Health Insurance Carriers

A 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 companies’ network 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 of companies 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 would 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 needs.