karen1027

The insurer approved admission to a day program for treatment last summer. (Attendance was due to mental health issues - not addiction.) Child attended the approved number of days. Employer terminated coverage 12/31/2018. I am now receiving collection notices for services in 2017 and 2018, one of which is from the day program last summer. Employer now, i.e. March 2019, says coverage was terminated 12/31/2016. What happens to those outstanding bills? Is the employer responsible? Plan is self-insured.

Plan is self-insured. I've been told a plan administrator can override a denial and authorize payment be made for claim previously rejected. IS that accurate?

Believe it or not, this is still an open issue. Health Plan is self-insured. Employer is now telling me they can waive the financial issues; i.e. - claiming dependent on tax returns and providing financial support. Employee, my ex-spouse, does neither. Last year the request for coverage for an overage dependent was denied as the form was unsigned and the employee did NOT support the adult child, including claiming the child as a dependent on their tax returns. Employer has indicated to resubmit medical information (a form which has a section for the doctor to complete). Employer is requiring me (the ex-spouse of the employee - actually shareholder) to sign the form rather than the employee. I'm thrilled if this will give the disabled adult child coverage(it's certainly much better than Medicaid), but I'm also concerned if this can actually be approved especially given the contract holder is not signing the form.

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Adult child is disabled (since birth) and lives with me. I am not, and have never been covered, under the health insurance contract of child's father. We've been divorced for over 20 years. Over one year ago employer provided me with an Overage Dependent Due to Disability form. It has to be completed by child's physician. The physician did complete the form; I then sent it onto my ex-spouse for his completion. There is also a section for the employee, i.e. the father, to complete. It asks for financial information - is child claimed as a dependent on his tax returns and what percentage of support does the father pay. Father provides NO support and does not claim this child as a dependent. Employer has again sent me the form and has advised me I must sign the form, not the father and that financial information can be waived. Previously, father sent in unsigned form without providing this information. Insurer responded that approval to continue coverage was denied due to missing information. Has anyone ever had a situation like this? I don't understand why the insurer doesn't want the information from the employee. It's been 18 months since the first form was sent to the insurer. I did not initiate this latest request for approval of an overage dependent. Ex-spouse received mail from the insurer regarding hospitalization of this adult child.

Adult child no longer lives with non-custodial parent. Child is covered under non-custodial parent's health insurance as a dependent. Insurer is mailing ALL health insurance documents/notices including health information to non-custodial parent. (Non-custodial parent is opening the mail even though mail is addressed to adult child.) Can the adult child require the health insurer send mailings to adult child? Additionally, non-custodial parent is sharing the mailings with others....

What happens in the case of divorce, if the child does not live with the employee (non-custodial parent), but lives with the custodial parent. Non-custodial parent provides no support and does not claim child as a dependent on their taxes. Can the disabled adult child remain on the non-custodial parent's policy?

What criteria is used to determine if the adult child is disabled?

Does it matter what state you reside?

Can an adult disabled child remain on their parent's health insurance past the age of 26? What documentation would be required? Disabled prior to age 22 (since birth).

Do HIPPA regulations apply to self-insured health plans? At what address should children over the age of 18 receive their explanation of benefits/reimbursement checks/ notices etc? Their residence or the parent's residence?

When does an employer notify an employee's dependent that the dependent's coverage will expire? Who gets the notification - the employee or dependent? It is a self-funded plan.

Are health insurers required to maintain accurate claim history? I have had instances where the prior history has been deleted which indicates a much shorter claim processing time.

Claims submitted electronically msut be paid within 30 days of receipt. If submitted in another way (mail, etc) they must be paid within 40 days.

Does prompt payment apply to self-insured health plans?

CHild will turn 26 in October 2014 and therefore, (I think) will no longer be covered under parent's plan. When does the parent's employer have to notify the child about COBRA, i.e. how much notice is given? Is it possible for a plan to extend parent's coverage past the age of 26?

past age 25. Adult child is disabled. Can coverage continue past age 25? Can coverage continue under any other situation (another child is in graduate school)?

Thank you Chaz!

Does one need to be employed to set up a health savings account? I have taxable income every year and purchase my own health insurance with additional medical expenses. If I can set an account up, who would I see to do so? Thank you!

Aren't there guidelines for the amount of time a claim is processed? Doesn't that timeframe include the issuance of a payment?

Lisa, How long does it take for you to get a check? I get EOB's about three weeks after they're issued. Sometimes I have to contact UHC for checks as they don't come or it takes another three weeks for them to send one out. This means it takes about six weeks to get a check AFTER the claim has finalized..... Currently, there are several checks outstanding.

Never received a certificate of coverage - is that issued to dependents?

Requested a Certificate of Coverage from Health Insurance Carrier. Was told that I cannot get one until coverage has been terminated. I do not want to terminate coverage but would like a certificate of coverage. Can I get one?

Are self-finded health insurance plans subject to time processing deadlines? If so, what is the maximum amount of time from receipt of claim to issuing a payment check? How long before the actual check is written to the time it is mailed out?

This is a joke - almost rwo months later and I haven't received one reimbursement check. Don't know who is more incompetent - the employer or the insurance company.