The Insurance Term of the Week
Health Insurance Portability and Accountability Act (HIPAA)
Prior to the passage of HIPAA, in 1997, people didn't have guaranteed portability with their health insurance. So if you changed jobs and had to change your health insurance company, you might not have been able to get coverage for pre existing conditions.
HIPAA assures continued coverage for employees and their dependents, regardless of pre existing conditions. The insurance companies can only impose a 12 month waiting period for any pre existing condition that has been diagnosed or treated in the last 6 months. As long as you have maintained continuous coverage without a lapse of more than 63 days, your prior health insurance will be credited toward the pre existing condition exclusion.
If you have had group coverage for at least 1 year and you change jobs your new plan can't impose another pre-existing condition exclusion.
The key is prior coverage for 12 months and no lapse in coverage of more than 63 days.
Larry's Tip of the Week:
We discussed with Bob Usdane, special guest on today's show. regarding some things that we can do to help keep our health care costs down, such as having an advocate when we are sick to help look out for our interests.
Health Insurance companies have mechanisms built into their policies to help curtail health insurance costs. These are called cost containment features. You need to be aware of these features so you can maximize your coverage and avoid penalty.
Instead of allowing a person to be admitted to the hospital a day prior to surgery, which results in a charge for an additional day of hospitalization, where applicable, insurance companies will require you to be admitted the day the surgery is to take place.
Pre-admission testing. Before authorizing hospitalization or surgery in a non emergency situation, insurance companies require additional testing is done on an outpatient basis.
Outpatient surgery requirement. Many surgical procedures are now being done on an outpatient basis reducing the need for reimbursement of hospitalization costs.
Second opinion. Prior to having a procedure, care and medical expenditures the insurance company may require the insured to get a second opinion from a qualified health care provider.
Prior consent for hospitalization. In a non-emergency hospitalization the insured is required to have their doctor present to the insurance company the course of treatment. This is also often times required within 48 hours after an emergency hospitalization.