June 27, 2006

When Health Insurance Doesn't Cover Your Medical Care

While it's true that the costs for health insurance coverage continue to increase, having a health insurance plan will save you more money in the long run. But no health insurance plan will cover every medical treatment an insured individual needs over the course of his or her coverage period. No matter how good your health insurance is, you may occasionally encounter a medical treatment or condition that is not covered by your health insurance policy. Although these situations are normally confined to elective treatments like cosmetic surgery and liposuction, that is not always the case.

If you are in need of a non-elective treatment that your insurance company is unwilling to cover, and it is not specifically listed on the "excluded treatments" section of your health insurance policy, ask your insurance company for a written explanation of their reasons for issuing such a denial. Then show this to your physician. Many times, simply re-coding a procedure or treatment and re-presenting it to your insurance company are all that's needed to get approval for the treatment.

But what happens when the procedure hasn't been miscoded or can't be re-coded and coverage for a medical treatment you already received has been denied by your insurance agency? The hard truth is that by this point in the process, you do not have many options, and you may end up being responsible for paying the full cost out of your own pocket.

NEED Health Insurance? In addition to featuring the largest selection of major medical health plans from leading companies, also offers a wide selection of quality short term, student, and dental plans. You can obtain FREE instant quotes, side-by-side comparisons, the best available prices, online applications, and a knowledgeable Customer Care team to help you find the plan that is right for you.

One option you do have is the opportunity to appeal a decision if you do not agree with it. Every insurance company has a process to go through to appeal a claim, and you need to follow the steps involved in the appeals process precisely. Insurance companies would rather throw your appeal out on a technicality than invest the resources necessary to investigate the claim. The appeal process is typically outlined in your policy handbook. You can also discuss the situation over with your medical care provider before proceeding with the appeal to get another point of view or advice on how to proceed. If, despite your best efforts, the treatment still is denied, all is not lost. Here are some other options that are worth pursuing that may help you avoid paying full price: 1. See if your doctor will negotiate a lower payment or authorize a payment plan. 2. See if your doctor is a member of a medical discount program that you can join. There are thousands of doctors who participate in these networks. 3. If you've not yet had the procedure, shop around for another doctor who is willing to do the procedure for a lower price. 4. See if you qualify for free treatment at a public hospital or clinic because of your income level, veteran's status, or some other socio-economic reason. With a bit of persistence and some extra effort, it is very likely that you'll end up with the treatment that you need at a price you can afford.


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Posted by HealthInsurance at 06:34 PM | Comments (0)

June 22, 2006

One-Size Health Insurance Does Not Fit All

Health insurance coverage and associated costs vary greatly based on whether the insurance is an individual policy (for the self-employed/unemployed), for a small businesses (from 2 to 50 employees), or for a large group. Coverage for group plans is far more comprehensive and considerably less expensive because there are more people paying into the insurance pool making more money available group-wide to cover medical claims.

Those who try to get health insurance on their own, either because their employer does not offer this benefit or because they are self-employed or unemployed often have difficulty obtaining health insurance. Many simply cannot find an insurance company in their state that is willing to offer individual plans. Pre-existing conditions complicate this search and put individuals into a 'high-risk' category. It's often the reason coverage is denied.

Those who are fortunate enough to find individual coverage don't feel so fortunate once they review the policy details. They typically find that the cost is significant and the coverage less than desirable and loaded with out-of-pocket costs. Those who obtain health insurance on their own can usually purchase a family plan, but then the costs are even higher.

NEED Health Insurance? In addition to featuring the largest selection of major medical health plans from leading companies, also offers a wide selection of quality short term, student, and dental plans. You can obtain FREE instant quotes, side-by-side comparisons, the best available prices, online applications, and a knowledgeable Customer Care team to help you find the plan that is right for you.

Those individuals who are employed by small businesses, defined as having more than 2 but 50 or fewer employees, also find themselves in a difficult situation when it comes to health insurance. If the employer chooses to, it may offer a group type of health insurance to the employees. When applying for coverage, the overall costs will be based on the number and physical condition of all the employees who wish to participate. High risk individuals and those with pre-existing conditions will bump up the costs for everybody. Even so, the costs for this type of coverage will usually be better than if each employee obtained an individual policy. Employers are not required to cover other family members and can choose the percentage of the employee's costs that they will cover.

Group health insurance generally offers the best coverage at the most affordable price. Group insurance is available to all eligible employees of the company offering the health insurance and generally also to the employee's immediate family members, including spouse and/or children. A group plan must accept every eligible employee even if the person has a known pre-existing condition and even if that person or his/her family members fall into a high-risk category.

Whether you need private health insurance if you participate in a group health plan is not an easy question to answer. To adequately assess this situation, you've got to review your group insurance coverage and compare it to what you need. Some group health insurance plans exclude certain medical services such as dental and vision care, experimental treatments, cosmetic surgery, some mental and substance abuse therapies, and more so you may find you need to complement your group plan with a private health insurance plan. In doing so, you'll incur more costs so you'll have to weight the additional benefits against the additional costs to see what makes sense for you.

Posted by HealthInsurance at 06:24 PM | Comments (0)

June 15, 2006

Health Insurance Benefits

One thing that's important to understand when researching health insurance benefits is that each policy includes its own set. It's easy to make the mistake of assuming that features or health coverage exists when they don't. However, these types of assumptions not only are wrong, but they could one day leave you facing insurmountable medical bills.

The ideal personal or family health plan would pay for every health issue that may arise—pregnancy, blood transfusions, sick and well care, minor and major surgery, hospital stays, etc. But the truth is health insurance benefits typically are limited and they seldom will cover 100% of the costs, which is why it's so important to read the policy's fine print. You've got to know exactly what is and is not actually covered.

While health insurance benefits do vary from policy to policy, one thing that most health insurance companies are offering in their policies nowadays is something called preventative or 'well' care. Administrators realize that their overall medical costs can decrease significantly when those they cover seek routine medical treatment. Staying healthy by getting annual check-ups and regular immunization oftentimes helps prevent illnesses from developing in the first place. And identifying potential health issues early on, before they become difficult and expensive to treat is saving insurers money and saving lives.

Generally, the types of health insurance benefits that most policies cover in full or partially include: annual physical examinations, emergency/urgent care, laboratory work including blood testing and x-rays, prenatal care, well baby visits, an annual routine eye exam, and most care required while admitted into a hospital. Some plans even offer discounts on health club facilities and programs that help individuals stop smoking.

NEED Health Insurance? In addition to featuring the largest selection of major medical health plans from leading companies, also offers a wide selection of quality short term, student, and dental plans. You can obtain FREE instant quotes, side-by-side comparisons, the best available prices, online applications, and a knowledgeable Customer Care team to help you find the plan that is right for you.

While health insurance benefits are sometimes difficult to determine, those responsible for putting policies together often do a great job delineating the types of medical treatments and services that are not covered. This is typically an alphabetical, detailed listing of everything that is not covered under a policy, from acupuncture to vision correction treatments such as Lasik and radial keratoplasty. When selecting a health plan, don't forget to carefully review this section.

Dental care and vision/eye care beyond an annual eye examination are usually not included in health care plans in the USA. Coverage for these types of services is instead typically offered as separate plans with separate benefits, separate premiums and separate deductibles. They'll typically have different forms to use and different procedures to follow. Because of the soaring costs associated with prescription drugs, many insurers have eliminated this type of coverage from their health insurance benefits package. More and more, prescription drug plans are being offered separately in the same manner as dental and vision plans.

Finally, several states have developed unique state-mandated health insurance requirements for their residents. These are usually designed to be consumer-oriented to protect consumers from predatory practices. The requirements are not transferable from one state to another so when a person moves out of state, they lose them (or they gain them). That's why it's important to use your correct residential address to ensure that you receive the health insurance benefits you're entitled t

Posted by HealthInsurance at 06:09 PM | Comments (0)

June 13, 2006

The Difference between Health Insurance and Life Insurance

Health insurance protects the insured against incurring extensive medical expenses by offering full or partial coverage for certain medical treatments and procedures. Life insurance, on the other hand, is an insurance policy that pays out the face value of the policy, in a lump-sum payment, to the person designated as the beneficiary, upon the death of the insured.

There are two basic types of life insurance: whole life and term life. Term life insurance is by far the less expensive of the two because it offers just life insurance. A term life insurance policy can be purchased for as little as one year and for as long as 30 years. In order for the beneficiary to cash in on the policy, the insured must die sometime during the term. This is probably why so many people wait until they are older before purchasing life insurance.

Whole life insurance is a combination of a life insurance policy and an investment plan. The premium associated with the whole life policy is shared between the two with a portion going towards the life insurance premium and the balance being invested into whichever investment vehicle has been chosen: mutual fund, money market, stock and bonds, etc. The benefit of a whole life policy is that it forces the insured to save money for retirement by using a portion of the premium as investment money. In reality however, these policies are typically loaded with fees and commissions, and after taking these costs into consideration, it often is not the best use of an individual's investment dollars.

A life insurance policy is totally different from a health insurance policy and the price for each ultimately depends upon a person's age and physical well-being. In general, individuals who are young and healthy pay less than those who are older, and especially those who are older and in poor health.

NEED Health Insurance? In addition to featuring the largest selection of major medical health plans from leading companies, also offers a wide selection of quality short term, student, and dental plans. You can obtain FREE instant quotes, side-by-side comparisons, the best available prices, online applications, and a knowledgeable Customer Care team to help you find the plan that is right for you.

It's not possible to advise a person which is better, a health insurance policy or a life insurance policy. Many people obtain health insurance through their employer, and many employers also offer as a benefit the ability to purchase a low face value life insurance policy for a nominal cost. If this is your situation, it's advisable to take advantage of both these benefits.

Otherwise, deciding which insurance policies to purchase becomes more a matter of how much you can afford each month and your personal situation. It's advisable to choose health insurance coverage, even though it probably will be more expensive because it only takes one uninsured medical illness or accident to leave you with insurmountable medical bills. Also consider this. If you don't have health insurance, and your medical bills (and/or other bills) are considerable, it might be a good idea to purchase term life insurance with a face value high enough to pay off your bills and designate your spouse as your beneficiary. That way, your spouse won't have to worry about inheriting your sizeable debt!

Posted by HealthInsurance at 05:57 PM | Comments (0)

June 09, 2006

What is Health Insurance?

Health insurance coverage varies greatly, but basically it is a type of insurance policy that pays a pre-negotiated percentage of a policy holder's covered medical treatments. Do you really need health insurance or can you live without it? The answer depends on whom you ask and the question is not always an easy one.

Like other forms of insurance, health insurance doesn't really become an issue until you need it. Automobile insurance doesn't do you any good until you get into a car accident. Life insurance doesn't do you any good until you die. And health insurance doesn't do you any good until you need medical assistance. If you believe in Murphy's Law—that whatever can go wrong, will—then you probably should consider getting health insurance.

In some countries, health insurance is not offered by private companies like it is in the United States. In England, France, Canada, Sweden and Norway, for example, the doctors and hospitals are reimbursed by the government instead of an insurance company.

In the United States, there are three basic types of health insurance:

1) Self-Insured/Uninsured. This is where an individual has no insurance or has health insurance but is responsible for paying 100% of the insurance premium. This group is estimated to comprise at least 30% of the US population.

2) Managed Care Plans. Managed Care Plans fall into three categories. All are essentially networks to provide contracted services by specific providers at contracted prices:

i) Health Maintenance Organizations (HMO) are prepaid plans in which members pay a fixed monthly fee, regardless of how much medical care is needed in a given month. HMOs provide medical services ranging from office visits to hospitalization and surgery, and usually insist that you stay within the network when you need services from physicians and hospitals.

ii) Preferred Provider Organizations (PPO) are groups of doctors and hospitals that provide medical service only to specific groups. PPO members typically pay for services as they are provided, and the PPO sponsor typically reimburses the member for the cost of the treatment. In most cases, the price for each type of service is negotiated in advance by the healthcare providers and the PPO sponsor.

iii) Point of Service (POS) plans are not as common as the other two. This is a type of managed healthcare system in which you pay no deductible and usually only a minimal co-payment when you use a healthcare provider within your network. You also must choose a primary care physician who is responsible for all referrals within the POS network. If you choose to go outside of the network for healthcare, you will be subject to excess charges or deductibles.

3) Indemnity Plans enable participants to seek medical assistance whenever they need. Participants can visit any doctor or specialist, as often as they feel necessary. There are no restrictions when it comes to seeking medical help, but this is by far the most expensive type of health insurance plan.

Which of these types of health insurance is right for you will depend on your personal situation. Choosing health insurance coverage is a time-consuming task and it can certainly be frustrating, but it's something that everybody needs to consider sooner rather than later.

NEED Health Insurance? In addition to featuring the largest selection of major medical health plans from leading companies, also offers a wide selection of quality short term, student, and dental plans. You can obtain FREE instant quotes, side-by-side comparisons, the best available prices, online applications, and a knowledgeable Customer Care team to help you find the plan that is right for you.

Posted by HealthInsurance at 06:33 PM | Comments (0)