health insurance policy is basically a contract between you
and the insurer to make the payments specified in the policy
if you incur covered medical expenses. So how do you separate
the “good guys” from the “not-so-good guys?”
Your state insurance commissioner’s office is a good place
to start. This office can provide you with useful information
about insurance carriers that you may be considering. All states
have websites that are dedicated to their insurance division.
These websites provide valuable research tools, license checks,
complaint ratings and financial performance reports for all of
the insurance companies authorized to do business in a particular
state. You can also find out if the managed care plan you are
interested in has been “accredited” and meets certain
standards of independent organizations.
You may also find helpful information from
the carriers’ plan
brochures or websites. Some independent organizations are beginning
to produce “report cards” that they make available
to the public. These reports often include satisfaction surveys
and information about quality.
Your friends and relatives can be valuable sources of information
about insurance carriers. Ask them about their health plans.
Are they satisfied with the way they are administered? Are they
having problems with claims being paid on time? How often do
they have rate increases? Have they ever had a claim denied?
If so, why was the claim denied?
Many health insurance carriers provide special services to
their health plan members. These may include things such as
a nurse help hotline, educational classes for specific illnesses,
healthy living programs, discounts on health care products
and many other services. The costs of maintaining these programs
are built into the health care premium you will be paying.
Review the member services offered by insurance carriers and
determine if any these will be beneficial to you and your family.
It is also important to explore the insurance
of providers. Does your physician accept this type of insurance?
Will you be allowed to use the hospital you prefer for medical
treatment? Most HMO plans won’t allow out-of-network benefits
except in emergency situations. If the plan you are considering
does provide you with out-of-network coverage, find out the coinsurance
percentages. Typically, your coinsurance will be considerably
higher and there may also be dollar limits on the amount of out-of-network
care that can be received in a given year.
Talk to your regular physician about which insurance companies
they contract with. You should also get some feedback from
your physician’s staff about which insurance companies
are the easiest to work with on preauthorization for certain
types of medical treatments. Your location is also an important
consideration when reviewing the network of physicians and
hospitals. Make sure the plan you are considering has a good
selection of providers in your area.
Insurance carriers can change their plan benefits
from year to year, so you should carefully check the history
that you are considering. Insurance companies continuously review
claims history and compare this to the premiums collected for
a specific plan. Based on this information, an insurance company
may reduce benefits, raise premiums, or both.
Although some health insurance plans are more comprehensive
than others, you will not find a health insurance carrier that
pays for 100% of all costs. You will need to review plans and
decide which one is the most financially feasible for your family.
Unless you have a crystal ball, nobody can
specifically determine what their health care costs will
be during the next year.
If you knew this, finding the right carrier and insurance plan
be a much simpler process. If you take full advantage of the
free research that is available you will find it much easier
to select the health insurance carrier that best meets your family’s