What Do You Mean It's Not Covered: Chapter 6 - Health Insurance

Please select a topic below to learn more about "What Do You Mean It's Not Covered"

• Health Insurance Introduction
• Different Kinds of "Health Insurance"
• A Sample Declarations Page
• Common Provisions of the Policy Forms
• Basic Terms and Definitions
• A Difficult Case of Dependent Child Coverage
• Suing One Insurance Company, then Another
• How One Policy Defined "Covered Family Member"
• An "Anti-Consumer" Tone to the Decision
• How the Policy Defines Health Care Facilities
• What Counts As a Hospital
• What Counts As an Injury
• The Role Medicare Plays in Health Coverage
• A Key Issue: Preexisting Conditions
• A Preexisting Condition Dispute
• What Policy Literature Said
• The Insurance Company Denies Coverage
• Allegations of Fraud
• Nullifying Coverage Retroactively
• You Have to Have Access to the Master Policy
• How the Policy Defines "Regular and Customary"
• A Dispute over an "Experimental" Procedure
• The Court Upholds the Policy's Language
• How the Policy Defines "Sickness"
• How One Policy Defined "Sickness" to Exclude Coverage
• Once Again, the Court Upholds the Policy Exclusion
• The Most Common Exclusions
• No Coverage for Teeth, Babies or Face Lifts
• The Mechanics of Health Coverage
• A Troubling Example of Health Insurance Problems
• The Grounds for Cancellation
• Definitions that Apply to the Mechanics of Coverage
• A Key Issue: Reinstatement of Coverage That Lapses
• Notifying the Insurance Company of a Claim
• Filling Out the Proper Forms
• How the Insurance Company Pays Claims
• Limiting Your Right to Sue the Insurance Company
• Requiring Physical Exams
• How One State Regulates Health Coverage
• The Most Common Health Insurance Form
• What Coverage the Base Policy Offers
• A Caveat: Your Policy May Not Be in Force
• A Key Issue: Replacement
• Questionable Sales Tactics
• No Coverage for a Pregnant Woman
• Punishing the Pushing Insurance Company
• Actual Authority vs. Apparent Authority
• Lies the Agent Told
• Other Terms and Definitions that Affect Coverage
• Who's Covered and Why
• How the Policy Handles Premiums and Payments
• How the Policy Can Be Terminated
• How Individuals are Terminated from the Policy
• Medicare Plays a Major Role
• Some Allowances When an Individual Has Been Terminated
• Other Rights That Continue Beyond the Policy Terms
• Converting Existing Coverage to Some New Form
• Specific Limits on Preexisting Conditions
• A Key Issue: Adding New Family Members
• A Major Family Member Dispute
• The State Guidelines Limited Coverage
• Another Case of "Reasonable Reliance"
• How the Policy Handles Out-Patient Care
• How the Policy Handles In-Patient Care
• How the Policy Defines "Hospital Services"
• Optional Coverage: Childbirth
• Optional Coverage: Extra Miscellaneous Expense
• Optional Coverage: Intensive Care Expense
• Optional Coverage: Doctor's Visits
• Optional Coverage: Private Nurse Expense
• Optional Coverage: Added Surgical Costs
• A Sample of Operation Coverages
• Conditions of Surgical Coverage
• Adjusting Benefits with Circumstances
• Coverage for Diagnostic Surgery
• The Other Common Kind of Health Coverage
• How Major Medical Policies Define "Medically Necessary"
• One Insurance Company Didn't Recognize MRI
• The Doctor's Themselves Disagree Over What's Necessary
• "Experimental or Investigative"
• Policy Langauge Impacts Coverage for Cancer and AIDS
• How the Policy Will Pay Claims
• The Main Coverage Section
• The Mechanics of Major Medical Coverage
• Buying Insurance Is Like Buying a Car
• Dire Results of Not Reading the Policy
• How the Policy Defines Various Kinds of Service
• Extended Care Coverage
• Coverage for Mental Illness and Drug Dependency
• Deductibles, Copayments and Other Mechanical Issues
• How the Policy Defines "Insured Expenses"
• How the Policy Pays Claims
• How One Catastrophic Medical Policy Compares to Major Med
• The Policyholder Got His Money but Ducked His Bills
• Threshold Amounts and Set-Off Violations
• Co-ordination of Benefits
• Other Coverage Mechanisms

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