Posts Tagged ‘Own Health Care’

Affordable Family Health Insurance For Children and Students

January 28th, 2010



Health insurance is a complex area and it’s very easy to overlook the special needs of children and students. Finding an affordable health insurance plan that fits your needs is not always easy but, with some guidance, it is possible.

Nearly 10 years ago now Congress passed a plan entitled Title XXI, or the State Children’s Health Insurance Program [SCHIP]. This plan was aimed at dealing with the growing number of children in the United States living without any form of health insurance. Unfortunately, for many families, their income is not sufficient to afford private health insurance but is too high to apply for Medicaid. Under this state plan however the family is charged a maximum of 5% of their gross annual income and, in many cases, can receive medical treatment at no cost at all.

The cover provided under this program varies from state to state, but all states must provide a minimum of cover including such things as well-baby and well-child physicals, immunization and emergency services.

One thing to note is that, if your child is already covered under a health insurance policy, then he or she will not be eligible for the state coverage.

If your children are not eligible for medical care under the state plan then you will need to consider whether they should be covered under a family policy or on their own individual policies. As a general rule, it will normally be more cost-effective to have a family policy although, if you have only one child, an individual policy for that child may prove to be more cost-effective.

When it comes to student health insurance most colleges and universities have their own health care clinic for treating routine ailments such as colds, sore throats and minor sports injuries. However, all students should have some form of health insurance cover for unexpected medical problems including more complex illnesses and surgery.

If possible, you should try to have your children covered on your own individual or family policy and most policies will cover children even when they are away at school. Some policies may however place certain restrictions on coverage and these should be checked carefully.

If you find that your children need their own individual health insurance policies whilst away at college, then there are a number of insurance companies that cater specifically to the needs of students. You should however research this area carefully and make certain that the cover being provided meets your needs.

It is all too easy to assume that the government will take care of the health needs of children and that colleges and universities will likewise take care of their students. Unfortunately, this is not the case and, as parents, it falls to us to ensure that our children get the health care that they need.

By: Donald Saunders


The Newbie’s Guide To PPO Health Insurance; Part 1

January 25th, 2010



A PPO or Preferred Provider Organization is a segment of health insurance that can be provided by an accredited health insurance company or provider. If you’re already familiar with an HMO or Health maintenance Organization then you have a good start in regards to what a Preferred Provider Organization actually is and can provide to a consumer seeking health insurance. The reason for this is because the Preferred Provider Organization is very similar to an HMO based on the fact that they have contractual agreements with many of the health insurance companies. The biggest difference is based on the fact that the Preferred Provider Organization doesn’t have as many limitations or restrictions when compared to the traditional HMO. Generally speaking this favors the consumer or individual seeking health insurance coverage through a provider’s health plan.

The advantage that a Preferred Provider Organization offers its clients is the ability for them to freely choose their own health care doctor or physician. This is particularly beneficial for an older person that has seen a regular doctor for many years. Naturally a bond of familiarity and trust builds up between a doctor and long time patient allowing for a comfortable feeling to take place during a routine medical appointment. The PPO allows this professional relationship to continue to exist ensuring better medical treatment. However, while the opportunity to seek medical care from the family physician or local doctor sounds nice it does usually mean that a higher out-of-pocket cost will be incurred by the individual consumer, although a referral isn’t normally needed to see a medical specialist.

As you can expect HMO’s are usually much cheaper due to the restrictions they place on who an insured patient can see and how they go about obtaining a referral to a health specialist for additional medical treatment. The PPO does offer more control over the providing of an individual’s health care needs so in this instance your health as opposed to money may be the final determining factor in regards to which health care plan you choose to apply for.

The Preferred Provider Organization’s main goal has been to provider health insurance coverage to large groups at a lower then normal rate or premium. They have been extremely successful at this endeavor by providing better information to the PPO network of doctors and by providing cheaper rates for medical insurance. In fact they were so successful that the PPO was the main driving force behind a dramatic drop in medical expenses throughout the last decade.

Based on the complex nature of the current health care system any plan, such as the Preferred Provider Organization, is a welcome sign of relief for many consumers needing and wanting adequate health insurance coverage at a very reasonable and affordable price.

By: Sharlene Raven

Avoiding Health Insurance Claims Denials on Group or Private Health Insurance Policies – Part 1

November 17th, 2009



These days a patient must be vigilant about his or her own health care in terms of researching treatment, securing pre-authorizations, and knowing what to do if their group or private health insurance policy denies a claim. After all, a health insurance claim denial is the last thing you want to have to worry about in the middle of a health crisis. A denied claim feels like a knife in the back placed there by the very company that’s supposed to be watching your back. Luckily, some claim denials can be easily avoided.

According to one lawyer at the Texas State Department of Insurance, “The most common basis for a claim denial in the health insurance industry is that the procedure, preparation, or pharmaceutical is not covered by the policy. So, the easiest and most important way to avoid a claim denial is to read through the most recent and most inclusive version of your health insurance policy and get a picture of the kinds of things that are covered, and those that aren’t.” This is a great starting point. Make sure your policy is the most up-to-date. In the past few years most policies have changed to put more financial burden on patients covered.

It’s also a good idea to contact your health insurance provider and ask to talk to someone who specializes in the area of treatment you’re receiving. After all, he or she might be the very person reviewing your claim, so feel free to ask specific questions about what might or might not be covered under your particular policy. For future reference, write down his or her name and telephone number at the beginning of the conversation. Keep detailed notes on exactly what happens every step of the way, and retain all related paperwork, even if you’re unsure whether it’s relevant. Include in your notes:

* When the required treatment pre-authorization was requested, and received, and from whom

* Date of the treatment

* What was discussed with the doctor, what actions were taken, and what follow-up will be required

Unfortunately, mistakes are common in claims processing. Consider a 2002 study by America’s Health Insurance Plans, which reported that 14 percent of claims submitted to insurance providers are denied. The same survey found that one out of every seven claims had to be re-submitted and re-processed due to errors in the original claims, a costly process for everyone involved.

Other things that you might consider include:

* Research your state’s laws regarding what should be covered in a claim, and what the law considers “arbitrary.” This would influence an insurance company’s definition of “medical necessity” and billable needs.

* Make sure your insurance provider and doctor’s office have been in contact with each other, and that all the necessary paperwork has been forwarded from one to the other.

* If your coverage is fully or partially paid by your company, make sure you keep your human resources department fully informed of the situation so that they can help with any paperwork that might come up that you can’t manage.

By: Ryan Patterson