Articles Tagged with insurance coverage

Before the enactment of the Affordable Care Act, also called ACA or Obamacare, under the guise of making health insurance more affordable, health insurers whittled away at the health services covered by individual and small group health plans. Slowly but steadily, health plans covered fewer and fewer services. Individual and small group health plans were a vulnerable target for health insurers. The purchasers of these plans do not have the same bargaining power a large employer does, and often were given insurance with substantially less favorable terms than large group policies. ACA was enacted in part to ensure that all individual and small group plans provide meaningful health insurance coverage.

To accomplish this goal, ACA requires all non-grandfathered health plans in the individual and small group markets to cover ten Essential Health Benefits. The Essential Health Benefits are:

  1. Ambulatory patient services – Medical treatment one receives without being admitted to a hospital. An example would be a check-up at a doctor’s office, or minor surgical procedures that do not require an overnight hospital stay. The size of a plan’s network may vary, but it must be “sufficient” to meet ACA guidelines

Surveillance is a common tool insurance companies use to gather information about long-term disability claimants. It can feel creepy to know the insurer may scan through your Facebook posts, run a background check on you, or even hire an investigator to follow you. Here are some common types of surveillance used, and advice about surveillance for anyone on disability.

Three Common Types of Surveillance

An insurance company may use different kinds of surveillance depending on how much money it is willing to spend to investigate a claim, what kind of activity it expects to uncover, and the type of disability.

Most people with long term disability (“LTD”) insurance obtain that coverage through their employer. Thus, most of us are stuck with whatever insurance company and policy our employer chooses to purchase. And while you might think to yourself, “they’re all the same, so who cares which insurance company my employer decides to go with,” nothing could be further from the truth.

LTD insurance policies vary widely depending on which insurance company is issuing the policy. Some companies offer good, comprehensive coverage that treats every type of disability more or less the same. Under these policies, regardless of whether your disability is due to physical or psychiatric reasons, you will be paid LTD benefits as long as you remain disabled under the terms of the policy.

Most LTD policies, however, will differentiate between physical disabilities and psychiatric disabilities. If your disability is “due to” a mental and nervous condition, or worse yet simply “caused or contributed to by” a mental and nervous condition, most insurers will only pay you LTD benefits for a maximum of 2 years (versus paying until age 65 for a physical disability). This distinction provides LTD insurance companies with one of their favorite tactics: They will cut off benefits for people under the 2 year limitation by arguing that while you might have some physical problems, the real reason you can’t work is because you’re suffering from depression/stress/anxiety.

Insurance is our safety net.

It’s our protection against the unthinkable. Our first line of defense when something goes wrong. Our safeguard for our health and our finances. Our security for our family and our homes. Our precaution against all the “what ifs.” Our surety in protection of our resources and access to healthcare and treatment.

On paper, health insurance sounds pretty anticipative and hopeful. It sounds like if an illness or tragedy were to strike, things would be okay in the end – because someone would be there to catch you. But the harsh reality seems to be a security net with many holes and many flaws. In the hands of insurance companies, so many people seem to be falling through the holes of the net, slipping through the worn out spaces, and some even missing the net completely as they fall.

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