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Stay Legal! Avoiding Insurance Fraud
Feb 12th
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 savings account holder 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.
Shop ‘Till you Drop: Shopping for Health Insurance
Feb 4th
Shopping for health insurance can be a frustrating hassle. There are so many companies with so many rates to compare. However, it is important to take your time and find the best company for your money. Although it may be frustrating, health insurance is a necessity. In any area, there are usually quite a few health care providers that can supply you with a quote over the phone. You could also use the Internet as a resource. By using these tools, you can make the shopping process go more smoothly.
The first step is going to be deciding which type of insurance you should be shopping for. If you have a family, it would be in your best interest to find a company that will give you one decided premium and co-payment plan no matter how many children you add to the plan at any time. Without a family, you would be shopping for individual health insurance but will need to decide if you are in need of short-term insurance or insurance for an extended period. Short-term insurance is for people who are in-between jobs and expect to enroll in whichever health insurance plan their future employer sponsors.
Once you have established what type of insurance you need, it is time to make some calls. Go through your local phone book and start calling down the line. After answering a few simple questions, you can get a quote and move on to the next company. Cost is one of the most important factors. If you find two or more of them with very similar premiums and a low co-payment amount, you should compare the benefits. Can you add immediate family at no charge? Will this health insurance include dental, emergencies, prescriptions, or doctor visits? This may help you find one that appeals more to your needs and is within your budget. Using the services of the Internet to find a company will be a very similar process. Some reputable web sites out there will ask you to fill in a few blanks and then give unbiased quotes from many different health insurance companies.
Whether you are going to be doing your shopping over the phone or on the Internet, you should use your best judgment of the information that you get on each company to decide on one that makes you comfortable. The Better Business Bureau can also help you be sure that you are not being scammed. Health insurance is a cost that is necessary to save you money in the long run on prescriptions, doctor visits, and unforeseen emergencies. Don’t get left with bills that you have no way of paying because you didn’t have insurance.
Healthcare for Long-term Patients: Is this Insurance Right for You?
Jan 23rd
Healthcare for Long-term Patients: Is this Insurance Right for You?
Long-term care insurance is not right for everyone. For a small percentage of the population this coverage is an affordable and worthwhile type of insurance. Determining whether or not long-term care insurance is right for you won’t be the only task at hand; looking for scams will also be a concern.
As you get older, the need for assistance in your everyday life increases. Whether it is in-home care or residing in a nursing home for a few months you will most likely need some way to pay for these types of services. In order to maintain long-term care insurance you must pay for them each and every year until death. Many policies are canceled by policyholders that are on fixed incomes and are simply unable to pay for the increasing premiums as they get older. If the only funds you are receiving were those from Social Security or SSI, then it would be wise to not purchase a policy. Also, if you find that every day purchases and paying for utilities makes you stretch your budget to the limit, you probably should stay clear of this policy. This type of policy is only right for someone who has significant assets they want to preserve for their family, remain independent, or just to spare their family the expense of a nursing home bill.
Comparing policies can prove to be difficult because every company is selling a different combination of benefits and coverage. Many companies offer to pay a fixed amount for each day you receive care, while others will cover a percentage of the overall cost of care or supply a specified amount. Beware of these types of policies unless they offer inflation protection. You see, if they do not account for the increasing cost of nursing home costs, then you are stuck with a policy that really does you no good.
Just like a standard healthcare plan, you will have to receive services at designated locations. If you go outside of this network they will simply refuse to pay for any care that you receive. If you have any type of mental disease or nervous disorder then don’t expect many carriers to accept you (the one exception is Alzheimer’s). There are more restrictions in this type of insurance than any other health insurance.
If this type of policy is right for you, please make sure that the company is reputable. There are many individuals who thrive on the fact that not many people will make an informed decision when it comes to purchasing long-term health insurance. Be sure to read the fine print and find out everything you can about the policy before committing to a company and a long-term health insurance plan.
Health Insurance for Every Need: Understanding the Kinds Available
Jan 15th
In the United States, 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 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 recently signed into law by President Bush. 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 auto insurance quote 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.
Attract Employees: Group Health Insurance
Dec 18th
Many small business owners know that in order for them to be successful they must offer an incentive to recruit employees to work for them. This can be any number of things, but most often it is the benefit of offering group health insurance. While this could be an excellent strategy for your small business to take in order to recruit new employees, there are a few things that you must know first before you dive into selecting a plan. Research group insurance policies thoroughly before choosing one for your company.
A group health insurance plan can be obtained by any small business that has as little as two employees to as many as fifty. There are two ways you can go about supplying the health insurance to your employees; this will mainly be decided by your own budget. Many small businesses that offer group health insurance help contribute towards the cost of the plan. On the other hand if an employee wants to have coverage for their families, the employer might offer to pay the employees’ premiums and have them pay the premium for their families.
Another aspect of the group health insurance plan will be deciding between managed care or fee-for-service. Managed care plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or Point of Service plan (POS).
An HMO will significantly reduce the cost that your members will have to pay for medical care as long as they use the providers specified by the HMO. A PPO will not require a referral in order for them to see a specialist. While the PPO is more flexible it will bring higher costs to the per-visit and annual deductibles. The POS plans are basically a combination of the features that you will find in an HMO and PPO. Members get to decide whether to pay a flat fee for offices in the network, or pay a deductible charge to see someone out of network. The fee-for-service plan gives the employee the power to select health care providers themselves. This means that they will have way more flexibility with where they can go for medical assistance.
Adding an appealing Group Health insurance plan to your business could potentially bring you more employees. This is just the basic information about Group Health insurance; there are many options to consider when choosing a plan. Be sure to investigate all options to create the best plan for your employees.