I’ve been a health insurance broker for on the decade and every day I read increasingly more “horror” stories that are posted on the web regarding health insurance businesses not paying claims, refusing to pay for specific illnesses and doctors not getting reimbursed with regard to medical services. Unfortunately, insurance providers are driven by earnings, not people (albeit they require people to make profits). When the insurance company can look for a legal reason not to pay for a claim, chances are they’ll find it, and you the customer will suffer. However, what most people neglect to realize is that we now have very few “loopholes” in an insurance plan that give the insurance provider an unfair advantage within the consumer. In fact, insurance providers go to great measures to detail the limitations of the coverage by giving the actual policy holders 10-days (a 10-day free look period) to examine their policy. Unfortunately, many people put their insurance cards within their wallet and place their policy inside a drawer or filing cabinet throughout their 10-day free look also it usually isn’t until they get a “denial” letter from the insurance provider that they take their policy out to actually read through it.
Most people, who buy their own medical health insurance, rely heavily on the insurance professional selling the policy to describe the plan’s coverage as well as benefits. This being the situation, many individuals who purchase their very own health insurance plan can let you know very little about their own plan, other than, what they pay within premiums and how much they need to pay to satisfy their own deductible.
For many customers, purchasing a health insurance policy by themselves can be an huge undertaking. Purchasing a medical health insurance policy is not like purchasing a car, in that, the customer knows that the motor and transmission are regular, and that power home windows are optional. A medical health insurance plan is much much more ambiguous, and it is often very hard for the consumer to determine which kind of coverage is standard and the other benefits are optional. For me, this is the primary reason that many policy holders don’t realize that they don’t have coverage for a particular medical treatment until they get a large bill from a healthcare facility stating that “benefits had been denied. ”
Sure, all of us complain about insurance businesses, but we do realize that they serve a “necessary bad. ” And, even though purchasing health insurance can be a frustrating, daunting and time intensive task, there are certain things that can be done as a consumer to ensure you are purchasing the kind of health insurance coverage you actually need at a reasonable price.
Dealing with small businesses and the self-employed marketplace, I have come to the realization that it’s extremely difficult for individuals to distinguish between the kind of health insurance coverage they “want” and the advantages they really “need. inch Recently, I have read numerous comments on different Weblogs advocating health plans that provide 100% coverage (no insurance deductible and no-coinsurance) and, although I agree that those kinds of plans have a excellent “curb appeal, ” I will tell you from personal experience these plans are not for everybody. Do 100% health plans provide the policy holder greater satisfaction? Probably. But is a 100% medical health insurance plan something that most consumers actually need? Probably not! In my personal professional opinion, when you buy a health insurance strategy, you must achieve the balance between four essential variables; wants, needs, danger and price. Just as if you would do if you had been purchasing options for a brand new car, you have to weigh each one of these variables before you spend your hard earned money. If you are wholesome, take no medications and rarely navigate to the doctor, do you actually need a 100% plan having a $5 co-payment for prescription medications if it costs a person $300 dollars more per month?
Is it worth $200 more a month to possess a $250 deductible and the $20 brand name/$10 universal Rx co-pay versus an 80/20 plan having a $2, 500 deductible that offers a $20 brand name/$10generic co-pay once you pay a one per year $100 Rx deductible? Wouldn’t the 80/20 plan still provide you with adequate coverage? Don’t you think it might be better to put which extra $200 ($2, 400 per year) in your money, just in case you might have to pay your $2, 500 deductible or purchase a $12 Amoxicillin prescription? Isn’t it wiser to maintain your hard-earned money instead of pay higher premiums for an insurance company?
Yes, there are many methods for you to keep more of the cash that you would normally share with an insurance company as higher monthly premiums. For instance, the federal government encourages consumers to buy H. S. A. (Health Cost savings Account) qualified H. Deb. H. P. ‘s (High Deductible Health Plans) so that they have more control over how their healthcare dollars are spent. Customers who purchase an HSA Competent H. D. H. G. can put extra money aside every year in an interest bearing account to allow them to use that money to cover out-of-pocket medical expenses. Even procedures which are not normally covered by insurance providers, like Lasik eye surgical treatment, orthodontics, and alternative medications become 100% tax insurance deductible. If there are absolutely no claims that year the cash that was deposited to the tax deferred H. Utes. A can be rolled over to another year earning an even higher interest rate. If there are no significant claims for quite some time (as is often the actual case) the insured eventually ends up building a sizeable accounts that enjoys similar tax benefits like a traditional I. R. The. Most H. S. The. administrators now offer a large number of no load mutual money to transfer your They would. S. A. funds into to help you potentially earn an even higher interest rate.
In my experience, In my opinion that individuals who buy their health plan depending on wants rather than needs have the most defrauded or “ripped-off” by their insurance provider and/or insurance agent. Actually, I hear almost identical comments from nearly every business owner that I talk to. Comments, such as, “I need to run my business, I do not have time to be ill! “I think I have attended the doctor 2 times within the last 5 years” and “My insurance provider keeps raising my prices and I don’t use my insurance! ” Like a business owner myself, I will understand their frustration. Therefore, is there a easy formula that everyone can follow to create health insurance buying simpler? Yes! Become an KNOWLEDGEABLE consumer.
Every time I contact a possibility or call one associated with my client referrals, I ask a number of specific questions that directly connect with the policy that specific individual currently has within their filing cabinet or bureau drawer. You know the policy they bought to protect them from needing to file bankruptcy due in order to medical debt. That policy they purchased to pay for that $500, 000 life-saving organ transplant or even those 40 chemotherapy treatments that they might have to undergo if they are identified as having cancer.
So what do you consider happens almost 100% of times when I ask him or her “BASIC” questions about their medical health insurance policy? They do not really know the answers! The following is a summary of 10 questions that We frequently ask a prospective medical health insurance client. Let’s see the number of YOU can answer without taking a look at your policy.
1. What Insurance provider are you insured with and what’s the name of your wellbeing insurance plan? (e. grams. Blue Cross Blue Shield-“Basic Blue”)
two. What is your season deductible and would you need to pay a separate deductible for every family member if everyone inside your family became ill simultaneously? (e. g. The most of health plans have the per person yearly insurance deductible, for example, $250, $500, $1, 000, or even $2, 500. However, some plans will only need you to pay a 2 person maximum deductible every year, even if everyone inside your family needed extensive health care. )
3. What is your coinsurance portion and what dollar quantity (stop loss) it is dependant on? (e. g. A great plan with 80/20 protection means you pay 20% associated with some dollar amount. This dollar amount is also called a stop loss and can vary in line with the type of policy you buy. Stop losses can be less than $5, 000 or $10, 000 or around $20, 000 or there are several policies on the market which have NO stop loss buck amount. )
4. What’s your maximum out of pocket expense each year? (e. g. All deductibles in addition all coinsurance percentages in addition all applicable access costs or other fees)
5. What’s the Lifetime maximum benefit the insurance provider will pay if you feel seriously ill and will your plan have any kind of “per illness” maximums or even caps? (e. g. Some plans might have a $5 million life time maximum, but may possess a maximum benefit cap associated with $100, 000 per sickness. This means that you would need to develop many separate as well as unrelated life-threatening illnesses priced at $100, 000 or less to be eligible for a $5 million of life time coverage. )
6. Is the plan a schedule strategy, in that it only pays a specific amount for a specific listing of procedures? (e. g., Super Life & Health & Midwest Nationwide Life, endorsed by the National Association from the Self-Employed, N. A. Utes. E. is known with regard to endorsing schedule plans) 7. Does your plan have doctor co-pays and therefore are you limited to a particular number of doctor co-pay visits each year? (e. g. Many plans have a limit of the number of times you navigate to the doctor per year for any co-pay and, quite the limit is 2-4 appointments. )
8. Does your plan provide prescription drug coverage and when it does, do you pay a co-pay for the prescriptions or is it necessary to meet a separate drug deductible before you decide to receive any benefits and/or would you just have a low cost prescription card only? (e. grams. Some plans offer you prescription benefits immediately, other plans require that you simply pay a separate drug deductible before you receive prescription medication for any co-pay. Today, many plans offer absolutely no co-pay options and only will give you discount prescription card that provides you a 10-20% low cost on all prescription medications).
9. Does your plan have any decrease in benefits for organ transplants and when so, what is the optimum your plan will pay if you want an organ transplant? (e. grams. Some plans only spend a $100, 000 obtain the most for organ transplants for any procedure that actually costs $350-$500K which $100, 000 maximum may likewise incorporate reimbursement for expensive anti-rejection medications that must definitely be taken after a transplant. If this is actually the case, you will often have to cover all anti-rejection medications from pocket).
10. Do you need to pay a separate insurance deductible or “access fee” for every hospital admission or for every emergency room visit? (e. grams. Some plans, like the Assurant Health’s “CoreMed” plan possess a separate $750 hospital admission fee that you simply pay for the first 3 days you’re in the hospital. This fee is along with your plan deductible. Additionally, many plans have advantage “caps” or “access fees” with regard to out-patient services, such because, physical therapy, speech treatment, chemotherapy, radiation therapy, and so on. Benefit “caps” could be less than $500 for each out-patient remedy, leaving you a bill for that remaining balance. Access fees are additional fees that you simply pay per treatment. For instance, for each outpatient chemotherapy remedy, you may be necessary to pay a $250 “access fee” for each treatment. So for forty chemotherapy treatments, you would need to pay 40 x $250 = $10, 000. Once again, these fees would be charged along with your plan deductible).
Since you’ve read through the listing of questions that I ask a prospective medical health insurance client, ask yourself how many questions you could answer. If you couldn’t solution all ten questions you shouldn’t be discouraged. That doesn’t mean that you’re not a smart customer. It may just imply that you dealt with a “bad” insurance professional. So how could you tell should you dealt with a “bad” insurance professional? Because a “great” insurance professional would have taken the time that will help you really understand your insurance coverage benefits. A “great” agent spends time asking questions so s/he may understand your insurance requirements. A “great” agent recommends health plans depending on all four variables; desires, needs, risk and cost. A “great” agent provides you with enough information to weigh all your options so you could make an informed purchasing choice. And lastly, a “great” agent looks out for the best interest and NOT the very best interest of the insurance provider.
So how do you know for those who have a “great” agent? Simple, if you were in a position to answer all 10 questions without taking a look at your health insurance plan, you have a “great” broker. If you were able to answer nearly all questions, you may possess a “good” agent. However, if you were just able to answer a few pre-determined questions, chances are you possess a “bad” agent. Insurance agents are no diverse from any other professional. There are several insurance agents that really worry about the clients they use, and there are additional agents that avoid responding to questions and duck client telephone calls when a message is actually left about unpaid claims or skyrocketing medical health insurance rates.
Remember, your health insurance purchase is equally as important as purchasing a home or a car, or even more important. So don’t be scared to ask your insurance agent lots of questions to make certain that you understand what your wellbeing plan does and doesn’t cover. If you don’t feel comfortable with the kind of coverage that your agent suggests or if you feel the price is excessive, ask your agent if s/he can pick a comparable plan to help you make a side by side comparison before you decide to purchase. And, most significantly, read all of the “fine print” inside your health plan brochure so when you receive your plan, take the time to see through your policy on your 10-day free look time period.
If you can’t realize something, or aren’t quite certain what the asterisk (*) alongside the benefit description really means when it comes to your coverage, call your agent or contact the insurance provider to ask for additional clarification.
Furthermore, take time to perform your own research. For example, if you research SUPER Life and Health or even the Midwest National Life insurance coverage company, endorsed by the National Association for that Self Employed (NASE), you will discover that there have already been 14 class action lawsuits brought against these businesses since 1995. So think about, “Is this a company which i would trust to pay my medical health insurance claims?
Additionally, find out in case your agent is a “captive” broker or an insurance “broker. inch “Captive” agents can just offer ONE insurance corporation’s products. ” Independent” agents or even insurance “brokers” can provide you with a variety of different insurance coverage from many different insurance providers. A “captive” agent might recommend a health strategy that doesn’t exactly be practical because that is the only real plan s/he can market. An “independent” agent or even insurance “broker” can usually provide you with a variety of different insurance coverage products from many quality carriers and may often customize a intend to meet your specific insurance coverage needs and budget.
Through the years, I have developed powerful, trusting relationships with my clients due to my insurance expertise and the amount of personal service that We provide. This is among the primary reasons that I actually do not recommend buying health insurance on the web. In my opinion, there are too numerous variables that Internet insurance coverage buyers do not often consider. I am a firm believer that the health insurance purchase requires the amount of expertise and personal interest that only an insurance broker can provide. And, since it doesn’t cost a penny more to buy your health insurance through a real estate agent or broker, my advice is always to use eBay and Amazon for the less important purchases and to utilize a knowledgeable, ethical and reputable impartial agent or broker for probably the most important purchases you may ever make…. your medical health insurance policy.
Lastly, if you’ve any concerns about an insurance provider, contact your state’s Department of Insurance Before you decide to buy your policy. Your state’s Department of Insurance can let you know if the insurance company is registered inside your state and can additionally tell you if there has been any complaints against that company which have been filed by policy cases. If you suspect that the agent is selling you a fraudulent insurance plan, (e. g. you have to enroll in a union to be eligible for a coverage) or isn’t being honest along with you, your state’s Department associated with Insurance can also determine if your agent is licensed and whether there has ever already been any disciplinary action formerly taken against that broker.
In closing, I hope I possess given you enough information to help you become an INFORMED insurance coverage consumer. However, I remain convinced how the following words of wisdom still complement way: “If it sounds too good to become true, it probably is actually! ” and “If you simply buy on price, you receive what you pay with regard to! ”
©2007 Small Company Insurance Services, Inc. http: //www. smallbusinessinsuranceservices. com
D. Steven Tucker, is the President of Small company Insurance Services, Inc. and is a Licensed Mult-State Insurance Broker serving the little business and self-employed market for on the decade. Mr. Tucker believes the best insurance consumer makes the very best health insurance purchasing choices. Mr. Tucker has written several articles that concentrate on small business health insurance coverage, which can be read on numerous web sites.
Mr. Tucker’s blog could be read at http: //www. smallbusinessinsuranceservices. vox. com
For those who have general questions regarding medical health insurance, or you are on the market to purchase a medical health insurance plan, you can get in touch with Mr. Tucker through his site at [http://www.smallbusinessinsuranceservices.com],
via E-mail at smallbusinssvcs@aol. com or even by plone, toll-free from 1-866-SBIS123 (724-7123)