Health, Vision & Dental Insurance:

1. At times a war veteran may be entitled to benefits from The Veterans Administration.
2. If there is a disability, we may resort to directing to Social Security Disability and Medicare along with either Welfare Medi-Cal or a Medicare Supplement plan.
3. If the person earns below poverty standards, Welfare Medi-Cal, County share of cost and plans can help. I have the literature here at my office. Insurance Companies are administrating this plan. Pregnant mothers and children from 1 -18 are eligible. There are no health questions to be underwritten. Copayments are only $5.00, and no deductible is imposed. This includes coverage for dental and vision.
4. If a lady is pregnant and has a Medical plan already in place but is concerned about deductibles and copayments on her plan, I have applications for the Access Infant & Mother program. It is very helpful during pregnancy, childbirth and for the first year of the child.

Health Insurance Tips

1. Even when a clinic, physician or hospital is on the preferred provider list, you need to check all of the personnel that your doctor refers your to or that your medical facility uses. Question every practitioner to verify their participation with your Insurance plan. The most current listing is on the website of your Insurance Company. If you do not have access to the internet, let me know and I will verify whether the person or institution is on the preferred list. If you go to an out of network provider, you run the risk of paying 100% of expense until have paid the deductible and/ or annual out-of-pocket maximum.
2. When you go in for your annual preventive care checkup, make sure that the billing department of your provider is accurately coding your visit. It is very common for the Biller to classify preventive care as a diagnostic procedure or as a routine doctor's office visit. Your plan charges you nothing at all for the annual preventive care benefit, and the Biller needs to bill the Insurer with the proper code.
3. Most diagnostic procedures are subject to your annual deductible.
4. When you travel outside of the U.S. or in International Waters, your policy benefits are only for life threatening circumstances. You usually pay your expenses upfront and wait for the Insurance Company to reimburse you. While traveling outside of your residence state within the U.S., your plan usually covers you only for urgent needs, but you don't have to pay the medical provider up front except for your co-payment.
5. Chiropractic benefits on some plans are subject to your deductible. This can also apply to x-rays in a chiropractic office. Also, most plans only allow for 12 annual chiropractic visits.
6. Save receipts for the payments you make for your medical expenses so you can verify when your annual deductible and annual maximum out-of-pocket has been met. Claims Departments usually do a good job of tracking progress, but it can't hurt for you to double check the "Explanation of Benefits" statement (EOB) for comparison.
7. Health Insurance pays for procedures that are "medically necessary". Some types of non-emergency medical attention must receive prior authorization from your Health Insurance Company. Most notable is Cosmetic procedure. While there is little question about responsibility to repair disfigurement from an accident during your policy period, the effects of aging are rarely a covered expense. If teeth are the cause of an illness, Medical Insurance will do what it takes to get you healthy. But your plan will not likely pay to make your teeth look good.
8. Treatments and procedures that have not been approved by the American Medical Association are not likely covered at all, regardless of how successful Alternative Medicine may be.
9. Cost for Medical Insurance has tripled in the last ten years. The medical profession point to lawsuits and the price that they must pay for Liability Insurance. Lawyers point to consumers, pharmacists and medical practitioners. Consumers say that the legal, insurance and medical world is greedy. Pharmacists say that U.S. residents should pay to help poorer nations and welfare recipients afford medicine. Medical providers say that consumers are too demanding, and that recipients of welfare abuse and take advantage of the system. It is quite a cycle.
10. 1. If you have been insured as an employee in a Group Health plan and you complete your application effort within 63 days, Cobra will accept you for eighteen months and cannot impose a pre-existing waiting period. After you have exhausted COBRA, you can get an additional 18 months with HIPAA.
    2. If you are within three months before or after your 65th birthdate, you can go on Medicare and a Medicare Supplement or a Medicare Advantage plan with an Insurer and no health questions can be asked.
    3. If you are under age 65 but are newly receiving Social Security disability income, you can get Medicare and a Medicare Supplement or a Medicare Advantage plan with an Insurer and no health questions can be asked. If you wait more than 63 days to get paperwork done, the Insurers can subject you to health underwriting. AARP and the Medicare Advantage plans are usually the most lenient. They simply ask if you have end stage renal disease with kidney dialysis.
    4. You can be guaranteed the privilege of transferring to another plan if you are relocating outside of your previous Carrier's boundaries, or you are losing employment because of retiring, getting fired or laid off or quitting your job as long as all work is completed within 63 days between plans. No pre-existing condition waiting period can be imposed.
    5. Go to the Welfare Department to see if you qualify to receive Medi-Cal (Medicaid). Beware that your estate can experience a lien that your survivors may have to deal with.
11. I seldom sell Individual Dental or Vision plans. I used to sell them in the beginning of my career. The plans cost a lot, have deductibles, limit annual maximums and have waiting periods for various procedures. I believe that you are better off taking care of those needs yourself. But I am an order taker, and you are the boss. I do whatever you tell me to, but voice myself in the process.