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Doctors go insurance-free for several reasons, such as decreased reimbursement rates from health insurance companies, and excessive paperwork. In many cases, doctors who do not accept insurance have flat rates, or income-based sliding fee schedules, to keep care affordable. Other providers have monthly, quarterly, or annual fees, where their patients pay in advance, in exchange for a certain number of services or visits. Some may require payment at the time service is rendered each visit.
If your doctor goes insurance-free, talk to the billing office to determine how much care will cost. In some cases, it may not be much more than you would pay with health insurance coverage. Caution here, you may mistakenly feel that insurance is no longer important or necessary. Nothing could be further from the truth! The true cost of health care totally out of your own pocket could devastate you financially. Tests, lab work, prescription coverage, and hospitalization or emergency care can be thousands of dollars. In all cases, if you are determined to stay with your doctor no matter what, until you have a new “enrollment period” so you can switch health insurance options, it is best to pay your doctor, sometimes referred to “cash pay” and keep your insurance for all other necessary reasons. One unforeseen emergency without insurance is why you’ll want to keep insurance. One bout of cancer, an embolism, a heart attack, a strange infection, an accident, so many things that could happen that your 1 specific doctor cannot take care of is why you’d want to keep that insurance plan in place.
If your doctor rejects your health insurance plan, it is a good idea to call the health insurance company and state your case. In some cases, your health insurance provider may honor your appeal. Obviously, this does not happen often, but if your provider is providing a service that no one in your city/county provides, your insurance company may make exceptions for you to continue seeing your provider. You can also ask if your doctor’s office will submit an out-of-network claim on your behalf or provide you with necessary paperwork to file it yourself. You may also inquire about what you would pay out-of-pocket as a cash pay client.
If you find yourself losing your health insurance plan and your new plan does not have your doctor in their network, now what do you do? There are some cases in which you are entitled to continue receiving care from your current medical provider, even if they are no longer within your plan’s network.
In Nevada, if you are actively undergoing medically necessary treatment, many insurance companies will work with their new members on transition of care. Depending on the patient’s need, there are times the insurance company may negotiate with the existing provider to complete their care.
At Nevada Insurance Enrollment, health insurance agents can help you find your plan’s list of in-network providers and understand your coverage for primary and specialty care. If you do not currently have health insurance coverage, we can also help you find a plan that your preferred health care provider accepts.
Most people have never heard of association health plans; however, these health insurance plans have been around for decades. Association Health Plans may have fewer benefits but will most likely have lower premiums, making them an attractive option for those who are young, healthy, and on a budget.
According to a recent study, health insurance premiums could increase for individual plans on the ACA marketplace between 35 and 94 percent by 2021. Concern over health care is nothing new; in fact, this is the fifth consecutive year that Americans have ranked health care as a top concern.
At least for now, many aspects of ACA are still in place. Currently, an insurer can’t turn you away for a pre-existing condition, and long-term health insurance plans still have to provide coverage for ACA’s 10 essential health care benefits. Prior to 2010, private health insurance usually did not cover maternity, or preventative like it does now, and mental health was generally non-existent.
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We HIGHLY recommend you double check that your physician will take the Nevada Health COOP plan you are enrolling into.
Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with health insurance
Anyone who can show that their individual or family policy has been cancelled, will be eligible to buy a “catastrophic” plan through the Nevada Health Link.
Changes to the way medical billing works will be coming on Oct. 1, 2014. The health care medical billing system will change over to a new computerized system.