Insurance
Insurance

Insurance (5)

Thursday, 27 February 2014 00:50

Penis Insurance is Coming

Written by John Van Dekker

Penis Insurance - YES Penis Insurance!

Penis Insurance you say? Other than adult film stars and possibly touring rock band members, who could need such a thing? Well, one could argue that roughly half the population has an "insurable asset" in this category, and it's probably also fair to say that this asset is near and dear to most of that population. Penis Insurance is an ingenius approach from an "I'm definitely cooler than you are" men's wear company out of beautiful (read as COLD) Canada. UNDZ.org is a purveyor of (primarily) men's underwear that's decided that they are going to offer a different kind of "coverage" for men's privates.

Penis Insurance from UNDZ

Normally they use a mixture of organic cotton and spandex to do the job, but now they also offering coverage in the form of $50,000 of Penis Insurance, underwritten by Lloyds, free to anyone who purchases three pair of underwear. The genius behind the move is, well... what man doesn't want to be able to say that his man-parts are insured by Lloyds. That's a conversation starter if I've ever heard one before. Hats off to these gentlemen for their move to protect the family jewels, and you can find out more about how to get your assets insured either by logging onto PenisInsurance.org or by going to the Penis Insurance page on the UNDZ website. While you're there, you can peruse their edgy designs, and read the manifesto that explains their environmentally friendly stance. Turns out they want to protect mother-nature too.

Saturday, 28 April 2012 20:53

Explaining Short Term Medical Insurance

Written by John Van Dekker

Short-Term Medical

Short-term medical insurance, also called temporary insurance is primarily designed to provide coverage in between employer provided coverage periods. Typically short-term coverage plans are offered for periods not longer than twelve months.

Situations where short-term coverage may be most appropriate:

  • While in-between jobs
  • While employed part-time looking for full-time employment
  • While waiting for employer benefits to begin
  • Temporary or seasonal employment
  • Recent graduates not covered under a parent’s plan
  • Non-U.S. citizens temporarily residing within the United States.

Short Term Medical

Short-term medical policies are available as HMO, PPO, POS, and Fee-for-Service plans. Short-term policies generally provide protection against serious illness, but do not provide significant benefits for routine and preventative care, though this isn’t always the case. Short-term policies can often be customized to fit the needs of a consumer in a particular situation, and can be a very affordable way to get temporary coverage to protect from the potential for high medical costs for sudden illness or accident.

It is important to know that short term medical policies are not covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and do not provide renewability protection for continuous health coverage of pre-existing conditions.

Saturday, 28 April 2012 18:49

Explaining Major Medical Coverage

Written by John Van Dekker

Major Medical Coverage plans generally fall into one of two categories; indemnity plans and managed care plans.  Indemnity plans, sometimes called ‘fee-for-service’ plans, generally offer greater flexibility in choice of doctor, hospital and care facility.

Indemnity plans typically require the insured to satisfy a deductible before beginning to pay benefits.

Indemnity plans will often also include a co-insurance component, which means after your deductible is satisfied, your insurer will pay a percentage of your medical expenses (e.g. 80%) and you will be required to pay the remaining percentage (e.g. 20%).

Managed care plans on the other hand generally have agreements with a network of doctors, hospitals and healthcare providers who provide services to members at negotiated rates. Care received from providers whom are not part of this network is often not covered or covered at significantly reduced rates.

 

Indemnity Plans

  • Indemnity Major Medical Plans – generally offer maximum flexibility in where one can seek care. Indemnity plans typically include an annual deductible, which applies prior to the insurance company paying benefits, and co-insurance applicable to expenses up to a certain amount. Indemnity plans will normally determine the amount of benefit payable for a given procedure based on what they consider the ‘Usual and Customary” charge for covered services. This can mean that you can be responsible for a difference in the fee charged by your provider and the amount covered by your insurer under their ‘Usual and Customary” scale.

 

Managed Care Plans

  • Health Maintenance Organization (HMO) plans – usually require that one choose a primary care physician from a network of providers. Specialty care must often require a referral from your primary care physician. Care received outside of the plan’s network will often not be covered or will be covered with significantly lower benefits.
  • Preferred Provider Organization (PPO) plans – are managed care plans which generally include a network of providers with lower negotiated rates, but allow some flexibility for one to seek care outside of the preferred provider network, but with higher deductibles and co-payments.
  • Point of Service (POS) plans – combine some features of HMO as well as PPO plans. Generally one must select a primary care physician. Out of network care is generally covered at a significantly reduced rate or not at all, unless referred to that doctor by one’s primary care physician.
Sunday, 27 March 2011 20:21

Outsmart Your HMO

Written by Sandra Gordon

Today, more than two thirds of Americans are enrolled in some form of managed health care. And when the name of the game is cost containment, "quality care" can be tough to get. The squeeze starts with the insurance companies, which are forcing affiliated physicians to see more patients in less time--in some cases, a new patient every seven minutes, while rationing resources such as lab and diagnostic tests. And many managed care doctors are “encouraged” to follow clinical practice guidelines (CPGs), written procedures designed to treat particular diseases for the least amount of money.

HMO doctors can recommend treatment not outlined in the CPGs, and they can spend more time with you during office visits. They can even prescribe brand-name drugs and they can order costly diagnostic tests if they feel you need them. But HMO doctors can't do this for everybody. You have to make yourself stand out.

With this in mind, here's what you can do to increase your chances of receiving the highest-quality service in today's managed-care climate.

BE CHOOSY

Be sure that you pick an HMO that has been awarded a full three-year accreditation status from the National Committee for Quality Assurance (NCQA). This award of three-year accreditation is the NCQA's highest distinction for managed-care organizations who demonstrate excellent programs that promote continuous quality improvement.

Know Your Health Plan. Learn as much as you can about your coverage. “You’re in a better position to navigate the system when you have better information,” says Nick Newsad, a senior analyst at a surgery center in Broomfield, Colorado and author of The Medical Bill Survival Guide (www.medicalbillsurvivalguide.com). Go to your health insurance carrier’s Website and log into its insurance portal with your health insurance card number. There you’ll find your benefit plan, including a list of in-network providers, your deductibles, co-insurance, and co-payments. These tools can help you estimate the cost of your treatment. If you’re not sure about something, call your health insurance company and ask. Get the name of the person you speak to and the date of your conversation in case there’s an issue later.

At your health insurance portal, you’ll also get access to your explanation of benefits (EOB). They’re the documents your insurance company sends your provider, telling them what they were paid and what to bill you. “The bill you get from your provider might not match your EOB. If you get billed for more than you should have, you can ask your insurance company to contact your provider about the discrepancy,” Newsad says.

DOCTOR SHOP

When selecting your primary care physician (PCP), keep in mind that "board certified" (which means that the doctor has passed the Board exam) is better than "board eligible" (the doctor hasn't yet taken this important accreditation test). But even the most credentialed PCP might not be right for you. "Choosing a doctor involves a gut response that starts when you call for an appointment," says James Kvale, MD, professor of family and community medicine at the University of Texas-Houston Medical Center. Clues you're in good hands: The doctor's staff is professional and concerned about your wellbeing. The doctor's office is clean. Your waiting room time is rarely more than 30 minutes. Your doctor listens to your concerns and answers your questions.

SEEK OUT SPECIALISTS

Referrals to specialists are usually authorized by your primary care doctor. But if you want to go to a particular specialist your doctor doesn't know and, for some reason, doesn't want you to see, you can get around it by working backward. Call the specialist and tell her you're interested in becoming her patient, and ask if she has a relationship with other PCPs in your plan. (Offer to fax her the list from your HMO's physician directory.) Then switch to the PCP she suggests. (You can always switch back later.)

SPEAK UP

If you believe that you are not receiving satisfactory care and your physician isn't being helpful, call your HMO's member services department. In many cases, they can help you get the benefit you need. Or you might want to work through the human resources department at your job. You might also consider filing a formal grievance with your HMO (check in your member handbook for the grievance process). Or send a letter directly to the HMO's medical director and the head of its member services department. Ask them to respond to you within a specified time, and tell them you'll seek regulatory or legal help if necessary. If the problem isn't resolved, you can ultimately file a grievance with your state's HMO regulatory agency. Call your HMO's member services department for this agency's address and telephone number. Remember, it's the squeaky wheel that gets the grease.

KNOW YOUR LEGAL LIMITS

If you receive a bill from your doctor for a covered service because your HMO hasn't paid the doctor on time, send the invoice back to your doctor. Include the note, "I'm not responsible for this bill. I'm covered by managed care," advises Harvey Wachsman, JD, MD, an attorney in Great Neck, New York, who specializes in managed care. When your HMO fails to pay your doctor, says Wachsman, it's breaching its contract with the doctor. "Let the doctor go after the HMO," Wachsman advises.

MENTION MONEY

Is this covered?" and "What is this going to cost?" are two relevant questions to ask your doctor, who may recommend a treatment that's not covered by your HMO. If your doctor isn't sure about your coverage, double-check your managed-care contract before consenting to any procedures.

DO YOUR HOMEWORK

To understand your condition and become a decision-maker in your own health care, do your own research online. By being more informed, "you may get better care and you'll feel more in control," says Kvale. If you discover a new treatment your doctor hasn't recommended, there's a good chance it's not yet covered by your HMO. But that doesn't mean it can't be.

Armed with information you provide, your doctor may be able to persuade the HMO to authorize the treatment.

TAKE NOTES

When speaking with HMO customer service representatives, be sure to jot down the date of your call and the name of the representative you speak with. If there's a discrepancy at some point later on, your notes (as in "On April 28 I spoke with representative Jane Doe, who told me this service was covered") may help to resolve the matter in your favor.

QUESTION DENIALS

If your claim is denied because the treatment you received was deemed "not a covered service," "not medically necessary" or generally "unauthorized," ask your doctor to write a letter to the HMO requesting to have the claim reconsidered. Or call your plan's member services department for an explanation. (HMOs have been known to sometimes reverse their determinations.

They've also been known to make mistakes, so it's always worth asking.) If your

HMO refuses to reconsider, file a formal appeal. Check your member handbook for the appeal process. Do research to back up arguments about your care. It's up to you to look out for yourself.

There is good news about insurance options for people living with type 1 diabetes. “Many people who in the past have been declined life insurance and long-term care insurance (LTC) solely on the basis of their type 1 diabetes diagnosis are now seeing some of the barriers come down,” said Danny Mensh, president of Mensh Insurance. “Under certain circumstances, several major carriers are now willing to underwrite and issue both long-term care insurance and term life insurance policies.”

In the past, insurance carriers did not know how to price the risk on life insurance and long-term care insurance for people with type 1 diabetes and automatically declined their applications. However, within the last 24 to 36 months, the insurance industry has become more lenient on this chronic condition. “Due to improved medications, advancements in the manner in which they are distributed and more precise blood sugar level monitoring, underwriters are increasingly more comfortable with the longer life prospects and health maintenance of those with stable histories of type 1 diabetes,” Mensh said.

Some of the basic underwriting criteria for issuing policies to a person with type 1 diabetes include:

  • Controlled A1c < 8
  • < 60 units of insulin
  • Controlled height and weight
  • Average fasting blood sugar < 200
  • Blood pressure , 140/90
  • No transient ischemic attacks (TIAs) within past five years
  • No smoking within last two years
  • No cardiac complications or retinopathy associated with eye impairments
  • No chronic steroid usage

“Many people with type 1 diabetes are very stable and can easily demonstrate via medical records that they should qualify for approval from major insurance carriers,” Mensh said. “It has been exciting to open up the options for future financial planning to people with this chronic condition.”