Monthly Archives

August 2013

What does Marketplace health insurance cover?

By Uncategorized No Comments

All private health insurance plans offered in the Marketplace will offer the same set of essential health benefits. These essential health benefits include at least the following items and services: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization Maternity and newborn care (care before and after your baby is born) Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) Prescription drugs Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) Laboratory services Preventive and wellness services and chronic disease management Pediatric services Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

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How to manually file a claim with Medicare

By Making the Most of your Medicare No Comments

In the rare occasion that your doctor does not file a claim for you with Medicare, don’t worry! you can actually file the claim yourself and it is pretty easy. You will need to follow the instructions on this document and make sure you provide as much supporting documentation as possible including: A copy of the bill Your Medicare information The doctor’s NPN (call the doctor who treated you and ask them for it) http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1490S-ENGLISH.pdf The process is pretty straight forward and a decision is usually provided within 30 days. Please send the completed claim form, your itemized bill, and any supporting documents to the appropriate Medicare contractor and explain in detail your reason for submitting the claim. For example, include a statement that notifies the Medicare contractor that your provider or supplier refused or is unable to file a claim for a Medicare-covered service and/or is not enrolled with…

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Is dental insurance worth it?

By Uncategorized No Comments

As my heart rate starts to climb and my palms get sweaty, it can only mean one thing.  I have a dentist appointment today!  I seriously despise going to the dentist.  I can think of 100 pain inducing things I would rather do than go to the dentist.  (For example, getting punched really hard in the stomach).  It’s not the cleaning and lying with your mouth open for an hour that I dread, it is the fear of the unknown that kills me.  Will the dentist find a cavity?  Is there something wrong?  That fear causes me to lose sleep at night! This brings me to the insurance point.  I get asked all the time, “Is dental insurance worth it?”  “Should I just pay out of pocket or buy an insurance plan?” If your views of the dentist are like mine, I think dental coverage serves a purpose greater than…

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Obama’s “Cadillac tax” creating a stir

By Understanding Health Care Reform One Comment

An interesting aspect of the upcoming health care reform is how expansive it is.  Health care really touches and affects many different parts of our lives.  It is going to be an interesting time in the next few months and years to see how this ultimately shapes our health care consumption as a nation. At the same time, we are seeing how these new rules affect different segments of the population BEFORE they even begin.  Take the Obama “Cadillac Tax” which is expected provide $80 billion to the federal government over the next decade, according to a Congressional Budget Office report issued in May. Here is how the Cadillac tax works: If an employer-provided health insurance policy costs more than $10,200 for an individual, the employer will be taxed 40%of what’s considered an “excess benefit,” according to insurer Aetna. The tax kicks in for $27,500 in spending on family coverage….

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