke
prescription assistance, debilitating stroke, medical issues: I would suggest when his insurance runs out that he applies for Medicaid. He should also start as soon as possible to apply for SSI. SSI is very difficult to get and they usually turn you down the first time you apply. Many people are in his situation....

Medicare, Medicaid, Insurance, HMO problems: Burial Policy, life insurance policy, burial policy
life insurance policy, burial policy, burial policies: Nancy, I am sorry for the confusuion surrounding your problem. I can tell you, however, that a burial life insurance policy is not an allowable expense. I believe the confusion may have come from fact that the cash value of the irrovacable burial policy...

Medicare, Medicaid, Insurance, HMO problems: Bypass Surgery, bypass surgery, insurance policies
bypass surgery, insurance policies, medical reasons: Hi Cecilia! Unless the tummy tuck is needed for medical reasons, most insurance companies will not pay. What I would suggest is to call the Doctor who performed the bypass surgery and ask them how to get this covered. They deal with this all the time...

Medicare, Medicaid, Insurance, HMO problems: Having a baby, childcare situation, many blessings
childcare situation, many blessings, school insurance: Hannah, As a pregnant woman, you should be eligible to apply as an individual household for Medicaid for you and your unborn baby. You should be eligible for TANF as well, as long as your individual income does not exceed the limit. Your parents income...

Medicare, Medicaid, Insurance, HMO problems: bariatric surgery and supplemental ins., walter reed medical center, vertical banded gastroplasty
walter reed medical center, vertical banded gastroplasty, pulmonary hypertension: Yes, Medicare does cover some weight loss surgeries. I would call them to find out exactly what they will and will not cover. You will also need to find out what they require you to do before the surgery will take place. The letter you recieved means...

Medicare, Medicaid, Life and Health Insurance: bcbs/medicaid, bcbs, medicaid
bcbs, medicaid, medical dental: Then the fact that she had Medicaid on the children is only so she doesn t have to pay any of the copays. His insurance should be primary and Medicaid would be secondary and would cover all of the copays that come up. Since the courts ordered him to cover...

Medicare, Medicaid, Insurance, HMO problems: bcbs orthognathic surgery, orthognathic surgery, insurance plan
orthognathic surgery, insurance plan, premiums: Read the fine print and go over the listing of Exceptions and Limitations. Also look for any riders that come with the plan. You want to specifically look for any limitations for surgery during the first year. Keep in mind that once you have a diagnosis...

Medicare, Medicaid, Insurance, HMO problems: benefit question, dollas, uncompensated care
dollas, uncompensated care, share program: As sorry as I am to say this, I don t think there is anything you can do. The way the system works is first come first serve. If you have a large claim, and you are waiting on any information before submitting, hoping to file a clean claim--the best thing...

Medicare, Medicaid, Insurance, HMO problems: benefits, plan hmo, traditional medicare
plan hmo, traditional medicare, advantage plan: Gracia, I am not sure I understand exactly what you are asking me. Is the Human HMO a Medicare Advantage plan? Or is it private insurance? What confused me is the fact that you have Medicare part A. Did you choose this plan INSTEAD of Part B, (traditional...

Medicare, Medicaid, Insurance, HMO problems: which is the best medicare insurance to get for medication?, ssa gov, medicare insurance
ssa gov, medicare insurance, pharmacy medication: While I cannot recommend any particular drug plan, I do know that other plans have higher initial limits than $2,200. For instance, Humana allows up to $3,500 in drugs before patient responsibility kicks in. I don t think you can change your drug plan until...

Medicare, Medicaid, Insurance, HMO problems: billing problem SOS, blue cross hmo, doctors office
blue cross hmo, doctors office, billing problem: Hi Hannah! If your EOB from UnitedHealthCare states you have no more responsibility than your $15.00 copay, I would not worry about it. Send the billing company a copy of the EOB stating that your insurance company has advised you that you are not liable...

Medicare, Medicaid, Life and Health Insurance: How to get bills paid if I have other Health Insurance, health insurance assistance, aetna hmo
health insurance assistance, aetna hmo, state health insurance: See if the provider will file. They have all the paperwork and right claim forms. You can call 1-800-medicare, tell them you need forms to file a claim, and the circumstances, and they will switch your calll to the right person to tell you how top fill...

Medicare, Medicaid, Insurance, HMO problems: breast reduction, breast reduction, kp
breast reduction, kp, insurance company: Hi Shelia! I think I would start with Kaiser and do an appeal questioning them and see if they will make some type of exception. If not, then turn to the Doctor to see if he would do it on a reduce rate due to your insurance company not paying. Good...

Medicare, Medicaid, Insurance, HMO problems: breast reduction & medicaid, state medicaid office, breast reduction
state medicaid office, breast reduction, food stamps: Ashley, I don t know if this will work for you or not, but here is my suggestion. Call the state Medicaid office and ask who administers their utilization review and precertifications for surgeries. If you hit a brick wall, and they will not help you,...

Medicare, Medicaid, Insurance, HMO problems: breast reduction- medical purposes, degenerative disk disease, medicaid office
degenerative disk disease, medicaid office, acceptable parameters: Sometimes Medicaid will cover this and some times they won t. Each state has different standards of what they consider acceptable parameters for this sort of surgery. I would start by consulting a surgeon and I would also call my local Medicaid office and...

Medicare, Medicaid, Insurance, HMO problems: breast reduction, medicare medicaid, l5 s1
medicare medicaid, l5 s1, rotor cuff: I cannot guarantee that for you. Your surgeon would have to submit information to Medicare/Medicaid and they have to approve it. In some cases they may ask you to see a chiropractor or a physical therapist to try and relieve your back pain. They may determine...

Medicare, Medicaid, Insurance, HMO problems: breast, breast reductions, welts
breast reductions, welts, different meaning: If it is considered medically necessary. This has different meaning but basically your breasts have to weigh a certain amount. Generally speaking you have to have related problems such a back problems or large welts on your shoulders from your bra trying...

Medicare, Medicaid, Insurance, HMO problems: bulecross&buleshield, weight loss surgery, survery
weight loss surgery, survery, high risk: Carolyn, check in his booklet in the Exceptions and Limitations part of the booklet. If it states that it will not cover any form of weight loss or weight loss related surgery then they will not cover gastric bypass. They are under no obligation to provide...

Medicare, Medicaid, Insurance, HMO problems: bypass, obesity treatment, heart attacks
obesity treatment, heart attacks, insurance companies: Hi Stephanie! All insurance companies are different. They have numerous policies under their main where some do pay and other do not. So it depends on your type of policy. So I would suggest going on line to some of the insurance companies to see what...

Medicare, Medicaid, Insurance, HMO problems: Caring for an elderly family member, elderly family member, recipient family
elderly family member, recipient family, other additional information: Medicare does not. Medicaid on the other hand may. Check with the social service agency in your stste. Regulations are different in different states. Call 1-800-252-9240 and you should get my counterpart in Texas. They should be able to give you what programs...

Medicare, Medicaid, Life and Health Insurance: Certification as a fitter for mastectomy products, breast cancer survivor, licensed vocational nurse
breast cancer survivor, licensed vocational nurse, mastectomy products: http://www.abcop.org/Credentialing.asp This is the American Board for Certification in Prostetics. I would star there. http://www.guidetohealthcareschools.com/orthotics_and_prosthetics.html?source=google_gths_orthot&kw=prosthetics%20certification&content=&gclid=CMTd-e6Lh48CFQINPAodEl-Y2w...

Medicare, Medicaid, Insurance, HMO problems: Change of medicaid to another state., qmb medicaid, food stamps
qmb medicaid, food stamps, all fifty states: Barbara, If I understand your situation, it appears you have QMB Medicaid. Since QMB is a program offered in all fifty states, you should be able to retain your coverage and have your premium paid by Medicaid, therefore leaving the 93.50 in your check....

Medicare, Medicaid, Insurance, HMO problems: Changing effective date of HMO to PPO move, humana choicecare, filing a grievance
humana choicecare, filing a grievance, ear operation: Hi Mike! Unforunately there is usually always a month or two of transition where problems occur........usually when you get a date of switch, and cards are not available yet, you usually get information on your new policy....you don t have to have a card...

Medicare, Medicaid, Insurance, HMO problems: Changing Health Plans, group health insurance, health insurance plan
group health insurance, health insurance plan, conversion plan: Please let me know if I am wrong. It sounds like you are going to have a conversion plan. If that is the case, nothing changes except that it is an individual plan and not a group plan. The wording does not change. Everything remains the same. Sar...

Medicare, Medicaid, Insurance, HMO problems: CIGNA approved, THEN denied??, cigna hmo, local news station
cigna hmo, local news station, customer service rep: Hi Suzanne! I would call Cigna right away and ask them what is going on. Explain that you did receive an authorization and based on this you made travel plans and paid for them already. Tell them this is dishonest and unacceptable and you want them...

Medicare, Medicaid, Insurance, HMO problems: Civil Summons for Medical Bills, civil summons, judgment by default
civil summons, judgment by default, sense advice: Jimmy, I am not an attorney, so please understand the advice I am giving you is not legal advice, just common sense advice. First thing to do is this. Determine if the summons you received was generated by a collection agency working on behalf of the...

Medicare, Medicaid, Insurance, HMO problems: COBRA, voluntary severance, alaska airlines
voluntary severance, alaska airlines, severance package: Hi Maryann Bad news. It sounds from the information you provided that they followed the rules regarding COBRA. Poorly handled,but not unusual. Most persons on COBRA are unaware of the time limit regulations built into the regulations. So in fact when...

Medicare, Medicaid, Insurance, HMO problems: COBRA Question, preexisting conditions, hippa
preexisting conditions, hippa, cobra: The protection from HIPPA is for preexisting conditions. There is no equirement that they accept you as a client. You will have to meet the existing underwriting rules in the stste you are in. If your health is bad you may be limited in the coverage available..Use...

Medicare, Medicaid, Insurance, HMO problems: COBRA and Social Security dilemma, social security dilemma, blue cross ppo
social security dilemma, blue cross ppo, medicare part d drug coverage: Hi Neil I need more information in order to answer this question. When did your employment end? Were you disabled at that time? When you first got COBRA was it for 18 months or 29 months? while the company can allow COBRA to continue for as long...

Medicare, Medicaid, Insurance, HMO problems: COBRA, group health insurance, cobra insurance
group health insurance, cobra insurance, interim insurance: Dear Jo: First of all, great news that you start a new job on 9-15-04! The answer to your question is more complicated than yes or no. See if this helps: 1) The primary reason to get COBRA for a short break in coverage, is that if you have a pre-existing...

Medicare, Medicaid, Insurance, HMO problems: Co-pay Question, medicare hmo, advantage plan
medicare hmo, advantage plan, hi john: Hi John! A referral does not guarantee payment.....it does usually but their are exceptions such as if you don t have coverage in your individual plan to cover a procedure or if your plan has exclusions. The fact the Specialist is asking for his fee...

Medicare, Medicaid, Insurance, HMO problems: Cobra ending, now what?, long term disability, brain cancer
long term disability, brain cancer, cardiac condition: Call your local Social Services office and see if you qualify for Medicaid until you can get SSI. I know what a pain it is to fight for SSI and they almost always turn people down on the first request. I had a friend who had brain cancer, 3/4 of a heart...

Medicare, Medicaid, Insurance, HMO problems: Company Closing, insurance coverage, new job
insurance coverage, new job, health insurance: They don t have to do anything if the company closes. With a small company they don t have to offer COBRA. Basically they will provide you will a letter that says that you had insurance coverage up to a certain date and that s it. After that point, it will...

Medicare, Medicaid, Insurance, HMO problems: Concerta, attention deficit disorder, concerta
attention deficit disorder, concerta, two choices: Hi! Most insurance companies do regulate their payout of all prescriptions now....something they did not do to much in the years past. If they state in your policy that they will not pay for a max of 72mg, then they do not have to...however it should be...

Medicare, Medicaid, Insurance, HMO problems: Concerta, attention deficit disorder, mail order
attention deficit disorder, mail order, mg dose: So what you need to do is have your doctor write a presecription to cover the 72 mgs per day however it has to be broken down and then you are going to have to pay the difference. You could see if your doctor has that drug in a sample form that he can give...

Medicare, Medicaid, Life and Health Insurance: Coverage under Private Ins and Medicaid, colorado medicaid, office bills
colorado medicaid, office bills, insurance fraud: According to the information in the Colorado Medicaid section of your state government pages, her baby is covered under Medicaid for the first year. So at this point it doesn t matter if she carried Medicaid or not. Her son will still be covered. I would...

Medicare, Medicaid, Insurance, HMO problems: CPT code, cpt code book, oral medicine clinic
cpt code book, oral medicine clinic, medical biller: Codes do come and go. Call the insurance company and ask what code they are currently accepting for that procedure. And get yourself a current CPT code book for 2006. Unfortunately they are the only ones who can tell you exactly what codes they want...

Medicare, Medicaid, Insurance, HMO problems: CPT code, oral medicine clinic, medical biller
oral medicine clinic, medical biller, hcpcs level: Hi Raisa.......... I really don t get involved with the dental side of billing......however I did find the below information on the Internet.... *Materials and supplies are not separately payable. Therefore, CPT code 99070 is not separately payable....

Medicare, Medicaid, Insurance, HMO problems: CREDIT CARD DEBT ON MEDICAID, common sense approach, credit card debt
common sense approach, credit card debt, interest cards: Elaiune, I am not an attorney, so I cannot give what amounts to as legal advice. What I can tell you is from a common sense approach, and draw on past experience. My sister was facing the same problem your mother is now dealing with. I can tell you,...

Medicare, Medicaid, Insurance, HMO problems: CRS/IPHC, state insurance commissioners, health maintenance organization
state insurance commissioners, health maintenance organization, coventry health: If they have refused an appeal, then I would appeal to your State Insurance Commissioners office. If this is standard treatment then it is not experimental and the SIC may override your HMO. You say you have an HMO and a PPO plan. Will the PPO plan cover...

Medicare, Medicaid, Insurance, HMO problems: cancer on face no insurance, sara sara, plastic surgeon
sara sara, plastic surgeon, dermatologist: Did the clinic recommend a plastic surgeon who would do this for free? I would call them back and find out what they have to say. It seems to me if they recommend you to any surgeon, they should have someone that you can go to with a referral and have the...

Medicare, Medicaid, Insurance, HMO problems: care choice hmo, term illnesses, care choice
term illnesses, care choice, refferals: I don t know anything about Care Choice but I do know a great deal about HMO s. You absolutely have to follow their rules or your claims do not get paid. Read your booklet and ask loads of questions. If you are basically a healthy person this shouldn t...

Medicare, Medicaid, Insurance, HMO problems: change health insurance, united health care, employer insurance
united health care, employer insurance, primary insurance: Don t dump the plan you are on now until after you have your visit in January. Depending on the plan wording and how many employees are involved, they may be able to check you for pre-existing. Use the insurance plan your employer offers as your primary...

Medicare, Medicaid, Insurance, HMO problems: change health insurance, prior insurance, employer insurance
prior insurance, employer insurance, insurance coverages: HIPAA provides that the insurance company must apply the pre-existing provision in a certain way if you have had other medical coverage with in 60 days of the new coverage. How long have you had the prior insurance, if it is longer than the pre-x time on...

Medicare, Medicaid, Life and Health Insurance: change health insurance, employer insurance, insurance question
employer insurance, insurance question, insurance coverages: Hi Laura: The discounted rate is something you d have to work out with the doctor in advance, or at least I would recommend you do so. Try telling him/her that you will be paying out of pocket, they may offer you an even deeper discount than they did...

Medicare, Medicaid, Insurance, HMO problems: Should I change wife primary to Medicare, medicare prescription drug program, medicare prescription drug
medicare prescription drug program, medicare prescription drug, prescription drug program: Hi Greg In all probability the best answer is to stay as is. Since she is on your insurance she does not need part Medicare part B, a savings of about $100 a month. Also if you have a certificate from the employer insurance that the prescription coverage...

Medicare, Medicaid, Insurance, HMO problems: changing insurance, social security office, changing insurance
social security office, changing insurance, hippa regulations: Hi Kathryn You could request the doctor to write a letter explaining the need for the drug and file an appeal with your PPO. However, you can also go on your husbands insurance without a waiting period. You are protected by the HIPPA regulations,...

Medicare, Medicaid, Insurance, HMO problems: changing from medicare to medicaid, social security check, billing medicare
social security check, billing medicare, medicare payment: Teresa, I don t know what state in which you live but several things you have said in your question raises alarm bells. First of all, there is no reason to pay the nursing home a dime as long as they are accepting Medicare as payment. They cannot by...

Medicare, Medicaid, Life and Health Insurance: changing states while on medicaid, changing states, myflorida com
changing states, myflorida com, first option: http://www.myflorida.com/accessflorida/ This is the site you need to go to. When you get there the first option is Prescreening to see if you might qualify for benefits . Click there and it will take you through the steps you need in order to qualify...

Medicare, Medicaid, Insurance, HMO problems: chemotherapy and hearing damage, american cancer society, hearing damage
american cancer society, hearing damage, hearing aids: Hi Valerie! BCBS is a tough insurance, probably the toughest.......Unsure why they denied the claim but if it is because they exclude hearing aids then you really can not fight them since they already told you that they excluded this type of coverage. ...

Medicare, Medicaid, Insurance, HMO problems: claim denial, self inflicted injury, dealing with teenagers
self inflicted injury, dealing with teenagers, tylenol pm: Did he do it on purpose or not? That is the question. If he was attempting to commit suicide then your insurance is not going to pay for it because they consider a suicide attempt a self inflicted injury. If he was physically ill and thought that more tylenol...

Medicare, Medicaid, Insurance, HMO problems: getting a claim paid, united health care, benesight
united health care, benesight, insurance administrator: Hi Tammie! You are in a tough spot that I was actually in once....since your company was self insured, which means they pay the bills as they are approved by the insurance administrator, there is usually very money left in the bank, they pay as the claims...

Medicare, Medicaid, Insurance, HMO problems: cobra, us department of health and human services, definitive answer
us department of health and human services, definitive answer, us department of health: Hi Aditee: I belive you probably can. However, for a definitive answer, you should contact the US Department of Health and Human Services and they will be able to answer the question for you. They can be reached via e-mail at phig@cms.hhs.gov or you...

Medicare, Medicaid, Insurance, HMO problems: cobra or medicaid, metastasis melanoma, melanoma cancer
metastasis melanoma, melanoma cancer, medicare medicaid: Hi Lorraine There are a lot of questions I would need answered before I could really give a good answer to this. I really believe you should contact the Medicare, Medicaid Assistance Program(MMAP) and request a face to face meeting, They cover the entire...

Medicare, Medicaid, Insurance, HMO problems: cobra or private insurance, conversion policy, chronic bronchitis
conversion policy, chronic bronchitis, city job: In cases like this COBRA is often the best way to go even if it is expensive, Check with his Company and see if they offer a conversion policy. Another option is to check with an insurance broker for other health plans. A lot of HMOs offer family plans...

Medicare, Medicaid, Insurance, HMO problems: collection, contract rates, poor response
contract rates, poor response, insurance group: Hi Christine! Do you mean billing the patient or send the insurance company to an outside collection agency? Most collection agencies won t work with insurance companies but many will for a percentage. If you are speaking of billing the patient...

Medicare, Medicaid, Insurance, HMO problems: comp d insurance, medicare eligibility, d insurance
medicare eligibility, d insurance, eligibility period: Hi Nikki! There are to many different types of coverage under BCBS to say this is true or not true..........it depends on the specific insurance contract. If this is what they told you, ask them to put it in writing........this way you will have some...

Medicare, Medicaid, Insurance, HMO problems: cosmetic surgery, ohio medicaid, internal organ
ohio medicaid, internal organ, medical purposes: Hi Brandi! Most insurance plans do not cover cosmetic surgery......they are only liable to cover procedures that are medically necessary, therefore they do not have to pay for cosmetic surgery. I know none that do. If your Dr can base the surgery on...

Medicare, Medicaid, Insurance, HMO problems: coverage question, state medicaid office, medical case manager
state medicaid office, medical case manager, large breasts: Kristina, There are very few states which allow Medicaid to pay for breast reduction. That is not to say it is impossible to get Medicaid to pay. Here is my suggestion. Call your local Medicaid office anad request a phone number for a medical case...

Medicare, Medicaid, Insurance, HMO problems: coverage, coordination of benefits, medicare part d
coordination of benefits, medicare part d, income persons: Hello Herbert Sorry about the delay. I thought I had answered this but the system advised today my answer did not go out. 1. I do not know the answer to this part of the question. It is out of my expertise. 2. Having a house has nothing to do...

Medicare, Medicaid, Insurance, HMO problems: covered?, waist area, excess skin
waist area, excess skin, surgury: There are some circumstances that it is considered medically necessary to remove excess skin, especially if there is a history of infections from the excess skin. And you would have to have literally inches (as much as 8 or more) to be removed. Chances...

Medicare, Medicaid, Insurance, HMO problems: covered?, breast reconstruction, excess skin
breast reconstruction, excess skin, customer service center: Hi Kathryn, I know of only a few instances where cosmetic surgery was covered without a cosmetic rider on the insurance policy. In these cases, it was due to medical necessity such as breast reconstruction or due to an accident. Unless you have or purchase...

Medicare, Medicaid, Insurance, HMO problems: criical care policy, kideny, heart failure
kideny, heart failure, doctor reports: Hi Mary! Yes you have the right to be treated fairly......of course an insurance company does not want to pay for bills that will cost them thousands and they will TRY to find a way out........you are in the right, so you must fight them all the way. ...

Medicare, Medicaid, Insurance, HMO problems: My Daughter, case worker, insurance programs
case worker, insurance programs, state web: Hi Joe She will not be covered by Medicare. The regulations are different in every State with regard to Medicaid. I am in Michigan. However each State usually has a program for children. In Michigan it is called My Child. Check with your case worker...

Medicare, Medicaid, Insurance, HMO problems: My Daughter, health programs, medicaid
health programs, medicaid, old girl: Hi Joseph! Medicaid should definitely pick up your daughter if you are currently on it. You will have to call them to add her. Most states also have many health programs for children for either free or small cost. Medicare in most states do not cover...

Medicare, Medicaid, Insurance, HMO problems: Dear Cherille Shelp,According..., health insurance costs, zorian
health insurance costs, zorian, plan booklet: You need to read your plan booklet carefully. Are they covering usual, reasonable, and customary charges? Are you in a PPO plan and using the right providers? Yes, there is something you can try, write in an appeal. Be sure and tell them exactly what you...

Medicare, Medicaid, Insurance, HMO problems: Denial of Dental Claim, denial letter, certified mail
denial letter, certified mail, dental claim: Hi Bobbi! Hopefully you have written down the person and date you spoke to your insurance company getting the pre-authorization......if you have it, then call that person to see why they told you that you had coverage and denied you....if you can not convince...

Medicare, Medicaid, Insurance, HMO problems: Denial of precertification, external appeal, necessary insurance
external appeal, necessary insurance, necessary surgery: Hi Jessica! Insurance companies deny alot of pre-certs even if your Doctor feels it is necessary. Insurance companies can deny surgery if they feel it is not medical necessary since they only have to pay if it is necessary surgery. You can file with...

Medicare, Medicaid, Insurance, HMO problems: Denied Claim, health insurance company, blue cross of ca
health insurance company, blue cross of ca, hospital administration: Hi Melissa! Most hospitals now are required to get a patient preauthorized even before they admit them so it sounds like the problem is between the hospital and insurance. Hopefully you have some information on who told you that your insurance authorized...

Medicare, Medicaid, Insurance, HMO problems: Denied NJ HMO Claims, expertise thanks, initial visits
expertise thanks, initial visits, explanation of benefits: Hi Joe! If you received a referral from a participating HMO Doctor, then it should be covered....he/she should have only referred you to an in-network DR......and if they could not, they should have advised you. You also should have checked out the Philly...

Medicare, Medicaid, Insurance, HMO problems: Denied Request for Hip Replacement Surgery, state medicaid office, hip replacement surgery
state medicaid office, hip replacement surgery, hip replacement: Melissa, your brother s doctor must take responsibility here and prove Medical necessity. I do not know what state you are in, so I do not know if hip replacement is one of the procedures that will be covered in your state. Medicaid is a state run program...

Medicare, Medicaid, Insurance, HMO problems: Denied speech therapy, cpt code, autistic child
cpt code, autistic child, speech therapy: Hi Hanna! There is no other way to win but to take their denial reason and prove it wrong.......if you can prove that this denial is wrong, then they may pay. Perhaps use a different CPT code........sometimes they go by the CPT code and perhaps your...

Medicare, Medicaid, Insurance, HMO problems: Dental HMO's, angelina angelina, dental hmo
angelina angelina, dental hmo, dmo: Angelina, the best thing for you to do is find someone who has an HMO and interview them and any of their coworkers who have an HMO and see how they feel. I am not a great supporter of HMO s or DMO s. Interview your friends. Find out what they like...

Medicare, Medicaid, Insurance, HMO problems: Dental Implants, upper denture, dental implants
upper denture, dental implants, dental association: Dorothy Sorry, but inplants are not covered in this situation.. Most States have detists that will do the implants for a very low fee depending on financial situation of the family. Check with the dental association in your State and see if there is a...

Medicare, Medicaid, Insurance, HMO problems: Dental Insurance, going to the dentist, x rays
going to the dentist, x rays, dental insurance: Generally speaking you have to pay the first $50 and then you are eligible for benefits. Don t let that stop you from going to the dentist. My six month check up without x-rays runs about $100. With x-rays it goes to about $136. So that $50 is not that...

Medicare, Medicaid, Insurance, HMO problems: Dental Insurance, new dentist, bridge restoration
new dentist, bridge restoration, lengthy periods: Call your insurance company first. Tell them that your dentist is not doing a very good job and you don t want him doing any more work on you. Then let them know that he has already collected from them and he has not completed the job. The dentist can...

Medicare, Medicaid, Insurance, HMO problems: Dental Insurance, new dentist, better business bureau
new dentist, better business bureau, bad publicity: I agreed that you need a new dentist. Contact your insurance company and let them know what has happened. Then contact the dentist s office and let them know that you will have someone else finishing the work and you would like a refund because the work...

Medicare, Medicaid, Insurance, HMO problems: Dental Insurance Narratives, practice management software, dental field
practice management software, dental field, dental claims: Donna, I m sorry..I m not in the Dental field so I m not sure what would be best for you in this situation. The Practice Management software that I use has the capability of interfacing with Microsoft word which is beneficial in all aspects of the business...

Medicare, Medicaid, Insurance, HMO problems: Dental Insurance., low cost insurance, many different things
low cost insurance, many different things, ppo providers: 1. An HMO is a plan where you must go to specific providers. HMO coverage is usually the less expensive and provides plans that have less out of pocket expense to you. However, you usually have NO coverage outside the HMO. A PPO plan has a broader base...

Medicare, Medicaid, Insurance, HMO problems: Dentist Insurance Issue, dentist insurance, new dentist
dentist insurance, new dentist, bridge restoration: Hi Bella! Alot of insurance companies will not ask for refunds however alot are very active on asking for them...it depends on who your carrier is and how much they want to get involved. I would send a certified letter to your dentist and cc your insurance...

Medicare, Medicaid, Insurance, HMO problems: Desperate for advice, hernia operation, medical issue
hernia operation, medical issue, c sections: Hi Yolon! I really do not know if that is possible..........perhaps call your Doctor and ask him/her. I would think it may be possible depending when the hernia is however most insurance companies would pay for a hernia operation but not a cosmetic tummy...

Medicare, Medicaid, Insurance, HMO problems: DISENROLLMENT IN HMO, hmo coverage, essex county
hmo coverage, essex county, disenrollment: I need a bit more information to accurately answer this question. Which HMO do you have and how long have you had it? How old are you? What did you have before you enrolled in your HMO? Let s start with those questions and we ll go from there. This...

Medicare, Medicaid, Insurance, HMO problems: Different insurance=different treatment?, health insurance providers, asthma attacks
health insurance providers, asthma attacks, oxygen level: the insurance company does not decide what to treat or how, but they do tell your doctors what they will cover so your doctor s may be using their knowledge of that in making treatment decisions. Also, how one doctor may treat you is not always the same as...

Medicare, Medicaid, Insurance, HMO problems: On Disability, ssi benefits, social security payments
ssi benefits, social security payments, family bills: Lenora, If your brother and his children are all receiving Social security payments, he is not likely on SSI. SSI benefits would not be payable to his children unless each one of them were disabled as well. The answer is yes, he can receive money for...

Medicare, Medicaid, Insurance, HMO problems: Disability benefits and Medicaid?, social security disability, medicaid office
social security disability, medicaid office, medicaid benefits: Sandy, Your case is a prime example of how the system fails. The reason you do not qualify for Medicaid is your income. Even though it is disability, the income limits for adult participation in Medicaid does have income restrictions and you undoubtedly...

Medicare, Medicaid, Life and Health Insurance: Disability M.S., ahccs, disability insurances
ahccs, disability insurances, disability insurance: Dear Beth: Sorry not to have seen this before now. I cannot afford to mail you the workbook, as it would cost too much. The best that I can do is to email it to you, assuming that yu can find someone to open and download it for you. Best of luck, carolyn...

Medicare, Medicaid, Insurance, HMO problems: Disenrolling from Secure Horizons Direct to get back on Medicare, secure horizons, disenrollment
secure horizons, disenrollment, oncologist: Call your congressman or senator and tell them what is going on. That s what they are there for. His/Her staff can work on this for you. Don t deal with someone local if you aren t getting satisfaction. Go to the top and let them find out what the problem...

Medicare, Medicaid, Insurance, HMO problems: Dispute with Medicare re:non-payment of claims, state insurance commissioners, medical policies
state insurance commissioners, medical policies, government pages: Call your state insurance commissioners office. They will be listed under your state government pages on the internet. File a complaint with them and let them straighten out who is primary and who is secondary. They can make those determinations where you...

Medicare, Medicaid, Insurance, HMO problems: DOUBLE INSURANCE, blue cross ppo, secondary coverage
blue cross ppo, secondary coverage, spouse coverage: The advantage to having dual coverage is that the insurance companies will coordinate benefits and pay up to 100% or the covered charges. Since you are saying that you wife is getting 100% coverage already, it seems that you do not need to cover her for secondary...

Medicare, Medicaid, Insurance, HMO problems: Can the Docotrs office do this, secondary carrier, doctors office
secondary carrier, doctors office, stearn: Hi Patricia! You are in your right to think that this Doctors office submitted all copays to your secondary carrier Medicaid since they had that info on file. You have usually one year to submit claims to Medicaid. I would send the copay bills back...

Medicare, Medicaid, Insurance, HMO problems: Doctor doesn't accept my insurance, emergency c section, local news station
emergency c section, local news station, little lie: Hi Amy! Yes you should have been advised.......since you did your job to ensure your Doctor and the hospital were in the network and you were not even aware of this so called Assistant, then it is not fair for you to be liable. I would call this Doctor...

Medicare, Medicaid, Insurance, HMO problems: Doctors, medicare medicaid, list of doctors
medicare medicaid, list of doctors, rome georgia: emma I am in Mich and do not know your area. Suggest you ask you case worker for a list of doctors that accept Medicaid in the area. Also check with the local Area Agency on Aging or the Senior Center for transportation services. Sorry. best I...

Medicare, Medicaid, Insurance, HMO problems: About Dropping Medicare, medicare system, medigap plan
medicare system, medigap plan, advantage plan: Hi Janice There seems to be something wrong here. With few exceptions Medicare covers just about everything except eye glasses and routine dental, and hearing aids. It would be extremely rare that dropping Medicare would be a good idea. In most cases...

Medicare, Medicaid, Life and Health Insurance: Dual EligibleMedicareMedicaidFull Coverage?Managed Care?, medicare savings program, affinity health plan
medicare savings program, affinity health plan, medicare medicaid: But what they have done is given you Medicare as your primary insurer and Medicaid should pick up what Medicare doesn t cover. Each state has different laws and rules but logically Medicaid should pick up anything that Medicare does not cover and since these...

Medicare, Medicaid, Insurance, HMO problems: Does my daughter's HMO include medicaid?, commercial insurance policies, medicare medicaid
commercial insurance policies, medicare medicaid, medicaid hmo: Carol, Once I answer your question, I would surely want you to verify the information I give you before making any other changes. But in most cases, when a person opts for a Medicaid HMO, then they are bound by the rules of the HMO. Most cases, the reasoning...

Medicare, Medicaid, Insurance, HMO problems: deductable, coverage booklet, routine matter
coverage booklet, routine matter, insurance group: Usually the routine well visits are under a special benefit and do not go to the deductible. You didn t say what your deductible is, but it must be met by the first charges that you incur for the year. Even if you got unnecessary things done just to meet...

Medicare, Medicaid, Insurance, HMO problems: denied approval for lapband, health benefit plan, lap band surgery
health benefit plan, lap band surgery, humana health: Hi Sonia! There always are exclusions to everyone s policy and you don t have any recourse if the surgery is listed as one with your carrier........ However if you can somehow list the surgery differently then perhaps they will pay.........talk to your...

Medicare, Medicaid, Insurance, HMO problems: denied insurance coverage, high colestrol, lap band surgery
high colestrol, lap band surgery, blue cross blue shield: Hi Christine! If you have met all the criteria then why does your insurance company refuse to pay. There must be a reason for denial. Whatever that reason is what you have to prove to get them to pay for this surgery. Let s say they feel the surgery...

Medicare, Medicaid, Insurance, HMO problems: denied for lap band surgery, lap band surgery, fad diets
lap band surgery, fad diets, morbid obesity: Hi Madeline! UHC has strict guidelines and if you don t meet them they can and will deny your coverage. You state that they require you to have a medical history of obesity....can you get perhaps your family Doctor or even your gynocologist to give you...