WELL-BEING & HEALTH INSURANCE

TAKING CHARGE OF MY MIND & BODY

Search or Tap for Answers Here:

What right do I have in choosing the person providing for my health needs?


Your right to choose a health care provider that meets your need include picking a male or female doctor, someone who speaks the same language as you or a physician who is LGBTQ culturally competent. It is important to note that this right cannot be guaranteed in an emergency or crisis situation.




I want to find a specialist; where do I start?


Begin by contacting your health insurance provider and asking for a list of providers in your area. Typically, this list can be emailed or mailed to you. You may also ask them to provide the names, addresses and phone numbers of the specialists. You’ll also want to ask if a referral is required for you to see the specialist. Once you decide on the specialist that you want to see, have your primary care doctor fax a referral to the specialist.

  • If you do not have insurance and are in need of a specialist, check with a local community health center or county health board for low-cost medical specialist options.




What can I do if I feel like my doctor isn’t listening to my concerns?


To ensure that your voice is being heard, here are some things that you can do:

  • Before every appointment, write down your concerns about your health and bring them with you to your appointment. As the doctor answers them, write down the responses.
  • Have someone you trust and can provide you with support attend your appointments with you.
  • Ask the nurse, medical assistant or another staff that you feel comfortable with in the doctor’s office for solutions on how to engage with the doctor.




Can I be alone with my doctor during my appointments?


Yes. You can ask that your parent/guardian leave the exam room. If you are not comfortable asking this, you may want to ask the doctor to have them to leave the exam room.




What’s a “well-check” exam?


This is a yearly physical health check-up typically done by your primary care doctor. At this check-up, your doctor typically examines your entire body & also checks your joints, abdomen, eyes, ears, strength, coordination & basic cognitive functioning. It’s also a time for you to discuss any changes in your health since your last doctor visit.




What are “Preventive Services” under the Affordable Care Act?


Preventive Services under the Affordable Care Act (ACA, a.k.a. “Obamacare”) are benefits that a health insurance provider must cover without any cost to you. These include services sexual transmitted infection (STI) counseling, immunizations, contraception, vision and dental exams to name a few. In total, there are over 60 preventive services covered by the ACA.




Do I need to get my parent/guardian’s permission to get birth control?


No. As long as your doctor provides you with the counseling required before prescribing contraception, there is not a requirement for parent/guardian consent.




Can I get into a program to help me quit smoking?


Yes. You can call 1.800.Quit.Now to enroll in a free program to help you stop smoking. If you are a minor, you will need permission from your parent/guardian to enroll into the program.




What right do I have to access a program for alcohol and drugs without needing consent or permission?


You can have the right to obtain confidential counseling and treatment for alcohol and/or drugs without obtaining parental/guardian consent.




Do I need my parent/guardian to make my own doctor appointment?


No. You have the right to access both medical and mental wellness treatment on your own and without parental/guardian consent.




Can I find my own counselor?


Yes, you have the right to find a counselor and obtain treatment for your mental wellness needs. If you’re a minor, you are limited to 6 sessions (or 30 days – whichever comes first) before your treatment has to stop and your parent has to be informed.




What is “mental health parity”?


The term “mental health parity” refers to health insurance treating mental wellness services just as equal to other medical services that you may receive. Prior to ACA, mental wellness services were treated as a substandard service by the health insurance industry.




Are mental wellness treatment records public?


No. Any treatment for mental wellness is completely private and confidential. It is also afforded extra protection under HIPAA.




What does it mean to be “pink-slipped”?


The process of being “pink-slipped” involves a qualified medical professional who, after an assessment, requires that you to stay in the hospital due to a mental wellness emergency. These types of hospital stays are typically short stays. In general, the term “pink-slipped” is considered a derogatory term and is not favored for usage.




What is HIPAA and why should it matter to me?


The Health Insurance Portability and Accountability Act (HIPAA) is federal legislation that was passed to help protect your privacy. It affords you the following protections:

  • Your doctor and health insurance provider must tell you how they use information about your health and who they tell that information to.
  • You have the right request a report of everyone that your doctor and insurance provider has given information about your health to, and even ask for a specific report that lists any atypical disclosures. You can also request changes to inaccurate information on the information that they have distributed.
  • Your formal consent must be given to share your information.
  • Additional, special protections for mental wellness records
  • The right to file a formal complaint with Health & Human Services for violation of any HIPAA rules.
HIPAA also applies when it comes to receiving treatment. In Ohio, youth and young adults do have some rights with regard to confidentiality to privacy when it comes to receiving medical care and treatment. It is important to note that when it comes billing, if you are on your parent/guardian’s insurance, they may receive a bill for a service (contraception, counseling, STI treatment, etc.) that you have not yet discussed with them. This is why it is important for you to identify someone who can help you to have these important, crucial conversations with your parent/guardian. *It is important to note that if you choose to maintain your privacy and confidentiality, while you will still have the right to access treatment, if consent has not been granted, your parent/guardian will not be responsible for payment. This means that insurance cannot be billed. If safety is a concern, please consider accessing a community health center or county health department for a referral to a low-cost option.




Do I have the right to know the expected cost of a procedure?


Yes. You have the right to know and be told upfront the approximate cost of a medical procedure that a doctor is advising to get. This includes having a breakdown of the associated costs. You also have the right to:

  • Seek a second opinion
  • Look for a more affordable provider
  • Negotiate the costs
  • Set up a payment plan in advance
  • Decline the procedure
You will always want to be mindful that this may not be an option in an emergency situation. Also, you will want to take into consideration your own health and well-being needs when weighing out all of the rights and options.





TAKING RESPONSIBILITY 
OF MY MIND & BODY

Search or Tap for Answers Here:

Is it okay to ask for someone to explain the forms that I’m asked to sign at the doctor’s office?


Yes. Those forms that you are asked to sign usually state that you are agreeing to something. If you do not understand all of the fine print, or would like more time to review the forms, let someone know that you need more time to review the forms or that you need someone to clearly explain the forms to you. You can also suggest to them that they should mail or email forms to you in advance for future appointments.




Is health insurance a right that I am entitled to?


No, health insurance is not a right. Current legislation does require that you enroll into a health insurance plan or you will have to pay a fine.




How do I access health insurance?


You can access a health insurance plan one of the following ways:

  • Enrolling in a plan at your place of employment
  • As a dependent on your parent or guardian’s plan
  • Enrolling into a plan on the Healthcare Insurance Marketplace
  • If eligible, enrolling in Medicaid




Can I be denied health insurance coverage?


No. In March of 2010, the Patient Protection & Affordable Care Act (a.k.a. “Obamacare”) went into effect and states that you cannot be denied health insurance for any reason.




How confidential is HIV testing?


Testing for HIV is completely private and confidential. You can obtain an HIV test both anonymously or confidentially:

  1. Anonymous Testing – testing is completed by code or number, not by name
  2. Confidential testing – testing results are recorded in a patient’s confidential medical record
If you take an HIV test, no one will know, as this information is never disclosed, not even to the parent/guardian of a minor.




Do I go on a public registry if I’m HIV positive?


No. This is a myth. There is no HIV/AIDS public registry or list. There are some private disclosures to health care facilities and government health offices that occur per state and federal law, but none of this information is made public. Disclosure can also occur by request only to one of the following persons:

  • Doctor or police officer with a medical need to know
  • A minor child or their parent/guardian acting on their behalf
  • Your spouse or sexual partner
  • An individual with written authorization
  • Your own doctor or other health care provider




What is my responsibility as someone who is HIV positive?


If you are a person who is HIV positive or you have the AIDS virus, you have the legal responsibility to notify any potential sexual partners and people you might share a needle with of your status.




I can’t afford the price of my plan on the Health Insurance Marketplace. What now?


You will want to contact someone by phone at 1.800.318.2596 and ask if you qualify for a subsidy. If you do not qualify, you will want to check into the following options:

  • Check into staying on your parent/guardian’s insurance policy
  • Ask your employer about coverage options
  • If married, see if you can be added to your spouse’s plan




Health Insurance costs too much; can I just pay the fine?


Yes, however it is strongly encouraged that you choose to get health insurance over paying the fine. Disadvantages to consider when choosing the fine include that it is a large sum of money due all at once and due immediately.




How do I know what my insurance plan covers?


You can find out what your health insurance plan covers using one of the following methods:

  • Call your insurance provider and ask them to walk you through your plan and benefits
  • Go online & review your plan’s summary of benefits
  • Ask your employer if they have a copy of the summary of benefits




What is a co-payment, co-insurance and a deductible?


Insurance terminology can be confusing. Below is a quick summary of these terms.

  • Co-Insurance – A cost share between you and your insurance provider that kicks in after any deductible is met.
  • Co-Payment – A set amount that you pay every time you use your insurance. Co-payments vary from plan to plan.
  • Deductible – The amount of money that you will pay before your insurance plan covers medical expenses.
    - All of these types of payments are to be paid to your doctor. You will always want to get a receipt for any payments that you make directly to your doctor.




Can I lose my insurance for not paying my co-payment, co-insurance or deductible?


No. Although you won’t lose your coverage, you do risk losing your medical provider for failing to pay them. To avoid being dismissed as a patient, you will want to contact your providers and set up payment plans as needed.




My insurance company denied a claim that my plan says is covered. What can I do?


You will want to contact your insurance provider first and ask for a clear explanation on why the claim was denied. If necessary, you may also exercise your right to:

  • Dispute the denial of payment
  • File an appeal for payment of the claim
  • Request your insurance company reach out to the provider for additional information about the claim




Instead of getting health insurance, can I just go to the emergency room for everything?


Because your health is important, it is vital that you access the right healthcare provider for what you need. The emergency room is typically reserved for critical/crisis medical issues. If you feel you believe that you have a critical/crisis medical issues, please go to your nearest emergency room. If you are in need of non-emergency medical care and lack health insurance, you can reach out to your county’s public health department and/or ADAMH Board and ask about free clinics and/or screenings. Your local library may also have information as well.




What rights do I have to receive medical treatment if I cannot afford to pay?


Unless you are in an emergency room, most clinics assess ability to pay before providing treatment. Because healthcare is not yet a right, you are encouraged to either obtain health insurance or visit an affordable health care center in your community.




Do I have to pay the amount that I am billed?


If you cannot afford your medical bills, you may be able to negotiate the amount that you end up paying in some cases. You need to reach out to the provider and discuss what options may be available to you. For hospital bills, especially emergency room bills, you will want to apply for their Hospital Care Assurance Program (HCAP). It is important that you follow the application instructions.