Benefits of Group Health Insurance

March 25th, 2010 1

Group Health Insurance is an insurance scheme provided by the insurance companies for a group of persons, such as the employees of an organization at a reduced individual rate. Most of the companies provide group health insurance schemes for their employees, which helps the employees to receive health treatments without any cost they need to pay. Group health insurance ensures the employees of an organization to receive medical treatment quickly so that they can avoid waiting long time in queues and other sufferings.

Group health insurance offers lots of advantages to both the employer and the employees. As far as an employer is concerned, the group health insurance scheme will provide enough medical treatment quickly for the staff of his company and thereby ensures speedy recovery from diseases and keeping disruption owing to illness in the office to some extend. The employee can also provide more focus on hisher job as there is no need to worry thinking about the time they want to wait for the treatment on the NHS, or suffering undue pain, or for a diagnosis.

Group health insurance plan offers several valuable benefits for an employee. The main advantage of becoming a member of the group health insurance scheme is that the insured doesnt have to pay large premiums for taking a private health insurance plan. The employee can work without being worried of their health as heshe will surely get quality medical help immediately if needed.

There are several health insurance companies offering group health insurance schemes. Most of the health insurance companies, as part of their Group Health Insurance Plan, provide the insured (the employees of the company) to take a health check once in every year at any private hospital with which the company has tie-up. The health checks will cover a complete check up, which include height, levels of fitness, weight, blood tests, blood pressure. The health checks are done so as to check whether the insured employee is in a good health or to find out a so far undiagnosed condition. What ever be the purpose, the health check is considered to be beneficial for the employee and the employer.

For those individuals who are not a member of the group health insurance scheme has to pay about 150 upwards to perform a complete health check. Hence this is considered as an added advantage for those who are in the group health insurance scheme. Group health insurance also helps to boost the morale of the staffs as they will know that their employer is providing special care about his employees.

Group health insurance schemes will differ from one insurance provider to another. The insurance coverage will also change according to the schemes you select. But there are certain factors which all the group health insurance schemes will cover for:

- In-patient and day-patient treatment
- Out patient treatments such as physiotherapy
- Free Help lines such as a GP Helpline and Stress Counseling Helpline.
- Specialist consultations after getting a referral from the employees GP

Group health insurance policy differs from one insurance company to another. It is always advisable to compare different insurance companies before selecting a group insurance policy. Select the one which suits your company.

Battling an Unfair Health Insurance Claim Can Really Pay Off

March 18th, 2010 1

Battling an Unfair Health Insurance Claim Can Really Pay Off

Are you having trouble getting your insurance company to pay your medical health costs? Join the club. When managed care entered the insurance scene a decade ago, its mandate was to contain rising medical costs. One way to do that is to deny claims, even when claims are legitimate. The consumer backlash led to many states establishing independent review panels and requiring insurance companies to develop in-house appeal procedures. Forty-two states now have independent review boards whose decisions can override those of insurance companies. Most consumers don’t even realize these review boards exist.

Another problem is that too many people just give up when their insurance claim is denied initially. The appeals process can be long and frustrating and many people don’t have the patience or time to pursue a claim no matter how legitimate. People must be persistent and they can win. Particularly if there’s substantial money involved, the time you dedicate to appealing insurance company decisions can pay off usually more quickly than you think. A Kaiser Family Foundation study recently found that 52% of patients won their first appeal for each claim made. The insurance companies aren’t getting with out paying anymore.

If your first appeal gets turned down, press on. The study found that those who appealed a second time won 44% of the time. Those who appealed a third time won in 45% of cases. Which means the odds are in your favor no matter how long it take. Remember that every time you appeal it costs the insurance company more money to fight you and they are not only going to lose money to you, but also in court costs. Medical health benefits are particularly tricky because insurance companies usually have a cap on the amount of money they’ll spend in a given year, or on the amount of visits they’ll pay for. But there’s often some flexibility when you can document that you or your child’s health warrants more care than your policy usually covers. Here’s how to get started:

Do Your Homework

Read your Policy: What are the benefits? Which kinds of services are included? Outpatient or inpatient care? Is it a serious or “non-serious” diagnosis?

Know the law: Contact your local Health Association to determine your states legal requirements regarding insurance payments for all illness. Does your state require full or partial parity? Are parity benefits available only to patients with “Serious Illness” or is a so-called non-serious illness also included?

Provide written documentation: Some insurance companies may not consider some diagnosis’s serious. In this case, you will need documentation to validate required services. Obtain a letter of medical necessity from your doctor and get test results showing the medical need for you or your child to receive certain services, based on the diagnosis.

Keep good records: Remember, you’ll be dealing with a bureaucracy. Keep the names and numbers of everyone with whom you speak, the dates on which you spoke, and what transpired in the conversation.

Start early: If you can, start the appeals process prior to initiating treatment. If the doctor says your child will need to be seen once a week for a year, begin immediately to appeal your insurance company’s policy of reimbursing only 20 visits a year.

Call and Ask the Insurance Company:

What are the prerequisites for receiving health benefits?

How many visits are allowed annually for you or your child’s diagnosis? Can multiple services be combined on one day and be counted as only one day or one visit?

Which services must be pre-certified–by whom?

Be positive, polite and patient with the customer service representative. Remember that heshe is only the messenger, not the decision-maker. They are the gatekeepers and can either provide you with access to a decision maker or make your life miserable, depending on how you interact with them.

Be persistent. There are no magic bullets. Be like a dog with a bone and don’t give up until you get the answer you want. If you get nowhere after several calls, ask for a supervisor or a nurse in the pre-certification department.

Remember that you do have the right to appeal if your claim is denied. Most consumers get discouraged and will not continue to pursue a claim that should or could be paid. Insurance companies count on that happening, so get out there and claim what’s justifiably belong to you.

Americans Without Health Insurance Have New, Affordable Options

March 11th, 2010 0

More and more Americans are going without health insurance because they can’t afford it. But there is a solution. New health insurance portfolios are available that are specially designed to help meet the national need for affordable coverage for individuals and employees of small businesses.

This is good news for many Americans who often cannot afford to purchase health insurance for themselves or whose employers do not offer insurance. This includes individuals who are self-employed; those who are employed by a small business or who run a small business; and individuals in other circumstances that require them to buy their own health insurance.

“More than 45 million Americans fall into one of these categories. Many of these people are uninsured or are struggling to afford the traditional plans that insurance companies typically offer,” says Melissa Crawford, senior vice president, Physicians Mutual.

The company bundles together existing and new products to provide an Integrated Health Portfolio (IHP) with a variety of choices and price points.

The IHP offers a choice of benefits, including coverage for:

• Doctor’s office visits

• Preventive care

• Hospital stays

• Surgeries

• Catastrophic major medical

• Outpatient treatment.

“This portfolio of products is designed for middle-income Americans for whom the only choice has been major medical plans with high deductibles-5,000, for example. That’s too much for them to absorb out of pocket,” Crawford says. “They’re looking for a plan that pays a portion of everyday health care costs such as doctor’s visits, childhood immunizations, and screenings like mammograms and prostate cancer tests. They also need prescription drug and vision discounts.

“We have options with no deductible to meet, so policyowners receive benefits the first time they have a covered medical expense,” Crawford says. “There are also no lifetime maximums on this type of policy.”

Crawford points out that individuals and small-business owners usually do not have benefits managers who can talk them through their insurance options. The health portfolio offers a needs assessment to help customers determine which insurance products are right for them.

Physicians Mutual Insurance Company and Physicians Life Insurance Company, a member of the Physicians Mutual family, provide a full portfolio of health and life insurance products, as well as financial products. Both companies consistently receive high grades from independent insurance analysts.

Alternatives To High Priced Health Insurance

March 4th, 2010 1

Most Americans are struggling to afford health insurance. In just the past few years, the cost of buying health insurance for your family has skyrocketed. I was talking with an insurance agent recently, who told me it’s not unusual at all for his clients to be paying 1,000 to 1,400 per month for their family to be covered.

I don’t know many people who can easily afford those kinds of monthly insurance payments. Most who are paying them are making major sacrifices in other areas. The vast majority of Americans put health coverage very high on their list of priorities, so the other things that get left behind might surprise you. No question, the quality of life is far lower for many people now that they pay so much to be insured.

Meanwhile, many employers are cutting back their employees’ insurance coverage. Professions that once paid all their employees’ health insurance premiums — like teachers and firefighters — are finding the employee footing the bill for larger and larger portions of their insurance.

How are people coping? Many Americans simply don’t have health insurance anymore. That’s a big problem not only for families, who often put off going to the doctor, but also for society in general. People who hesitate buying medicine or seeing a doctor often end up very sick in hospital emergency rooms.

Others are simply reducing the amount of health insurance they have. They pay a larger portion of their doctor visits and prescription medicine costs. If you are a young adult, it may not make a lot of sense to pay huge insurance premiums to be covered for major illnesses that you are very unlikely to experience.

There are a growing number of health insurance plans that let you pick and choose the areas of coverage you want to pay for. While this practice was prohibited in many states, more and more places are seeing the wisdom and necessity of this approach.

Even more pressing than the cost of health insurance is the cost of buying prescription medicines. Many people simply can’t afford the spiraling cost of the medicines they need. Others might insist, willingly lowering their standard of living just to afford overpriced medicine. The solution to this problem increasingly has nothing to do with insurance. Organizations use their large pool of members to negotiate big discounts on prescription drugs at thousands of chain and independent pharmacies nationwide. Typically you can save up to 60% off generic drugs and up to 15% off name-brand drugs.

This is a big advantage for the elderly, families, businesses, organizations, and anyone who wants to lower their cost of medicine. Additionally, some programs also cover medicine for your pets. If you often care for an ill animal, this can save you a lot of money over time.

Unlike insurance, discount drug programs are often very low cost or free. Pharmacies participate in the discount programs to encourage you to buy from them. It’s a win-win for both you and the medical industry.