Insurance
Stay Legal! Avoiding Insurance Fraud
Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not understand what health insurance fraud entails, though. With reports estimating health insurance fraud is a $30 billion to over $100 billion industry per year, the topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and its consequences. By doing so, you are more able to recognize and fight fraud.
Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Essentially this means that you assert that you paid for certain medical procedures or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud is to conceal pre-existing conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may think that this is a small issue in comparison to your sister receiving treatment, it is actually very serious to your health insurance company and industry, and will result in fines and possible imprisonment if your are caught.
Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company’s investigation.
Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear – along with the money you have been paying in premiums.
The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember - it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.
Dental Benefits
Dental insurance is often an afterthought when obtaining health insurance for a number of reasons. Some people may simply dislike the dentist and use the lack of dental insurance as a reason to not visit the dentist; others may feel that dental insurance is not worth the added cost to their monthly health insurance premium. Still others may simply feel that their teeth are in good shape and there is little need to spend the extra money to cover a part of their body that does not currently have any problems. Nevertheless, dental insurance is important because of several benefits.
When people think of the cost of dental work or procedures, they often think of costly bills. Even simple procedures like getting your wisdom teeth removed can average in the hundreds of dollars per tooth! However, one obvious benefit to dental insurance is the coverage of simple but costly dental procedures such as getting a tooth removed. In the end, the slight increase in a monthly premium may be worth it to avoid a high dental bill. Moreover, dental insurance also helps financially if a dental emergency develops. Perhaps you are in need of a root canal or dental implants – both extremely costly procedures that you often do not anticipate. Dental insurance will most likely cover a portion, if not all of these expensive procedures.
Also, while many feel that brushing and flossing daily is all the dental care they need this is simply not true – even for young, healthy adults. Dental disease is common and can affect your body in a number of ways. For instance, some dental diseases left untreated can lead to more serious medical issues such as kidney infections or even diabetes. Most people do now know of the connection between dental diseases and other illnesses. Thus, having dental insurance that covers routine visits to the dentist, which can help uncover dental diseases early, is extremely important. Dental insurance is designed to encourage preventative care, because spotting dental diseases or dental problems early reduces the overall cost of treatment.
Dental insurance may seem like just another gimmick to get a few more dollars out of you, but it is essential for your health. Your regular health insurance plan, whether it is through your employer as a group plan or an individual plan, should offer you the option of buying dental insurance coverage, and you should consider this piece of the plan thoroughly when purchasing health insurance.
Do You Need A College Health Insurance Plan?
When you are finally done with your high school education, there is no doubt that you’ll be enrolling into a college. Many times when a child reaches the age of 20, they are no longer covered by their parents’ insurance and this can lead to a troubling situation if they are not working and just strictly going to college. However, many colleges offer health insurance plans. Whether one of these insurance plans are right for you or not takes a lot of deliberation.
College health insurance benefits are going to vary from campus to campus. Although many people think that they are free, this is not true. While there is usually no charge for an office visit and routine checkups, the student will have to pay for lab work and other specialist type of visits. Benefits will usually pay completely for only types of covered services at the campus health center. In the event that you have to see an outside doctor then the student’s coverage can drop up to 70% and run the risk of being required to pay a high deductible.
If you have a pre-existing condition, then you may have a problem with getting treatment at the college health center. Having a pre-existing illness or disability does not mean that you will be disqualified for obtaining a college health insurance plan, but you may not be able to get treatment for that pre-existing illness. This can lead to a number of problems if a new problem arises and is a product of a pre-existing illness.
All plans are different, so be sure you find out everything you can about your college’s plan. Be sure to check if you or your child will be covered during summer break when students are not taking classes. This is important because you don’t want to have an accident and find out that the insurance becomes inactive when they are not in class. Many colleges have coverage during summer break, but some do not.
Make sure you understand the plan. Is it an HMO, or can the member use any provider they want? This is just as important because you want to know where you can go in the event of an emergency, and there is nothing worse than finding out after the fact that you will be stuck with paying the full amount for a medical bill.
There really is no definitive answer as to whether you should or shouldn’t commit to getting college health insurance. Be sure that you understand your plan fully so that no problems can arise in the event of an emergency. While it is not free insurance, it surely will save you money in the event of an accident or illness.
Disability Insurance
We all know how important typical health insurance is, but did you know that disability insurance is just as important? In the event that you are hurt on the job, and cannot work, disability insurance will give you peace of mind—you will still able to provide for your family. While we would like to think that we always work safely, accidents do happen and you need to be sure that you have every angle covered in the event of an accident. If you become ill or injured on the job and as a result you are unable to return to work, there are a couple of options that will replace lost income. These types of disability insurance are not going to fully replace your income because they want you to have an incentive for returning back to work once you get well.
Social Security benefits are paid to you when your disability is expected to last for at least 12 months. Most of the time this is when no gainful employment can occur and you must remain out of work for the entire duration of your leave. Employer-paid disability is required by almost every state in the United States. This type of disability insurance is deducted from your paycheck, and is there for you in the event of an accident. When you are looking at disability insurance policies, it is important to understand what they mean. While the two available policies are both for disability, they both cover a different amount of time you will be covered, and when you will start receiving your compensation.
A short-term disability policy means that you will be covered for no longer than 2 years. With this policy you may have to wait up to 14 days before you start receiving compensation. A long-term disability policy is a little different. The disability compensation will not kick in for several weeks, sometimes a couple of months. However, long-term disability will cover you for a longer period of time, and sometimes for the rest of your life.
Along with having the two different types of insurance policies, there are also two different protection features. Protection is offered to you to ensure that you are not going to be treated unfairly due to your inability to work. Non-cancelable means that for no reason other than not paying your premiums can your policy be canceled. With this type of policy you will lock in your premium and will not risk a decrease in the benefits. On the other hand, a guaranteed renewable policy means that the same benefits will be available every year. The only way that your premium will be increased is if every policyholder within the same rating class as yourself increases also.
While there are many options when choosing disability insurance as well, these are the most popular selections. It is important to discuss all available options when choosing a disability insurance policy to ensure that you know what you will receive in the event of an accident or illness. Research your options to find the best choice for you and your family.
Attract Employees: Group Health Insurance
Many small business owners know that in order for them to be successful they must offer an incentive to recruit employees to work for them. This can be any number of things, but most often it is the benefit of offering group health insurance. While this could be an excellent strategy for your small business to take in order to recruit new employees, there are a few things that you must know first before you dive into selecting a plan. Research group insurance policies thoroughly before choosing one for your company.
A group health insurance plan can be obtained by any small business that has as little as two employees to as many as fifty. There are two ways you can go about supplying the health insurance to your employees; this will mainly be decided by your own budget. Many small businesses that offer group health insurance help contribute towards the cost of the plan. On the other hand if an employee wants to have coverage for their families, the employer might offer to pay the employees’ premiums and have them pay the premium for their families.
Another aspect of the group health insurance plan will be deciding between managed care or fee-for-service. Managed care plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or Point of Service plan (POS).
An HMO will significantly reduce the cost that your members will have to pay for medical care as long as they use the providers specified by the HMO. A PPO will not require a referral in order for them to see a specialist. While the PPO is more flexible it will bring higher costs to the per-visit and annual deductibles. The POS plans are basically a combination of the features that you will find in an HMO and PPO. Members get to decide whether to pay a flat fee for offices in the network, or pay a deductible charge to see someone out of network. The fee-for-service plan gives the employee the power to select health care providers themselves. This means that they will have way more flexibility with where they can go for medical assistance.
Adding an appealing Group Health insurance plan to your business could potentially bring you more employees. This is just the basic information about Group Health insurance; there are many options to consider when choosing a plan. Be sure to investigate all options to create the best plan for your employees.
What You Don’t Know Can Kill You
Health Insurance Limitations
Health insurance often requires a mountain of paperwork that has a lot of fine print. Unfortunately, this means that few people read their plans thoroughly nor do they fully understand what their plan covers or does not cover. Here are some common limitations in health insurance coverage that you should know.
Some of the most shocking health insurance limitations are found in the the fine print holes in the insurance policy. For instance, many people have found that their health insurance did not cover a routine or necessary medical procedure because they did not receive an authorization code prior to the procedure or the hospital did not correctly fill out the paperwork. Your medical claim can be denied simply because the hospital used odd codes for your treatment. While any claims denied by the insurance company can be disputed, this process is not only tedious, but time-consuming and draining, especially for someone who is already ill. There is also little success in winning disputed claims, which makes this option rather limiting.
Another surprising health insurance limitation happens more often than people realize. Imagine this situation: you are diagnosed with a medical condition and need an operation. You research surgeons and hospitals within your plan. You understand your plan’s coverage of hospital care. You have your operation and then you find a massive medical bill in the mail. Apparently your health insurance did not cover the anesthesiologist or other specialists that may have consulted in your operation. Thus, you have to pay these specialists for their services, even though you were under the impression that your plan would cover these costs associated with the surgery. Such a bill can be in the thousands of dollars, and there is little you can do to dispute the charges. The only way to avoid these charges is to make sure that you ask before the operation who will be involved and ensure that they are covered in your health insurance plans.
Other limitations are put on a number of treatments. For instance, you may need physical therapy or visits to a psychiatrist. Many health insurance plans will put a limit on the number of covered visits for such medical treatment. Without realizing it, you may surpass the maximum visits allowed by your health insurance and end up racking up huge bills.
Many people think that buying health insurance will cover them medically, but this is only correct to a point. When securing insurance, you should read through your health insurance package carefully, and when you are about to undergo any expensive medical procedure, be sure to consult your health insurance plan first.
Ways of Paying for Health Insurance
When it comes to health insurance, many people don’t exactly know everything that there is to know about the subject. That only stands to reason, it is not something that is easily understood because of its complexity. For instance, when you visit the doctor you may be asked to pay something that is called the “co-pay”, and other times you may not have to do anything at all depending on your plan. Let’s look at some of the ways that health insurance is paid for.
Often times, your employer will sponsor your insurance and you only have to pay what is known as a “co-pay” or co payment. The co-pay is a set amount that is determined by your insurance company when you receive covered services. This is a significantly smaller fee than you would be paying without the co-pay. Many companies offer this type of payment option because it is easier on the employee to pay this way.
You may consider opening what is known as a Healthcare Savings Account (HSA). This will assure that you always have a location in which to retrieve payments for various medical expenses. The HSA is a pre-tax savings account where a portion of your pre-tax income, determined by you, is deposited into an account automatically. Since this account comes from your paycheck pre-tax, that means it will lower your overall taxable income. This means you are saving money in terms of taxes and saving lots of money towards your overall health care costs.
For certain disabled individuals and those above the age of 65, Medicare is also another way to pay for health insurance. While they will not pay all of your healthcare expenses, they will pay for most of them. Medicare, however, doesn’t cover prescription drugs and nursing homes. It is important that you check the different types of restrictions that may apply. There are low-cost prescription discount cards that have been proven to save people who require costly medications on a regular basis over 50% of what they would have been paying without any health care.
Paying for health insurance doesn’t have to be complicated as long as you understand just what is going on in terms of where you stand with your plan. Discuss any questions you may have about the plan before committing to one. While one plan may be right for many people, it does not always mean that it will fit your specific needs.
Healthcare for Long-term Patients
Is this Insurance Right for You?
Long-term care insurance is not right for everyone. For a small percentage of the population this coverage is an affordable and worthwhile type of insurance. Determining whether or not long-term care insurance is right for you won’t be the only task at hand; looking for scams will also be a concern.
As you get older, the need for assistance in your everyday life increases. Whether it is in-home care or residing in a nursing home for a few months you will most likely need some way to pay for these types of services. In order to maintain long-term care insurance you must pay for them each and every year until death. Many policies are canceled by policyholders that are on fixed incomes and are simply unable to pay for the increasing premiums as they get older. If the only funds you are receiving were those from Social Security or SSI, then it would be wise to not purchase a policy. Also, if you find that every day purchases and paying for utilities makes you stretch your budget to the limit, you probably should stay clear of this policy. This type of policy is only right for someone who has significant assets they want to preserve for their family, remain independent, or just to spare their family the expense of a nursing home bill.
Comparing policies can prove to be difficult because every company is selling a different combination of benefits and coverage. Many companies offer to pay a fixed amount for each day you receive care, while others will cover a percentage of the overall cost of care or supply a specified amount. Beware of these types of policies unless they offer inflation protection. You see, if they do not account for the increasing cost of nursing home costs, then you are stuck with a policy that really does you no good.
Just like a standard healthcare plan, you will have to receive services at designated locations. If you go outside of this network they will simply refuse to pay for any care that you receive. If you have any type of mental disease or nervous disorder then don’t expect many carriers to accept you (the one exception is Alzheimer’s). There are more restrictions in this type of insurance than any other health insurance.
If this type of policy is right for you, please make sure that the company is reputable. There are many individuals who thrive on the fact that not many people will make an informed decision when it comes to purchasing long-term health insurance. Be sure to read the fine print and find out everything you can about the policy before committing to a company and a long-term health insurance plan.
Easy as 1-2-3: Obtaining Health Insurance
Many people are often concerned about obtaining health insurance. They are confused about their options or about how to obtain the best health insurance for them or their family. There are several ways to obtain health insurance, though, and some of them are not always obvious, but can be quite easy in the end.
Health insurance is commonly obtained through an employer. Nearly all employers these days offer some sort of “group” health insurance plan for employees. The term “group” simply denotes that there is a large group of people on the plan, which decreases the cost of the monthly premium for all members. These plans can cover yourself, your spouse, and your family, depending on the specific policy. Covering more than just yourself obviously increases your monthly premium, but the ability to cover your family inexpensively is a huge benefit. To obtain group health insurance through your employer, you should contact your human resources department or whoever is in charge of benefits in your company. You should be able to buy into the group health insurance plan at any time during your employment.
If you leave an employer who offers group health insurance without first finding other coverage, you can also use the COBRA law with your previous employer’s health insurance coverage. COBRA is a government act that allows you to continue coverage under your previous employer, though at a more expensive rate. If you had coverage for your entire family, COBRA will allow you to continue this full coverage for a certain period of time.
There are several million people in the United States who are unable to participate in any group health insurance plans, however. Health insurance companies do offer individual plans for those who do not have coverage through their employer, are self-employed, or are ineligible for government health insurance assistance, such as Medicare or Medicaid. Individual health insurance plans are more often than not very expensive in relation to group health insurance plans. These plans can also cover family members and spouses for additional costs. Finding individual health plans is not difficult. Almost all health insurance companies offer individual plans; you can now search online for individual health insurance plans. Some Web sites even allow you to compare pricing and details of plans offered in your area – much like shopping for car insurance.
There is also federal health assistance available depending on certain criteria. If you are over the age of 65 or if you have a disability or specific condition (detailed by the government), you are eligible for Medicare. Medicaid is another government health insurance program that is based on income. Overall, it is simply important to be covered, no matter how you go about doing it. Research your options of coverage and speak with a professional to find out more about the health insurance options available to you.
Advantages to Managed Care Plans
There are many different types of Health insurance plans out there. Picking the right one for yourself can be troublesome in the beginning, especially if you don’t know what you are looking for. You might have trouble deciding which one would be better for you.
Health insurance is divided into two large categories—indemnity and managed care plans. Indemnity plans, also commonly called reimbursement plans, will reimburse your medical expenses up to a certain limit. Under the Reimbursement plan, the insurer pays a percentage of the total charges, regardless of how much the charges are. With the indemnity plan, the insurer will pay a specified amount every day for a specified number of days. The amount reimbursed does not rely on the cost of medical care, but what you are reimbursed will never exceed your expenses.
The other popular type of health insurance plans is managed care plans. The three types of policies categorized as managed care plans are HMOs, POSs, and PPOs. This type of insurance is more popular than the indemnity plan, as they offer more flexibility. With these types of options you either pay a monthly fee no matter how many times you see a doctor, or pay a co-payment but no monthly fee. With managed care plans, you are given options of care. The plan you choose and the amount of money you wish to pay determines how big of a network of doctors and specialists you can see and still be covered under the plan. Some managed car plans (most often PPOs) offer sponsorship programs from a network of hospitals and medical services. You can often get this kind of plan through your employer.
Managed healthcare plans are better for the average person due to the fact that they are more cost effective. While indemnity plans may give you a lot more freedom in cost, you will have to use the healthcare provider that the insurer chooses. If you have a specific disability, this can present itself as a problem. In the long run, a managed care plan will save you money, especially if emergencies arise when you are out of town. These types of plans also are more flexible in policy. Before you purchase any kind of health insurance, be sure to research the many options available for you and your family to ensure you receive the best coverage possible for the lowest monthly premium or deductible.
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