Category Archives: Health Insurance

Health Insurance Limitations

Health insurance often requires a mountain of paperwork that has a lot of fine print. Unfortunately, this means that few people read their plans thoroughly nor do they fully understand what their plan covers or does not cover. Here are some common limitations in health insurance coverage that you should know.

Some of the most shocking health insurance limitations are found in the the fine print holes in the insurance policy. For instance, many people have found that their health insurance did not cover a routine or necessary medical procedure because they did not receive an authorization code prior to the procedure or the hospital did not correctly fill out the paperwork. Your medical claim can be denied simply because the hospital used odd codes for your treatment. While any claims denied by the insurance company can be disputed, this process is not only tedious, but time-consuming and draining, especially for someone who is already ill. There is also little success in winning disputed claims, which makes this option rather limiting.

Another surprising health insurance limitation happens more often than people realize. Imagine this situation: you are diagnosed with a medical condition and need an operation. You research surgeons and hospitals within your plan. You understand your plan’s coverage of hospital care. You have your operation and then you find a massive medical bill in the mail. Apparently your health insurance did not cover the anesthesiologist or other specialists that may have consulted in your operation. Thus, you have to pay these specialists for their services, even though you were under the impression that your plan would cover these costs associated with the surgery. Such a bill can be in the thousands of dollars, and there is little you can do to dispute the charges. The only way to avoid these charges is to make sure that you ask before the operation who will be involved and ensure that they are covered in your health insurance plans.

Other limitations are put on a number of treatments. For instance, you may need physical therapy or visits to a psychiatrist. Many health insurance plans will put a limit on the number of covered visits for such medical treatment. Without realizing it, you may surpass the maximum visits allowed by your health insurance and end up racking up huge bills.

Many people think that buying health insurance will cover them medically, but this is only correct to a point. When securing insurance, you should read through your health insurance package carefully, and when you are about to undergo any expensive medical procedure, be sure to consult your health insurance plan first.

Value Your Health-Buy Insurance

Many feel that health insurance is a waste of money. These people are often quite healthy and have no need to see their physician beyond yearly check-ups. However, health insurance is extremely important because it not only offers you protection from harmful illnesses or diseases and creates a better quality of life, but it can protect you from financial devastation in the case of an emergency.

One of the most crucial reasons to have health insurance is to cover the costs of medical bills – emergency or non-emergency. Without health insurance, you may be tempted to not see a doctor about medical issues you have, or you may assume that they are not serious. Both of these options are harmful and unwise as medical issues will often progress and become worse over time.

Insurance is often about ensuring you are covered in an emergency situation. For instance, you carry automobile insurance so that if you ever get into an accident, you will not be responsible financially. Health insurance works in much the same way, but it is also used to cover basic medical expenses and sometimes even preventative care depending upon your insurance provider. This can increase or improve your quality of life by allowing you to be proactive in your health care instead of simply reacting to medical issues that may arise.

Furthermore, the costs of medical procedures and consultations have increased with time. Even a routine outpatient procedure, like the removal of gall bladder stones, can be a costly medical expense. Even a short visit to a specialist for diagnosis can be extremely expensive. Emergency medical issues or the development of possibly fatal or debilitating illnesses are one reason to have health insurance. The expenses to treat these medical issues can cost hundreds of thousands dollars and pull you into a financially disastrous situation. With late fees and minimum payments, you may never be able to pay off your medical bills, and hospitals and doctors will often send collection agencies after you. This is not only inconvenient, but can also can ruin your credit and make it impossible to rent an apartment or buy a car.

As you can see, health insurance is very important. It will not only improve your quality of life and ensure that you are in top-notch health, but it can save you money in the long-run. When you consider what in your life is most important, your health has to be on the top of the list. If you protect your possessions or your home with insurance because of their value, then you should insure your health as well. After all, isn’t your health valuable too?

Avoiding Insurance Fraud

Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not understand what health insurance fraud entails, though. With reports estimating health insurance fraud is a $30 billion to over $100 billion industry per year, the topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and its consequences. By doing so, you are more able to recognize and fight fraud.

Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Essentially this means that you assert that you paid for certain medical procedures or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud is to conceal pre-existing conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may think that this is a small issue in comparison to your sister receiving treatment, it is actually very serious to your health insurance company and industry, and will result in fines and possible imprisonment if your are caught.

Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company’s investigation.

Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear – along with the money you have been paying in premiums.

The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember – it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.

The Importance of Good Records

Keeping your own records of any medical care that you and your immediate family have received is the only way to be sure that your insurance and bills are free from mistakes. It may seem unimportant now, but later in life when you try to get life insurance or get treatment that is appropriate for you, the importance will be in the spotlight. Everything from your allergies to your payment records with medical facilities can hurt you if they are wrong in your report. You could be given improper treatment or even denied treatment at all. By keeping your own records, you can dispute anything that is false.

Would you believe that you could be denied a job because of something erroneous on your medical records? It is true; if you are reported to have a disability, whether it is true or not, you could be turned down. You would be labeled as a risk, especially if the company offers insurance; they would know that you are going to cost more money to employ. The same goes for applying for health insurance where your medical records show that you would require prescription drugs, doctor visits, and increased chance of emergencies. It is quite the ordeal if you do in fact have a disability, but imaging if you did not have one at all-you would be turned down for insurance, while also being completely ineligible for disability financial help.

An example of a mistake that could be made on your record would be a diagnosis error. Perhaps you request that your doctor check a suspicious lump in your breast. On the first visit he may suspect that it is cancer. Most people will get a second opinion or go for a more thorough conclusive examination. If the second doctor decides that it is only a cyst and has it removed, your personal records would show that you are cancer-free. However, if this visit was documented incorrectly, or not at all, you may have trouble getting insured and not know why. If you had a record of the second visit that found the cyst, this situation would be easily disputed and your record would be accurate.

Human error is simply a part of life, even on medical documents. It is important to always keep your own records so that insurance companies get accurate information about you and your health condition. If you are being turned down for insurance and do not know why, you are best advised to be sure that you are not being misrepresented within your medical records. This problem can be cleared up quickly and easily if you are responsible enough to keep your own personal records.

Ways of Paying for Health Insurance

When it comes to health insurance, many people don’t exactly know everything that there is to know about the subject. That only stands to reason, it is not something that is easily understood because of its complexity. For instance, when you visit the doctor you may be asked to pay something that is called the “co-pay”, and other times you may not have to do anything at all depending on your plan. Let’s look at some of the ways that health insurance is paid for.

Often times, your employer will sponsor your insurance and you only have to pay what is known as a “co-pay” or co payment. The co-pay is a set amount that is determined by your insurance company when you receive covered services. This is a significantly smaller fee than you would be paying without the co-pay. Many companies offer this type of payment option because it is easier on the employee to pay this way.

You may consider opening what is known as a Healthcare Savings Account (HSA). This will assure that you always have a location in which to retrieve payments for various medical expenses. The HSA is a pre-tax savings account where a portion of your pre-tax income, determined by you, is deposited into an account automatically. Since this account comes from your paycheck pre-tax, that means it will lower your overall taxable income. This means you are saving money in terms of taxes and saving lots of money towards your overall health care costs.

For certain disabled individuals and those above the age of 65, Medicare is also another way to pay for health insurance. While they will not pay all of your healthcare expenses, they will pay for most of them. Medicare, however, doesn’t cover prescription drugs and nursing homes. It is important that you check the different types of restrictions that may apply. There are low-cost prescription discount cards that have been proven to save people who require costly medications on a regular basis over 50% of what they would have been paying without any health care.

Paying for health insurance doesn’t have to be complicated as long as you understand just what is going on in terms of where you stand with your plan. Discuss any questions you may have about the plan before committing to one. While one plan may be right for many people, it does not always mean that it will fit your specific needs.

Health Insurance and Retirement

Health insurance for retirees or senior citizens can be confusing, especially with so many options and requirements. However, health insurance is crucial for retirees. As you grow older, your health obviously becomes more of an issue; you may visit the doctor more, need to fill more prescriptions, or even receive in-home care. Before you retire, prepare for health insurance to ensure that you receive the best benefits.

The first step in planning your health insurance coverage in your retirement is to see if your employer offers insurance coverage after you retire. If the company does, you should certainly consider it. Look at the plan, the deductible, and the coverage. Many near-retirees believe that Medicare will cover their medical payments, but this is not always the case. With this sort of coverage, you will most likely receive better health care but at a more expensive cost. As a retiree, you will certainly have a health insurance budget to maintain, and you will have to decide if the cost of your employer’s insurance is too expensive.

If your employer does not offer coverage, Medicare will be an important and integral part of your health insurance if you are 65 years of age or older. Medicare works like traditional health insurance plans in that you have been contributing a small portion of every paycheck you earn into this plan. Once Medicare begins, you will make co-payments for office visits or treatment. Medicare will also cover the expense of certain medical equipment or needs.

However, Medicare did not cover a number of items that are typical of health insurance. The government recently updated Medicare and divided it into three parts: Part A, B, and C. Part A covers hospital care, such as home health care, hospital stays, and hospice care. This part does not require a premium. Part B covers the more routine medical expenses, such as office visits and laboratory tests, while Part C enrolls you into a fee-for-service or managed care plan that reduces your out-of-pocket costs. Despite these different options, Medicare restricts your coverage by not covering certain kinds of care or illnesses and diseases. Thus, there is also Medigap coverage, which helps fill in the gaps in health insurance that Medicare leaves. Medigap coverage differs from state to state and has different payments.

Beyond Medicare and Medigap, there are also long-term care insurance plans that you can buy. You often see these plans advertised on the television at very low prices. These plans can help cover the costs of a nursing home or home health care. With so many different options and limitations, if you are retiring soon, you should take a look at your budget and what you can afford as well as what sort of coverage you feel you will need.