I have been a health insurance broker for over 10 years and have heard "scary" stories online about health insurance companies not paying out, refusing to cover certain illnesses, and doctors not reimbursing medical services. I read more and more every day. Unfortunately, insurance companies are driven by profits, not people (although you need people to be profitable). If an insurance company finds a legal reason not to pay out, they will likely find one, and you, the consumer, will suffer. There are few “loopholes” in insurance policies that give insurers an unfair advantage over consumers. In fact, the insurance company has given the policyholder 10 days (10 days free review period) of her to review the policy, detailing the limits of coverage. Unfortunately, most people keep their insurance cards in their wallets and keep their policies in a drawer or filing cabinet during the 10-day free search. Usually, we don't actually take out the insurance card until we receive a denial notice from the insurance company. Company to read through.
The majority of people who buy their own health insurance rely heavily on the insurance agent who sells the policy to explain the plan's coverage and benefits. people can hardly talk about their plans, other than what they will pay in premiums and how much they will have to pay to meet their deductibles.
For many consumers, purchasing health insurance alone can be a daunting task. Buying health insurance is different than buying a car. Because the buyer knows that the engine and transmission are standard and the power he windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don't realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that "benefits were denied."
Sure, we all complain about insurance companies, but we do know that they serve a "necessary evil." And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.
Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they "want" and the benefits they really "need." Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great "curb appeal," I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is 100% health insurance what most consumers really need? Probably not! In my professional opinion, when buying health insurance, he should balance four key factors: Desires, needs, risks and prices. Just like buying options for a new car, you have to weigh all these variables in front of you.
Having a $250 deductible and $20 brand name/$10 general copayment provides a $20 brand name/$10 general copayment after payment 80/20 with a $2,500 deductible Is it worth the $200/month compared to the plan? ?$100 Rx deductible once a year? Wouldn't the 80/20 plan still provide enough protection? Pay the $2,500 deductible? Wouldn't you rather put an extra $200 ($2,400 a year) into your bank account in case you need to buy a $12 amoxicillin prescription? Wouldn't it be wiser to keep your hard earned money instead?
Yes, there are many ways to keep more money than you pay your insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) Eligible for her H.D.H.P. (high deductible health insurance plan) to give her more control over her medical expenses. Consumers who hold an HSA certified H.D.H.P. You can save extra money each year in your interest-bearing account, which you can then use to pay your medical bills out of pocket. Even procedures not normally covered by insurance companies, such as LASIK eye surgery, orthodontics and alternative medicine, are 100% tax deductible. If there is no claim in that year, the money paid to the tax-deferred HSA will be carried forward to the next year for an even higher interest rate. If there have been no material claims for several years (which is often the case), the insured will pay the traditional her I.R.A. We offer mutual funds. By investing, you may be able to earn even higher interest rates. In my experience, people who base their health plans on wants rather than needs are the most likely to feel cheated or “cheated” by insurance companies and insurance agents. I hear pretty much the same comment from almost every business owner who has done it. "I have to run my own business, so I don't have time to be sick!" "I think I've been to the doctor twice in the last five years." I'm not using it!" As an entrepreneur, I can understand that frustration. So is there a simple formula anyone can follow to make buying health insurance easier? Yes! Be an informed consumer. Every time you reach out to a prospect or call a referrer, ask a few specific questions directly related to the policies that person currently has in their filing cabinet or dresser drawer. I know the policy I purchased to prevent bankruptcy due to medical debt. The insurance they purchased was to cover a $500,000 life-saving organ transplant and 40 chemotherapy treatments they might have to undergo if they were diagnosed with cancer.
So if I ask these people a "basic" question about health insurance policies, what do you think will happen almost 100% of the time? You don't know the answer! Below is a list of 10 questions I often ask prospective health insurance customers. Let's see how many you can answer without looking at the policy.
1. What is your health insurance company and the name of your health insurance company? (Example: Blue Cross Blue Shield "Basic Blue")
2. How much is your annual deductible? And if everyone in your family gets sick at the same time, do you have to pay a separate deductible for each family member? annual deductions of $250, $500, $1,000, $2,500, etc. However, some plans require you to pay only two deductibles per year, even if you need the whole family. of medical care.)
3. What is the coininsurance percentage and amount (stop loss) based on? (For example, a good plan with 80/20 coverage means you pay 20% of a certain amount. This amount is also called stop loss and depends on the type of policy you purchase. Stop The loss can be as low as $5,000, or $10,000, or up to $20,000, or there are some policies in the market that do not have a stop loss dollar amount.)
4. What is your annual spending limit? (e.g. all deductibles and all coinsurance percentages and any applicable access or other charges)
5. What is the maximum amount of lifetime benefits your insurance company will pay if you become seriously ill? Also, does your plan have caps or per-sickness caps? $5 million, but with a maximum benefit cap of $100,000 per illness, which means having to develop many independent, unrelated, life-threatening illnesses that cost $100,000. Lifetime warranty.)
6. Is your plan a schedule where only a certain amount is paid for a certain list of procedures? (eg Mega Life & Health & Midwest National Life is supported by the National Association of the Self-Employed? , N.A.S.E. are known to support schedule planning)
7. Does your plan have a copay from your doctor, and is there a fixed number of doctor visits per year? There is a limit to how many times you can do it, often the limit is 2-4.)
8. Does your plan provide prescription drug coverage? If so, do you pay a prescription drug co-payment or must you meet another drug deductible before receiving benefits? and/or do you only have a discounted prescription card? (For example, some plans allow you to receive prescription benefits immediately, while some plans require you to pay a separate drug deductible before you receive prescription drugs as your co-payment. Currently, Many plans don't offer a copay option, only copayments (they offer discount prescription cards that offer 10-20% off all prescription drugs).
9. Does your plan reduce organ transplant benefits? If so, what is the maximum amount your plan will pay if you need an organ transplant? Only up to $100,000 in benefits is paid for organ transplants that actually cost between $350,000 and $500,000, and this maximum of $100,000 includes reimbursement for expensive anti-rejection drugs taken after the transplant. In the case you are
10. Do I have to pay a separate deductible or “access fee” for each admission or emergency room visit? There is a separate hospital charge of $750 for 3 days, which is billed on top of the deductible.Many plans also have perks."Physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Outpatient Service “Cap” or “Access Fee”. Benefits can be capped as low as $500 per outpatient treatment and the rest will be billed. The Access Fee is an additional fee that you pay for each treatment. For example, for outpatient chemotherapy, you may have to pay a $250 “entry fee” for each treatment. So for 40 chemotherapy sessions, you will have to pay 40 x $250 = $10,000. Again, these charges are in addition to the deductible.) Now that you've read the list of questions I ask health insurance prospects, ask yourself how many questions you were able to answer. That doesn't mean you're not a smart consumer. It only means that you have dealt with a "bad" insurance agent.So how can you tell if you are dealing with a "bad" insurance agent? A “good” insurance agent will take the time to really understand the benefits of insurance. A "good" broker will take the time to ask you questions so that they understand your insurance needs. A "good" agent recommends a health plan based on all four variables. Desires, needs, risks and prices. A “good” agent provides enough information to consider all options so you can make an informed purchasing decision. Finally, a "good" agent looks out for your best interests, not the insurance company's best interests. So how do you know if you have a "good" agent? Simply put, if you can answer all 10 questions without looking at your health insurance policy, you're a "good" broker. If you can answer most of the questions, you may be a "good" agent. However, if you can only answer a few questions, you are probably a "bad" agent. Insurance agents are no different than any other professional. Some insurance agents genuinely care about the customers they serve, while others answer questions or avoid calling customers when they leave messages about unpaid claims or skyrocketing health insurance premiums. .
Remember, having health insurance is just as important as buying a home or a car. So don't be afraid to ask your insurance agent a lot of questions and make sure you understand what your health insurance plan covers and what it doesn't. If the price seems too high, ask your agent if they have comparable plans for you to compare directly before buying. And most importantly, once you've read all the "bylaws" in your health insurance booklet and received your policy, take the time to review it during your 10-day free viewing period.
If you have any questions about your coverage or what the asterisk (*) next to your benefits statement actually means, call your representative or contact your insurance company. Please contact us for details.
Also, take the time to do your own due diligence. For example, a survey of MEGA Life and Health and Midwest National Life, an insurer sponsored by the National Association for the Self Employed (NASE), found 14 class action lawsuits filed against these companies since 1995. I understand. So ask yourself, "Is this a company I can trust to pay for my health insurance?"
Also, check to see if the agent is a "captive" agent or an insurance broker. A “captive” agent can only offer products from one insurer. An “independent” agent or insurance “broker” can offer different insurance plans from different insurance companies. A "captive" agent may recommend a health insurance plan that doesn't exactly meet your needs because it's the only plan they can sell. "Independent" agents or "insurance brokers" are typically able to offer a wide variety of insurance products from many quality insurers, often customizing plans to meet specific insurance needs and budgets. can.
Over the years, I have developed strong and trusting relationships with my clients due to my insurance expertise and the level of personal service I provide.This is one of the main reasons I do not recommend buying health insurance online. It's one. In my opinion, there are too many variables that internet insurance buyers often don't consider. We firmly believe that buying health insurance requires a level of expertise and personal attention that only insurance professionals can provide. And it won't cost you a dime to get health insurance through an agent or broker, so use eBay and Amazon for non-essential purchases and use a knowledgeable, ethical and reputable independent agent Or we recommend using a broker. One of the most important purchases you will ever make...your health insurance.
Finally, if you have any concerns about your insurance company, contact your state insurance agency before purchasing a policy. Your state insurance department can tell if an insurance company is registered in your state and if a policyholder has a claim against the company. If you suspect that an agent is trying to sell you fraudulent insurance policies (for example, you must join a union to receive coverage) or if you believe they are dishonest, contact your state insurance department. may also be investigated. No disciplinary action has been taken against the agent. Finally, we hope that we have given you enough information to become a customer of INFORMED Insurance. However, I believe the following wisdom still applies.
"If you think it's too good, it's probably true!" and "Buy on price alone, you get what you pay for!"
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