Getting Health Insurance in an Emergency

This is an attempt to drive people to urgent care centers or doctor’s offices which are less expensive and can save the insured money. Exceptions exist for referrals from a physician to the ER for non ER services, non ER services provided to children under age 14, instances when an urgent care clinic is more than 15 miles away and when care is administered on Sundays and major holidays.

Necessary ER Visits

There is a lot of grey area here but the Affordable Care Act defines an emergency as anything that “a prudent layperson, possessing an average knowledge of medicine and health” would believe to be emergent and in need of immediate attention.

That leaves it to the patient to self-diagnose and then decide which is the most prudent place to go. Of course, it does not help that ER staff and doctors often cannot determine if an ER visit is necessary without examining the patient and possibly performing additional tests to rule out a condition.

True Emergencies

While coughs, sore throats, and headaches are usually not emergencies, the reality is that the Journal of American Medicine discovered that six of the top ten reasons for unnecessary ER visits are also in the top ten symptoms of real emergencies!

Before You Head to the ER:

Try telemedicine or a virtual doctor’s visit. This approach is just beginning to get traction. Many major insurance companies provide this coverage benefit.
Choose a retail or “nurse in a box” clinic often located in big box or drug stores. The majority have non-business hour availability.
Check out a faith-based program. This is where participant’s support each other’s medical needs across the country and world by utilizing Medical Cost Sharing Principles.
Before an Emergency Happens – Know Your Policy
Make sure you know what your insurance policy says about emergency care reimbursement and what defines an emergency. This is more important than ever in a world of rising deductibles, higher co-pays and co-insurance, less coverage and increasing premiums.

Do your due diligence before you receive an ER bill and also check the hospital’s financial assistance guidelines. While many folks assume this is only for non-insured or low-income situations, there typically is an option for insured to under-insured patients as well. You must meet their guidelines to qualify.

The Features Of A Good Health Insurance Plan

The skyrocketing medical expenses, make health insurance plans very essential. When you have an insurance plan, you feel more secure because you are covered even in emergency medical situations. You do not have to start looking for money to get medical attention and you do not have to use the money you have to cater to the medical needs when you have a health insurance plan. There are so many health insurance providers today offering all sorts of plan and you therefore must know what features to look out for to get a plan that is most valuable for your medical needs.

1. Good room rent limits. This is an important feature when hospitalization is inevitable. A good health insurance plan should not have a maximum limit on the room rent so that you know this expense is well covered no matter how long you or a member of your family gets admitted in hospital. Such plans are however hard to find because most come with small percentages on maximum limits, they will pay for room rent. At least choose a reasonable percent to get better value from your plan.

2. Preexisting disease cover. A good plan should cover even pre-existing diseases you have before you buy your insurance plan. This is the best kind of policy because then you get the important medical care you need with the diseases compared to plans that do not include preexisting diseases in their plans. Choose a plan that covers the preexisting conditions and one that has a lower waiting period for claims on the same.

3. Impressive hospital network. When getting a health insurance plan, a good one is the one that makes it possible for you to get medical help from a number of hospitals. Such an impressive hospital network ensures that you get help as soon as you need it and from a hospital nearest to you. Choose a plan that directly ties you up with the good hospitals within your locality to enjoy better delivery of services. Cashless facilities are best because you won’t have to go through the process of filing for reimbursements.

4. High no claim bonuses. The truth is that you will not always make claims on your health insurance. For this reason, a good plan should offer you no claim bonuses when no claims are made. It affects the sum assured by the next renewal, but you definitely want to choose a policy that offers you high no claim bonus, so you get better value for your money even when you do not end up laying claim.

5. Least exclusions. A good health insurance plan should cover most of your health needs. There is always an exclusive section of the policies and unfortunately most people forget to go through it before taking up the policies. Ensure you check the section out and select a plan that has the least number of exclusions to help you relax knowing that it has you covered for most health issues.

The Affordable Alternative to Traditional Individual Health Insurance

As a way to begin let’s define what I mean by traditional health insurance. The traditional health insurance policy is composed of:

The deductible – This is the amount that you have to pay for a medical event before your health insurance will start to pay. In today’s world that deductible is often $3000 or more.

The coinsurance – After the deductible is met most policies require that the insured pay a percentage of all medical costs up to a maximum. Usually the insured pays anywhere from 20% to as much as 50% of every dollar billed.

The copays – In an attempt to make routine health care accessible many policies include a copay for doctor visits and prescriptions in lieu of having to meet a deductible. An example of this is the $10 office visit copay.

Maximum Out-Of-Pocket Costs – This is the most that an insured can expect to pay regardless of how large the medical bills are. As a general rule the maximum out-of-pocket costs for an individual are limited to around $7000. This can be a very misleading number because it assumes that all of your providers are in your network. If they are out of network your costs can be significantly higher.

And finally the “Network” – Virtually every traditional individual health insurance policy is tied to a network of providers. The narrower the healthcare network, the lower the premium. There is too much wrong with “networks” for this article. Suffice it to say that “networks” are the enemy of the healthcare consumer (you).

The Problem Facing Working Americans

The problem is simple: health insurance premiums are too high for most working Americans in the absence of a subsidy and when combined with extremely high deductible and out of pocket costs, healthcare becomes unaffordable. Let’s look at a couple of examples right here in North Carolina.

A non-smoking couple ages 62 and 63 find that their lowest premium option with BCBS of NC is $1999 a month for a $13,300 family deductible with no copays. A plan with a $7000 deductible and $25 office visit copays would cost $2682 per month.

Assuming the least expensive plan the annual cost would be $23,988 annually. And if either person had a medical event such as cancer, the actual cost for healthcare would be $37,288. You have to ask: “Why even have health insurance?”

A non-smoking 30 year old couple found that the least expensive plan would cost $787.84 a month for a $13,300 family deductible with no copays. The least expensive plan that included copays was $1056.88 but had a $7000 deductible and the most restrictive network. Assuming the least expensive plan, should either member of this young couple have a medical event their total annual cost (deductible + premium) would be $16,454.08. That is a devastating amount of money for a young couple.

The simple solution to this problem is a Fixed Benefit Health Insurance. Unlike a major medical policy where the policy pays for all eligible expenses after the deductible and out-of-pocket maximum, a Fixed Benefit Health Insurance Policy states exactly how much will be paid for each specified service. Examples of specified services might include: daily benefit for in-hospital stay of 24 hours, specific dollar benefits for specified surgeries, a specific benefit for doctor visits and other specified charges. A great Fixed Benefit Health Insurance Policy will have very robust benefits, a wide range of specified covered charges, a very comprehensive surgical schedule and more. The most important service that Fixed Benefit Health Insurance Policy can include is medical bill negotiation, a service that can significantly reduce out-of-pocket expenses.

What is really great about this type of policy is that empowers the insured to be a better consumer. Knowing how much your policy will pay you for a specified medical service allows you to better shop and negotiate the price. But the really great thing about this policy is the affordable premium.

The couple ages 62 and 63 are an actual client of mine who had been uninsured for 5 years as a result of the high premiums. I was able to put them into a robust Fixed Benefit Health Insurance Policy with a $5,000,000 lifetime benefit for $683 a month. That is an annual savings of $15,792. As I explained to my client the Fixed Benefit Health Insurance Policy will do a great job of covering 70% to 80% of everything that can happen. If they actually saved the $15,792 difference in premium they would have incredible access to healthcare with very little out of their own pocket.

Back in 2014 I was diagnosed with colon cancer and had a partial removal of large intestine (CP44205). Back then I was covered on a traditional major medical policy. My total out-of-pocket costs were more than $7000. Had I had the Fixed Benefit Plan that I sell today not only would my costs have been zero but I would have received a check from the insurance company for $4619. Not every medical event would have resulted in a check and many might have resulted in out-of-pocket costs of several thousand dollars, but in general the savings would have more than offset those costs.

Health Insurance Plan for Students

What have you observed recently on the enrollment system of your school? Aren’t they now asking for a certain amount that will go under your personal health insurance? Do you think it’s worth it or not? Well practically speaking for me it is really important, especially in case of accidents. That’s just one of the many ways you can benefit from a students’ health insurance policy. Other example is when you plan to travel and study abroad during an upcoming semester; you need to consider purchasing overseas student health insurance seriously because who do you think will going to take care of you there? Having a health plan for student like us will make us rest assured about any kind of illness and medical expenses that we may face anytime during our student life. This is very important if you are staying in abroad or traveling for study.

As we all know that students’ life is full of excitement and adventure and this leads to an exposure of unorganized and unhealthy way of living. Examples of these are attending parties late at night, bar hopping, frequently eating on different fast food chain, and dorm style of living provides refuge to various types of microorganisms, health disorders and finally diseases. Having a health plan will save a huge amount of money that you would otherwise be spending on paying your hospital bills and medicine required by the doctor. Some people think that college health insurance is enough for their children, but actually it is not good to depend only on this, because, a college health insurance may not provide you with a broad coverage for some health issues.