A Look at Two Case Studies and How Legislation Impacted Their Insurance Options Becky L. Bell
American Sentinel University
A Look at Two Case Studies and How Legislation Impacted Their Insurance Options
The government’s involvement in the delivery of health care has substantially grown over the past few decades. Beginning with the enactment of Medicare and Medicaid to the PPACA of 2010, the laws passed by legislation have impacted the health care system in the United States. This paper reviews two case studies and the impact legislation had on their options for health care insurance coverage. Case Study Number One
Ms. Jones recently had a surgical mastectomy procedure for breast cancer. She discussed with her physician the possibility of restoration surgery. Later, she was informed by her physician’s office that her insurance company denied coverage for the procedure. Research and report on what Ms. Jones' options are under the “Women’s Health and Cancer Rights Act” and what steps she would need to take to secure coverage.
The Women’s Health and Cancer Rights Act (WHCRA) enacted in 1998, requires group health plans, insurance companies, and health maintenance organizations to cover all stages of reconstruction of the breast on which a mastectomy was performed if coverage was given for the mastectomy (US Department of Labor, nd). “All stages of reconstruction” include reconstruction of the breast removed, reconstruction of the other breast for symmetry, any external breast prosthesis, and any complications at all stages, including lymphedema (Cancer.org, nd). There are some exclusions for coverage including church plans, governmental plans (Medicare and Medicaid), and non-federal government employers that provide self-funded group health plan coverage (The Center for Consumer Information and Insurance, nd). The health plan or issuer is required to provide the insured with a notice of their rights...
References: American Medical Association. (nd). HIPAA: Health insurance portability and accountability act Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act.page
Cancer.org. (nd). Women’s health and cancer rights act: The federal law. Retrieved from http://www.cancer.org/treatment/findingandpayingfortreatment/managinginsuranceissues/womens-health-and-cancer-rights-act
The Center for Consumer Information & Insurance Oversight. (nd). Women 's health and cancer rights act (WHCRA). Retrieved from http://cciio.cms.gov/programs/protections /WHCRA/ whcra_ factsheet.html
Koman, S.G. (nd). What to do if a claim is denied. Retrieved from http://ww5.komen.org/BreastCancer/ DeniedClaim.html
United States Department of Labor. (nd). Your rights after a mastectomy...women 's health and cancer rights act of 1998. Retrieved from http://www.dol.gov/ebsa/publications/whcra.html
United States Department of Labor. (2010). An employee’s guide to health benefits under COBRA-The consolidated omnibus budget reconciliation act. Retrieved from http://www.dol.gov/ebsa/pdf/cobraemployee.pdf
United States Department of Labor. (nd). Frequently asked questions COBRA continuation health coverage. Retrieved from http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html
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