Facts About Health Insurance

By
Services for Real Estate Pros with Policy Online

 

Information Before Buyingcall

Facts You Should Know Before Buying Any Health Insurance Plan!
Health care is a hot topic in America. When you buy a health insurance policy, never make your decision based on price alone. This report will reveal to you some critical facts about health insurance that should be considered before making your buying decision.

Fact #1

All Health Insurance Companies Are Not The Same

Before you run out and purchase your next health insurance policy, you should know something about how insurance companies are rated. The company that is best known for rating insurance companies is called the A.M. Best Company. A.M. Best is the oldest, most experienced rating agency in the world and has been reporting on the financial condition of insurance companies since 1899.

Here Are The Ratings The A.M. Best Company Assigns:

  • A++ and A+ (Superior)
  • A and A- (Excellent)
  • B++ and B+ (Very Good)
  • B and B- (Adequate)
  • C++ and C+ (Fair)
  • C and C- (Marginal)
  • D (Very Vulnerable)
  • E (Under State Supervision)
  • F (In Liquidation)

For additional information, call A.M. Best at 908-439-2200.

Solution To The Problem

You can ask your agent to show you a current copy of their company's A.M. Best Report. Get on the phone and call A.M. Best to find out the real story on any company before buying a health insurance policy.


 

Fact #2

All Health Insurance Companies Do Not Pay Claims According To The Same Standard

There are only three main categories in which claims may be considered for payment:

1. Let the hospital or doctor decide what the insurance company should pay.

2. Let the insurance company decide how much they should pay.

pills3. Let data from an independent third-party determine the amount paid.

If a hospital or doctor decides, it's the equivalent of giving them a blank check and saying, "fill in the blank $________ for how much you want and we'll pay it." This is called Actual Charges. This is not a common practice with insurance companies, because they can go broke if they don't place some restrictions on how much money is coming out of the insurance pool. If claims payments are not restricted in some way, there would not be enough money in the insurance pool to help cover the risks of other policyholders. Proceed with caution when an insurance company claims they pay actual charges. What is more common is that the majority of insurance companies decide what they want to pay. When an insurance company decides how much they choose to pay for a claim, they use wording like this:

  • We pay reasonable charges
  • We pay prevailing charges
  • We pay average charges
  • We pay permissible charges
  • We pay regular charges

The above terms mean whatever the insurance company says they mean. The company is in control of determining what the meaning is. This is usually not what the hospital, doctor or policyholder feels it should be and therefore much confusion and misunderstandings occur as a result. As long as the insurance company is in the deciding seat, their standards can change at any time.

Solution To The Problem

The insurance company should use data from an independent third party to make the determination about how much to pay. There are companies that specialize in conducting nationwide studies of Usual and Customary Charges by health care providers in geographic areas throughout the United States. They publish these findings for insurance company use. Some companies pay based on these Usual and Customary Charges, but some companies pay something less, whatever they feel is reasonable, etc. Choose an insurance plan from a company that pays Usual and Customary Charges based on data from an independent third party after any deductibles or co-payments have been met. Ask your insurance agent before buying. 

Warning! Beware of companies who attempt to fool you by adding extra wording like usual, customary and reasonable charges. (U,C,R) Adding another word to the term changes the true meaning and is a loophole for the company to still decide how much they want to pay for any claim.


 

Fact #3

All Health Insurance Plans Do Not Cover Doctors The Same Way

A policyholder may be shocked to find that when they need two or more doctors for a medical procedure, that only one is covered and additional doctors are not. This goes back to an old English lesson we learned in grade school. For example, let's take the word surgeon. There is a difference between surgeon 's fees and surgeons' fees. Still confused? Take a closer look. Notice where the little apostrophes are placed? N's means one surgeon. Ns' means two or more. Most people don't pay attention to this when an insurance agent "says" our plan covers surgeon 's or surgeons' fees, because both sound the same.  An agent may not tell you this means only "one" is covered and you will be responsible for the charges for any additional surgeons. You can lose thousands of dollars of your hard-earned money by overlooking where the little apostrophe is placed.

Solution To The Problem

Make sure your health insurance plan covers multiple doctors and does not limit who can treat you. Make sure your agent explains to you in simple terms how many are covered. Ask your insurance agent before buying.


 

Fact #4

All Health Insurance Plans Do Not Cover All Medically Necessary Hospital Care

Some plans will only cover certain hospital procedures as outlined in the policy. If it 's not listed, it 's not covered unless you see the phrase "and all other medically necessary hospital expenses". This phrase is important. Because if a doctor performs a medically necessary procedure that 's not on the list, it 's not covered, leaving you responsible for the charges. 

Solution To The Problem

Make sure your health insurance plan covers all other medically necessary hospital expenses. Ask your agent before buying.


 

Fact #5

All Health Insurance Companies Do Not Treat Pre-Existing Conditions The Same

If you have been accepted by a health insurance company, you will normally have a waiting period before your pre-existing condition is covered. A waiting period of 24 months is typical for most plans in the industry. Some companies will give you credit for waiting periods satisfied on your previous policy and some states even require this benefit. If you have a serious health condition that is unacceptable, a company may offer you a Rate-up or an Exclusionary Rider in order to issue your policy. A rate-up means you 'll be charged more to cover your serious condition. An exclusionary rider means a specific condition will not be covered. A company should be upfront with you about any exclusions. If you accept an exclusionary rider, make sure any major system of your body is not excluded.

Solution To The Problem

Make sure you know exactly how your pre-existing conditions are covered and about any waiting periods. Ask your insurance agent before buying.


 

Fact #6

All Health Insurance Companies Do Not Perform Rate Increases The Same Way

Some companies implement rate increases in a way that can single you out for an increase independently of most other policyholders. They may raise your rates each year you have a birthday or because you have collected too much money from the plan. The purpose of a rate increase is to offset claims loss and inflationary increases. Since all insurance companies are subject to paying claims and the economy, there will always be a need for periodic rate increases. However, when this need arises, you don 't want to be "singled out" due to your age or health status.

Solution To The Problem

Make sure you can NOT be singled out for rate increases on an individual basis. Buy a plan that performs any necessary rate increases on all the policyholders of the same type in your particular state. Ask your insurance agent before buying.


 

Fact #7

All Health Insurance Plans Do Not Provide The Same Dollar Limits

Many health insurance companies only provide up to $500,000 for each injury or illness and a $1 million to $2 million lifetime maximum for all insured applicants combined. Medical costs are not what they used to be. Don 't get stuck with an outdated policy. For example, premature childbirth may have expenses of $200,000 or more in the first six months alone. If you encounter a major catastrophic injury or illness, you want to be sure you 've got a plan with sufficient dollar limits to cover today 's rising medical costs.

Solution To The Problem

Consumer-oriented health insurance companies now provide $1,000,000 to $2,000,000 for each injury or sickness and a $3 million to $5 million lifetime maximum for the entire family. Choose a plan that is keeping up with the rising costs of medical care. Ask your agent what the limits are before buying.


 

Summary of Report

Hopefully this report has helped you become a better educated consumer about health insurance plans. Choose a health insurance plan based on the quality of the Company and the Plan first. Then adjust the rates by increasing your deductible or co-payment amount to make it affordable. If you buy a cheap plan, you 'll get what you pay for. Don 't make your buying decision based on low- cost prescriptions, doctor visits and the monthly premium payment alone. Find out if you 'll be covered 24 hours a day, on or off the job, and if the plan is good in any recognized hospital in the world. Buy from a professional, licensed Agent in whom you can have complete trust and confidence. Find out how long it takes the company to pay its claims. Have your Agent explain the general list of exclusions and limitations on the plan. Get the phone number of your Agent and your insurance company 's customer service division for help and assistance. Finally, stay informed and remember to vote on issues to improve the health insurance industry

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Rainmaker
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Anthony Stokes-Pereira
Better Homes and Gardens Rand Realty - Nanuet, NY
Realtor

Hi Rocco;

Great Post! I do appreciate this information, thank you for sharing.

Anthony

Apr 16, 2008 01:06 AM #1
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Rainer
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Rocco Solorzano

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