If it weren’t for getting health insurance through your employer, more Americans would be uninsured than there already are. Its greatness, however, does not in any way make it any funner to sift through all of the different plans offered by your company to try to figure out which one best fits the needs of your family. Such tedious work is necessary, but for someone who already has a full time job, it can be a serious violation of the little free time that you have. Even so, if you want to do what’s right for you, research and time are basic necessities.

If you get group health insurance with your employer, usually you’ll get an option of what kind of plan you want, and the type you choose will determine both how much freedom you have in determining your health care path, and how much you will be paying for your monthly premium. Figuring out whether you should opt for more expense with freedom or cheaper premiums with lots of restrictions is difficult, so here’s some points to follow.

• Network. Deciding between a plan where you are required to stick to a network of physicians or going with a different plan can often be determined just by seeing what the selection offered by the plan’s network is. Research into a few of the doctors and make sure they give quality care, ask other patients about them, and so on. You may have a family doctor that you’re attached to and should choose a more flexible plan if you want to keep going to that doctor.
• Travel. Are the doctors in the network within good distance of your home and office? Do you have options if you have an emergency and have to go to the nearest place? What happens if you get sick or injured while you are traveling?
• Price. Lucky for you, as someone who has group health insurance through their employer, your boss will be picking up part of the tab. Still, you should find out the details about what exactly your company will pay and what will be left over to you, as well as asking questions about co pays and prescriptions and the like.
• Freedom. Do like to pick your doctor or save your money? Usually, employer sponsored health insurance will require you to stay within a network, but often there are more expensive options for going out of the network.
• Think ahead. You may be a healthy bachelor right now with a health care plan that fits you, but what about down the line? If you get married and start a family, will your insurance cover your spouse and children? Pregnancy? Retirement? What about huge things such as surgery or treatments if something happens in the future that you can’t foresee? If such things are covered, are they covered immediately, or do you have to wait until the end of the year for your company’s enrollment?
• Coverage. Does your health plan cover preventive care? What about physicals and dental appointments? Prescriptions? Ambulance and ER visits?
• Extras. These are the things that not all health care plans provide for, but you might need in the future. Lots of plans don’t cover mental health care, but do you need it? What about family planning, such as abortion or infertility treatments? Chiropractics?
• Pre existing conditions. This might be one of the biggest things that you need to worry about if you have one and need to get good health care coverage.
• Coverage caps. Health insurance plans do not provide you with infinite coverage. Often, they’ll set a certain amount that they can pay out through your plan over a year or a lifetime. You should make sure that this is a decent amount so that, even if you end up with some huge medical bills, you will come out okay. Many employers will offer health savings account to help their employees avoid problems with these caps.
• Claims and complaints. One of the most important things to getting a good experience out of your health insurance plan is being able to have a voice in your coverage. You should be able to complain and be listened to. You should be able to fight against claims being rejected or being reimbursed for too little.

Cheers,

Fashun Guadarrama.

Contrary to popular opinion, there are ways that you can save money on your health insurance coverage. There may never be plans that could be considered cheap, but if you know your needs, there is no problem getting low cost health insurance for yourself and your family, at least in comparison to other plans and, well, lacking health insurance altogether.

It is true that of the many Americans today that don’t have health insurance, many actually can’t afford any. However, there are also many of that number who don’t have health insurance because of misconceptions about insurance and the health care system. A lot of people don’t get health insurance because they think it costs too much, and, besides, they’re in perfect health. What they don’t realize is that some of the most expensive health care bills and some of the highest numbers in medical debt are billed to people who were otherwise in perfect health but were victims of bad luck or tragedy.

The first law of health insurance is that no matter what, it’s always more expensive to be uninsured. People who don’t have health insurance and then find themselves in something as simple as a small car accident can go through their savings, ruin their credit, and fall into huge debt. Even a minor ER visit can cost five hundred dollars.

If you can get insurance through your job, do it! It’s always cheaper, especially if you have previous medical problems that would make it hard for you to get medical insurance through anywhere else. Your employer foots part of the bill and you often get a choice of plans. And when you have a choice, compare, compare, compare. It’s frustrating and time consuming, but it’s the only way to save money and figure out what’s best for you.

Even when you find a plan that looks pretty cheap, cheap isn’t always best. The real deal breaker should be value. You don’t want simply the cheapest premium. You want the cheapest premium with the best coverage. This might be a little higher than that great quote you got, but it will save you more money down the line. Even if you do get a plan with great coverage though, remember that some expenses still fall through the gap. Things like mental health care and prescription drugs are the areas where even the best plans have little to no coverage.

As you were taught in history class, freedom ain’t free. The more flexibility that your health care plan gives you, the higher your premium will be. So it is up to you to decide what is more important to you: deciding who you go to for health care, or paying less on your premium. Less freedom of choice among health providers isn’t necessarily bad, so long as the physicians in the network are quality. And you can research a plan’s network before you sign up for it. Maybe not through the company itself, but there are a lot of sources online or off where you can find out about a certain plan’s track record.

One thing that might worry some people who are using employer based insurance is where they would be if they lost their job. Lucky for them, you don’t lose your health insurance when you lose your job. The government provides you with COBRA for a period of time after you lose your job. It can be more expensive, but it’s better than nothing and can ease a lot of minds.

Cheers,

Fashun Guadarrama.

In Illinois, all of those with aching backs and hurting muscles are about to get a big break. The Blue Cross Blue Shield health insurance in Illinois is going to start covering chiropractic care, an area of medicine that many people want and need, but that most health insurance providers won’t touch because they deem it to be something elective, or not medically necessary. Those who have to deal with aches and pains everyday, and for whom pain pills aren’t enough or aren’t acceptable, they are very necessary, and Blue Cross has come to the light.

The program is called CAM, which stands for complementary and alternative medicine, and it is slated to start on the first of January. The problem that many consumers might find with it is that it is not an actual part of the coverage of their health insurance plan. Rather, it is separate, set up as a discount health insurance card. This does make things easier, as it means claims and referrals won’t be necessary like they usually are, though.

While the actual Blue Cross discount card is cheaper to begin with, it costs more than your usual health care plan if you have to end up using it. You pay the chiropractor or the practitioner of whatever type of alternative treatment you are getting, and the card is only responsible for giving you a discount. While it is a big discount, at twenty five percent, that is only the case if you work within the network that Blue Cross has chosen.

More and more people are becoming interested in alternative forms of health care, and Blue Cross is just the first health insurance company to have buckled under the weight of demands for coverage for this type of treatment. For those who cannot afford any other kind of health insurance, it might be a good start on getting some medical care, considering the lower costs.

Blue Cross is putting itself forward to help current and potential customers understand the program by providing them with a website called Healthy Roads. The website is still in its early stages, but it contains a load of information about different types of alternative health care. It also has a directory of alternative care providers who are part of Blue Cross’s program, and a bunch of products that might appeal to people interested in alternative health care. It’s a great source of information, even for those who do not have a Blue Cross Blue Shield health insurance plan.

Cheers,

Fashun Guadarrama.

Infertility is a huge problem that many women in American society face, and it can be a difficult thing to deal with, especially for couples who desperately want children of their own. Finding a way around the infertility that they have can be an extremely difficult and expensive process, and many couples go through years of intensive treatments, implantations, and drugs to try to get their bodies to jive with fostering life. In many cases, the cost is simply too much, and in others it never works at all.

For those in the former category, New York is making it easier for them to reach their goals. According to the New York state legislature, having children is a “fundamental aspect of being a human”, essentially a human right. For many years, infertility treatment has been considered an elective procedure, and most health insurance companies did not cover it. With the passing of this bill, though, it will become clear that, while infertility treatment is not medially necessary for health, it is for many people’s lives.

The law will make it easier for health insurance companies to provide coverage for this type of treatment, having them insure women between the ages of twenty five and forty four for infertility treatment, with a $60,000 lifetime cap. For people who have put their entire savings into trying to conceive a child, this is welcome news. It also requires that prescription drug coverage include fertility drugs, although these will not be taken out of the sixty thousand dollar lifetime maximum.

Like any type of health insurance coverage, women with this plan will also have to make co pays and pay deductibles. The plan will cover the following methods of fertility treatment:

• in vitro fertilization
• intracytoplasmic sperm injection
• assisted hatching
• gamete donation
• embryo donation
• embryo transfer
• gamete intrafallopian tube transfer
• zygote intrafallopian tube transfer

Those are the most expensive types, although they are not the only ones covered. You are only allowed to get this type of treatment if other, less expensive types of treatment have not been successful in bringing about a pregnancy sustained to the point of childbirth.

In order to get this coverage, you must have had a health insurance plan with the company for at least a year, and there must be reasonable belief that the fertility treatment undergone will bring about the birth of a healthy baby. The treatment must be undergone in a facility that is up to the standards set by the medical community. It is even possible to continue getting treatments once one has resulted in the birth of a healthy child. If an embryo transfer works, then you are insured for two more.

Cheers,

Fashun Guadarrama.

According to research, one out of every five Californian women are without health insurance coverage. That’s twenty percent, a disproportionate amount of the population, where the nationwide number is fourteen percent. The grade given to Cali by the study from The Women’s Foundation is only an average: in the category of access, it received in F; health status a C-; and health policy a C-.

That’s two million women in California who don’t have insurance, and sixty percent of them have full time jobs. There are certain types of women who are less likely to have health insurance in California, and those include younger women, women over 55, women of color, and immigrant women. There are adequate programs in place in California to cover the health care for children under the age of 19, but for their parents and for anybody else that is below the poverty line, there simply isn’t an option much of the time.

All of these women being without health insurance coverage has a big impact on the state’s overall women health statistics. California has one of the worst records for the prevention of cervical cancer through regular tests such as pap smears. It is in the bottom tenth percentile among the states when it comes to access to various forms of contraception, while at the same time having a less than normal access to abortion procedures. One of the areas where California has seen the least success is in the area of mental health care for women, which has gone down by eighty percent over the past ten years.

Cheers,

Fashun Guadarrama.

Columbia University’s health insurance program operates on a referral basis. You can go at any point to the on campus clinicians without a referral, but if you intend to go to a doctor or hospital outside of the Columbia campus, then you have to get a referral, either from the Primary Care Medical Services department or from Counseling and Psychological Services. If you are a full time registered student of Columbia and you have an emergency requiring you to go to the hospital, then it isn’t necessary for you to get a referral. You can get treated and then file a claim later.

In order to get a referral from PCMS or CPS, you have to go to the on campus clinicians first. Once they have attempted to treat you, or partially treated you, they can give you a referral to go outside the campus. Here are the steps that you have to follow.

• If you don’t get a referral before receiving medical treatment off the Columbia campus, then you aren’t covered. The only exception is for emergency situations.
• The way to get a referral has been made easier by making it to where you don’t need a new one every time you go to the same off campus doctor. Instead, the referrals are based on your condition. So, if you have to go see a certain off campus physician for one condition, a single referral covers all of your visits to said doctor for the same condition, with no limits unless you visit the doctor for a different reason.
• You’re still covered by the Columbia health insurance plan even when you aren’t in the city. If you are on break somewhere else and you get sick or hurt, you still have to get a referral, but you can do it over the phone.
• Copays are required most of the time for visits to off campus physicians.

Cheers,

Fashun Guadarrama.

Reader question:

I attend Columbia University and know that you have to get a referral to go off campus. Is this the case for everything?

Griselda

Nope.

Just because you are a registered full time student covered by the University of Columbia’s health insurance doesn’t mean that there are no exceptions to the many rules that they set out for you. It is true that in most cases if you go to an off campus physician you need to be able to pay for it all yourself, and that if you want to be covered, you have to first be referred by the campus clinicians before you are able to seek outside coverage. The main exception to this is for emergencies, but there are many more. Here are some situations in which you would not need a referral first. You may not need a referral, but if you look for service off campus, it would be wise to let the campus clinicians help you find it.

• Emergencies. If you have to go to the hospital there is no way to demand a referral, but once you have been treated and released, if you need follow up care you have to go to the on campus clinicians.
• Pre-natal care.
• OB/GYN appointments.
• Abortions.
• Mammograms are covered off campus with one between the age of 35 and 40, and one yearly once you reach forty. You can get more if you have a personal or family history of breast cancer and are recommended to get more by a doctor.
• If you attended Columbia before and got a referral for a certain condition, when you go back you are able to continute with the treatment of this condition using the same referral, without having to get a new one.
• Yearly pap smear and OB/GYN visit. You can get a pap smear on campus without a copay, and if you go off campus you will have to pay a co payment. If you go off campus to get a pap smear and are given other treatment or tests, it is acceptable so long as it is reasonable and you won’t have to get a referral for it.,

Cheers,

Fashun Guadarrama.

Reader question:

What types of health care plans are offered at Columbia University?

Randall

Great question.

There are two types of health insurance plans that you can get if you are a registered full time student at Columbia University, either as a grad student or an undergrad. One of them is the basic level, and the other the comprehensive, and you have the option to get both. Every student who registers full time at Columbia is automatically enrolled into the Columbia health insurance program, so it is likely that if you attend Columbia you will be choosing between one of these health insurance coverage plans.

The basic level plan is the one at which everybody starts. You are automatically put into this plan, although you may get a waiver or even get the comprehensive plan instead. This is the average plan that works for most students and is made for the people with less risk. If you don’t plan on using a more than average amount of health service, and you want a cheap plan, then the basic level may be for you. The basic level comes with $300,000 of coverage and might be a good option for students who can’t afford to pay high monthly premiums, as it puts more of the burden on co pays than on premiums.

The comprehensive plan is the next level up, and it comes with a million dollars worth of maximum coverage over the course of the insured person’s life. It comes with everything that the basic level does, with a little extra. It helps for people who need more extensive mental care by providing them with off campus mental evaluation and treatment, and it also comes with greater provisions for things like prescriptions and recovery treatments. This is the best option for students with a pre existing condition, although it can be expensive because the monthly premium costs more, but copayments and deductibles are smaller.

Cheers,

Fashun Guadarrama.

Reader question:

Does Columbia University’s health insurance plan cover dental as well?

Amber

Sure it does!

Luckily for full time students at Columbia University, they are able to get a lot of health insurance coverage at a decent price, with flexible rates and a nice referral system. They are also covered by the Columbia health insurance plan for dental, which is something that many health coverage plans lack. It’s a good thing, too, because many Americans avoid getting regular dental check ups because they have no insurance or it is not covered by their insurance, and the results much later are terrible on their teeth.

The dental care coverage extends beyond students themselves and to their families as well, and it is very comprehensive. There are several kinds of programs, and when you pick one for you and your family you should think about what kind of dentist and business you want your family to go to, how easy it is to get an appointment there, what the wait times are with and without an appointment, where it is located, and how much it costs.

The range of dental plans varies. Some come with certain networks from which you have to choose a dentist, and others are more flexible, operating on a referral based system. If you are going for just a regular tooth care and check up visit, the co pay is cheap for many of them, at only five dollars. For actual tooth care that isn’t a well check up, the cost is even less.

Cheers,

Fashun Guadarrama.

Reader question:

I live in Cincinnati and my health insurance claim was recently denied. I think it was wrongly denied. What do I do?

Maddie

Great question.

I’m sorry that you’re having to go through this, Maddie. I know I worry about paying bills often that I know I have enough money to pay, so I can imagine what it is like when you get a necessary service that you should be covered for and then find out that the payment is all on you. It doesn’t have to be that way, though. If you feel that your health insurance company has wronged you by denying a claim of yours, then you can file a complaint with the Ohio health insurance department so that they can research your complaint to find out who was in the right.

Before you file a complaint you should be very sure that you were wronged, because it doesn’t make the ODI very happy to be looking into false claims. In order to be sure that you are in the position to have the right to file a complaint, you have to meet every single one of the following criteria.

• You got a treatment or medical service that you assumed was covered by your health insurance plan, but your provider has informed you that they aren’t paying because it wasn’t medically necessary.
• You have waited two months since receiving a letter stating that you will not be covered for this service.
• You have already gone through the internal review process with your health care provider and are still denied.
• The treatment or service that you were not covered for would have you pay more than five hundred dollars.

If you meet that criteria, go ahead and file a complaint through the Ohio Department of Insurance website or through one of their physical offices.

Cheers,

Fashun Guadarrama.