Question

A patient of the medical office who is in the fourth month of pregnancy is reluctant to have a diagnostic ultrasound test. She explains to the medical assistant that she isn’t worried, even though the physician has said he is concerned because her uterus seems to be larger than expected based on the date of her last menstrual period. The medical assistant remembers the patient telling her that her husband switched jobs about 6 months previously. What insurance concerns might be affecting this patient’s reluctance to have the diagnostic test? How should the medical assistant discuss this with the patient?

Answer 1

1.She is concerened about the coverage of insurance plan because her husband had switched his job recently (within 6months). Because in the past, insurance used to turn down patients if they apply for coverage while they are pregnant. Because at that time, they consider pregnancy as a pre-existing condition. That is the reason why she is reluctant to have the diagnostic test.

2. Medical assisstant can educate her regarding the rules of health insurance

Health plans can no longer deny the coverage if you are pregnant

An insurance company can no longer raise the premium amount based on sex or health condition

Instruct her that her partner's insurance will probably get the maximum coverage at the best price offerred by the employer. That's partly because most employer's share the insurance premium with the employees.

If she belongs to a low income group persuade her to apply for medicaid from her state which she resides

If her income is in the range to qualify for financial help from government , which will lower the cost of insurance premium; she may also qualify for out of pocket costs such as deductables,copay, coinsurance

The Health Insurance Portability and Accountability act offers special enrollment rights for qualifying life changing events , such as changing the jobs. This means you can get the health insurance coverage through the spouse or parents without waiting for the plan's open enrollment period

Advise her to enroll in an individual  health plan through health insurance market place which helps to accumulate the previously paid premium into a individual health savings account, the funds are still available even if your job was lost.