What is point of service medical health insurance?
Reader question:
What is point of service medical health insurance?
Maggie
Great question.
A point of service medical health insurance program is kind of like a mix of both traditional indemnity insurance and health maintenance organization insurance. It has some of the qualities and cons of both, and while it has some of the flexibility of the traditional indemnity plan, it also contains the requirement of the HMO plan that you must pick a primary care provider and go only to them without a very good excuse. It’s like being both free yet organized if you pick a point of service medical health insurance plan.
If you have a point of service medical health insurance plan, then you have to choose your primary health care provider and hospital from a network chosen by the health insurance company. This isn’t a strict arrangement. If you go to a physician or hospital within the network, then you will be covered or have to make a co-payment in order to be treated for your sickness or injured part. But there is also the option of choosing a physician or hospital outside of the network to go to. If you do this, you must then file a claim with your POS.
The Good:
- Most of the point of service medical health insurance plan allow you to receive your health care outside of the network that they provide. This sounds nice and flexible at first, but it has its drawbacks. While you can get good coverage within the network, it drastically decreases once you move outside of it.
- Point of service health insurance plans are very good on things like preventive medicine and services. Not only are you covered for things like pap smears, but you even get things like cheaper rates for gyms and classes to help quit smoking.
The Bad:
- Like in an HMO, point of service medical health insurance plans require that you choose a primary health care provider, and you are then required to use that provider if you want the best rates.
- Yes, you are allowed to go outside of the network to see a doctor or specialist, but that doesn’t mean that it will be easy to get covered. If you do it without a referral from your primary health care provider, then you have to send in the bills all by yourself and might not get a check back at all, and if you do it will be a small one.
Cheers,
Fashun Guadarrama.
What is traditional medical health insurance?
If you want to get traditional indemnity medical health insurance, also called FFS or fee for service medical health insurance, then you’re going to have to like paperwork. That’s why I’m including this video of a cute baby kitty in this post. Because, naturally, thinking of adorable kittens makes any distasteful action funner. Well, that might be overselling it a little bit.
Regardless of the extra amount of paperwork required, fee for service medical health insurance isn’t all that bad. It does cost more, with both more pricey monthly premiums as well as deductibles that tend to be on the high end, but at the same time it is a lot more flexible than many kinds of medical health insurance plans. If you’re willing to pay a little extra money and spend a little extra time for a lot more freedom and choice, then traditional indemnity medical health insurance might be the best option for you.
The Good:
- Lots of flexibility, in that you can pick what doctor, specialist, or hospital you patronize instead of having to choose out of a network and having to get a referral to go outside that network. It helps you take control of your medical experience and handle the way your health is going more than other, more controlling plans.
- No referrals, again. If you have to go to a specialist, you don’t have to worry about getting denied by the primary care giver that your insurance company picked for you. You can choose on your own.
The Bad:
- If you want the medical health insurance company to pay for the health insurance claim, you have to pay the deductible first, and this often is high. Also, after you have paid the deductible, you usually have to co-pay. Although the insurance company tends to pay around eighty percent, you still have to pay the other twenty.
- Your medical health insurance doesn’t cover your needs right away. Rather, you have to pay first and then file a health insurance claim to get your money (most of it) back to you.
- Traditional indemnity medical health insurance decides what is the normal price for a medical service, so if you go to a physician that is more expensive than others around the same area, then you’ll have to pay that extra money because the insurance won’t cover it.
Cheers,
Fashun Guadarrama.
Don’t get your health insurance claim denied!
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.