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If your health care plan won’t cover a procedure

If your health care plan won’t cover a procedure

You’ve just had an expensive medical procedure, and your health care plan won’t cover it. You probably have some options to resolve the dispute. The best defensive against having a health care plan from denying a claim is being informed before you have the procedure. This includes reading your plan description to determine if the procedure is covered, calling your benefits administrator to ask any questions, and communicating with your health care provider about exactly what procedures you will undergo. There are several reasons a health care plan will not cover a procedure. Here are a few of the most common: Failing to get a pre-certification for non-emergency surgery. Most insurance companies require physicians to obtain a pre-certification before the surgery and will send you a letter stating that the surgery has been approved. Be sure to have a copy of the letter before the surgery. If you must have emergency surgery, make sure to let your health care plan know as soon as possible. Make sure a family member or friend has a copy of your insurance card and is willing to call your health care provider and your plan’s benefits administrator. Pre-existing conditions. If you have an individual policy or had a lapse in coverage between group health care plans, some conditions you were treated for in the past may not be covered for a designated period of time. When you change health insurance plans, be sure to ask if any of your conditions will be considered pre-existing and the length of time the conditions will not be covered by your plan. Treatment for a condition related...
Benefits From a Flexible Spending Account

Benefits From a Flexible Spending Account

Flexible spending accounts (FSA), or, cafeteria plans, offer employees a menu of services they pay on a pre-tax basis. Authorized under Section 125 of the Internal Revenue Code, cafeteria plans allow employees to set aside money throughout the year to use toward medical or dependent care expenses not covered by health insurance benefits, including co-payments and deductibles. By setting aside money during the year for medical or dependent care services before taxes, employees are able to reduce their taxable income, which increases their take-home pay. Taxes are not paid on claims paid to employee from the account either. When you sign up for a flexible spending account, it is important to know that the money deducted from your pay throughout the year must be used or they will lose it. Therefore, deducting too little is better than too much. A cafeteria plan is not a savings account – the funds do not build up year after year. The federal government allows two types of spending accounts. One is for medical reimbursement and the other is for dependent care spending, whether it’s for child care or care for an elderly family member. The IRS does not set limits on the amount of medical and dental expenses that can be reimbursed by a spending account, buy your plan may establish annual maximums. Be sure to check to find out what yours are. When filing income taxes, you must complete the IRS Form 2441 if you participate in a dependent-care spending account. Dependent-care contributions are reported in Box 10 of the W-2 forms. Sometimes your flexible spending account administrator will provide a...
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MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.