WomensCancerRightsandHealthcareCoverage

.docx

School

American Sentinel University *

*We aren’t endorsed by this school

Course

520

Subject

Health Science

Date

Apr 3, 2024

Type

docx

Pages

Uploaded by mizpebbles

Running head: WOMEN’S CANCER RIGHTS AND HEALTHCARE COVERAGE 1 Women’s Cancer Rights and Healthcare Coverage American Sentinel University HCA520

WOMEN’S CANCER RIGHTS AND HEALTHCARE COVERAGE 2 Case Study #1 According to the Women’s Health and Cancer Rights Act (WHCRA) of 1998, Mrs. Jones has a right to reconstructive surgery post mastectomy. While reviewing the WHCRA, there are guidelines that are in place to ensure a patient undergoing a mastectomy, receives the proper reconstructive surgery, to ensure health and well being post operatively. The WHCRA includes all insurance plans that are self-funded group plans, fully insured group plans, and individual health insurance plan. Mrs. Jones had previously discussed the desire for reconstructive surgery after the mastectomy was performed. The WHCRA does state that her insurance provider must notify her if they do cover any specific procedure due to being self-insured however, because her mastectomy was covered by her insurance company and it appears that she was not previously notified of any exclusions, the insurance company must provide coverage for all stages of her reconstruction. Coverage would include all the following. Reconstruction of the breast on which the mastectomy was performed. Surgery and reconstruction of the other breast to create a symmetrical appearance. Breast implants, as well as treatment for physical complications of the mastectomy, including lymphedema. Mrs. Jones will need to first contact her insurance company and fully discuss her insurance plan with the administrator. Obtaining full information and records from her surgeon’s office to ensure all proper documentation has been included, to ensure the insurance company has full understanding of what procedure was performed, needed reconstruction, as well as the previously discussed reconstruction surgery in the surgeon’s office. This information would have been provided prior to the surgery for approval of the original surgery. Mrs. Jones will need to

WOMEN’S CANCER RIGHTS AND HEALTHCARE COVERAGE 3 appeal the decision of the insurance company informing them of her wishes as well as her rights under the WHCRA. In her arguments, Mrs. Jones should inform the insurance company that due to the WHCRA and no prior notification of exclusions in coverage, that it is the law that they must cover all aspects of her reconstruction surgery as well as any needed therapy during this time. Mrs. Jones should continue to peruse full coverage for her reconstruction surgery, including having her surgeon’s office contact the insurance company and appeal on her behalf. Case Study #2 Mr. Roberts losing his employment will offer several options for healthcare coverage for himself as well as his family. First, Mr. Roberts qualifies to apply for Marketplace insurance, this period falls under the special enrollment period due to lose of employment. This time period entitles Mr. Roberts to apply outside of the yearly open enrollment period that all other applicants are subject too. Should he qualify, insurance coverage would begin the first day of the month after lo sing his employment. While filling the Marketplace application, Mr. Roberts would also find out if he qualifies for savings on monthly premiums and out-of-pocket health care costs, this would be based on his income. When submitting this application it also includes the possibility of meeting the qualifications for free or low-cost coverage from Medicaid, Medicare or the Children’s Health Insurance Program (CHIP). Option two would include signing up for Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit. This option would allow Mr. Roberts continuation of his coverage for himself as well as his spouse, and dependent children. A final option would be to contact the insurance company of his spouse and inquire about enrolling in her plan. Under the Health Insurance Portability and Accountability Act (HIPAA), it is stated that if you or your

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help