A New Idea To The Health Insurance Crisis In America

Lack of health insurance coverage for over 41 million Americans is one of the nation?s most pressing problems. While most elderly Americans have coverage through Medicare and nearly two-thirds of non-elderly Americans receive health coverage through employer-sponsored plans, many workers and their families remain uninsured because their employer does not offer coverage or they cannot afford the cost of coverage. Medicaid and the State Children?s Health Insurance Program (SCHIP) or HAWK-I here in Iowa help fill in the gaps for low-income children and some of their parents, but the reach of these programs is limited. As a result, millions of Americans without health insurance face adverse health consequences because of delayed or foregone health care and extending coverage to the uninsured has become a national priority. -(Information taken from kff.org)

The number of people that are forced to go without health insurance is nothing less than a crisis in this country today. We have fallen into a vicious cycle over the last few decades in which health insurance premiums have become too expensive for even a middle class family to afford. This in turn results in the inability of the uninsured to cover medical costs which often times results in the financial ruins of the family, and in turn results in the continuing loss of income by the medical community, which in turn drives the cost of medical expenses higher, finally cycling back to the insurance company which then must drive the premiums of health insurance higher to help cover the rising cost of health care.

Many proposals have been tossed around by politicians on both sides of the isle ranging from socializing health care comparable to the Canadian system, to endorsing health savings accounts and cracking down on frivolous law suits against the medical community. Many of these proposals have good points, but along with whatever good points they bring they also bring major downfalls. For instance; a socialized national health care program would eliminate the need for health insurance all together and the cost would be taken on by taxes, which in theory doesn’t seem like a bad idea. However, the downfalls to this system include a deficit in new doctors willing to get into the field due to the inevitable decline in income while the demand would grow due to no personal responsibility. In short if people didn’t have to worry about deductibles or copays that would normally keep the person from seeking medical treatment for minor things, they would simply go to the doctor every time they had an ache or pain. So now we have waiting lines for people with major health problems since everyone is scheduling an appointment while at the same time we are loosing doctors due to lack of incentive.

The current battle cry by the republican Bush administration is to push HSA’s (Health Savings Accounts) which reduce premium by taking a less expensive high deductible health insurance plan with a tax deferred savings account that earns a small interest on the side that you contribute to along with your premiums each month. Any money withdrawn from the savings account for qualified medical expenses are taken “tax-free”, and unlike a flex spending account like many people are familiar with in employer based plans, you don’t lose the money you put into the account that you don’t use. Basically if you never used any of that money in the savings account you could withdrawal or roll it over into another vehicle once you turn 62 1/2 penalty free to be used for retirement. This is a viable option for some people, however for many the premiums for these plans are still too expensive, and the problem remains that if you need major treatment in the first few years of the policy you will not have a big enough amount in the savings account to help cover the gaps leaving that person responsible for a large portion of the cost out of pocket.

Now we come to what I believe is one of the biggest problems from a health insurance agent’s point of view, which is the inability for persons with pre-existing health conditions to obtain coverage. From the number of people that contact my office searching for health insurance coverage, I would have to say that about half of them have a health condition that will either result in an insurance company declining that persons application, or result in an amendment rider which basically excludes coverage for any claims related to that condition. An example of a condition that I run across constantly is hypertension or high blood pressure. This condition will sometimes result in a company declining an application all together if other factors are involved, but most generally result in an amendment exclusion rider. You may think that this isn’t that big of a deal, after all, blood pressure medicine is about the only thing they would have to pay for out of pocket, but what many people don’t realize is that this rider will exclude ANYTHING that could be considered part of this condition including heart attacks, strokes, and aneurisms which would all result in a huge out of pocket claim. Consider the fact that my father had a double by-pass surgery recently that ended up with a final bill of around %150,000. This whole amount would have had to come out of pocket had he had a hypertension rider on his health insurance policy, not to mention the added cost of 2 months off of work thrown into the mix. On a modest income of %40,000 per year this would have ruined him financially.

So what how do we fix this problem? Obviously the proposals thus far have been flawed from the beginning, and even if one of these plans gained support from the American people chances are it would never be passed into law simply due to political infighting. One side wants to keep health care privatized while the other wants to socialize it, which as we discussed before both have upsides and downsides. It seems that we are doomed on this issue and there is no real ideas or light at the of the tunnel right? Maybe not, let me tell you about a client I had in my office a couple of years ago.

A young woman came in wanting to compare health insurance plans to see if there were any options for her and her family. She had several children and had been on Title 19 Medicaid and had been going to college paid by the state. She had recently graduated from college and had gotten a job with the local school system, however for whatever reason she was not eligible for health insurance benefits. Obviously she still couldn’t afford 5 or 6 hundred dollars per month for a plan so she went back to the aid office and explained her situation. They ended up working with us to find an acceptable private health insurance plan and reimbursed her for a percentage of the cost which I didn’t even know was possible!

This got me thinking, consider how many more people would be able to obtain coverage if they could be reimbursed by the government a percentage of the premium according to their income. For example; take a young married couple in their 20’s with one child, let’s say that their family income is %25,000 and that the average premium for a %500 deductible health insurance plan for them is %450. Just as an example let’s say that the government determined that a three person family with an annual income of %25,000 is reimbursed 50%PRCTG% of their premium taking the actual cost to the family to %225 per month. This is now an affordable enough premium for the family to consider.

With this merging of private insurance with government assistance we get the best of both worlds. Of course the next question goes to cost, how much more would this cost the American tax payer and how much would this raise taxes? I don’t think that it would cost the tax payers much more an here’s why I think that: First off we would bring down significantly the amount of uninsured people that are unable to pay for the medical care they get in turn driving down the total cost of health care. Secondly the number of people that are forced into bankruptcy and driven to Medicaid Title 19 assistance due to medical bills stemming from catastrophic medical conditions that don’t have health insurance coverage would be significantly reduced. This is important to keep in mind considering that once someone is on Medicaid they are receiving health care basically 100%PRCTG% covered by the government so there is no more incentive to not seek treatment for minor or non-existing conditions. On the flip side many conditions that would have not been caught before they became severe because a person didn’t seek treatment due to not having insurance coverage would now be caught before they turned into a catastrophic claim. Finally, if the government allocated a certain amount of money to help cover claims by people that have pre-existing conditions the private insurance companies could do away with exclusions and declines due to already existing health problems, this is already done is some states such as the HIPIOWA Iowa Comprehensive Plans which insures Iowa residents that can not obtain coverage elsewhere.

You may be sitting there thinking that this is all just wishful thinking and that these ideas could never be implemented, but all of these ideas are already being implemented. The problem is that only some states do some programs and not even most health insurance agents know that some low income families can get reimbursed for health insurance premiums. If these programs were all standardized and put into effect on a national well publicized level I believe it would put one hell of a dent in the uninsured population in this country. Now I don’t pretend to know what the reimbursement levels should be for what income levels but I do know that anything is better than nothing, and in my opinion this is the best middle ground we could find. The Democrats would be happy with the socialized aspect of the reimbursement, and the republicans should be happy that health care remains privatized giving this solution a better chance at a by-partisan backing.

I have faxed this idea to several senators and congressmen but always received the same type of standard response about how they are concerned with health care and that they are working hard to find a solution knowing full well that no one really even read my letters. The only way to get these ideas out into the public is for you that read this to pass it on to others by word of mouth, by email, or by linking your websites to this webpage. If enough buzz is created than these ideas would get the consideration that they deserve, and if enough people like you and I demanded that a solution be found than perhaps enough stress can be placed on the politicians to get something done. The number of uninsured Americans is only going to go up, the cost of health care is only going to go up, and the cost of health insurance premiums are only going to go up if something isn’t done now! Until then the only thing that I as a health insurance agent can do is to compare all of the options out there and present you with the lesser of all of the evils, which in too many cases the option that is chosen is the biggest evil of going without coverage.

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Health Insurance Explained

In the competitive world today people spend more than half of their lives working day and night for some or the other reason. Though it gives them good financial rewards and gratification of their desires yet what suffers a big setback is their health. This is because individuals fail to pay significant heed to health, the most crucial aspect of their lives. But being occupied is not the only factor in deteriorating health. Reasons like environment, epidemics, natural calamities etc. also contribute largely to fading human health.

Keeping in mind the precariousness of human fitness and the immensely expensive medical treatments available nowadays, health insurance has become the need of the hour. Health insurance is an ideal way to care for your health. A health insurance policy enables you to have the best medical therapy for your illness at any point of time.

The American health care system provides four basic health plans. These are HMOs, PPOs, POSs, and Free-for-Service (Indemnity) Plans.

1. HMOs Plans- these plans are least expensive of all and are offered by Health Maintenance Organizations. In case you avail this plan, you are required to pay for every health related service in advance in the form of monthly premiums. HMOs cover a spectrum of health problems such as dental, vision etc. HMOs provide a list of service providers to all its subscribers. The latter is required to choose from these a so called ?primary care giver? who will be supervising or coordinating his health care.

2. POS plans- these are HMO plans that give you the freedom to have a health care of your own choice. These plans are a little pricier than the HMO ones. Here it is not mandatory to go with the referrals from your primary care physician. But if you desire to abide by the HMO plan system per se, you can even do that. In case you opt for services outside the HMO or PPO networks, you will be served accordingly.

3. PPO Plans- Preferred Provider Organizations provides health care at discount rates. The PPO plans cost more than the two aforementioned. The PPOs cover a range of hospitals, doctors, clinics etc. The cost-sharing rate will be less within the network and more outside it. However unlike the HMO plans, PPO plans allow you to avail services from outside the network.

4. Fee for service plans or Indemnity plans are simple an easiest plans that compensate for each service you avail on case by case basis. For instance in case an emergency situation arises and you go for an ultrasound, the hospital needs to submit a claim to your insurance agency and you will be facilitated with the hospital expenses. But with a myriad of options and convenience the Fee-for Service plans come out to be most high-priced of all.

For further details you can surf the net and even get health insurance quotes online. This will save your time money and energy you would spend in consulting an agent.

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How to Appeal When Your Medical Insurance Declines Your Claim

If you are like most people, when your medical insurance declines your claim, you are left feeling helpless and frustrated. After all, if you need health care and your insurance is saying you don?t, you have two choices ? appealing your claim or paying for the treatment out of pocket.

Most claims are declined for specific reasons and causes. The most likely cause for your health plan to deny your claim is a direct consequence of missing data. Before appealing your denied claim, you can verify that by assuring any and all pre-authorization requests were filled out with accurate patient information.

For example, is your social security number correctly listed? Does the doctor have the most current copy of your health plan?s identification card? Does your doctor have the most up to date copy of diagnosis and procedure codes in order to fill out the forms correctly?

By verifying that you have submitted the good documentation to the physician and they in turn submitted good documentation the health plan, you are ready to move to the next level. When it comes to dealing with your health insurance company, think paranoid.

Document every phone call, every contact person and every piece of information you are given. It only takes one break down in communication to cause a problem; by documenting all of your communication with the insurance company, you are pre-preparing for any appeals case.

If you are facing an appeals claim for treatment coverage, be sure you?ve reviewed the appeals process in your company?s health insurance handbook. Most patients overlook reading through the handbooks their insurance company will provide. Plan requirements and appeal processes are detailed in these handbooks and you should make sure that your plan covers any treatment you are going to receive before the treatment is received, if possible.

When An Appeal Is Necessary

Since every plan should have a clear appeals process, you should follow it explicitly. You should talk to your doctor about appealing the claim so they can provide supporting documentation and expertise as needed. Remember, most insurance claims must be appealed within a limited amount of time, so if you wait six weeks after a denial and you only have 60 days to appeal; you may already be out of time.

You should always appeal internally to your insurance provider before going to an external source such as a government or state appeals process. Most appeals have a process that goes as follows:

? Phone Complaint
? Written Complaint
? Written Appeal

This is another area where you should be very specific citing the coverage rules of your plan as well as documenting each contact you have with the insurance company. While the insurance carrier will approve the majority of valid appeals; there has been documented cases of insurance fraud and health plans that do not play by the rules. By documenting response times and any required response times; a patient can exhaust their option against the insurance carrier for a valid appeal and then take it to the next level.

Laws in many states govern an appeal to a state or federal insurance oversight process; these requirements often allow for an external, expert review of the appeal. By providing accurate documentation and detailed medical support from your physical, a board of qualified experts can then judge your case on an individual basis. If an external appeal validates the claim and overturns the denial, then your insurance company will not be able to deny the claim.
Knowledge of your health plan, your doctor?s knowledge of procedures and a detailed review of the appeals process are your best tools to getting the approval of the treatment you need. Do not overlook the details, keep accurate documentation and review your coverage plans if you have any questions. Remember, there are always options.

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Medical Insurance. NHS Consultants Go Private!

The funding crisis in the National Health Service is so dire that at least 4,000 frontline jobs might be axed say the Royal College of Nursing. ?There’s no doubt that there will be an impact on patients?, says their spokesperson. ?This is not the sort of thing that is going to be resolved by cutting back on chocolate biscuits in the boardroom. The staff that we are looking at losing are not office based, they’re people who are providing frontline services.? Little surprise therefore, that people in the know are going private for their medical care! According to a recent survey by BUPA, 41%PRCTG% of NHS Consultants have protected their medical care by going private. Isn’t that a vote of confidence!

The British Medical Association (BMA) feebly argues that the Consultants’ commitment to private medical cover doesn’t demonstrate a lack of confidence in the NHS.

The Deputy Chairman of the BMA’s Consultants’ Committee whispers, ?Consultants may also like the anonymity of private care. One of the problems of being treated in the NHS is that Consultants might find themselves in a bed next to one of their patients?.

What a joke! Surely, being treated in a bed next to one of their patients would underline their commitment and confidence in the NHS. Their presence in a private ward only serves to emphasize their lack of confidence!

Remember that private medical insurance doesn’t provide care if you have an accident - that’s still the role of the Accident and Emergency Unit at your nearest NHS hospital. The overwhelming advantage of going private, is to ensure you get prompt care for planned surgery and medical situations that arise at short notice, in a hospital of your choice. The case of Dr Sarah Burnett makes the point.

Dr Burnett is a Radiology Consultant with 15 years service in the NHS. She chose to take out private medical insurance because she was unhappy with the level of care she saw first hand. ?NHS treatment is not a pleasant experience in any way ? from the standard of the food, to ward cleanliness and the chance of catching MRSA?, she observes.

Last year during a private medical screening, Dr Burnet was diagnosed with multiple small tumours in her breast. The cancer required urgent and specialised surgery. Within hours she saw the consultant surgeon who organised a skin-sparing mastectomy. A few days later she was recovering from the surgery.

?I was lucky enough to have exceptionally prompt treatment because I choose to pay for insurance. Under the NHS I would not have been screened for breast cancer until I was 50 and would not have been able to catch my cancer at such an early stage. The type of surgery I had is only rarely available on the NHS, depending on the experience of your local surgeon?, said Dr Burnet.

If you, like Dr Burnet and almost half of the UK ’s NHS Consultants, want to sidestep the NHS and go private, it’s wise to take out private health insurance. Choosing the right medical insurance cover is, unfortunately, quite complicated. You need to decide the standard of hospitals you would want to use, the level of cover and various other options. For this reason, you need specialised advice from a professional medical insurance broker. These people know exactly what’s on the market and can access it.

Where better to find these brokers than the Internet? Just use Google or your favourite search engine, to search for ?medical insurance?. You’ll find all the top medical brokers there. If you see the insurance company’s own sites steer clear - they can only sell you their own products and you really need independent advice to be able to identify which, within the whole market, is best for you.

Oh yes, make sure you chose a site that puts you directly in touch with an adviser. Ideally, you should talk over your requirements and chat to the adviser about the best alternatives. You don’t need a home visit as all this can easily be done over the phone. And buying through a broker won’t cost you a penny more than going direct to the insurance company. In fact a broker can sometimes be cheaper!

The marvels of the Internet!

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California strengthen health reforms

While Massachusetts previous year became the first state wanting each one to purchase health insurance, the proposals in California could come up with an even bolder trial, because the Golden State’s problems are so much larger. “It’s now a bigger face in California,” says Marian Mulkey, a senior program officer at California HealthCare Foundation, a non-profit organization think tank. “That’s not to say it’s insurmountable.”

California health insurance, for example, a predictable 4.9 million people are short of health insurance. That compares with a forecast 500,000 in Massachusetts before its plan began. That’s why politicians from other states ? along with policy specialists and officials in Congress ? are watching the California try closely, with its latent to set a nationwide model. Some desire a worldwide program paid for and overseen completely by the government. Some states all individuals must be obligatory to purchase health coverage, while others say such a go-ahead is draconian when premium costs are so high.

Health insurance in California hit a barrier surprises few. The challenge is huge and the solutions are contentious, splitting lawmakers. Republicans devastatingly do not support the two Democratic health-improvement measures, which are in play in California, nor did any back the governor’s plan. While their suggestion shares some of the governor’s ideas, Democrats part with Schwarzenegger in two important ways: They do not desire to need individuals to purchase health insurance, and they wish employers who do not provide insurance to pay more than the governor proposes.

“Any development in California would make a considerable dent in the problem of the uninsured nationally,” says Larry Levitt, a health insurance policy forecaster for the Kaiser Family Foundation, a non-profit study group based in Menlo Park, Calif. “Action in California would make genuine momentum, both in the presidential debate and in other states.”

In Massachusetts, years of preparation went into the health-reform attempt before the government ? overpoweringly in agreement ? passed its measure. “If you are going to refinance one-sixth of the world economy, you would better not do it on a 50-to-49 vote,” says Jon Kings dale, head of the state agency overseeing rollout of the program in Massachusetts. “Enacting something is only semi the challenge.”

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