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Health Insurance Policy Data

When you purchase a health insurance policy, shop online for rate quotes, coverage limits, and complaint information, indicating the reputation of the insurance company underwriting your policy. Don’t rely solely on the advice of insurance agents, as they’re paid on a commission basis. The most expensive plan may not offer the best quality of care, and the cheapest health plan may not cover the benefits you need. How much are the monthly premiums, and is there a deductible that you must pay out of pocket, in the case of treatment? Is there a hospital, physician, and pharmacy network that the policy limits you to, and if you need to choose a new primary care physician, are there enough doctors in your area that are accepting new patients? What health care services does the policy cover, and what is excluded?

Fill out the health insurance application accurately, because if you knowingly provide incorrect or incomplete information, especially about a pre-existing condition, your coverage can be cancelled later when you most need it. Make certain that your new policy contains the deductible you have selected, the amount of insurance coverage purchased, the full name of the insurance company, as well as the effective date and expiration. Never sign a partially blank form or pages with wording that you do not fully understand. Keep a copy of all signed insurance documents in a safe place, as your signed insurance policy is a legal contract establishing your rights and the insurance company’s liability in the case of a claim.

A supplemental health insurance policy will cover health costs that your primary health insurance policy doesn’t. It will pay limited benefits, such as a daily dollar amount if you are hospitalized, or a set sum if you are diagnosed with a disease. Discount plans, on the other hand, are not health insurance. Watch out for discount plans and limited benefit plans, as they don’t most basic health care services.

Health Insurance Coverage

Health insurance policyYour health insurance policy only pays for services that are medically necessary, such as hospital care, visits to your primary care doctor and specialist procedures, like emergency and urgent care, occupational therapy, pregnancy, and required surgery. It also covers lab tests and diagnostic services, like x-rays, ultrasound, and mammograms, as well as preventive and routine care, like vaccines, checkups, mental health care including therapy for autism, and some home care, such as rehabilitation after a hospital stay. Many health insurance policies will cover diabetes supplies. Beginning in 2014, policy coverage will extend to prescription drugs, substance abuse treatment, and oral and vision care for children.

Preventive care helps doctors catch health problems early, with a better chance of successful treatment. Blood pressure, diabetes, and cholesterol tests, cancer screenings, vaccines, and child screening may be covered without any out-of-pocket cost. This means that even if you haven’t met your deductible yet, you don’t have to pay for preventive care. Choose a primary care physician or pediatrician that you trust, and freely seek a second opinion about a diagnosis or treatment, even changing doctors during treatment if you are not satisfied with the quality of care you are receiving. If English isn’t your first language, you have the right to use an interpreter. It is your responsibility to understand the risks and benefits of your treatment. Ask questions and educate yourself before undergoing any serious treatment plan, such as a surgical operation. Protect your health information, by obtaining a copy of your medical records, and checking them for accuracy.

Read your health plan’s ‘summary of benefits’ to learn what is covered and what is excluded. Health insurance only pays for care that is medically necessary, which is defined in your health insurance policy. Your insurance plan may not pay for experimental procedures or investigational testing, but if you have a serious illness and would like further treatment, you can ask for an independent medical review. While you need to get pre-approval from your health plan for some kinds of care, you do not need pre-approval for emergency care, such as admittance to the emergency room, emergency medical technician care, or ambulance service from the scene of an accident.

Health Insurance Companies

$varToll-free CallDirect Website
Aetna Life Insurance
Banner Life Insurance
Blue Shield Health
CIGNA Health and Life
Illinios Mutual Life Insurance
John Hancock Life Insurance
Kanawha Insurance Company800-635-4252
Knights of
Liberty Mutual Insurance
Metropolitan Life Insurance
Mid-West National Life
Monumental Life Insurance
Mutual of Omaha
National Benefit Life
National Foundation
New York Life Insurance
Ohio National Insurance
Pacificare Health
Physicians Mutual
Prudential Insurance
Standard Insurance
State Farm Insurance
State Life Insurance
Thrivent Financial for
Transamerica Life Insurance
United Teachers Associates
West Coast Life Insurance

Employee Health Insurance

Employees are eligible for group health insurance through their employer. Employers with 50 or more employees buy large-group policies, and those with fewer than 50 purchase small-group policies. In most cases, group insurance is better than individual insurance, as it provides more benefits at a lower cost to the employees. In an HMO, you may select a primary care doctor, who will provide your basic care and make referrals to specialists. The doctors and other providers may be employees of the HMO, or they may have independent contracts with the HMO. Further, you must live in the area the HMO serves. The main benefit of an HMO is that it costs less to see providers in your HMO network. These are called preferred providers. You get care from doctors, labs, and hospitals outside your plan’s network, but it costs more, and only in an emergency or if your plan gives you pre-approval to do so.

Insurance Claims

If have to file a health insurance claim against a hospital or physician for errors committed in your case, or worse file a medical malpractice lawsuit, document the facts of your case as soon as is practical. To be prepared, collect your records in one place, such as a file cabinet or desk drawer, so a family member can retrieve them in the case of an emergency. Time counts in an insurance claim, and valuable information and documentation may be lost if you don’t take action when it counts.
Keep a copy of your insurance policy, noting coverage impacting your claim.
Obtain your medical and hospital records, and get a notarized copy made.
Specify alleged misconduct or neglect if involved.
Get a copy of medical services performed, and lab tests done.
Consult other physicians and specialists, for testing and evaluation.
Keep records of the progress in the settlement of your claim.
Print out emails and save all correspondence for your records.
Attach all supporting documents as an index.
Insurance companies have attorneys on their payroll whose job is to limit the liability of the insurance company in the settlement of claims. You may be offered a settlement by your insurer initially, but you don’t need to accept it. You’d be better off consulting your own attorney, as medical malpractice lawyers will accept new cases on a contingency basis. That means that you pay nothing up front, and that the legal fees will be deducted from your settlement only if the lawyer wins the case.

While attorney fees are high, ranging from 25% of your insurance settlement to an astounding 44% of the total claim, a competent attorney can win you a much larger settlement than you’d be able to negotiate yourself. In most instances, the case will never go to court, as the insurance company’s main interest is to limit their payouts, and they don’t want to run up expensive legal fees in a protracted court case. Not only can you sue for actual damages, such as personal injury and loss of income, but you are also eligible to receive money for related damages, such as the assignment of punitive damages if neglect was involved.

Health Insurance Reform, Affordable Care Act

Beginning in 2014, it will become mandatory for most people to purchase health insurance. Health insurers will also no longer be able to deny your application beginning January 1, 2014. Your state department of insurance can guide you in finding affordable health insurance, and the federal government will provide subsidies for individuals who qualify. Further, under the new health insurance laws, Medi-Cal coverage will be expanded, to include a greater number of low-income families. Several health care policy changes have already gone into effect, such as no more cancellations of your health insurance policy after you’ve become sick, and no more add-on charges for preventive care such as mammograms, vaccines, child care, and selected health screenings. In most cases, children under age 19 cannot be denied coverage because of a pre-existing condition, and children can stay on their parents’ policy until age 26, as long as the policy offers dependent coverage. Finally, there will be no more lifetime caps on essential health benefits, and annual limits on essential benefits are also ending.

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