When typical Americans go shopping for insurance they often sift through dozens of company quotes to get the lowest priced policy. "I saved $XXX.00," they'll boast. What they tend to forget is: HEALTH INSURANCE IS NOT GENERIC.
what to do when |
Copyright © 2005
by Lin Stone
| Not only do different policies cover different procedures in different ways with different amounts of coverage, there are also those exculpatory clauses designed to protect the insurance company from excessive zeal. That's why a 30-day grace period is written in with every policy. It gives you time to go over your new policy with a fine-toothed comb. You have time to consult with your legal representative if necessary. You should do this, you need to do this, because if crunch time ever does come you will want and expect to be covered. In their search for low-priced bargain insurance it seems that the vast majority of Americans now receive their health coverage from Preferred Provider Organizations, Health Maintenance Organizations, or other types of managed care plans. This type of company works on a smaller margin than conventional types of insurance providers. Consequently, they have to keep costs down. There are only two ways of doing this, #1, Make the care providers work for less. #2, Give policy holders less. This is good business sense and usually it is better all around for everyone involved. | Lin Stone is an author, writer and photographer living in Mena Arkansas among the gentle mountains known as Ouachita. His articles and essays are syndicated by talewins to be published automatically on other web sites. He writes about adventures for talewins.com, and he writes about the peaceable things of this world for Share Your State.com. You can have immediate, and free, reading of many more pieces when you send your little surfer scooting to Lin's home page where he keeps stirring up more good things for the soul. |
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| Problems arise when the provider offers more benefits on the day-to-day medical procedures (runny nose, fever) in order to attract more customers -- but pay for it by lowering their coverage of traumatic expenses. One of John Grisham's first novels explored a situation where one insurance company systematically denied EVERY claim over a specific amount. What a money-saving concept! As Grisham pointed out, it was bound to be successful because of human nature. When medical claims are not paid the patient will blame everything and everybody -- except the insurance company. To this faceless corporation they knuckle down, and never make even a meek squeak of complaint. That isn't right, and it isn't good business on the patient's part. If there are extenuating circumstances, if the ruling is a little iffy at the corporate level, or when the dispute is over "usual and customary" charges you should challenge the insurance company. Now there is help for you in pursuing that course. “Problems with health plans often arise during the course of a health crisis, making it especially difficult for consumers to resolve these issues successfully,” Kaiser Family Foundation president Drew E. Altman said. The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries. The Kaiser Family Foundation and Consumers Union has produced an updated guide to help consumers through the process of resolving disputes with their health plans. Named "A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2005 Update" the resource, reveals information about how consumers can take advantage of their health plans' internal processes to resolve disputes. It also provides outlines of some external review processes that patients may use under state laws. “This guide provides valuable information to help people navigate what is often a confusing health insurance system,” president Altman added. |
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| The guide includes state-by-state details on the external review programs in the 43 states and the District of Columbia that have such programs, including Arkansas and Nevada which implemented programs after the 2003 version of this guide was issued. Trudy Lieberman, Director of the Center for Consumer Health Choices at Consumers Union agrees. "States told us that consumers often make mistakes in filing their appeals. "Too often they don't follow their state's rules or they don't bring sufficient documentation or (don't bring) their medical records when they begin the appeal process." When you know the rules you can act more intelligently; there is less chance of being bowled over by every whim of circumstance. You'll be glad to know the updated guide also includes a new section about experiences with state external review programs. This includes important data about the outcomes of appeals made by consumers to their state programs. Going one step further, the guide then provides tips for avoiding some of the more common mistakes that may prevent consumers from properly filing and successfully resolving their disputes through external appeals. The guide was developed under a partnership between the Kaiser Family Foundation and the Center for Consumer Health Choices at Consumers Union. The updated version of this consumer guide is available for free on the Kaiser Family Foundation’s website at http://www.kff.org/consumerguide or the Consumers Union website at http://www.ConsumersUnion.org/health/hmo-review . You will also find an article about health plan choices has been included in the September issue of Consumer Reports magazine, which is published by Consumers Union. The article highlights the guide and its information on how to appeal health plan denials of care you, or a friend may be having. This guide can help you understand your coverage under these plans. You can determine your rights under the governmental rules that health plans must follow, and the role that state external review programs play in resolving your disputes. Remember too, there will be times when it isn't your insurance company you should be challenging; it may well be that the hospital itself is working you over in more ways than one. A traveling friend of mine who is passing kidney stones on a regular basis at this time has found a startling difference in price for overnight stays. One hospital in Salt Lake City charged only $500 and one in Little Rock Arkansas charged $2500. My friend could have flown to Salt Lake and had money to spare. "The difference in price a hospital charges seems to come from how affluent its patient list is." That makes sense, when a hospital can easily collect the money owed to it, less money has to be charged to get what it needs to survive. Some University hospitals only collect $2 out of every $10 it charges. In order to survive it has to charge the patients who are paying five times as much. This is one of the major reasons insurance rates vary so much in various states, and why insurance companies boggle over "usual and customary" charges flung on their desk by physicians and hospitals. No company wants to pay five times more than they would have if you had just let your fingers do the walking instead of sitting back and letting human nature take its course. How can you determine how much to expect your hospital to charge? Your doctor is restricted to using the hospitals that let him or her work there. Simply ask which hospital that will be, then investigate how much higher or lower that hospital has a history of charging its patients. Every hospital that accepts Medicare and Medicaid is required to submit annual reports detailing their financial operations to the Centers for Medicare and Medicaid Studies (CMS). A record of their Medicare claims are available in public use files. (The files have been encrypted to protect patient confidentiality) AHD presents these data in easily accessible, user-friendly reports that are consistent with CMS Data Release policies. If the hospital your doctor prefers to use is charging WAY too much you may want to shop around for a second opinion. | Learn the meaning of the most important terms in your car insurance policy. Most people will do anything they can to steer far clear of situations that may take a violent turn. But there is always the chance that violent behavior can erupt -- uninvited and unexpected. What can you do then to protect yourself from danger? Your long distance telephone service carrier can be changed without you knowing it. Check HERE to see who your carrier really is, and learn how to make sure NOBODY changes it in the future! Get Your Own Survival Tools and Equipment. Thousands of items to choose from. Just for example, you will find 23 different tools to start a fire. There is one method that will easily and surely light a fire in a fierce rainstorm any time you need it. Yet the fire will extinguish instantly to avoid detection, leaving no residue, no odor, and no smoke. Speaking of smoke, Can you quit smoking? Probably not. Some people try everything, even kicking themselves, and STILL can't quit. For more insight into this stubborn problem, Click HERE. Gum disease, gingivitis, or bleeding gums can cost a fortune if you let it go too long. Learn how you can stop gum disease naturally. SlimSweet is an incredible exciting new sweetener that provides benefits no other sweetener can! Now everyone can enjoy SlimSweet's great sweet taste without worrying about calories, cholesterol, weight gain or harmful insulin surges caused by other sweeteners (even natural ones). With SlimSweet, you'll never eat sugar again! Life's most important lessons are amazingly varied and can be quite confusing. Even so, they most all have two things in common. First, they usually are not particularly complicated. It certainly can sometimes take a while to get it; but once you do get it, the lesson is normally straight-up and to the point. Second, and here is the rub, the lessons invariably are a "So now you tell me!" kind of thing. Leave A Legacy: Be Your Own Banker! Money you are already spending can make you rich, provide a stable income over your whole lifetime, and still leave millions of dollars for your heirs. |
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Get your next health insurance quote at www.Roundup.com where the best and friendliest insurance company web sites are listed. If you have appreciated this article you will want to explore www.Roundup.com/foryourprotection/ too. Lin Stone is a professional author, writer, photographer living in Mena Arkansas. You can download most of his public writing from www.talewins.com/StoneSoup.htm
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NOW is the time to share this information with every neighbor and form a neighborhood group that can help each other. Anarchy and riots could break out and law enforcement agencies may be operating sporadically if at all as we have witnessed in New Orleans.