Questions & answers · Health insurance
Health insurance claim questions
225 short answers. Each one quotes the official rule it is based on, with the date we checked it. Information only — not legal advice.
Any state · federal rules (100)
- Can a Medicare Advantage plan use an algorithm to deny my care?Denied
- Can I get a faster Medicaid hearing if waiting could harm my health?Appeal
- Can I get an outside review of my employer health plan's denial?Complaint / outside review
- Can I get my claim file from my employer plan, and when can I go to court?Appeal
- Can my Medicare start date be backdated if I signed up late or got wrong information?How to file
- Can my Medigap plan pay a claim that Original Medicare denied?Who pays
- Can my Medigap plan pay a claim that Original Medicare denied?Denied
- Can my state help pay my Medicare premiums?Buying a policy
- Do I have to apply for Medicaid before a hospital will give me financial assistance?Who pays
- Do I need a lawyer for my employer health plan claim?Lawyer / bad faith
- Do I need a lawyer for my health insurance claim, and what if the plan does not follow the rules?Lawyer / bad faith
- Do I need prior authorization before going to the emergency room?Denied
- Does Medicare pay for a hospital stay, and what will I owe?Who pays
- Does Medicare pay for an MRI, CT scan or X-ray?Who pays
- Does Medicare pay for dental work like fillings, extractions or dentures?Who pays
- Does Medicare pay for my prescription drugs?Who pays
- Does Medicare pay for therapy or counseling?Who pays
- Does my health plan have to cover this? What do Marketplace plans cover?Who pays
- Does the No Surprises Act cover ground ambulance or dental-only plans?Appeal
- HMO vs PPO vs EPO vs POS — what's the difference?Buying a policy
- How can I find out if Medicare denied a claim?Slow or stuck
- How can I find out if Medicare denied a claim?Slow or stuck
- How do I add my newborn to health insurance, and what is the deadline?Deadlines
- How do I appeal a denied claim with Aetna, and what is the deadline?Appeal
- How do I appeal a denied claim with Aetna, and what is the deadline?Appeal
- How do I appeal a health insurance denial?Appeal
- How do I appeal my employer health plan's denial for pregnancy or birth care?Appeal
- How do I apply for Medicaid, and how long can the state take to decide?Slow or stuck
- How do I file a health insurance claim for an illness or injury, and how long until I hear back?How to file
- How do I file a health insurance claim through my job's plan, and how long do they have to decide?How to file
- How do I get out of Medicare Advantage and go back to Original Medicare, and can I still buy a Medigap plan?Buying a policy
- How do I lower my monthly health insurance payment with the premium tax credit?Buying a policy
- How do Medicare Part D plans charge: premium, deductible and tiers?Buying a policy
- How does a Medicaid spend down work if my income is too high?Buying a policy
- How does the ACA premium tax credit work, and what if my income changes?Buying a policy
- How fast must a Medicare Advantage plan decide a prior authorization request?Appeal
- How fast must a Medicare Part D plan decide a redetermination?Appeal
- How long can my health plan take to decide a prior authorization request?Denied
- How long do I have to appeal a denial from a job-based health or disability plan?Appeal
- How long do I have to appeal a denial from a plan I bought on HealthCare.gov?Appeal
- How long do I have to appeal a Medicare Part D denial, and how fast must the plan decide?Appeal
- How long do I have to ask for a Medicaid fair hearing?Appeal
- How long does a job-based disability plan have to decide a claim?Appeal
- How long does a job-based disability plan have to decide my claim, and how long do I have to appeal?Appeal
- How long does a Medicare Part D plan have to decide a prescription coverage request?Appeal
- How long does an employer health plan have to decide a claim before or after care?Appeal
- How long does my employer health plan have to decide my claim?Appeal
- How much are the copays in a Medicare Advantage plan?Buying a policy
- How much do I pay for Medicare Part A and a hospital stay?Buying a policy
- How much does Medicare Part B cost me each month and each year?Buying a policy
- How much is the copay for Medicare Advantage plans?Buying a policy
- How often does Medicaid have to be renewed, and what if my Medicaid was ended?Appeal
- I already paid a lot this year. Why is my plan still billing me, and what is the out-of-pocket maximum?Who pays
- I am 65, still working, and have Medicare and my job's health plan. Which one pays first?Who pays
- I didn't sign up for Medicare Part B or a drug plan when I turned 65. What is the penalty?Buying a policy
- I filed a claim with my employer health plan. How long does the plan have to decide?How to file
- I got a bill after my «Welcome to Medicare» visit. Isn't that visit free?Who pays
- I got a bill from an out-of-network provider I didn't pick. Is it allowed?Denied
- I got a huge out-of-network air ambulance bill. Does my health plan have to cover it?Who pays
- I got a surprise out-of-network bill after an ER visit, and I have insurance. What protections apply?Other
- I got an out-of-network bill after an emergency room or in-network hospital visit, and my insurer did not pay. What can I do?Denied
- I got an out-of-network bill for emergency surgery at an in-network hospital. Do I have to pay it?Denied
- I got married or had a baby. Can I add my family to my job's health plan now?Deadlines
- I had a baby and missed Open Enrollment. Can I still get health coverage?Buying a policy
- I have a Medicaid plan. They denied my ER visit, or the hospital bills me. Is that allowed?Denied
- I have a Medicare Advantage plan. Can it pay for a doctor who opted out of Medicare?Who pays
- I have both Medicare and Medicaid. Who pays first, and what do I still pay?Who pays
- I have cancer. How do I compare Original Medicare and Medicare Advantage?Buying a policy
- I have insurance and got a surprise out-of-network bill. Where can I complain?Appeal
- I have Medicaid. Can the doctor or hospital bill me?Who pays
- I have Medicare and a job plan. Which one pays first, and what if the wrong one was billed?Who pays
- I have Medicare and also retiree coverage or COBRA from a past job. Which one pays first?Who pays
- I have Medicare and was hurt in a car accident. Who pays my medical bills first?Other
- I just joined a new Medicare drug plan and my medicine isn't on its list. Do I have to go without?How to file
- I left my job, my COBRA papers have not come, and I have surgery soon. What are my rights?Slow or stuck
- I lost Medicaid at renewal. What can I do?Appeal
- I lost my job-based health coverage. Should I take COBRA or buy a Marketplace plan?Buying a policy
- I lost my job. Should I take COBRA or look at the Marketplace, and how long do I have?Buying a policy
- I lost my other health coverage. Can I join my job's health plan now, or do I have to wait for open enrollment?Deadlines
- I missed the deadline to appeal my health insurance denial. Is there anything I can still do?Deadlines
- I paid without insurance and my bill is far above the good faith estimate. Can I dispute it?Appeal
- I'm 65 and still have insurance through my job. Can I wait to sign up for Medicare Part B without a penalty?Buying a policy
- I'm turning 26 and losing my parent's health plan. How and when can I get my own coverage?Buying a policy
- I'm turning 65 and have a Marketplace plan. What happens to it when Medicare starts?Buying a policy
- I'm turning 65 but still working with job-based health insurance. Do I need to sign up for Medicare Part B now?Buying a policy
- I'm under 65 and get Social Security disability. When do I get Medicare?Buying a policy
- I'm unhappy with how my Medicare plan treated me. Do I file a complaint or an appeal, and where?Complaint / outside review
- I'm uninsured and my hospital bill is much higher than the good faith estimate. What can I do?Paid too little
- If Medicaid pays only part of the hospital bill, can the hospital bill me for the rest?Who pays
- If Medicare denies a surgery claim, do I have to pay the surgeon?Who pays
- If Medicare denies a surgery claim, do I owe the surgeon?Denied
- Insurance dropped me for not paying my premium. What is a grace period?Denied
- Is the Medicare Part D Level 2 review automatic, or do I file it?Appeal
- Is there help paying for my Medicare Part D premiums and drug costs?Buying a policy
- Medicaid denied my claim saying I have other insurance, but I don't. What can I do?Denied
- Medicaid denied my claim saying I have other insurance, but I don't. What can I do?Denied
- Medicaid paid only part of my hospital bill. Can the hospital bill me for the rest?Who pays
- Medicare denied my "Welcome to Medicare" visit and I got a big bill. What can I do?Denied
- Medicare denied my "Welcome to Medicare" visit and I got a bill. What now?Denied
- Medicare denied the claim. Does my doctor get to bill me for it?Who pays