Americans Without Health Insurance Have New, Affordable Options

September 2nd, 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.

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.