Got questions about health insurance? Here are the top 10 health insurance questions and answers:
1. What kinds of health insurance plans are there?
There are two basic types of health insurance plans – indemnity plans and managed health care plans. Indemnity plans let you choose your own physician, while managed health care plans – HMOs, PPOs, and POSs – assign you to a network of physicians and hospitals. Managed health care plans are less flexible, but much cheaper than indemnity plans.
2. What’s an HMO?
With an HMO you pay a monthly premium for which you are assigned to a network of physicians, specialists, and hospitals who provide your medical care. A primary care physician oversees your care and you can only see physicians within your network. Prescriptions may completely covered or partially covered and generally require a co-payment of $5 to $10. This is the cheapest type of health insurance.
3. What’s a PPO?
A PPO is similar to an HMO, but it allows you to visit non-network physicians without a referral from your primary care physician. You may have to pay for the non-network physicians fee, then get partial reimbursement from your PPO provider. Co-payments are generally $5 to $10, and this plan costs a little more than an HMO.
4. What’s a POS?
A POS plan is a combination of an HMO and a POS plan. You choose a primary care physician within your network, but you can also see physicians outside the network. If your primary care physician refers you to an outside physician your POS provider picks up the costs. This is the most flexible and the most costly of the three managed health care plans.
5. What is a deductible?
A deductible is the amount you pay toward a claim before the insurance company pays.
6. What’s coinsurance?
Coinsurance is the percentage of your medical expenses you have to pay after you pay your deductible.
7. What is a co-payment?
A co-payment is the amount you must pay when you visit a physician.
8. How do I choose a health insurance plan?
Ideally, you want to choose a plan that will give you the most amount of benefits for the least amount of money. If you want to continue seeing your current physician, find out what plans he or she is associated with. And if you have special medical needs, make sure the plan you choose will provide for those needs.
Other things to consider when choosing a health insurance plan are:
* What are the co-payments, deductibles, and coinsurances?
* Does the plan cover pre-existing conditions?
* What is the waiting period for pre-existing conditions?
* Will the insurance company give me good service?
9. Where can I get cheap health insurance?
Insurance premiums vary substantially from one company to another, so you want to get quotes from several companies in order to get the best price.
The quickest way to get quotes from different companies is to go to an insurance comparison website. Once there you’ll fill out a short questionnaire, then receive your quotes. The best comparison sites only deal with A-rated insurance companies so you know you’ll be getting a reputable company. They also have an insurance expert on call to answer your questions. (See link below.)
10. How do I know I’m getting a reliable health insurance company?
One of the best places to check out an insurance company is your state’s department of insurance website. You can also visit J.D. Power & Associate’s website (jdpower.com) to get consumer ratings on insurance companies, and A.M. Best’s website (ambest.com) to get financial ratings.
President Clinton did not and now President Bush will not address health care reform in a way that deviates even slightly from the HMO and Managed Care Industries that have given large sums of money to both campaigns to keep them quiet. Thus these special interests maintain the status quo of the for profit health insurance corporations that have taken over the health care system in America.
Every day, approximately 100,000 people lose health insurance coverage in the United States. Over forty-four million Americans do not have health insurance at all. The people who have HMO’s as their only choice of insurance routinely face rejection of payment when serious health problems arise. The doctors employed by HMO’s make decisions about a person’s health without laying hands on the patient. They do not examine, listen to or have any contact with the patient about whom life and death decisions are made regarding their health.
This is a human rights abuse in a civil society such as ours, or any other society, for that matter.
There are over 1500 insurance companies in America with different rules of what services will or will not be funded. Our facility has hired two people just to handle the health insurance questions that arise every day. They often have a frustrated and perplexed look in their eyes as they undertake to find solutions to problems, and then have to contact a faceless bureaucratic entity about whether or not a service will be paid for.
Health care providers must also take the time to speak to these people, to convince them to pay for proposed services. Letters must be written to convince the HMO/Managed Care bureaucrats to take a second look at what needs to be done for patients, to ensure good quality medical care.
Health care workers have accepted the unacceptable and do not seem to know the way out of the quagmire.
I once helped to raise $3,000.00 for a seven year old patient who was in an automobile accident, and suffered a lower spinal cord injury. He is paralyzed from the waist down. The proposed goal for the fund raiser was to buy a handicapped accessible van. Since these vans cost anywhere from $15-30,000.00 dollars, the family bought a computer, instead, enrolled the boy in a study offered online by the Shreiner’s Hospital in Philadelphia for spinal cord injured patients.
At the fund raising dinner, I sat with the patient’s grandmother. She told me she wanted the money to be put in a trust fund to pay for the child’s catheter supplies, diapers and medicine that the Managed Care Insurance company would not pay for.
“Wait a minute,” I said. “You mean you are paying for all of the supplies out of pocket without insurance reimbursement?”
“Yes,” she said.
Back in the office the following week, one of the women whose job it is to deal with insurance questions, solved the dilemma and the supplies are now paid for. The child’s mother had receipts, and the HMO reimbursed her from the time of the car accident.
I wondered why the insurance company did not automatically pay for these services? If I had not helped stage an elaborate fund raising event and had dinner with the boy’s grandmother, this revelation may not have surfaced. A Universal Single Payer health care plan would make it possible for all people to get the services they need and free up doctors and nurses to give the care that people deserve, plus fulfill all of the reasons doctors and nurses entered their respective professions to begin with: to be of service, to help other people and to bring healing to patients and their families.
Physicians for a National Health Program in America have devised the following plan for implementation. For more information, please access http://www.pnhp.org.
National Health Insurance, if implemented, would minimize any disruption to the current health system because health care delivery mechanisms would remain in place while only the financing mechanism changed. Single Payer National Health Insurance would resolve virtually all of the major problems facing America’s health care system, today.
Single Payer Insurance is defined as a single government fund with each state which pays hospitals, physicians and other health care providers, thus replacing the current multi-payer system of private insurance companies and other plans.
It would provide coverage for the forty-four million people who are uninsured.
It would eliminate the financial threat and impaired access to care for tens of millions who do not have coverage and are unable to afford the out-of-pocket expenses because of deficiencies in their insurance plans.
It would return to the patient free choice of health care provider and hospitals, not the choice that only the restrictive health plans allow.
It would relieve businesses of the administrative hassle and expense of maintaining a health benefits program.
It would remove from the health care equation the middleman-the managed care industry-that has broken the traditional doctor-patient relationship, while diverting outrageous amounts of patient care dollars to their own coffers.
It would control health care inflation through constructive mechanisms of cost containment that improve allocation of our health care resources, rather than controlling costs through an impersonal business ethic that robs patients of care so as to increase profits for the privileged few.Single Payer Universal Health Care would provide access to high quality care for everyone at affordable prices. This would be beneficial for individual business as well as the government.
So why don’t we have a National Single Payer Plan?