 Understanding a health insurance
Why we need a health insurance?
We all usually enough good understand the health insurance benefits. Job
accident, or some serious illness need us to pay hospital bills from own pocket,
include a deposit before admittance to private hospitals. The medical bills
can lead our saving up to bankruptcy.
Another reason is that you and your family have to go to public health care
facilities and meet a line with hundreds other patients. And you still have
to pay for costly operations that are not covered under public health care.
Yes, good health is very important to everyone. If we need a regular visits
to doctor we can end up with high medical costs. Health insurance can cover
a range of services including visiting a doctor and tests that we receive out
of hospital. Many people probably do not need to visit the doctor on a regular
basis, but there are some of us who need it and health insurance can provide
needed financial support.
Another side of health insurance
The best way to see and be sure your case will really covered your health
insurance, is understand your health insurance rules and exceptions before you
become ill.
Before all, carefully read all the insurance forms to make sure you know
what is covered and what is not. Making your own research help you prevent problems
later. You must be sure you read your insurance policy carefully and follow
exactly the steps your insurance company requires for filing a claim.
Health insurance company can advertise to attract new members. At first look
this insurance company look like the policy covers all major medical costs,
but the fine print may reveal you that it is not true.
You have to learn how the insurance company willing to pay for procedures.
Some policies may saying about to cover up to 80% of "reasonable customary
charges". But if a doctor submit a bill for $20,000 treatment, the company
could not admit it due "not a reasonable charge".
Dirty tricks of health insurance companies
Last years large number of patients have been alone with costly treatment
and astronomical bills for a serious illness because their policies canceled.
Now we explain you the mechanism of retroactively a health insurance. It is
named rescission.
If you have a serious disease, or you need a costly medications, you may
meet a rescission. When insurance company receive the bills, they look into
your file, your application, and review your medical records from the last few
years. If they find some inconsistency in your application, even honest mistake,
your policy maybe rescinded. A lot people has been harsh punished this way.
For example, large US insurance company Blue Cross being fined $1 million
in March 2007 for rescinding around 6000 policies without proving that these
patients willfully falsified their applications.
So, you will be very careful filling out your insurance application. You
have to answer the questions as best you can. If you are not sure if you’ve
had a certain condition or some treatment, write down that you do not remember
it. Many forms don’t allow even space for that answer, so you have to be prepared
to squeeze it in.
Now about how to keep from getting denied. Insurance company may veto a doctor's
orders if they see your treatment is not necessary or it is experimental. This
mean, risk of deny very high for new treatments, especially for newest cancer
treatments.
You have to try get your treatment preapproved in case if you have any question
about covering. Clear, this question is warning sign to the your insurance provider.
Exactly preapproval very often trigger the rescission review. For example,
if you need a hip surgery (that is enough expensive surgery), they will look
at your application and medical records for see if you can be a candidate for
rescission.
Appeal to a decision
What you can do if your call for coverage has been refused? You must be sure
you carefully read and understand your policy and follow exactly the steps that
your insurance company requires for filing a claim.
If you are sure, what your insurance company have to cover, you have to call
for preapproval. You have to tell to authority how carefully you check your
policy and you meet company's criteria for desired procedure. Usually you have
to call a medical director that is the person responsible for such area.
Your doctor have to write a letter that explaining why exactly this procedure
is necessary for you. Try to find some journal articles showing the effectiveness
this kind of treatment. As result you make your insurance company hard say that
desired surgery is not necessary for you.
Other places for preapproval is your state's department of insurance and
/ or you can file a lawsuit. You know, insurance companies don’t like any lawsuits,
but most patients don't like it too due to get involved in litigation.
Common advices around health insurance
First of all, do everything in writing. You have to do all via e-mail, fax,
or snail mail. This mean, avoid to do anything by phone. Usually with phone
when hang up nothing happen after.
In case you have to talk by phone, always ask for representative’s phone
number and name and carefully listen how your call typing to make a record.
You have to carefully record of all your correspondence and other related
documents. Even if now here is all okay, or you win the batter and your claim
has been paid, keep all paperwork for three or four years. It's not hard and
can help you when need.
Individuals who can get coverage through employer having more power because
unhappy policyholders employed at corporations or some company can complain
to human resources department. If the employer see the employees are not being
well taken care of, it may decide for different insurance company.
And vice versa, individuals without coverage through an employer should look
for a group to join, such as an association affiliated with your job.
At end, the hardest thing in relations with insurance companies is be not
emotional. It is battle for our nerves too. You have to win, and your calm will
help you.
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