Interesting Queries

     The past two weeks have been rather interesting in this office, especially with Betsy on her honeymoon. We received a number of very interesting queries about health insurance benefits. Hopefully you will find this information helpful to you.

Q. I heard that insurance does not pay for mobile air vac services, is that true?

A. Mobile air vac means helicopter or air ambulance transportation services to a facility equipped to handle your emergency medical crisis. If the air vac (helicopter) is needed because of an automobile accident, the costs should be covered by your automobile insurance. If someone is critically injured ‘on the job’ and needs mobile air evacuation the cost should be covered by workmen’s compensation. If, however, a person becomes suddenly and critically ill and is not near a medical facility that can provide the necessary care, the air evacuation should be covered by your health insurance. However, if you are diagnosed with a life threatening illness and decide that you would like to go to another part of the country for treatment, an air ambulance will not be covered by your health insurance if you can receive the same treatment locally. For example, you are diagnosed with cancer and decide that you would like to go to M.D. Anderson Medical Center in Texas. Your cancer can be treated at any number of excellent cancer institutions in the New York-New Jersey Metropolitan area so insurance would certainly not pay for you to go to M. D. Anderson. Once you get there, your medical claims will be covered, but not the transportation costs.

Q. I was on a business trip in Arizona when I suffered a heart attack. I had open-heart surgery in Arizona and was not allowed to come home for several weeks. When I was discharged from the hospital I had to stay in a local hotel until I was well enough to travel. Will my health insurance pay for my hotel bill?

A. No.

Q. At least three people called in the last week to tell me that their children finished their formal education in December, but they will not graduate until May. What should they do about health insurance for these children?

A. Whether or not your children continue to be insured upon finishing their formal education depends on the health insurance plan. Some plans will cover children if they are a full time student until age 23. If that is the case, these children no longer have insurance once they finish full time classes. Some plans will pay up to age 25 regardless of student status and then there is no concern. However, those plans are very rare. In most cases, the most cost effective way to continue health insurance benefits is for the former student to continue benefits under the parents’ policy, under the COBRA law. If they are not eligible for COBRA benefits, then they should buy an individual health insurance policy. Time is of the essence. You do not want a gap of more than 30 days between two policies or there will be a one-year waiting period for pre-existing conditions.

Q. I have a relative living in India that would like to visit the USA. She has many health problems so I must purchase health insurance for her before she comes to this country. I am hoping she can receive medical care here. How do I purchase health insurance for my Aunt?

A. You don’t. You must have a Social Security number to purchase health insurance and if someone is visiting from a foreign country for just a few months, they are here on a visitor’s visa and are not eligible to buy permanent health insurance. Travel agencies can arrange for travel insurance but this is a very limited policy and in most cases, travel insurance does not cover pre-existing conditions. This gentleman knows he will be at great financial risk if his Aunt comes to this country for a visit.

Q. I recently had a baby and my obstetrician’s office submitted the claim to my insurance carrier as though all of the services were rendered in the hospital. This means some of the charges were applied to the deductible. My policy will pay 90% in the doctor’s office with no deductible and I feel the claim should have been categorized for pre-natal office visits plus the actual delivery in the hospital. Did they submit this claim correctly?

A. Yes. Insurance companies lump maternity charges into one fee which includes prenatal office visits, delivery and post delivery charges. In this instance, the woman had to meet her deductible and then pay 20% of the eligible charge.

    Irene Card & Betsy Card Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company . If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, or visit our contact page.

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