A Surgical Mastectomy Procedure, Research Paper Example

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.

According to the United States Department of Labor, the Women’s Health and Cancer Rights Act of 1998 (WHCRA), “group health plans and insurance companies offering mastectomy coverage also must provide coverage for certain services relating to the mastectomy in a manner determined in consultation with your attending physician and you”. Thus, if the insurance company provided the surgical mastectomy coverage, the restoration surgery must also be covered. This remains the case even if an individual insurance company is made responsible for coverage.

Ms. Jones’ first step is to remind her doctor’s office about the Women’s Health and Cancer Rights Act of 1998, demonstrating that the insurance company is not being honest about their denial for coverage. Next, she should attempt calling the insurance company herself to determine if there is a mistake or if she can speak to a higher-level supervisor regarding the case. Once an attempt has been made to communicate with the insurance company both through the lens of the physician and as an individual, it may be necessary for Ms. Jones to file legal proceedings. This could be reported to the U.S. Department of Labor or fought with personal representation in a court against the company or the individual denying coverage. Typically, it will not be necessary to advance to this step due to the expenses that the insurance company will incur as a consequence.

According to law, it appears that Ms. Jones deserves to be provided with coverage. It is necessary for her to determine why the care is being denied with the help of her physician and potentially a lawyer. She should then take needed steps to fight the company’s decision under legal grounds so that she can receive the surgery that she is entitled to. While this legal battle may take a long time, the facts of the case are fairly straightforward and will weigh in her favor. Thus, it is important for Ms. Jones to remain insistent and continue her battle until she is provided with the rights she expects to be given. If this is taken to court, it is likely that the insurance company will settle the case immediately.

Mr. Roberts has worked for a large healthcare organization with healthcare insurance coverage for ten years. His department was recently downsized and Mr. Roberts lost his position. What are his options for healthcare coverage and why?

According to the Affordable Care Act, employers with 50 or more employees must provide health insurance benefits to their workers. Thus, if having too many employees would be consider too expensive to support, businesses have the option of reducing the number of individuals that work for them or replacing some full-time workers as part-time staff members. Unfortunately, Mr. Roberts doesn’t have a legal case for being provided with insurance unless he signed a contract with the company specifically stating that these benefits would not be taken from him. Thus, whether he has been released from the company altogether or has been moved to a new position, continued coverage from the company is not an option. However, Mr. Roberts does has several options available to him.

Under the Affordable Care Act, it is required for Mr. Roberts to find coverage. Thus, he can acquire affordable coverage at a discounted rate through the online health care marketplace. If he does not elect to participate in this method and cannot find coverage, he will be subject to a fee during tax season. Next, if Mr. Roberts is under the age of 26 and his parents are insured, he can be covered by his parents’ policy. To do so, he should coordinate enrollment with them to ensure that there is no significant pause on his coverage. Next, it is possible for Mr. Roberts to find a new position that does offer benefits coverage. His previous job may not offer all of the benefits he expected, so he can leave and find one that is a better match for his needs. Last, if he is still employed with his company, but in a different capacity, he could ask to be given additional money to purchase his own insurance option. This is a choice that many companies prefer to make instead of offering insurance because it allows employees to have some funds to contribute towards purchasing a policy without having a need to fund the full thing.

Since Mr. Roberts has had an extensive career, it will be easy for him to find a more reliable position. However, it is also important for him to understand the value that health insurance has when selecting a new job.