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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

June 2007 Archives

Insurance Price Hikes

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Question: I'm looking around for another plan because my insurance company keeps raising th e price - twice this year already and I have not cost them a dime! Is there a company out there who recognizes a good customer when it sees one?

FACT and Golden Rule

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Question: I have some questions -
1. I have two cards. Golden Rule and FACT. I believe that FACT is a route to discount services for Dental and Vision. However, on the cover of the document it is stated that the Policyholder is Fact. Could you clarify for me FACT vs Golden Rule?
2. I will need to visit an orthopaedic specialist. Do I select a specialist from www.goldenrule.com (to get a preferred supplier) and make my own appt, or do I need to go through my Primary Care Physician first?
3. When I get medical treatment, should I simply present my Golden Rule card, have them bill Golden Rule, and then pay when they invoice me (i.e. to ensure that applicable discounts are applied)?

Thanks and sorry for the bother.

Question: I take Lomectol for bi-polar. I was denied coverage by blue cross blue shield nevada. Dont you think thats insulting? I thought it was mean.

Question: What do I do about this? The court says I have to get insurance for my son in Houston Texas but I live in Wisconsin. I tried to do a application on teh computer but its asking for all kinds of infomation I dont have about him. I didnt even know I had a son until last week.

Question: I'm over 50 which means that I need a bone scan. My doctor says its not necessary but will give me an Rx if I really think I cant live without it. How do I know if its covered on my plan?

Which Plan Should I buy?

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Question: When I ran a quote on the website it wasn't clear about bills that the insurance company would pay and what bills I pay . What happened the last time I had insurance was I went for some blood work and I ended up paying for the whole thing! The plan I was looking at was the Unicare performance 2000 in Texas. I can afford it ok. but does it cover the things I need?

Question: I have to have a breast lump removed because my doctor is not sure if its cancerous or not. I tried to schedule the surgery but the hospital wanted my deductible up front. I was shocked. Do I have bad insurance?

Copayment vs Coinsurance

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Question: I get confused between what a copayment is and what a coinsurance is. Can you tell me the difference? Thanks!

Question: I never see a doctor but consider myself fairly healthy. My wife on the other hand takes really good care of herself and sees her doctor for regular maintenance. Over the past year she has had trouble getting her thyroid levels right, which gave her a bit of high blood pressure but her doctor says their ok now and the blood pressure also. She is 5 ft 3 in tall and weighs 172 pounds. She was declined by Blue Cross 18 months ago and now we want to try and add her on to my plan because she's not covered at all right now. We live in Shasta County, CA which means we can only to apply Blue Cross or Blue Shield. I guess no other companies operate out here.

Question: My wife is completely healthy and takes premarin for menopause. I have high blood pressure and take a low dose of Mavik to keep this controlled. I've been told by Aetna that they charge an extra 25% on top of the standard premium for this. This doesn't seem fair with my wife being so healthy -- why is she being penalized? She goes to curves and stays fit, eats well and takes good care of her self.

Question: I live in Texas and my wife and children are currently in Oklahoma and will be there through the end of the year. I'd like to be covered when I visit them and vise versa. Is there such a thing as an insurance plan that will cover all of us?

Question: Is it possible for me to get medicare supplement insurance? I am 62 and had lukemia which is why i have medicare in the first place.

Health Insurance Deductible

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Question: I spoke to another angent about getting some insurance. He talked about a deductible and I got so mixed up. What does deductible mean, is it a yearly amount that I to pay? Im a student so I can't afford $5000. Thanks for your help!!!!

Question: My broker told me to get travel insurance for my vacation to spain next month. Do I really need this? Seems a bit overkill.

Group vs Individual Coverage

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Question: My wife and I run a small business selling greetings cards. A friend told me that a small group policy is totally the better way to go and that his insurance covers everyting. Would it be a good thing for us my wife is 52 and doesn't smoke. I'm 55 and smoke about a pack a day.

Out of Network Providers

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Question: I was told by the insurance company I'm with now that I was allowed to go to any doctor. I went to see a holistic practitioner and the bill was almost $400. I have now found out that they won't cover any of this and quite honestly I cant afford a big bill like this. I saw a normal doctor and only had to pay a co pay. What can I do to get the insurance company to pay up like their supposed to?

Separate Dental Coverage

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Question: I need a dental plan for myself (aged 42) my wife (also 42) and my two children 12 and 8. Is this possible or would I have to buy health insurance as well?

COBRA options

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Question: I need your help to know what to do. I have the option of taking Cobra but its super expensive. First off why? Is my former employer taking a cut or what? Next is it a good idea to take the Cobra even though itcosts so much? I have a new job starting soon but I don't want to go uncovered.

Child Denied Coverage

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Question: I applied for my 5 year old son for the Blue Cross Tonik plan and they denied him which was a huge surprise to me. He's a healthy young boy with no health problems whatsoever. He gets a flare up of excema now and then and I use a cream and it calms down right away. Is it right that they denied him for something so simple or is this just the insurance company being all about the money?

Child only application

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Question: Can I make an application for my two daughters without me having to be on the plan? I have insurance from my employer but Its too much to add my kids on.

Question: My ex wife and son live in Texas and I've been told by the court to get health insurance for my son. he has PDD NOS so I cant get regular insurance for him. What are my options or maybe I should ask do I have any options at this point?

Question: I have an application for United Healthcare and it's asking for so much information that I'm way overwhelmed. What do I include and what do I leave off? I'm completely healthy other than I'm taking HRT meds for hot flashes. I had a summer cold last year but I'm not sure of the date - do these two things need to be on there? Their asking for 10 years back.

Question: My wife and I are in the process of adopting a baby girl from China.We live in Escondido, California. We need to get her some health insurance but the application form for Blue Cross is asking for all kinds of information we just don't have. We don't even know her height and weight at this point! What do you suggest?

Question: I need health insurance but I dont know if I can get it because I have a couple of health issues and you know how insurance companies are. Is it ok to put applications in with a couple of companies at the same time?

Underwriting Timeline

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Question: How long will it take for my application to go through? I did it online a few day's ago and need coverage to start on the 1st of next month.

Moving to Another State

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Question: I live in Florida and I'm moving with my wife and two sons to Colorado when I start my new job in September. My new employer doesn't offer benefits so I need to get my own insurance. I don't want to be without insurance. My question is how can I get insurance in Colorado when I'm still living in Florida?

Declined Coverage in Texas

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Question: I applied for health insurance with Unicare and they turned around and told me they couldn't cover me. Can they do this? I was covered with them for years through my employer and paid them thousands of dollars in premiums. I only have a little acid reflux and use one prescription called Nexium!! Are they allowed to do this? How do I get them to change their minds about this?

Question: I think I might well be pregnant and I want to get insurance to cover the birth etc. Is it okay if I apply and say I'm not pregnant seeing as I'm only about 3 weeks in? How would an insurance company know I'm pregnant if I haven't seen a doctor yet? Help!

Question: I work for a small company that doesnt have benefits like health insurance so my employer will be paying. When I called Unicare and they told me that I couldnt have health insurance with them if my employer is paying for it. Why??? Is there another company out there that will cover me?

Declined for Health Insurance

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Question: I was declined insurance and they said it was because of a previous claim that I made while I had employer coverage with the same insurance company. I called them to find out why and they said I was treated for high cholesterol while I had the group plan. I have never had high cholesterol, in fact I'm completely healthy!!! What do you think I should do about this?

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