Health Insurance

Texas Health Insurance Cancellation

March 22, 2010 | Mark S. Humphreys

Everybody in the Dallas, Fort Worth area, including Grand Prairie, Arlington, Mansfield, and out in Weatherford have some form of health insurance. The majority of this insurance is private plans.

The Texas Supreme Court decided a case in 1994 that still has relevance today. The style of the case is, Union Bankers Insurance Company v. Thomas D. Shelton and Ann Shelton. The issue in the case dealt with misrepresentation in the insurance policy application.

Here are the facts. In April 1988, Mr. Shelton applied to Union Bankers Insurance Company (Union) for a health insurance policy. Mr. Stone completed the application with the agent’s assistance. In response to certain medical history questions, Mr. Shelton indicated that he had never been treated for, and had no indications of, any disorders of the skeletal or muscular systems. Union subsequently issued a policy. Seven months after the policy was issued, Mr. Shelton underwent a total hip replacement to correct necrosis of his left hip joint. He then filed a claim for benefits. Union denied the claim, saying that the necrosis was an undisclosed pre-existing condition.

Rate Hikes Result In Lawsuit

March 8, 2010 | Mark S. Humphreys

It does not matter where in the State of Texas that you live. Whether you are in a small community like Weatherford or in the middle of the Dallas, Fort Worth, area, in cities like Arlington or Grand Prairie, you will see rate increases in your health insurance.

In the state of California, a consumer group filed a lawsuit on March 1, 2010. This was reported by the San Francisco Chronicle. The article is found in the health care section of the paper and is titled “Anthem Blue Cross Sued Over Rate Increases”. The lawsuit alleges that Anthem Blue Cross, by raising rates, was forcing policy holders to move into other policies with higher deductibles and lower benefits.

The consumer group, called Consumer Watchdog, accuses Anthem of violating state law by failing to offer policy holders comparable coverage and minimized rate hikes after the company directs customers to alternative plans when closing existing plans. One lady in the lawsuit, said the company offered her the option of switching to a policy with a higher deductible and skimpier benefits by a specific deadline, but also told her she could stay in her current policy. The company then notified her of the enormous premium increases in her plan after the deadline for switching had passed.

Health Insurance Exclusions

March 7, 2010 | Mark S. Humphreys

All over the Dallas, Fort Worth, Arlington, Grand Prairie areas and even out in Weatherford in Parker County, are immigrants. What many people fail to understand because of all the media coverage on illegal immigration in the United States, is that there is a large and growing number of legal immigrants in our country.

A newspaper in Massachusetts recently ran an article about health insurance and legal immigrants. The newspaper was The Boston Globe. The title of the article is “Immigrants Sue State Over Exclusion From Health Care”.

The State of Massachusetts, prior to 2006 provided health care to legal immigrants. According to the article, in an effort to save money, the legislature voted to eliminate coverage to about 26,000 immigrants. About a third of the money cuts were restored and the immigrants were given a stripped down health care plan with significantly higher copayments for medications and other treatments.

Health Insurance And What They Pay Doctors

February 21, 2010 | Mark S. Humphreys

People living in Grand Prairie, Arlington, Dallas, Fort Worth, Weatherford, or any where in Texas or the nation have a hard time understanding how their health insurance works when it comes to paying medical providers. This is particularly true with the “out of network” medical providers involved in a health claim.

The Palm Beach Post recently published an article. The article addressed the possibility that a class action lawsuit was going to get traction against some of the larger medical insurance companies. The Palm Beach Post article is titled “Lawsuits Filed Against Blue Cross Claims Reimbursement Rates Kept “Artificially” Low”.

The first line in the article starts out; “Ever wonder why your insurance company claims a procedure that cost you dearly could be gotten for a fraction of the price you paid?” An example of this is given in the article where a Palm Springs resident was charged $1,210 for an MRI. Blue Cross said the cost should have been $419. Since he had not met his deductible, it would not cover the MRI. Further, it would not allow him to claim the full amount toward his deductible.

Corporation Changing Retirees Insurance Plan

January 22, 2010 | Mark S. Humphreys

Very few people doubt that the face of America is changing in that more and more companies are changing the way benefits are provided to employees. The automotive industry is probably the biggest example of this change. Along with the automotive companies themselves, the changes effect all the companies that are intertwined with the big auto companies.

But it is not just the automotive companies. The same is happening in the airline industry, other transportation companies, and all phases of manufacturing. These changes include changes to wages, health care, retirement, and other benefits.

NewPage Corporation is a company that makes paper products. The Dayton Daily News recently ran an article wherein it reports on a change being made by NewPage in the way it handles health-care benfits for its premiums as it relates to their retirees.

Insurance Debate

December 11, 2009 | Mark S. Humphreys

This blog does not try to spend time on the health care debate occurring on the National scene. Rather the focus here is to make people aware of their rights as they relate to their dealings with insurance companies and why they need an experience Insurance Law Attorney when faced with a problem when dealing with an insurance company. The occassional news item is thrown in when it relates to a large number of people, some of whom may be in Texas.

Recent articles on the Chinese drywall, sold by Knauf Plasterboard Tianjin, affecting many residents along the Gulf Coast pointed out that new construction and remodeling done after hurricanes hit the areas on the Gulf Coast have left many homeowners in rough financial situations. This is because many insurance companies refuse to cover the losses resulting from using this drywall.

One recent article points out that the deadline for involvement in a national class action lawsuit against Knauf Plasterboard Tianjin expired on December 2. This lawsuit involves about 35,000 Florida homes where about 30 percent of the installations of this drywall are believed to have occurred.

What Does “Manifest” Mean In A Texas Health Insurance Policy?

November 27, 2009 | Mark S. Humphreys

An interesting case has recently been reported in The Boston Globe. It is a lawsuit about whether or not the State of Massachusetts should be providing insurance coverage for adjunct professors in the public higher education system.

Rather than getting into a discussion about the insurance that a business or governmental agency should be providing its employees let us talk about a specific issue that comes up in health insurance situations. Most of the time when someone buys health insurance they are going to be required to fill out an application which asks questions about the applicants past and present medical conditions.

Almost every health insurance policy is going to have conditions that are not covered by the insurance. The conditions will be pre-existing conditions and also conditions that “manifiest” themselves within 30 days of the inception of the policy.

Texas Laws On Health Insurance And Billing By Health Care Provider

October 15, 2009 | Mark S. Humphreys

Did you know that there is a law in Texas which requires a health care service provider to bill the patient or other responsible person for services, not later than the first day of the 11th month after the date the services are provided. This law is found in the Texas Civil Practices & Remedies Code, Section 146.002.

Whether a patient receives care at a hospital or clinic in Dallas, Texas, or in Arlington, Grand Prairie, Weatherford, or anywhere else in Texas, the health care service provider is required to bill the patient or the issuer of health benefits plan for services within the time frame set out above. An exception would be the unlikely event that the contract between the health care provider service provider and the health care insurer provide a longer time to submit the bill for services. It is an unlikely for this exception to exist because from a practicle standpoint, no health care service provider is going to sign a contract requiring them to wait longer than 11 months before getting paid.

If the health care service provider is required to directly bill the third party payor who is operating under State or Federal law, including Medicare and Medicaid, the requirement is the same as stated above.