John asks…

Health insurance company is asking my health records before making a decision. Is it good to give consent?

Has anybody heard about world health insurance company? its asking for my doctor records. I am concerned that they will end up on MIB or other insurance companies. Also, isnt it weird asking for records for a health insurance? I thought they only do that for life and disability insurances.

Wize Guy answers:

Ask them what they will do with the information completely, record the conversation, and if you feel like they sold it, bring your tape to court. (If they lied to u).

Anyway in the netherlands we are all insured, I think you will be all insured aswell, and wont be declined in 4 years.

You wait 4 years or just give it to them.

Daniel asks…

How does health insurance work in the US?

I am a non-US citizen and need this information to do a case.

Specifically:
1) Is health insurance compulsory for everyone?
2) What happens if someone cannot afford it?
3) In the event that a medical procedure needs to be done, does health insurance cover all the bills? Does the patient need to pay anything extra?
4) Does the patient have any say over what kind of procedure he can take? Say if 2 treatments are available for his condition, can the patient choose the more expensive treatment? And if so, is it covered by the insurance?

Thanks for reading this. Your help in answering any part of the questions would be greatly appreciated!
Thanks to those who have responded so far.

I would like to further ask:

Does a health insurance contract state that it will only cover the “normal” rates for a procedure? For eg. if there are 2 possible treatments for a disease, 1 of which is more expensive but more effective than the other, will the patient only be covered by the LESS expensive one?

Or is it a case in which the patient can opt for the more expensive one and “top-up” the difference?

This is a crucial question to my understanding the case. Thanks!

Wize Guy answers:

You’ve asked a very broad question. There is no simple answer.

In truth, health insurance works a little differently in each state.

To answer your specific questions:
1) No, health insurance is not compulsory for everyone. If you’re lucky, you are able to join a group policy at work. (If you’re really lucky, it’s a good policy and the employer pays at least half of it.) Some states have recently made it compulsory, but that’s such a recent change that there’s no clear cut answer yet for how that’s going to work.

2) What happens if someone can’t afford it is… they don’t get it, usually. Except if your income puts you below the “poverty level”, in which case you qualify for Medicaid. (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)

3) Health insurance rarely covers all the bills when you have a procedure done. Most plans cover 50-80% after you meet your deductible. The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.) If you’re really, REALLY lucky, you don’t have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges. (These plans are few and far between. As in, you might have them if you’re in Congress.)

4) Yes, the patient has some say over procedures. However, if the patient opts for an “experimental” procedure, or one that isn’t deemed “medically necessary”, then health insurance may refuse to cover any charges at all.

In the end, as with most things, the middle class takes the brunt of these costs. This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)

** Edited to add:
It’s not ALL about the money when a procedure is involved. If it is, the state keeps track of complaints filed on behalf of consumers with “managed care” (ie. any type of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point of Service organizations — also known as PPO, HMO, and POS) and may very well revoke a company’s charter to do business in the state should the company be turning down too many legitimate claims.

However, insurance companies are sticklers for following the “standard” for medical care. This is what makes it difficult to answer your question. Because they should not deny anything that’s considered standard for care in the given circumstances (should not and will not being two completely different things, of course.) And there may be several options that would be considered “standard.” If the patient wants treatment that isn’t yet considered “standard”, they would balk. Period.

Sandra asks…

What health insurance plans cover toenail fungus medication and nail removal surgery?

Hi,

I suffer from toenail fungus, and I’ve tried ALL home remedies available without success. I’m also about to buy health insurance. I thought I would take this opportunity to finally visit the doctor and get rid of this problem. My questions are:

1. Which health insurance plans offer the best coverage to treat toenail fungus?
2. Do they cover the medication and the surgery required in some cases to remove the toenail?

Thank you for all your help!

Wize Guy answers:

most insurance will cover the costs you mention if the doctor thinks it is medically necessary.

Sandy asks…

Can I reimburse myself health insurance costs from my company?

We used to have individual health insurance, and I would pay for it out of my own company (an S Corp). When we got insurance through my husband’s employer, I stopped reimbursing myself.
He is paid for by the company, and then it costs extra to add myself and our child.

I was just going to deduct health insurance premiums on our Sch A, but we don’t have enough other medical expenses to meet the limit.

Is it ligit to go ahead and reimburse myself the amount that it cost for the health insurance? Then it would be a business expense. Thanks.

Wize Guy answers:

No.
The insurance through your husband’s employer does not meet the test of having been established through the S-corp.

Maria asks…

How do health insurance tax deductions work for a member managed LLC?

I own a business (LLC) with two other people. It is only us three; we do not have any additional employees. We pay for our health insurance through our business. Based on these facts, I was wondering how much I stand to save on my personal taxes. Is this a standard write off like any other business expense or does the IRS treat health insurance differently?

Wize Guy answers:

Multiple member LLC’s can be taxed 3 different ways:

1. As a partnership
2. As a C corporation
3. As an S Corporation

The deductability of health insurance premiums for your LLC will depend on which of the 3 types of entities your LLC elected to be taxed at (the default is the partnership form of taxation).

Typically, you will be able to deduct 100% of your health insurance premiums although there are some specials considerations for owner/officers of S Corporations who own more than 2% of the company.

If you speak with a CPA or qualified tax advisor they should be able to give you plenty of good tips. One thing that you may want to mention is a medical reimbursement plan. Here is some more detail on medical reimbursement plans:

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