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Health Insurance FAQ

  Introductory Healthcare plan advices from our Expert

Health Insurance FAQBrokers can be your best allies when it comes to making decisions on your individual or group health insurance because their commission is always paid by the insurance company it is never paid by you. The broker's commission is embedded into the cost and is impossible to change, even if you tell the insurer you have no plan to use a broker. The cost is fixed no matter what. As brokers are paid by insurers and not the clients, they are free to help you choose a plan and assist you with claim issues without it affecting their earnings.

Under the terms of my health plan, why must I see my primary care physician before I can see a specialized doctor?

Primary Care Physicians or PCP's are an HMO based term. It is not always necessary to be referred to a specialist by your PCP. The HMO model, however, insists that you do get a referral from your PCP before seeing a specialist because the Health Insurance provider hope that the PCP may be able to treat your problem first and if so, it might not be necessary to refer you to a specialist. This is a way the insurance company can save money. Although your personal belief may be that you need to see a specialist, the insurance company use this checks and balance system to give the less expensive HMO PCP physician a chance to fix the problem and avoid referring you to a specialist if they.

When adopting a health insurance plan, what would you say are the most important points I should consider?

First of all, you should always choose your broker carefully. You should use personal experience and added value services and well as recommendations from friends and family when deciding which broker to opt for. Then you must consider your personal financial resources as well as your health history and any expected events to come including pregnancies and operations. You should also decide whether you would rather pay more for your monthly premiums and then pay less when you need to use your health insurance, or whether you would rather pay less in monthly premiums and pay more when you need to use your health insurance and also if the network of your chosen health insurance plan includes the network of physicians and professionals you prefer to use. For example, nowadays HMO is a much less prevalent health plan than it used to be. Insurance companies now pay the physicians much more for PCP patients than they pay for HMO patients so inevitably, there are more doctors on HMO networks than there are physicians on PPO networks.

When choosing a health insurance provider, what would you say are the most important factors I should consider?

There is a health insurance provider that should be distinguished from all the others because of the way it offers its services - Kaiser. Kaiser is a large company in some areas that offers a one-stop-shop kind of arrangement that you don't get from any of the other insurers. This means that although Kaiser is very cost-efficient, you do not have the luxury of being able to choose your own doctor. All physicians, pharmacists, dentists and opticians are taken care of in-house by Kaiser regardless of any networks they may belong to. Whereas all of the other insurance companies buy networks of physicians who belong to Independent Physician Associations (IPAs) with whom the insurance company must negotiate and agree the cost for the particular services in both the HMO and PPO networks. That's why it is important that you choose a health insurance plan for a provider attached to the appropriate network for your particular needs. For example, your personal physician may not be a member of the HMO network for your carrier but may be in the PPO network for your carrier. This could well have a significant effect on which Health Insurance carrier and policy you choose to sign up for. It comes down to a matter of freedom of choice. If you want the convenience that comes with a one-stop-shop, join Kaiser or if you want to choose you own physicians and experts, you should choose one of the other Health Insurance providers.

How much health insurance coverage would you advise that I have?

Ideally, you should have as much health insurance as you can afford. It is about balancing what you can afford to pay on a monthly basis with what you can afford to pay when the time comes that you actually need healthcare. For example, you can have a zero deductible, $10 co-pay plan, which would offer many benefits and cost a large monthly premium or you could have a $250, $500 or $750 deductible plan with $20-30 co-pay plan which would cost much less in monthly premiums because you've agreed to pay the deductible first yourself. To conclude, you need to engage in a cost-benefits analysis if you want to determine how much insurance it is appropriate for you to purchase.

I find it hard to make a right decision while choosing a health plan between PPOs, POS, and HMOs. I wonder why there are so many variants and how is it possible to prefer one to another?

Well, we have already mentioned that point above. The first step you need to take is to contact an expert broker to help you figure out your needs and identify your priorities after a long constructive conversation with you. Secondly, you have to decide if you the Kaiser model of medical benefits is good enough for you or if you feel like you need more freedom of choice to go for those experts that will guarantee you the best plan for your family or you personally. The third point you need to consider is that your plan should cover the network of physicians you will consult with. Another important moment is to figure out if you can afford on both a monthly basis for premiums as well as worse case scenario, out of pocket expenses, if something unpredictably bad happens. There is also such thing as the X number. The X factor, or amount, is what will drive your premium costs. Meaning, the lower the X number is, the higher your monthly premiums will be. So if you accidentally got into the hospital and you need to stay there for a couple of weeks, as long as you remained in-network, you would never be out of pocket more than $x sum.

How can I make sure the provider I chose will be the one that will guarantee enough coverage for all the claims?

It is a dubious question, to be honest. There are too many things to consider here. Let's take a look at one of the examples. If you know you have some serious illness or if you know you are planning on getting pregnant any time soon, you need to look up for the health insurance plan that will be perfect for the condition you are in or will be in soon. This insurance should provide enough coverage for your claims in the future.

What measures should I take when my provider denies my claims?

You need to establish what coverage was denied and why it happened. You need to start an appealing process for your case to be reviewed and the denial to be reconsidered. If this process doesn't meet your satisfactions you can start alternative coverage with another insurance company or insurance provider. This is where the individual insurance comes into play and changes something. Most of the time these insurances are most expensive and it may be a little problematic to change but for small group insurance in California, you could change as of the first of the following month to another carrier that may cover those items that are currently being denied with your present insurer.

I am the owner of a little enterprise with less than 10 employees and I want to offer them a good healthcare deal. How can I make sure the offer is brilliant and the costs are down at the same time?

Here are a few advices on how you could keep the costs down and provide your employees with the best healthcare offer. You need to discuss everything with your employees. It is important to do it to figure out which offers and which plans would suit everybody better. For that you will probably need a broker that can gather you all in one place to sort it out. As we know there are different plans: HMO's, PPO's, H.S.A. plans as well as HRA plans. A good broker will always tell you how to keep your budget strong and get you the best possible healthcare deal. You need to decide for yourself the amount of money you want to pay. It can be done either on a fixed dollar basis or a percentage of costs. This way your employees will have a freedom of choice and they will know their options well.

I used to have my son on my healthcare plan. But now he is a graduate, but one without a job. I don't think my plan keeps on covering him and I don't think the school does either. How can I make sure he is covered?

There are various insurance companies that will deal with this case. But we must warn you that lots of them have high deductibles. Still, there are certain plans that offer first dollar benefits up to a certain point that would help the situation.

I am almost a retired man. I have always had a healthcare plan sponsored by my employer. What types of plans should I go for if I am about to buy additional healthcare coverage together with Medicare?

You do need an additional healthcare coverage as Medicare system doesn't seem to be the costumer's top choice. There are a few other coverage plans to consider. They are: Medicare A, B and D. they are all different, and totally relate your medical benefits coverage. Medicare part D, is not as simple as it may seem. People think that it is hard to adopt and being new it has some contradictions to go with it. That is why we advice you to consult with an experienced broker who specializes in this area and can help you make up your mind. Once there is a specialist helping you, you will find it easy to choose a coverage plan. We would also recommend you to find an additional policy to fill in the gaps where Medicare falls short.

I found a new job, but before I start it I want to go on vacation. I would really like to go no with my current coverage but COBRA seems to hit my pocket. What are my other options?

It is news that COBRA was always very expensive and depending on your plan while employed and in order to not miss out on any important things your medical insurance market may offer you will surely need to stop by. There are different plans to pick from but you will probably need the one that suits your case the most. You need to find the plan that will cover you if any unpleasant incidents happen in your life but the premium should be low. This would require a higher deductible plan, without a doubt.

The enterprise that I am engaged in decided to change the healthcare provider for their employees. This is the first time it ever happened. I have been seeing the same doctors for quite a while now and I don't want to try others. I am afraid that my new healthcare plan will not consider my physician as a primary care option. How can I keep my doctor by my side as I am used to him and he treats me well from my maladies?

Let's take a look at what you could do: You will have a few options to consider. To start with you will be required to proceed to your companying altering suppliers; you are requested to find out which health physician is the network. If the physician you want to be treated by is not in the network, then try to reveal if your doctor is claimed as an in-network PPO doctor. Mostly, you will be notified that your medical assistant will be in the PPO lists, if not in HMO lists. As it was previously stated, the case when doctors drop their HMO plans raise daily because it is not beneficial for them to have HMO patients in this large number. The situation is the following their HMO plans take too much time and their income from HMO patients is not worth the number of hours they spend on these patients. The health insurance providers offer the physicians a different amount of money than they offer for PPO patients. That is the reason why; many of doctors are found on the PPO providers' lists and not anywhere else.


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