Health Insurance | Health Insurance Blog

June 3, 2011

The Basics of Dental Health Insurance

Filed under: Health Insurance — Tags: basics of dental insurance, dental coverage, dental insurance, health policies, private dental care — admin @ 3:34 pm

You don’t have to like visiting the dentist’s office but you can’t ignore buying dental coverage for your financial well being. Dental treatments can be very expensive and can be upsetting to your budget as well. To shop for the best dental insurance you have to understand the basics of dental policy. This article is therefore dedicated to the discussion of the basics of dental insurance.

The first thing that you need to understand about dental insurance is that it is not offered by all the insurance companies. Also, dental isn’t offered as a standard coverage under health policies. You are therefore required to buy it separately.

Sometimes the dental insurance may be offered along with the employer provided health policies. But often these policies offer coverage only for the basic preventive care. Employees with serious dental problems may find themselves paying out-of-pocket for the more intensive treatments.

Next, if you are looking for private dental care you need to find an insurance policy which is accepted by your dentist. You may not want to change your existing dentist and hence find the policy which is accepted by him.

While shopping for dental plan you may stick to an insurer who has an established record of providing the best coverage. Check out the claim settlement record of the provider before purchasing the policy. You can check out both the past business record and claim settlement record of the insurer from the Better Business Bureau (BBB) site.

The dental insurance policies offered by different insurers vary largely between the insurance companies. Hence, you should check out the services covered by different policies along with their prices and decide accordingly.

To find the best dental insurance plan you may shop around. You can also approach to an independent insurance broker to find the most suitable deal for you.

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June 2, 2011

Limitation Of Group Health Policy

Filed under: Health Insurance — Tags: Group Health Insurance, group health policies, health insurance coverage, health plans, rivate health policies — admin @ 2:53 pm

Most Americans enjoy health insurance coverage at their jobs through their group health plans. When this is obviously the best and the most feasible solution to stay covered against the rising cost of private health policies, group health insurance has certain limitations of its own. This write up would reveal the negative side of a group health plan to help you make better choice.

The employer participating group health plan covers the workforce without discriminating against their age, sex, ethnicity and most importantly health condition. This is, hence, the source of health coverage for people with health condition. The cost of the policy gets distributed amongst the participating members of the group. But, since group health policies ensures guaranteed issue the healthy members of the group end up paying more than required for older members and members with health conditions. The cost of group health plan can be more than private health plans in the long run for the healthy members of the group.

Another disadvantage of group health plan is that you are not allowed to shop around for better rates and also, can’t customize the policy to meet your needs. A group health plan is a packaged deal and you have to accept what is offered to you. Often the group health plans offer only basic coverage and don’t shield against more intensive health conditions. Further, you can’t terminate the plan in between or switch your insurer easily.

A group health plan is also more expensive than private health plans. You can enjoy a cheaper rate in a group plan as long as the employer is contributing to it. But during the COBRA continuation period your premium rate increases to 102 percent for the same amount of coverage.

The most significant disadvantage of group health plan, however, is that you lose coverage when you leave employment and if you don’t opt for COBRA, your health plan gets discontinued.

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January 5, 2011

HIPAA: Your Medical Information Is Protected

Filed under: Health Insurance — Tags: HIPAA, HIPAA privacy, HIPAA restrictions, medical information — admin @ 2:49 pm

Your medical file may contain sensitive information which you may want to guard with your life. It may leave you worried about the information you have disclosed during your last visit to the physician. The Health Insurance Portability and Accountability Act of 1996 or HIPAA as it is most commonly known as has been devised to protect medical information from being available freely. There has been lots of ambiguity regarding what and what not can be disclosed staying within the HIPAA restrictions. Also, often the patients aren’t aware of their rights and access to their medical information.

The HIPAA in simple terms, however, suggests that medical information of a patient stay protected under the law and only the patient can decide to disclose the information. The medical service providers, i.e. the doctors, nurses, hospitals, nursing homes and also the billing department are required to protect the information obtained about the patient during treatment. Also they have to limit divulging information about patients during training sessions of the employees.

Like in any law, HIPAA has also given some relief to certain organizations which are not required to follow the non-disclosure rule. They are – life insurance companies, employers, child protective agencies, school board in some states and the law enforcement bodies.

The covered agencies are required to ensure that safeguards are placed to protect the information. They also have to limit the uses of information for different purposes. The covered entities are also required to place limit on people who can view and access your medical information.

Patients are required to learn about their rights under the law to safeguard their medical information from being misused. They must evaluate the pros and cons of allowing third parties to access their information. You must thoroughly evaluate all your options before waiving your HIPAA privacy and security protection.

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January 4, 2011

The Most Common Types Of Health Insurance Frauds

Filed under: Health Insurance — Tags: Health Insurance, health insurance claim, health insurance frauds — admin @ 3:27 pm

One of the reasons for high cost of health insurance is the pilferage due to health insurance frauds and abuses. Health insurance frauds are so prevalent that it is estimated that every year the USA economy loses over $100 billion in such fraudulent activities.

Health insurance frauds can take many shapes but one of the most common practices is to inflate the bills and charges for the services that are not rendered. Following are the types of health insurance frauds that take place almost everyday.

Fake procedure: Often the insurers are charged with bills of tests that were not performed. Often falsified tests are mingled with the legitimate tests performed. Unfortunately this is often done in collaboration with the patient.
Inflated bills: Charging more than actual cost is one of the most common form of health insurance frauds. The health bills are exaggerated to receive more money from the insurer. Doctors are found to charge the patients more who are insured and describing it as the right amount. This is an illegal practice.
Copay exemption: Copay is the part of the claim that the patient has agreed to pay on the total bill amount. The patients are exempted of their copays and it gets attached to the bills claimed against the policy.
Unbundling: Separate bills are sent for services that otherwise would have come under a bundle. Insurance providers often pay lower cost of the commonly offered services, known as bundle and hence separate bills are sent to receive more compensation from the insurer.
Double billing: Duplicate claims are submitted in order to gain from the health insurance claim. Often the offices of the insurer is inundated with claims and immoral physicians take this advantage of submitting multiple claims for the same services offered.
Upcoding & Miscoding: Putting wrong codes for the services offered or charging for more complex procedures than the one performed are known as miscoding and upcoding respectively. These methods are commonly used to get more money on claims.

It is important to identify and prevent the fraudulent activities to keep check on the rising health insurance costs.

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Types of Health Insurance Plans

Filed under: Health Insurance — Tags: Fee-for-Service, Health Maintenance Organizations, indemnity plans, insurance agency, medical insurance coverage, Point of Service Plans, Preferred Provider Organization, primary health care provider, types of plans — admin @ 3:24 pm

Whatever may be the reason to visit the hospital, it often turns costly. So, world over, the common practice is to get into a medical insurance coverage for getting over the costly health care bills in such situations. There are different types of schemes to get into and the coverage style also varies. So it is better to have a basic knowledge of the different types of plans available before deciding upon a plan that seems perfect for a person.

Generally there are 4 types of plans which the insurance agencies provide.

The first of these is the Health Maintenance Organizations (HMO). In this type of plan one pays for the coverage in advance and does not have to pay for each health service activities separately. The premiums are generally of monthly nature and the range of benefits includes preventive care, dental care, care for vision, etc. The health service providers are generally employees of the organization and will act as what is known as ‘primary care giver’. They will be responsible for coordinating the health care operations and generally need a co-payment option for hospital stay specialist visit, and the like of it.
The next type of plan is Point of Service Plans. The POS plans do not need one to get referrals from the primary care giver for any medical needs. Instead there are three options. One can still get referral from the primary health care provider and then get under HMO plan; or, one can avail care through the Preferred Provider Organization and get coverage under their terms and conditions; or, choose for care options outside these two and get benefits on out-of network rules.
The third type is the Preferred Provider Organization or PPO where the insurance agency offers an assortment of doctors and medical and health care facilities for treatment under their network. One has the flexibility of opting for treatment outside their network subject to ‘out-of-network’ rules.
The last type is the Fee-for-Service or Indemnity plans. This is the traditional service plan that has a fixed deductible coverage which reimburses the cost of treatment within that amount. This is the most flexible of the plans and allows choosing a physician and medical care provider at one’s wish.

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