Health insurance providers, both public and private, are looking for ways to cut spending. One of their strategies is to deny claims for treatments they deem unnecessary. The effectiveness-testing studies receiving funding in Congress’ healthcare reform bill is a case in point. While that’s a laudable goal, what if your doctor recommends an unusual course treatment?

Experts recommend that you never tell your health insurance plan that you are receiving an “investigational” or “experimental treatment; or if you are enrolled in a clinical trial. These phrases are codewords that make insurers more likely to look closer and reject your claims. First off, health insurance plans will cover treatment your physician considers medically necessary. When it comes to insurance, you obviously shouldn’t lie (that could lead to cancellation of your policy, leaving you uninsured); but you also shouldn’t give more information than is specifically asked for.

You may even be wrong about the experimental status of the procedure. Some procedures aren’t typically used, but are proven medically effective nonetheless. In that case, health insurance plans should cover it. Check with your doctor, even if he or she used wording such as wanting to “experiment with a treatment”. Don’t let semantics cost you!

Sometimes having the wrong health insurance is even worse than being uninsured. An recent article in Chester County’s Daily Local News made that clear. After becoming unemployed, many people are left in dire straits once their employer’s COBRA coverage expires. With little money, most are only able to buy inferior health insurance plans. At that point, millions of individuals and families become underinsured. Imagine if your insurer refused to cover even one emergency room visit! No wonder some people decide to go uninsured instead; they’d still have to pay for their medical care, but at least wouldn’t still be paying premiums.

Unfortunately, some people doesn’t find out what their health insurance plan does and doesn’t cover until it’s too late.  Avoid the underinsurance trap by reviewing your plan and talking with an insurance agent. The best solution is to find a plan that suits your needs and provides the most value. It’s important to save money on insurance, but don’t forget your health. If you are currently underinsured, you can get an affordable health insurance quote for a better plan.

(Image: Commonwealth Fund)

Rationing: It’s a dirty word.  Some politicians and activists warn of the dangers of a public option that would have the government ration out health care, and point to Europe as a cautionary tale; others claim that care is already being rationed indirectly by a patient’s health insurance plan. Either way, the thought of being denied needed medical treatment because of a callous calculation is scary. Costs need to be cut, either by the federal government or private insurance companies looking to maximize their profits–therefore, everyone’s looking for whatever procedures may be considered unnecessary and wasteful.

How do you know if you’re a victim of rationing, as opposed to a recipient of high-quality, sensible health care? In Newsweek magazine, medical school professor Christopher Moore acknowledged this dilemma. Sometimes, excess treatment can hurt the patient more than it helps. Take CT scans, for example. Admittedly, they are costly, with prices continuing to rise (and also being passed onto your family health insurance bill); but CT scanners are amazing medical technology that can identify if a head injury is life-threatening. However, studies have shown that the probability of that being the case are relatively tiny. Meanwhile, there is up to a 1-in-1,000 chance of each CT scan causing eventual death from cancer (due to the radiation involved), even more so for younger patients. The medical risks of doing a CT scan on a teenager with a concussion could outweigh the benefits, even after removing cost from the equation. Keeping a close watch on the patient might be a better bet.

So if your doctor refuses to perform an expensive test or other procedure, it’s very likely that he or she has a legitimate medical reason for it. If you get more affordable health insurance because of the reduced cost, so much the better, but that’s not the #1 priority.  Occasionally, a physician who performs the procedure might be doing it solely to avoid a malpractice lawsuit. The prospect of a government-run public option won’t stop that. Moore insists that a doctor who genuinely believes an expensive procedure is sorely needed won’t let cost concerns stop him or her from ordering it. Let’s hope so.

(Image: Akira Oghaki under CC 2.0)

For years, Americans have been struggling to find an affordable health insurance plan that fits their needs. Some insurers are more reputable than others. Unfortunately, some unscrupulous providers have promised healthcare coverage but failed to deliver, leaving consumers stranded. Reuters recently exposed Florida couple Renée-Marie Stephano and Jonathan Edelheit and the bogus health insurance they sold.

Their health insurance plans were sold under the name OptiMed Health Plans, a subsidiary of United Group Programs (not to be confused with United HealthCare). The states of Montana and Washington have accused OptiMed of selling fraudulent, unauthorized policies from 2003 to 2007. People duped into buying discount health insurance from them ended up saddled with thousands of dollars in medical costs, since OptiMed failed pay its customers’ claims. It’s another example of why you should be careful when looking for health insurance. Speak with an agent to find reliable, affordable health insurance.

Following her Senate counterpart’s reveal of his healthcare reform plan earlier this week, Speaker of the House of Representatives Nancy Pelosi has now unveiled her chamber’s proposal for expanding affordable health insurance coverage. As expected, the House’s plan is farther-reaching than the Senate’s and more similar to the one outlined by President Obama during his campaign.  Here’s a quick Q&A on Pelosi’s plan:

Q: How much is this going to cost?

A: It’s projected to cost a whopping $894 billion over ten years.

Q: How is the government planning to pay for reform?

A: It will raise income taxes on couples making over $1 million and individuals making over $500,000 yearly. In addition, Medicare spending will be cut by an unknown amount.  Liberal representatives also floated the idea of having the government dictate the rates paid to health care providers by the public option, but moderates managed to strip out that provision. (The government, as well as private insurers, will instead negotiate payment rates with hospitals and doctors.)

Q: Is a public option included?

A: Yes. Unlike the Senate version, the House’s bill doesn’t allow states to opt out of it. So far, it doesn’t include a so-called “trigger” either.

Q: Will illegal immigrants be covered by the public option?

A: As of now, it’s unclear. That’s one of the main sticking points preventing the House bill from reaching a vote. However, remember that illegal immigrants are already receiving a form of public healthcare: hospital emergency rooms are required to serve everyone who comes in.

Q: What about abortion? Will it be covered?

A: That’s another controversial topic that will see much debate before the bill hits the House floor. A handful of pro-life Democrats will probably try to have abortion coverage removed from the public option in order for it to receive their votes. Meanwhile, some pro-choice representatives oppose a bill that doesn’t include abortion services. Either way, the Democrats have a solid majority in the House and can afford to lose some votes in either direction.

Q: What if I have a pre-existing condition and can’t get insurance?

A: These reforms are supposed to change that. Health insurers will no longer be allowed to deny coverage to people with pre-existing conditions. They won’t be able to charge those with pre-existing conditions significantly more, either.

Q: When will healthcare reform take effect?

A: It’s hard to believe, but the bill won’t fully kick in until 2013. By then, a mandate will require everyone who can afford it to buy health insurance. They can be insured via the newly created exchange (consisting of private insurers, in addition to the public option), by their employer, or an existing government program such as Medicare or Medicaid.

Q: But I need health insurance now! What can I do in the meantime?

A: The government is putting together a temporary program to insure individuals and families that have been rejected by private insurers. Otherwise, do you really want to wait for the government’s health insurance plan? Keep in mind that the House bill needs to be reconciled with the Senate bill before there’s a final vote, and that could take months.

(Image: U.S. House of Representatives Portrait)

Senate Majority Leader Harry Reid has joined the strong push for a public option in Congress’ healthcare reform bill, but its inclusion is not guaranteed. The provision’s fate is in the hands of moderate Democrats. Despite the ability for individual states to opt out of the government-run health insurance plan, centrist Democrats like Senators Ben Nelson and Max Baucus are still leery of voting for it. You should get a health insurance quote while you wait for the endless wrangling of votes to finish, since garnering 60 Senate votes to pass this bill will no doubt take awhile. The fact that several politicians in the party have received large campaign contributions from the health insurance industry doesn’t help.

Why the delay? The Senate and the House of Representatives have to debate exactly what form the public option will take, and moderates hold its fate in their hands. They need to compromise between comprehensive health coverage and cost. Gaining Republican votes is a lost cause at this point, so party leaders will be forced to exert their power. For example, Reid may try to convince a swing vote with a seat on a prestigious Senate committee–that a Senator will only get if he or she votes with him on healthcare reform. The more liberal House has a more comprehensive public option proposal included in its bill, and it must be combined with the bill in the generally more conservative Senate prior. Afterward, it’ll see even further amendments by the rest of Congress before a final vote. There is also the possibility, albeit less likely, that some liberal politicians will vote against the bill because it doesn’t do enough to reform our health insurance system. However, centrist politicians receive more attention from leaders because they are the wild card. Can you wait for Washington to decide, or would you prefer to be safe and get health insurance quotes from multiple insurers now? If, years from now, you like what the public option shaped up to be better than your existing health insurance plan, you’ll be able to switch–but if you’re caught uninsured before then, you’ll wish you hadn’t waited.

A recent story in the Boston Globe, while sad, has given me a deeper appreciation of those health insurance companies that provide mental health coverage. During a therapy session at Massachusetts General Hospital’s Bipolar Clinic, a patient with bipolar disorder stabbed his psychiatrist. The psychiatrist is recovering, thankfully; the patient was soon killed by a security guard after he failed to stop.

Many people forget that psychiatrists are also medical doctors that treat a variety of conditions and put themselves in harm’s way each day. While it appears that this particular patient was too far gone, millions of individuals with mental health disorders have seen significant improvements with the help of psychiatric treatment. People who need treatment are more likely to get it if they have health insurance with mental health coverage. There are insurance plans that cover most or all of the cost of psychiatric and therapy visits, as well as medications.

Please don’t wait to get help until it’s too late. If you or someone you love is struggling with paying for treatment of their mental illness, get a health insurance quote instead of giving up. I wish you the best of luck.

(Image: Pink Sherbet Photography under CC 2.0)

One of the most difficult things about switching healthcare providers, visiting specialists, and being prescribed medication is that often your doctor doesn’t know what your previous doctor has prescribed or done; This includes lab work. millions are spent every year on duplicate lab tests. Imagine how much you will save, and your insurance companies will save when people start synchronizing information and start keeping their own records so that the story doesn’t change every time there’s a new form to fill out.

Keeping your doctors consistently informed is vital, the more they know the easier it is to help you. Often doctors can cause harm because of misinformation, chopping off the wrong limb during a surgery. Don’t risk it! Start creating a data mine of your own, on yourself. Share it with family and doctors to keep you as healthy as possible. There are so many pharmaceuticals nowadays its almost impossible ot keep track of them all and which ones conflict.

As a side note: wouldn’t it be interesting if Google Health had a Datastore of all pharmaceuticals and their side effects, so that if you are taking two that can cause you harm it would put up a red flag? Perhaps I will suggest this myself.

When you are in an emergency and the ambulance comes to pick you up, you often don’t have a choice as to which medical professionals or ambulabnce service is on its way. You wake up in the hospital full of tubes sticking out of your arms and sometimes mouth.

This is not the best time to ask wether or not what is being done to you is covered by your insurance…

However, after the fact if your health insurance company tries to stick you with out of network fees for emergency services, argue till your head turns blue. You have no choice as to who picks you up and you MUST be treated in an emergency situation…but dont for a second believe that you MUST accept every charge the hospital gives you. Research it, look into it…but when you are healthy again.

Unfortunately, this type of argument is only usually done when someone has a third party such as a family member helping to mediate for you. Being sick or in an emergency often drains you, so look for support from friends and family if possible.

The whole notion of pre-existing conditions is debatable. On one hand insurance companies only want to take your money as long as you are healthy, and have no real need for medical attention. On the other hand, an individual facing illness on a daily basis could make it difficult for others to acquire affordable coverage. For people with pre-existing conditions, the only alternative outside of group coverage, are limited medical benefit plans and discount plans. Limited medical benefit plans provide some coverage for basic medical necessities, but most plans fall short of substantial assistance when faced with catastrophic medical issues. The plans open the portal to health care but are limited, as the name suggests, in the care that an individual who really needs it, can get. Moreover, the risk of being taken advantage of by opportunistic insurance agents is high. Discount plans only provide discounts. Most are not accepted by the health care providers that they claim to be affiliated with, thus mounting frustration with the consumer who bought into the hype. Most importantly, discount plans are NOT insurance.
The idea of insurance is to insure in case of loss. In the case of health insurance, loss is illness. If an individual is willing to pay a monthly premium why not allow them the health care coverage they so greatly desire? Recently there has been a lot of discussion regarding pre-existing conditions and the government is trying to make it illegal for insurance companies to deny people converge for those who do have a pre-existing condition. But until that time it’s really slim-pickens’, but don’t loose heart here’s a company that excells in coverage for those with pre-existing conditions, Vital One Health, 877-500-2945.