Best Health Insurance Agencies in Bolingbrook, IL

FAQs

• Introduction

  If you're looking for health insurance for yourself or your family, an agent can help you save time, understand your options, and manage your costs. Insurance agents must be licensed in the state where they operate. They can provide information about on- and off-exchange plans to help you weigh all of your options, and they can see if you qualify for tax credits that can lower your monthly premiums. There's no cost to work with an agent, and they can help you save quite a bit by recommending the best plan for your needs. Here's what you should know before you get started.
  

• What is the timeframe for health insurance claims appeal in Bolingbrook?

  If you have previously filed an internal appeal, it may take up to 30 days to receive the requested service or treatment. If you have already received the service or treatment and are awaiting reimbursement, it could take up to 60 days. If your health insurance provider in Bolingbrook has denied a service, procedure, or other healthcare service that significantly increases the risk to your health, you may request an expedited internal appeal.

• How does the Coordination of Benefits work for individuals with multiple health insurance plans in Bolingbrook?

  If you have coverage through two different health plans, your healthcare provider may submit your claim to both. The health insurance providers will then determine which plan covers which claim expenses. This is known as benefit coordination, and it serves several purposes. It prevents duplicate payments by ensuring that the total amount of the claim is not exceeded by the combined payments from both plans. It also ensures that each plan makes the necessary payments. Finally, it aids in lowering the overall cost of insurance premiums.

• What should one expect in an Explanation of Benefits (EOB) received from an insurer after a health insurance claim?

  An Explanation of Benefits describes the services you received and their cost. Remember that this is not your bill. Expect the following in the document:

  • Patient data
  • Provider information
  • A summary of services
  • Cost of service
  • Deductible and copayment or coinsurance responsibilities, if applicable. Additionally, the EOB will indicate whether your claim was approved or denied. If your claim was denied, you can still file an appeal with your Bolingbrook health insurance provider.

• What are the common reasons for health insurance claim denials in Bolingbrook?

  Health insurance claims in Bolingbrook are denied for a variety of reasons, including claim errors, using an out-of-network healthcare provider, a lack of prior authorization for certain procedures or services, or billing the incorrect insurance company. Some claims are also denied because the procedures, such as cosmetic surgery, are not covered. Your Explanation of Benefits (EOB) can assist you in identifying the problem, and you have the right to appeal the decision.

• Can a Bolingbrook individual sue a health insurance provider for denying his claim?

  While it is not always necessary, health insurance policyholders in Bolingbrook may choose to sue after being denied coverage. Before you can sue, you must first complete the ERISA-mandated formal appeals procedure for group health plans. However, if you have exhausted all of your options for appealing your claim's denial, you may file a lawsuit. You may also be exempt from the exhaustion requirement if your health insurance company fails to respond to your appeal in a timely manner or otherwise violates ERISA's notice obligations.

• How can you find affordable health insurance? 

  Affordable insurance is available through employers, Medicare, Medicaid, and the federal Health Insurance Marketplace, which offers subsidies in the form of tax credits. You can also purchase coverage through private insurance companies and independent agents. Nearly half of all Americans have employer-sponsored health insurance, and about 10% of the population is uninsured.

• What is health insurance?

  Health insurance policies are contracts that require an insurer to pay some or all of a beneficiary's health care expenses in exchange for a premium and deductible. Plans cover preventive care and emergency medical services arising from an injury or illness. They may also offer optional coverage for dental and vision.

• How do health insurance companies make money?

  Health insurance companies make money by collecting premiums from consumers and reinvesting the funds. Federal law requires insurers to put approximately 80-85% of collected funds toward claims, and 15-20% is used to pay for administrative expenses.

• What is subsidized health insurance?

  Subsidized health insurance is available exclusively through the Health Insurance Marketplace. This system applies federal tax credits that can reduce or eliminate premiums. Tax credits are available to consumers who earn up to 400% of the federal poverty level based on household size.

• What is a health insurance deductible? 

  A deductible is a fixed amount you must pay out-of-pocket before normal copays or coinsurance rates apply. Under the Affordable Care Act, some services, such as annual physicals and wellness screenings, must be covered at no charge.

• Is it illegal to not have health insurance?

  No. Starting in 2019, the federal government eliminated the penalty that applied to individuals who could afford health insurance but chose not to purchase it. Financial penalties still apply in California, Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, D.C.

• Does health insurance cover therapy? 

  All Marketplace plans must cover behavioral health care services, including counseling, inpatient care, and substance abuse treatments. However, there are coverage limits, and preauthorization may be required.
  

• What is a copay?

  A copay is a fixed price that you pay at the time of service after your deductible is satisfied. Insurance companies set specific rates for primary and specialty care and other services, such as emergency room visits and X-rays. Alternatively, plans may have coinsurance rates that require beneficiaries to pay a certain percentage of covered charges.

• What is the Health Insurance Marketplace?

  The Health Insurance Marketplace is a federal service designed to help consumers compare and purchase subsidized health insurance plans that comply with the Affordable Care Act. A number of states operate their own insurance marketplaces, including California, Colorado, New York, and Pennsylvania.
  

• How can you find health insurance without a job?

  Individuals who don't have access to health insurance through their job can purchase ACA-compliant plans through the Health Insurance Marketplace. Off-exchange plans are also available through private insurers and independent agents. The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives certain individuals who are losing their coverage the right to maintain the same plan for a limited time period. 
  

• Can you cancel health insurance at any time? 

  Consumers can cancel their health coverage at any time. Cancellations may be effective immediately or at a specified date. However, you must wait until Open Enrollment to sign up for a new plan unless you qualify for a Special Enrollment period.

• Can you have more than one health insurance policy?

  It's possible to have primary and secondary health insurance. This is most common with Medicare and Medicaid beneficiaries, including dual enrollees and individuals who purchase supplemental plans. Secondary plans can cover some additional expenses, but you're still responsible for premiums and deductibles.

• Is health insurance pretax?

  Premiums for employer-sponsored health plans are generally deducted from the worker's pretax income. The same is true for voluntary contributions made to Flexible Spending Accounts and Health Savings Accounts that are paired with a qualifying high-deductible health plan.

• How long can a child stay on a parent\'s health insurance policy?

  Children can stay on their parents' health insurance plan until their 26th birthday. There's a 60-day special enrollment period following this date. Exemptions allow disabled adult children to remain on their parents' policy beyond this age.

• Do you have to pay a health insurance deductible upfront?

  In most cases, out-of-pocket expenses for approved services count toward your deductible. However, it's increasingly common for hospitals to request all or part of the deductible upfront when scheduling major services, such as CT scans and surgeries.

• Do employers have to offer health insurance?

  The Affordable Care Act requires companies with at least 50 full-time employees to make essential health benefits available to 95% of their workforce. Companies that choose not to offer such benefits may have to pay a penalty.

• Is there a tax credit for having health insurance?

  The Advance Premium Tax Credit is a federal tax rebate designed to lower the cost of health insurance plans purchased through the Marketplace. Eligibility is based on income and household size. Consumers can decide how much of their tax credit to put toward their premiums.