Don't Get Robbed on Health Insurance

Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not understand what health insurance fraud entails, though. With reports estimating health insurance fraud is a $30 billion to over $100 billion industry per year, the topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and its consequences. By doing so, you are more able to recognize and fight fraud.

Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Essentially this means that you assert that you paid for certain medical procedures or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud is to conceal pre-existing conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may think that this is a small issue in comparison to your sister receiving treatment, it is actually very serious to your health insurance company and industry, and will result in fines and possible imprisonment if your are caught.

Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company’s investigation.

Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear – along with the money you have been paying in premiums.

The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember – it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.

Medicare is a governmental program which provides medical insurance coverage for retired persons over age 65 or for others who meet certain medical conditions, such as having a disability.

Medicare was signed into legislation in 1965 as an amendment to the Social Security program and is administered by the Center for Medicare and Medicaid Services (CMS) under the Department of Human Services.

Medicare provides medical insurance coverage for over 43 million Americans, many of whom would have no medical insurance. While not perfect, the Medicare program offers these millions of people relatively low cost basic insurance, but not much in the way of preventative care. For instance, Medicare does not pay for an annual physical, vision care or dental care.

Medicare is paid for through payroll tax deductions (FICA) equal to 2.9% of wages; the employee pays half and the employer pays half.

There are four “parts” to Medicare: Part A is hospital coverage, Part B is medical insurance, Part C is supplemental coverage and Part D is prescription insurance. Parts C and D are at an added cost and are not required. Neither Part A nor B pays 100% of medical costs; there is usually a premium, co-pay and a deductible. Some low-income people qualify for Medicaid, which assists in paying part of or all of the out-of-pocket costs.

Because more people are retiring and become eligible for Medicare at a faster rate than people are paying into the system, it has been predicted that the system will run out of money by 2018. Health care costs have risen dramatically, which adds to the financial woes of Medicare and the system has been plagued by fraud over the years.

No one seems to have a viable solution to save this system that helps so many people throughout the country.

In the United States alone, there are about five different types of health insurance available:-

• Traditional health insurance
• Preferred provider organizations or PPOs
• Point-of-service plans or POS
• Health management organizations or HMOs

and most recently

• Health savings accounts or HSAs.

With so many types of health insurance, it may be confusing trying to figure out which one best fits your needs, so thoroughly research each one and speak with a professional if you need clarification.

Traditional health insurance is the one that most people think of when they think of health insurance. You pay the insurance company a premium every month, and if you have an accident or need for health coverage, you have a deductible amount you must pay and then the insurance company picks up the rest of the bill. You often have an inexpensive office and/or prescription co-pay with traditional health insurance.

With people living longer, health insurance companies began to look for more ways to reduce their costs, developing different health plans such as PPOs. PPOs are plans which will cover nearly all of your medical expenses as long as you stay within a preferred network of physicians or hospitals. This network creates a “preferred provider” list that you can choose from. Treatment outside this network of providers is covered but only at a reduced rate, meaning you end up paying more to see a physician outside the network. By limiting the physicians and hospitals covered in their network, the insurance company can control, to an extent, their costs and lower your premiums.

POS plans work like PPOs, but require you to have a primary care physician through whom you can receive referrals for specialists. If you need to see a neurologist or a dermatologist, you must first visit your primary care physician for an initial diagnosis in order to receive a referral to a specialist for a more thorough diagnosis. POS plans also have a preferred provider network, and if you choose to visit a specialist or physician outside that network, your coverage will be limited.

HMOs combine a stricter version of PPOs and POS plans. HMOs have a defined list of physicians, often much smaller than PPO networks, which you may see. You will not be covered at all if you see a physician outside your HMO network. Furthermore, you must also get a referral from your primary care HMO physician to see any specialist. However, these restrictions mean that you pay an extra low or no monthly premium.

HSAs were signed into law by President Bush in recent years. You can deposit money into a special non-taxed, interest-gaining savings account that must be used for medical expenses. The ideal situation for an HSA is to combine the account with a low-cost, high-deductible insurance plan. The savings account is designed to allow you to cover the high deductible if you find the need to cover expensive medical costs while the insurance company will pick up the rest of the bill.

Again, it is important to carefully consider each option before choosing a single health insurance plan. Your health is important-make sure it is protected in the best way possible.

In Australia, where I hail from, life is much simpler.

In this modern world of cancer, heart disease, AIDS, diabetes, asthma, ageing and other diseases and afflictions, it is essential to have some sort of health insurance.

There are many levels of health insurance coverage available. Unfortunately, like most things in life, you get what you pay for, and good coverage can be very expensive.

The two most common terms in referring to health insurance are premium, which is the amount paid for the insurance, and deductible, which is your out-of-pocket expense before the insurance pays your provider.

For instance, you might pay $300 premium per month for family coverage, and your deductible might be $250 per person, which means if you fell and broke your ankle and went to the hospital emergency room, you would be required to pay the first $250 of the bill.

You can purchase very basic catastrophic coverage, which would carry a very high deductible and the premium would be less than comprehensive coverage which would have a higher premium and lower deductible.

It pays to invest the time to investigate various insurance options, taking into consideration your age, your general health and the health of your family members.

Your employer may offer group health insurance, which is most likely the least expensive option for you, and usually the premium is deducted from your paycheck.

Health insurance is a calculated risk; can you afford the premiums or are you willing to risk that you would pay less out of pocket for medical expenses in a year than the premiums would cost? Consider carefully.

There are thousands of unsuspecting folks who wind up falling victim to health insurance cons every year. Unauthorized insurers are prepared to sell you health insurance with a low-cost premium and many individuals would never consider that there are fake insurance firms out there looking to steal your money. With so many companies tendering health insurance, how does one decipher which ones are scams? The current trend of scams is on the increase due to the multitude of uninsured people compared to the growing price of prescription medicines. Simply put, people are searching for the best buy. There are methods to keep yourself safe from these con artists and still pay a fair insurance premium.

Does a health insurance company appear to be proposing a policy that’s too good to be true? It could be. Victims of health insurance scams are typically those who go shopping around and find a fantastic deal (then find that, in an emergency, they’re without coverage). There are no distinct indicators of fraud unless you know what specific red flags to listen for during the sales pitch for their particular policy.

Con-artists are professionals at what they do because it’s often how they make their entire living. They will have paperwork that appears identical to a genuine insurance firm and uphold everything that seems to be that of a genuine and legitimate broker. First off, common scams include loopholes that make sure what they are marketing isn’t actually insurance. This would mean it is a discount program of some kind. These scams may get to you by telephone, proposing a discount rate to individuals who, for any reason, don’t qualify for genuine insurance. Also be suspicious if an agent mentions their plan being “reinsured.” It is true that a few legitimate insurance companies do have reinsurance to protect themselves, but it is never referred to when attempting to sell an insurance policy to a client.

Health insurance scams are not easily spotted, liars may be seeking to capitalize on your ignorance. Consequently, it is important to know all you are able to about health insurance prior to purchasing a plan. If somebody phones your home and attempts to sell you a form of health care or health insurance, take what knowledge you have and ask as many questions as you can think of. Any indication that this may be a fake insurer should be taken to the state insurance regulators for investigation. You could be saving yourself and other people from being a victim.

When you use a respected and well-known company such as iSelect, you can be assured that all quotes received are from honourable insurance companies because iSelect will not list any broker who does not have all the proper credentials. For a free, no-obligation quote for your health insurance, start at iSelect and narrow the field of possible health care providers to ones that suit your needs perfectly. You can then approach each company directly and choose the best package deal for you.

Finding the right health insurance policy to fit your individual needs can be a time-consuming task. Here are 5 tips to help you to find the hospital and extras cover that is perfect for you or your family’s needs.

1. SET YOURSELF A TARGET
Finding the right health insurance for you generally begins with deciding what you want. There are hundreds of health insurance products on the market with thousands of combinations so knowing exactly what you want helps you to quickly focus your search.

Some questions you will need to ask yourself should include;

• Do I want hospital cover, extras cover or both?

• What are the inclusions that I feel I “must” have?

• Do I want basic cover, full cover or perhaps something in between?

• How much can I afford to pay up-front as a premium?

• Am I prepared to pay an excess in exchange for a lower premium?

2. TRIM THE POLICY WHEREVER POSSIBLE.
Health insurance policies are designed with a wide cross-section of people in mind. To accommodate the needs of many different individuals, health funds offer a variety of products some of which offer a full spread of inclusions, which may not all be appropriate for you. As you would expect, more inclusions translates to higher premiums so it is important to identify those inclusions that are not relevant for you. For example;

If you’re finished having or have no intention of having children then you shouldn’t be paying for cover for obstetrics and IVF. The same rule applies if you realize that the extras inclusions you want revolve primarily around dental and optical cover. Avoiding products with unnecessary inclusions could save you a bundle while still allowing you to get what you want.

3. SEEK EXPERT ADVICE
There is really no substitute for experience and expert advice is an important part of finding the product that is best for you. Here are a few sources for different types of useful information that can help with your decision.

CANSTAR CANNEX STAR RATINGS: The CANSTAR CANNEX health insurance star ratings compares health insurance products on pricing and features and presents a short list of the best performing products for consumers to use as they shop around for the right cover. Five-star-rated products offer superior value but it may well work out that you need a product they have rated as four-star simply because you require a more expensive feature that contains, for instance, cover for blood glucose monitoring for a diabetic.

FRIENDS & FAMILY: While not strictly experts, asking friends and family about their experiences with different health funds can be quite enlightening. This is especially important as a resource to find out about claims experiences.

PHIO WEBSITE: Another good source for claims experience and complaints is the Private Health Insurance Ombudsman’s website. Each year the Ombudsman publishes a report of each fund’s performance including the total number of complaints received.

YOUR DOCTOR: Your primary physician is also a great expert resource because he or she knows your medical history and risk factors for future health-related issues. Make sure to check with your GP about things that you must have included as part of your cover.

4. CHECK THE INTERNET
Once you’ve established the criteria for the cover you’re after, it’s time to surf the web to compare health insurance cover. You can easily find five star health funds in the state you live in and for your profile. Make a short list of funds you are interested in. The next step is to look up the health funds on the web. Each health fund now provides Standard Information Statements (SIS) which are standardized pages detailing the most important information about the cover. These can be used to quickly compare products. Health Fund websites also provide valuable insight into additional programs, initiatives or services they offer (such as help with quitting smoking, kid-friendly policies, surgery follow-up etc) that don’t seem to fit in the SIS.

You can also check to see if the fund has agreement hospitals or extras providers in your geographic area. Shopping around allows you to find the policies that cover the inclusions you want and then allows you to sort them by price.

5. REVIEW ANNUALLY
Life is constantly evolving so it’s unlikely that your life and therefore your health insurance needs will remain the same year after year. It’s more likely that, as you move on through life, the cover that fitted perfectly before no longer fits as comfortably. New products are also routinely introduced to the market which may be better than your existing cover. It’s therefore important to routinely review what you expect of your private health insurance cover and have a look at what is on offer.

iSelect offers you a database of health insurance companies, policies and special deals all in one convenient location. Start your research at iSelect and cut your research time by automatically weeding out the companies and policies that simply don’t suit your lifestyle or budget.

Health insurance frequently involves a slew of paperwork that bears a lot of fine print. Regrettably, this means that few people study their plans thoroughly nor do they fully understand what their plan covers or doesn’t cover. Here are a few primary limitations in health insurance coverage that you should understand.

Some of the most shocking health insurance limitations are discovered in the the fine print holes in the insurance policy. For example, numerous people have found out that their health insurance didn’t cover a routine or essential medical procedure because they didn’t obtain an authorization code prior to the procedure or the hospital did not correctly complete the paperwork. Your medical claim could be refused merely because the hospital utilized odd codes for your treatment. Although any claims denied by the insurer can be challenged, this process is not merely tedious, but time-consuming and draining, particularly for somebody who is already ill. There is also little success in winning disputed claims, which makes this alternative somewhat limiting.

Another surprising health insurance restriction occurs more frequently than people realize. Envisage this situation: you are diagnosed with a medical condition and need an operation. You research surgeons and hospitals within your plan. You understand your plan’s coverage of hospital care. You have your operation and then you find a massive medical bill in the mail. Seemingly your health insurance didn’t encompass the anesthesiologist or other specialists that may have consulted in your surgical procedure. Hence, you have to compensate these specialists for their services, even though you were under the impression that your plan would cover these costs associated with the surgery. Such a bill can be in the thousands of dollars, and there is little you will be able to do to dispute the charges. The only means to avert these charges is to ensure that you inquire prior to the operation who will be involved and make sure that they are covered in your health insurance plans.

Additional limitations are put on a number of treatments. For example, you may need physiotherapy or visits to a psychiatrist. Many health insurance plans will place a limit on the number of covered visits for such medical treatment. Without realizing it, you may exceed the maximum visits permitted by your health insurance and finish up racking up huge charges.

Many people believe that purchasing health insurance will cover them medically, but this is only correct to a degree. When procuring insurance, you had better read through your health insurance package cautiously, and when you are about to go through any expensive medical procedure, make certain to consult your health insurance plan first.