Reader question:

My health insurance claim was denied. What do I do?

Mary

Great question.

Not being in control of your health care is a very scary thing to think about, and when you get a health insurance claim denied, it leaves you feeling as though you don’t have any options left. This is a most stressful situation, because if you want to get out if it you have to take charge and change things, and provide your health insurance company with incentive to do that, but since the consequences of having a health insurance claim denied are so overwhelming, it’s hard to get up the strength to do all that once you’re put in that situation.

The best thing to do if you get your health insurance claim denied is to ask for a face to face appeal hearing. Almost all of the health insurance plans out there will let you come to one, maybe more, of the appeal hearings over your case. If you request one of these, then your case will be looked at all over again and you’ll be able to present new evidence, and maybe get a chance of getting your health insurance claim approved this time around.

If you were following the correct steps, you should have documented everything all the way through this health insurance scare, and if you have that extra documentation you can use it in your favor. Perhaps you could even hire a lawyer. Whatever you do, go into your appeal confident that you will leave a winner, because if you don’t, you could lose the nerve.

If you really want to get your health insurance claim approved, you should try to get your doctor involved. Sometimes health insurance claims can be denied because the treatment or procedure is considered not needed. In order to fight this claim, you can get help from your own doctor, who can contact the insurance company and provide reasons for why it really was necessary and should be covered.

Cheers,

Fashun Guadarrama.

Health care is expensive, which is why one of the most important things you must do to protect both your health and your assets is to get medical health insurance coverage. Without this, you’ll end up responsible for many high medical bills that you probably can’t afford, which will put you deep in debt and ruin your credit. But just getting medical health insurance doesn’t assure you of always being covered. The darkest aspect of the medical health insurance industry is that your health insurance claim can be denied, even when you need the coverage the most. For this reason, you must be very careful when getting medical health insurance coverage and step through the claims process with care.

I found a funny, kind of weird video on YouTube that I think illustrates this very well. It’s a cartoon of a bunch of pirates (who are actually health insurance providers) singing that you should go ahead and die because they won’t pass your health insurance claim. It’s cute and hilarious, in a silly way. Check it out.

Getting your health insurance claim denied can take a lot of people aback. A lot of times, it has nothing to do with and it’s done for a reason that you can’t control. Many, though, you can take charge of by controlling your policy and your own actions. Sometimes a health insurance claim will be denied because the insurer doesn’t have all the information that they need. You might be able to get the claim approved after you already paid, but that doesn’t help when you don’t have the money in the first place and a refund isn’t an option. Always submit complete information.

If you document everything concerning your medical care and medical health insurance, this is also a great way for dodging denied health insurance claims. Hold on to all of your paperwork and hospital and primary care provider information, because if your health insurance claim gets denied, you’ll have this to back up your case.

A lot of the time a health insurance claim will get denied for a reason you would have known about if only you had been knowledgeable about your plan. Read your policy, be thorough, and study your health insurance plan book so that you don’t fall into the trap of ignorance that could end up costing you a lot.

Cheers,

Fashun Guadarrama.

Let’s face it. What’s going on in the video above isn’t exactly unusual. Kids will be kids, right? And as kids, they’re that much more likely to get them self into some kind of trouble that involves a hospital visit. Kids are walking disasters, which is why no house with children or even teenagers is complete without lots of band aids and disinfectant. And if you have children who are so prone to accidents, it makes getting a family health insurance policy extremely important. Accidents happen a lot, and when you’re already working on raising a family and paying bills, you don’t want to put your future in trouble by being hit with huge medical bills.

There are basically two ways that you can get family health insurance. The cheapest and most popular family health insurance is the kind that you get through your job. Your employer pays part of the premiums, so you and your family pay less per month. With this choice, though, you’ll have fewer options for the kind of plan that you can choose, because it’s controlled by your employer.

The other way is to take out your own family health insurance policy. It will cost more–as of 2002, the average monthly family health insurance premium was $330, but you’ll have a lot more options. Getting to pick your own deductible will make it a lot more comfortable for you financially, but the main perk of this way is that you can choose a doctor that you like.

Don’t just run straight into your family health insurance plan. You should consider your plan choices very carefully. A low deductible doesn’t always mean a great deal, especially when you consider that some of the cheapest family health insurance lacks one of the most important parts of a child’s healthy upbringing–preventive medicine.

You should also consider how your family health insurance plan covers prescriptions. Health insurance is paying for these less and less these days, so you want to be careful not to get a plan that doesn’t pay at all. You might have to end up choosing a co-payment plan.

Finally, the best way to find the best family health insurance plan is to shop around. Get quotes from different health insurance companies and then research further after that. If you’re between jobs, it might be a good idea for you to get temporary health insurance to keep you covered until you can get an employer provided plan.

Cheers,

Fashun Guadarrama.

Reader question:

What kinds of group health insurance are there?

Richard

Great question.

There are four kinds of group health insurance, although the most popular ones these days are the HMO and the PPO. There have been a lot of changes in employment based medical insurance in recent years, and the employee has come out the winner, with more and more benefits as well as lower premiums and better options than ever before.

• Traditional group health insurance.

In 1988, the majority (74%) of group health insurance was provided in the traditional way. Well, things have changed quite a bit, and as of 2003 that number has dropped to only 5%. The best thing about traditional group health insurance is that it has room to move around in. You can pick any doctor you want, go to any hospital you want, and see a specialist without having to get a referral, among more things. The main reason that you don’t see traditional group health insurance around anymore is because this amount of freedom meant high costs, both for company and employee.

• HMO group health insurance.

HMO means Health Maintenance Organization. This was the first group health insurance type to offer an option other than the traditional kind. This is the cheapest group health insurance option, but only because it has so many limits. A network of doctors and hospitals is created so that you can choose from among that list, and can only go anywhere outside of it and still be covered is if you get a referral from a doctor on the list. If you go to a doctor or hospital not in the network, you’ll be paying out of pocket.

• PPO group health insurance.

PPO means Preferred Provider Organization. This is the most oft-used type of group health insurance these days. It’s similar to both traditional and HMO group health insurance, because you can go within a network or outside. If you go within the network, then you’ll get very low prices and most often won’t have to co-pay anything. If you go outside, you’re still covered, it will only cost more, but still less than if you had no coverage.

• POS group health insurance.

POS means Point of Service, and is also called an open-ended HMO. This is very similar to PPO because there is a network of doctors which the insured must visit and get referrals before going outside the network if they want to be fully covered. They can still go outside the network without referrals, but it will cost them more, though they will still be covered.

Cheers,

Fashun Guadarrama.