New Rules for Old Healthcare: Many of us are ‘Going it Alone’

After nine months of back-and-forth public debate, big corporate bail-outs and strained political ties amongst members of Congress, the shock of the new economy and all its moving pieces has officially worn off. But healthcare reform still dominates our national agenda at a time when few of us can afford to be without. Whether or not the so-called “Public Option” becomes part of any finalized healthcare bill signed into law, the average American will have some vital decisions to make about when, where and how they seek coverage. The old rules of group coverage no longer apply in the new economy.

No Safety in Numbers

Just as fast as the U.S. housing meltdown completely redefined what it means to live within our means, so too are the days when finding a good job guaranteed you’d find affordable health coverage where you work. Companies of all sizes are cutting back benefits now that they’ve cut back their workforces. As a result, the old-school “pool” insurance model is proving less and less sustainable. The good news is while debate still rages on Capitol Hill, health insurance providers are restructuring their product portfolios to make coverage more affordable for millions of individuals — no matter if they’re employed or not.

“Next to salary, health insurance is the largest expense any company has,” says Larry Johnson, a human resources officer with Nashville, Tenn.-based Hospital Corporation of America (HCA), the nation’s largest for-profit hospital company. “The reality is that individuals can go online and out in the open market now and get low cost, low deductible coverage on their own.  Lots of times it’s cheaper than what we can provide our own employees.”

Inside Out

In the same way telephone companies broke themselves up into smaller, regional providers in the 1980s (to address government concerns that telecommunications had become a monopoly of a few big providers), health insurance companies are breaking themselves up from the inside out. It was clear several years ago, says one industry health insurance executive, many healthcare companies saw the governmental reform train coming down the tracks.

“Changing an entire product set, expanding a marketing strategy and creating a new pricing model for an industry that’s been pretty much self-regulated up until now doesn’t happen overnight,” says Miami-based independent health insurance agent Jerry Sommers. “Public option or not, this has been in the corporate pipeline for years before it ever got into the media or Congress. It’s only going to get more confusing before it gets better. I’m quoting a lot of policies for people who are scared of what we might end up with when the government gets done.”

When you shop for health insurance be sure to ask your licensed health insurance agent as many questions as possible about the providers being recommended or chosen. You don’t want to end up like this poor woman who went through an absolutely terrible experience with Blue Cross and Blue Shield of Kansas.

Stories like this make the Health Insurance Industry look bad, when the reality is the majority of the time your Health Insurance is there to help you. It is true that administrative errors do occur from time to time, but this is not unique to just the Health Insurance Industry. However, some research and analysis into issues found with different companies in your specific state (as they are all managed differently by different people) can help you make a sound decision for your demographic area and healthcare needs. Knowledge is power, keep yourself informed before making any quick decisions.

More than 30 % of medical claims are improperly denied. You should always fight if you have been denied coverage by your provider. It takes a bit of personality and tenacity to get this done. It is unfortunate, but it is the way the system has grown to work. Be firm in your resolution that you have been improperly denied and voice it over the phone, email, and written letters. Written letters are the best way to get through to companies, they almost always get answered whereas phone calls and e-mails do not. Keep hard copies of those letters and their responses. They may come in handy if your company claims it did or did not say something.

How valuable is your health to you? I bet your thinking, “What kind of question is that?” Your health is invaluable, right? Now here’s a little insight, if you should ever experience any health problems there are doctors that will quickly put a price tag on how much your health is worth. If for any reason an illness or accident should send you straight to the hospital you could end up spending your lifetime savings on treatment. Luckily, for these types of situations there is health insurance. Although choosing the right one can be overwhelming.

There are several factors that have to be determined before you can choose the best insurance that meets your specific needs. When searching or even considering any type of health insurance take the time to consider you and your family’s current lifestyle first. Then take in account how much you can afford for monthly premiums and co-payments. Make sure you consider a premium that will not increase at least for 12 months just so when it does you can be prepared. Take your time and understand the basics of health insurance, you have to understand that every year you get older and as you get older more risks are taken by your insurance carrier that’s the reason for your premium increase.

There are also many other benefits from taking just a couple minutes out of your day to really sit down and think or speak to your spouse about. Always remember that there are hundreds of health insurance agencies, or at least that’s what they’ll call themselves these days. It’s always better to have an insurance agent, someone you can talk to if you don’t understand something about the policy you are considering to purchase. I know trusting someone that you deal with over the phone is very hard, but you always have to remember that by law you have 10 days from the receipt of your policy (meaning the day you receive it in the mail) to cancel any policy and get a full refund with no penalties attached. Last but not least take a look at the type of plan you are purchasing.

What type of plan are you purchasing?

Is it an HMO or a PPO? Take in to consideration that although an HMO can have low monthly premiums they do not cover as much and you are looking to spend more money out of pocket. Usually with an HMO you would have to stay in network and/or get a referral if you have to see a specialist. A PPO on the other hand sometimes has the same monthly premiums of an HMO but allows you more benefits and you don’t need to stay in network, and depending on which insurance carrier you are purchasing the plan with you won’t need a referral to go see a specialist. You may have heard the term “You get what you pay for!” So if you are searching for quality health insurance why settle for less.

There are certain things in life that we cannot time, and one of these is needing healthcare services. Aside from managing basic healthcare services such as doctor visits, simple examinations, etc., catastrophic accidents or illnesses are unpredictable. This is why we all need health insurance, so that we transfer this risk to the carrier. The carrier distributes the risk amongst a large pool of insureds in order to effectively manage healthcare costs for all of the policyholders.

Everyday that passes without being insured is a day in which we run the risk of suffering from a catastrophic incident and not having the finacial support of health insurance. Health insurance coverage should be viewed as what it is, protection for our health. There are many people thatt complain that they have paid years of health insurance premiums and have only used it to go to the doctor twice a year. My response to that is that they should be very thankful for maintaining their health. The opposite would be the unfortunate perosn that suffered a catastrophic illness or accident and although they were covered by their health insurance, they would have much rather not have to have suffered such an illness or accident.

It is like the person who may be upset because they haven’t collected on their life insurance!

Be healthy and wise, get health insurance through a licensed and experienced health insurance agent.

The American public struggles to make decisions on buying individual health insurance policies, mainly because health insurance has been supplied by employers for decades. The average worker is told by the company they are working for if you want health insurance, this is the way it is. Because a large portion of the employee rate is paid by the employer and because it’s easy just to add your dependents, most people know very little about how health insurance works or the reason a lower deductible plan costs more. Not being knowledgeable about health insurance can cost you a lot of money. The time factor also makes purchasing health insurance an expensive venture. Because most people don’t have the knowledge on how health insurance works (the amount of time needed for underwriting), they wait to the last minute to purchase protection.

First, you need to know there are different types of health insurance plans available to purchase. Major medical PPO plans for an individual has different guidelines than the group Major medical plan you have had for years. There are also Short term Medical plans and Mini medicals to consider. And on top of different products to consider there is a time factor, depending on your current health status, to speed up your selection process or be penalized with preexisting clauses. In less than two paragraphs I’ve probably mentioned five phrases that have no meaning to you whatsoever. It doesn’t matter what your income is, with the price of everything going up, protecting your income needs to be a priority to survive in this economy.

Second, become familiar with your current policy. Understand the layers of protection in the group health insurance policy you have today. You may not be aware of your total liability only because you have been so healthy. When you look you’ll see you have co pays for doctor visits and for your prescriptions. Anything at the hospital is subject to an annual deductible and coinsurance and an additional deductible per occurrence on some procedures. These types of limits are common in all policies, these are ways to keep the premium low enough for everyone to afford. When selecting an Individual Policy these levels of protection are normally higher.

Last but most important, hire a professional licensed agent to help you understand your options; agents’ commission is already included in the premiums, this makes them part of buying a policy. Get in touch with a general agency on the internet; they represent multiple individual health insurance companies. They are not tied to one carrier; this will assure you are getting the best coverage for your needs. Once you have found an agent and an agency you are comfortable with, stay in contact with them, especially at renewal time. If you are not happy with what the insurance company is telling you about the increased costs at renewal, have your agent shop for a new carrier for you.

Washington State’s insurance commissioner, Mike Kreidler, has a plan to improve the health care situation in his state:guarantee citizens coverage during a health crisis.

Kreidler is currently running for a third term in his current post and even though he realizes his proposal would be a difficult sell to the state’s legislature he believes it’s an important step and a way for Washington to take a leading role in the country’s medical insurance debate.

Although the full details of his plan have not yet been released, Kreidler does want the state to provide “catastrophic” health insurance for all residents. This medical insurance would begin picking up costs once they hit $10,000 for the year. Some types of preventative care would also be included in the coverage. Anyone under the age of 65 (the age when Medicare eligibility begins) who has been a resident in the state for at least six months would be covered. Pre-existing conditions would not be covered for the first year.

To pay for the plan, Kreidler is hoping voters will approve an employment tax. Employees would pay a percentage (assumed to be about 1%) of their gross pay and businesses would pay between 2 to 5%.Although this type of coverage would not be comprehensive, it would allow consumers to purchase less expensive insurance because about 40% of all medical insurance premiums go towards this aspect of coverage.

It is important when searching for an individual health insurance policy to understand the health insurance company’s underwriting criteria and their process. The reason for this is more than just not to have wasted your time by applying to a carrier that is going to decline your application, but because of that very outcome, a declination of coverage.

This result serves then as a red flag to other insurance companies with respect to providing you coverage. There are even carriers that do not go one any further with an applicant once they learn that they have been declined for coverage in the past. The reason for the declination is not even looked into, for the worry that they might be providing coverage to high utilizer.

Yes, I agree this is unfair but it is the reality in which we live today. Therefore, it is important to understand a carriers process. It is better to not even apply for coverage if you along with your agent believe that due to your specific medical conditions, age, medical history, etc. will have a good chance of being declined.

There are many carriers available today and only a good experienced insurance agent can help you navigate these rough waters. The cost of the policy doesn’t change anyway. It remains the same, so why not utilize (no pun intended) their services to your benefit (again, no pun intended).

Here’s to your good health and coverage!

You start by providing us with basic information that we use to prepare an estimated quote range from many carriers and plan designs. The next step allows you to review the basic information and gives you the opportunity to speak directly with one of our licensed health insurance agents.

This part of the process is truly unique. Our licensed health insurance agents will listen to your needs and expectations, will ask you a few questions, will qualify you, and then customize several plan options specifically for you and your family.

This will be done from the many health insurance plans and carriers that are available and will be customized through our software for you.

You can then review and compare plans, quotes, and benefits and receive a free expert consultation from our licensed health insurance agents. They will be focused on assisting you and servicing you.

Our goal is to provide you with the information you need and assistance from a qualified licensed health insurance agent that represent you, not any one carrier or plan.

Our unique process is geared towards efficient better service to each individual and family.

A survey released on January 8, 2008 of preventable deaths in 19 industrialized countries ranked the United States last when it comes to providing health care to its citizens. The survey was conducted by the Commonwealth Fund, a charitable organization created to promote health care in the industrialized parts of the world. Their study, which was called “Measuring the Health of Nations: Updating an Earlier Analysis” and published in the Health Affairs journal this month, examined the death rates for individuals under the age of 75, particularly looking for problems that could have been prevented through more effective health care.

The same study had been conducted twice before: once in 1997/1998 and more recently in 2002/2003. Part of establishing the country rankings involved looking at each country’s improvement as compared to past studies. While all of the other countries saw a decline in preventable deaths by an average of 16 percent, the United States’ rate only decreased by 4%. The U. S. was also ranked last in the 2002/2003 results after placing 15^th in the 1997/1998 results. Had the United States shown similar improvements approximately 100,000 deaths would have been prevented.

The survey’s top five countries included France in first place followed by Japan, Australia, Austria, and Canada. The survey also pointed out the United States spends more on health care than do any of the countries with better results.