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Archive for the ‘Health Insurance’ Category

About 50 years ago, health insurance started to be an attractive incentive offered by employers to attract and keep good employees. Overall, group plans tended to be inexpensive for employers, with employees contributing a small amount of money or none at all to secure health insurance for themselves and their families.

It was more expensive for individuals to pay for non-group policies, but coverage was fairly affordable. Then medical costs started to rise, people started to live longer and the medical profession became adept at curing various diseases and saving and prolonging the lives of people with serious injuries and life-threatening illnesses. Health care and insurance prices started rising much more quickly than annual incomes and premiums began taxing both employers, who were paying the lion’s share of premiums, and for employees, to whom businesses often passed on costs through larger deductibles, greater out of pocket expenses and higher premiums.

According to a recent report by the MSNBC News Service, 41 percent of Americans whose income ranges from moderate to middle had no health insurance for at least part of 2005. In 2001, that number was much lower—28 percent. Additionally, more than 50 percent of uninsured Americans in 2005 found it difficult to pay their medical bills. Another alarming statistic—28 percent of Americans in 2005 had no health insurance, while 24 percent had none in 2001.

So, what should a person do if they don’t have any health insurance or if they have a choice between a cheap discount plan that does not cover core expenses and an affordable plan that may cost a bit more but also provides much better coverage? According to data from the U.S. Centers for Disease Control and Prevention, the majority of people who are not covered for important screening tests, such as a mammogram, colon cancer screening or a PSA test, will not undergo those exams. Also, close to 60 percent of people without health insurance missed treatment or did not buy medicine needed for a chronic condition.

All of these figures point to one thing—people who lack health coverage for essential services are often unable to pay for those services, putting them at greater risk for developing new or exacerbating existent health conditions.

What should you look for in a health insurance plan, especially when cost is an issue? It’s important that you get the best coverage you can afford. Skimping on premiums can save you money upfront, but the result can prove to be penny-wise and pound-foolish. Sometimes people can’t afford coverage and sometimes they believe because they are healthy that they simply don’t need it. However, healthy people get ill or are involved in serious accidents all the time. You never know when you’ll need coverage.

Some people opt for “catastrophic” insurance, which usually covers only major medical and hospital expenses above a specific deductible. Under such a plan, the insured pays for routine doctor visits and prescription drugs. With this type of plan, you’ll pay a low monthly premium but will also have a high deductible and limited coverage. Deductibles start at $500 per year but can be considerably more. If you purchase an inexpensive policy with a $10,000 deductible and you undergo surgery that costs $8,000, you must pay that $8,000. If your surgery costs $12,000, you would owe $10,000.

One insurance company offers a plan that costs $29 per month for a 21 year-old, non-smoking female. There’s a yearly $250 deductible and $2,500 in out of pocket expenses that the insured must pay before the policy kicks in. Hospital, surgical and x-ray expenses are covered but other costs, such as doctor visits, prescription drugs, maternity care and mental healthcare are not included. There’s a lifetime maximum of $1 million.

It’s certainly a bargain, if you don’t plan on going to the doctor very often. To enroll in a plan that will cover doctor visits, prescriptions, maternity expenses and more could easily cost $400 per month—a jump of $371 every 30 days for a total cost of $4,800 per year!

Group health insurance plans, which you can usually enroll in through your employer, union or guild, are the best buy. Individual plans, especially those that offer comprehensive coverage, can be crippling to many people’s pocketbooks. When buying health insurance, it’s important to shop around. Your choice of what type of plan you purchase will be determined by what you can afford and what you need as far as insurance is concerned. There’s no right or wrong choice when it comes to health insurance but at the very least you should have catastrophic insurance.

There are basically three types of plans—Fee-For-Service, Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). Fee-For-Service plans offer the most choice regarding doctors and hospitals but they often involve quite a bit of paperwork and are the most expensive. If you’re willing to give up some or a lot of choice, do less paperwork and save some money on premiums then either a HMO or a PPO is for you.

A HMO offers the least amount of choice, involves co-pays, has the least amount of paperwork and is the cheapest of the three types of insurance. A PPO combines some elements of Fee-For-Service and a HMO. You’ll have more choice than you would with a HMO but less than you would with a Fee-For-Service plan. It tends to be more expensive than a HMO but less expensive than Fee-For-Service. All three types of insurance have some aspect of Managed Care—which determines how much health care you can use—attached to them, with Fee-For-Service having the fewest restrictions and a HMO being restricted the most.

When shopping for health insurance ask the following questions—

* How much is the premium?
* What services are covered?
* What are the total deductible and out of pocket expenses per year?
* How much are the co-pays?
* What is the maximum lifetime benefit?
* How much freedom will you have when choosing doctors and hospitals?
* What are the pre-approval procedures for seeing specialists, undergoing a procedure or being given a test?
* What prescription drugs are covered and to what degree?
* Is mental health covered and to what degree?
* Is dental covered and to what degree?

As you begin to narrow down your choices, you can look more closely at specific plans that seem to fit your needs and determine which offer you the best value for your dollar?

America has one of the finest healthcare systems in the world and one of the most complex health insurance systems across the globe. Often, they seem to be at odds with one another, unable to communicate and work together. That can be one of the most frustrating parts of anyone’s foray into the world of healthcare professionals, hospitals and health insurance companies. For this reason alone, it’s important that you carefully and thoughtfully choose your healthcare benefits provider.

You almost have to take out a loan to pay for health insurance these days. Even if your company pays for half or more of your premium, a premium for a family still runs at least two to three hundred dollars a month. This is ridiculous, especially for people that do not visit the doctor very often. However, everyone is worried that if they do not have health insurance, then they will need it and they will not be able to get the help that they need, or they will get substandard healthcare because they do not have insurance. Many factors have surfaced over the years that cause health insurance to continue to stay on the rise.

One of the major problems that cause health insurance to continue to rise is the amount of frivolous malpractice lawsuits that are filed against doctors every year. Even if a doctor does not do anything wrong, they still have to pay the court costs, which usually are paid for out of their malpractice insurance. And if a doctor does make a mistake they can pay ten’s of millions of dollars in damages. All of this causes doctor’s to pay more for malpractice insurance, which translates into higher costs to their patient’s so they can continue to survive. One of the best ideas I have heard to help combat this problem, is legislature that puts a cap on monetary awards that are awarded for punitive damages in these lawsuits. Anything over the cap will be given to the state to help pay for schools, roads, and other things for the community. This will slow people down who want to sue just to get rich quick, but will still allow people to sue if a wrong has truly been committed.

Another major problem that causes health insurance problems is the ability of health insurance companies to get out of paying the full amount requested by a doctor. Health insurance companies rarely pay half of what a doctor’s office requests, so the doctor’s office usually has to eat the lost costs. This causes doctor’s offices to raise their prices to help shoulder the burden of these lost profits. An easy solution would be to implement some kind of regulations that would allow doctor’s offices to collect the full amount for a visit. These regulations would force health insurance companies to pay the amount that doctor’s charge, thus lowering the prices of doctor’s visits for all of their patients.

Around 7 million people in the UK are covered by health insurance, the majority being covered through their employers. The problem is that few have really studied their policy documents and many misunderstand what is covered. And perhaps just as important, what isn’t. If you expect health insurance to pay all your health costs, you’re mistaken.

Health insurance is designed to provide protection for curable, short-term health problems and allow policyholders to jump the NHS queues to see consultants, be diagnosed, receive surgery or be treated. That sounds fine, but before you buy you need to appreciate the treatments and situations that fall outside the scope of the cover.

But first a word of warning. This article does not relate to any specific policy and the terms and conditions issued by individual insurers do vary. So please ensure you also check your policy documents. After reading this article, you’ll know what to look out for!

Sorry – it’s a chronic condition

If a condition can be cured and is not a long-term problem, your insurance company will classify it as acute and should meet the cost. If your problem is incurable or it’s a problem that, despite appropriate treatment, will be with you for a long time, then your insurance company will classify it as chronic – and no, you won’t be covered.

But drawing a firm line between what is acute and what is chronic is fraught with problems, and leads to the biggest area of conflict between insurer and policyholder.

Everyone agrees that diabetes and asthma are chronic conditions as you’re likely to suffer from them for the rest of your life. So those sorts of condition are not covered.

Problems arise when the medical team initially considers a patients’ illness to be curable, but the condition subsequently deteriorates and the doctors change their mind, it’s now become incurable. This can happen especially in the treatment of some types of cancer.

In these circumstances, the condition is initially defined as acute and is therefore insured, but deteriorates and becomes chronic – and outside the terms of cover. This is possible as insurers retain the right to reclassify a condition from acute to chronic during treatment.

Sorry – it’s too long term
The insurance company will not pay out for long term treatment. But you need to check your policy documents to see how they define “long-term”. You can find the situation where a course of drugs extends for say 12 months, but the insurer will only pay for ten months.

Sorry – it’s preventative
Your insurance is designed to pay for the treatment and cure of conditions when they arise. It is not designed to pay for treatments that are used to prevent an illness.

Again, the problem of definition arises. Sometimes it is arguable whether a treatment is preventative or a cure. Take the drug Herceptin for example. This drug can be used in the early stages of breast cancer. Research shows that Herceptin can halve the incidence of cancer returning for women who have a particularly virulent form of the cancer known as HER2. In this situation, is Herceptin offering a cure or is it a preventative?

Insurance companies are split on the debate. Norwich Union, WPA, BUPA and Standard Life Healthcare will pay for Herceptin for HER2 patients whereas Legal and General and Axa PPP will not.

Sorry – the drug is not approved
Two of the main attractions for taking out health insurance are: to jump the queues at the NHS, and to get the latest treatments and drugs. But there’s a rider.

Unless the drug has been approved for use by the NHS in England and Wales, by the Institute for Health and Clinical Excellence, your insurer is unlikely to approve its use. The problem is that the Institute’s brief is not simply to decide whether a drug works, but to carry out a cost/benefit analysis to ensure that the benefits to the nation outweigh the financial costs of using it in the NHS. Not an easy brief – and one that has placed the Institute under scrutiny for the extended delays in drug approval.

The compromise hit on by the Financial Ombudsman is that if a health policy won’t pay for the use of experimental treatments, then it should meet the cost of an approved conventional treatment with the policyholder footing the bill for the balance if the experimental treatment is more expensive.

Sorry – it’s a pre-existing condition

The basic principle is that if you are already suffering from a condition when you start a policy, then that condition “pre-exists” the policy and any claims for its treatment are invalid.

For this reason, insurance companies insist you complete an exhaustive questionnaire before they agree to insure you. After all they need a clear picture of your medical condition before they quote. For many applications, the insurer will, with your approval, also write to your GP for specific details of your medical history. They like to have a complete picture.

So lets say some years ago you injured your knee playing football. It appeared to recover but now it turns out that you have a torn cartilage and need an operation. The insurer could argue that this is a pre-existing condition and you have to pay for its’ treatment.

Some insurers try to accommodate these grey areas with a moratorium provision within your policy. These provisions typically say that so long as you have been symptom free for two years relating to any condition you’ve suffered from within the last 5 years, then they will pay for subsequent treatment. Not all policies have these moratorium provisions and the time periods do vary between insurers. You should carefully read your policy.

Sorry – its not covered

Health Insurance is an annual contract – just like your car insurance. So when it comes to renewal, your insurer is at liberty to review not only your premium but also change the conditions on which your cover is provided.

Therefore, if your policy comes up for renewal mid way through a course of treatment, it’s possible to find that your new policy no longer covers that particular treatment. This means that you will have to foot the bill for the balance of the treatment.

Furthermore, with ongoing advances in medical research, more and more conditions are becoming treatable. This progress has the effect of shifting back the dividing line between chronic and acute conditions.

This hits the insurers’ pocket in two ways. With more conditions being reclassified as acute, the number of claims is increasing. And there’s also a trend for new treatments to cost more – Herceptin being a good example. The net result is that the insurers are finding themselves having to pay out far more. This is inevitably passed back to you through increased renewal premiums. And in an attempt to reduce their risk exposure, insurers have a tendency to adjust their definitions and exclusions. This means that you must read your renewal notice closely before you decide to renew.

So when you are considering Health Insurance, be aware that everything is not always black and white. And if you’ve got insurance and need treatment, always contact your insurer without delay and get them to confirm that your treatment is indeed covered

Health Insurance is the only solution for increasing health care cost in todays world. It is an absolute necessity to have a good health insurance as it will help keep you and your family safe and insure that you do not get engulfed with health care bills if one of you should have an accident or have grave health issues.

Many people do not get insured because they think that it is a waste of money and consider health insurances to be very costly. But the fact is that it is not that costly and you can get health insurance for a fair amount of money.

The simplest and cheapest way of getting a good health care insurance is through your employer. But you must understand that when you leave that job you may lose the coverage. Other way of getting health care insurance is through a personal plan. Entrepreneurs & people whose employers do no offer coverage, acquire this kind of insurance. This kind of insurance policy will come out of your pocket, but the cost of insurance is much cheaper than bearing your own medical costs.

If you have to go with a personal health insurance then be sure to shop around to ensure you get the best coverage for the really best price. There are numerous insurance companies offering different health/medical insurance plans but before you choose one, you need to think of few important things like general state of your health, your age, any medical problem history, your boozing and smoking habit etc. If you are going for family cover, then your will need to find these details for each member and then think carefully what kind of coverage you want. Do not conceal any medical problem from insurance company as bearing a claim denied later because you had failed to disclose medical truth to the insurance company would be far more displeasing – and very expensive.

A careful study of above mentioned factors will help you decide the kind of coverage you need and where you can cut the expenses of premium. This might appear like a boring process, but it will assist you considerably in ascertaining appropriate and affordable health insurance and making sure your healthcare needs can be met by the medical insurance you select.