Search Results for: blog viewpoint health insurance dictates treatment options

What is an EPO?

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You may have a good understanding of what it means if your health insurance is part of an HMO, or part of a PPO. Those are the two most well known kinds of health insurance. They are not the only options, however. There is also EPO health insurance. What is an EPO? It stands for Exclusive Provider Organization. It consists of a network of doctors and health care providers, who have been contracted by an insurance company to provide care to the people who have signed up with the EPO for a reduced cost. So far, this sounds a lot … Continue reading →

Insurance Company Refused to Cover than Reconsidered Too Late

Welcome to 2008, hopefully your family had a better end to the year 2007 than the family of Natiline Sarkisyan. Their year ended with a funeral for their teen-aged daughter who died after her health and medical insurance company refused to pay for a liver transplant and then reconsidered. The Philadelphia-based Cigna HealthCare insurer has a history of approving coverage for over 90% of all transplants claims requested by their insured members, with over 90% of the liver transplant request being approved according to Cigna company President David Cordani in a memo addressed to employees and distributed to the media. … Continue reading →

Why is My Pain Treated Differently at Work?

I have a close friend who works all day behind a computer and has for over 20 years. During the past five years his hands, elbows, shoulders and neck have started to feel the stress. Over the last year the pain and difficulty has become progressively worse and the company Ergonomics department has actively attempted to make his work area a custom fit in order to reduce the stress. My friend earns a great living at what he does, and over the last five months returns home a little early in order to make out with a heating pad, take … Continue reading →

Copy of All Documents, Relevant to Your Appeal.

In a previous Blog I outlined our situation and the fact our Employer Provided Group Health Insurance had sent us an Initial Denial of Authorization for continued psychiatric residential treatment our 9-year-old daughter needs. We expected the letter, and knew our private group health policy had decided in a Doctor to Doctor meeting they would not authorize any further care. This time however, I decided to request a copy of all the documents the insurance company use to make their decision. I called the “Appeals” number provided in the initial denial of authorization letter and exercised my rights to receive … Continue reading →

Initial Denial of Authorization: The Letter

It’s not easy to parent a child who suffers from mental, emotional, and physical disabilities. Navigating the medical and mental health system can be a job in itself. Top things off with a less than cooperative Employer provided group health plan and life can become more then just a little stressful. Our beautiful 9-year-old daughter was placed for adoption with us at the age of 5. It’s been a long hard road filled with difficult parenting choices. I thought I knew everything after raising my older two children. Helping Makala has become the definition of Advocating for the best interest … Continue reading →

Doctor to Doctor Review: Employer Provided Group Health Insurance

It’s been one thing after another since the placement of our special needs siblings for adoption in 2003. We added our children to our Employer Provided Group Health Insurance as soon as possible. In order to be sure all of their needs are met children adopted from foster care have Medicaid or State medical benefits until the age of 18 as part of the Adoption Assistance provided for special needs children. Our private employer group health insurance is seen as Primary with the Medicaid/State medical as secondary. Recently the federal government has passed laws requiring insurance companies treat mental health … Continue reading →

Primary and Secondary Health Insurance Coverage

Our family has had a difficult start to the year 2007! As some may know we are the Adoptive Parents of two special needs siblings placed through the state foster care system. Our daughter, Makala, was 5-years-old and her biological brother Jeremiah was 1-year-old at the time they were placed for adoption in our family during 2003. This has been an interesting and long four years. Our little girl has had several issues no one knew existed among them Alcohol-Related Neurodevelopmental Disorders, (ARND). Special Needs children adopted from the child services system often have continued benefits. Older, or special needs … Continue reading →

Understanding Employer Provided Group Health Insurance

Working Americans fortunate enough to have private health insurance are covered under an employer provided group health insurance plan. There are two popular plans employers might choose for their worker’s benefits package. A standard indemnity health insurance policy, allows employees and their insured dependents the freedom to visit any health care provider they choose. The cost of the appointment or medical service is paid out of pocket by the employee and insurance plan reimburses covered members for a portion of the paid services. The other most common health plan employers choose is a managed care plan. Managed care plans offer … Continue reading →

Mental Health and Insurance: Statistics and Other Information

The American Psychological Association reports on their website; An, estimated 15 to 18% of Americans, suffer from a diagnosable mental disorder. These statistics include almost 10 million children. Mental health issues impact general health it is likely some 50 to 70% of visits to primary care physicians may be for medical complaints that are rooted in some kind of psychological issue. Primary care physicians report that anxiety and depression are some of the most common conditions patients seek care for. In many cases, primary care physicians report, their patients mental health problems are compounded with the use of drugs and … Continue reading →

Anorexics: Losing Weight and… Medical Insurance

Recently I posted a blog about the death of anorexic high fashion model Ana Carolina Reston. According to medical reports, Reston, a 21-year-old Brazilian model, weighed only 88 pounds at the time of her death. Doctors at the hospital where Reston was pronounced dead said she “succumbed to a generalized infection caused by anorexia nervosa.” Her family is currently trying to lobby the modeling industry to address eating disorders in an effort to help save other lives. I thought about Reston the other day when I read that many insurance companies are forcing families into a life-or-death struggle for coverage. … Continue reading →