Here you'll find answers to the most common questions about my book.

Q: What's the most common reason a claim has not paid?
A: The claim never reached the insurance company in the first place.

Q: Who is responsible for the charges when the claim goes unpaid?
A: Ultimately you are!  For this reason it is important to keep on top of claims, intervening when your insurance company hasn't paid or the claim hasn't even showed up in the claims payment system.

Q: What is the difference between group and individual insurance coverage?
A: The main difference is that individual insurance generally requires a person to complete a health questionnaire and submit to a medical examination in order to determine what, if any, health conditions will be limited from coverage. On the other hand, group insurance rarely requires a medical questionnaire or exam because the insurer can cover enough individuals in the group, which allows them to balance people in poor health against healthy individuals.

Q: What is an exclusion and can the insurance deny payment for an excluded procedure if the treatment is medically necessary?
A:  An exclusion is a certain treatment for which the plan does not provide benefits.  When the treatment is medically necessary and excluded in the plan document, plans do not have to cover the excluded treatment.

Q: When do I have to make my copayments?
A: You are responsible to pay your copayment, to your health care provider, at the time services are rendered.