Insurance works best when it’s rarely used. That’s why life, automobile and homeowner’s insurance are relatively affordable.Death occurs only once, and we make every effort to avoid it. Auto insurance isn’t designed to reimburse us for oil changes, gasoline, car washes or tires. We don’t use our homeowner’s insurance to pay for light bulbs, lawn maintenance, cleaning people or paint.Shouldn’t health insurance work the same way?Ordinary health maintenance should not be treated as an event that triggers insurance coverage. Health maintenance should be encouraged, but not financed by an insurance company. Insurance should be limited to unpredictable and expensive medical events that seldom occur… the way all other types of insurance perform.Deductibles that are too low, doctor visit co-pays and first dollar coverage for prescription drugs, encourage people to overuse health care services. They also drive insurance premiums to a level completely beyond the value of any benefits received.Insurance companies are in business to make money, remember?Your premiums are calculated to exceed the cost of any benefits that are likely to be paid out. On average, you would need to run to the doctor every month in order to justify and break even on the additional cost of a having an office visit co-pay benefit. Realistically, have you ever been that sick?Prescription co-pay coverage can easily account for over 25% of the cost of insurance… and over 95% of the population is better off just paying cash at the pharmacy!The term “medical insurance” has become a misnomer. The general definition of an “insurable event”… whether a traffic accident, tornado, heart attack or spinal injury… is something that is (1) unlikely to happen; (2) will occur without warning; (3) is not something that the insured person wants to happen; and (4) would create a severe financial hardship if paid for out-of-pocket. This definition applies to catastrophic health events… serious illnesses and injuries. It does not apply to routine health maintenance, does it?Homeowner’s insurance covers fires, roofs destroyed by falling trees, and other costly events. Automobile insurance covers major damage and theft. But what passes as health insurance has expanded to include just about everything, including the routine, the predictable, and the easily affordable.And, as you know, there’s no such thing as a free lunch!Most health insurance plans use co-pays as the method of cost sharing. Co-pays became a standard part of drug-benefit and doctor-visit coverage during the managed care revolution of the 1990s. However, they are not consistent with any rational health plan design. When something is free or inexpensive, there is an overwhelming tendency to consume as much of it as possible. If there is very little cost (at the point-of-service) to see your doctor, why not schedule a visit for the sniffles, or pop the latest, greatest pill?Co-pays are helping fuel the health insurance crisis in America.The overuse and abuse of coverage is what drives annual double-digit cost increases. Insurance companies are forced to either pass on the costs in the form of rate increases or to reduce coverage… often in areas that can bring about financial devastation at claim time!So, ironically, a major reason that health insurance has become so expensive is because co-pay medical care appears so cheap!The Solution…Health insurance is needed to protect against large medical expenses. The majority of our insurance agents (and their most enlightened clients) select high-deductible health plans for themselves and their families… to protect against true medical emergencies… and they “self-insure” for doctor visits and prescription drugs.Doctors are often quite willing to offer deep discounts to those who are willing to pay in full by cash at the time of the visit because they rid themselves of the time spent coding and filing insurance claims. And most insurance companies offer prescription drug discount programs, free of charge.In fact, outpatient prescription drug coverage should be a non-issue with the advent of low-cost retail generic drugs. Wal-Mart pioneered the concept of charging only $4 for generic drugs, and now more in-store pharmacies are adopting similar pricing. The good news is that there’s a generic equivalent, if not an exact chemical copy, of virtually every brand name drug in the world. So why waste hard-earned dollars on a $10 Rx co-pay plan?This returns health insurance to its original purpose and eliminates administrative expenses for small claims. And with the variety of low-cost alternatives to high-priced health plans that are readily available… even for the least healthy among us… as health insurance premiums drop through the floor, those savings will almost always offset any potential additional out-of-pocket expenses.
Pet health insurance is not a new idea. It has been available for more than 20 years. But there are still some people that find pet health insurance is still relatively new.Currently, there are many options. While some pet owners are doubtful, some fear that adding insurance to veterinary medicine will follow the path of insurance red tape and problems found in human health care fields.Pet health care policies are in some ways similar to human insurance policies. There are annual premiums, deductibles and different coverage plans based on what the owner chooses. Plans are based on species, age, pre-existing conditions and in some cases, even upon the lifestyle of the pet.According to some experts, the best time to purchase pet insurance is when the animal is still young. Many pet health insurance plans do not cover pre- existing conditions. Insuring early can also provide coverage for certain initial veterinary procedures such as vaccinations and spaying.When looking for a pet health insurance, consider the company stability. Even if pet health insurance has been available for more than 25 years and has grown to become a strong industry, there are few companies who have been on the market for a while. So, when shopping for pet insurance, do your research about the insurance company. Know how long it has been in business and if it is financially solid.Make sure that the company has in-depth veterinary knowledge. A quality pet health insurance provider should have knowledge of the veterinary and insurance industries. It should have trained veterinary professionals on their staff. It pays if your veterinarian actually recommends the pet health insurance.When looking for a pet health insurance, check for the wellness coverage. Preventive care is important for the long-term health of the pet. In order to encourage and remind pet owners to take their pet to the vet on a regular basis, there are pet insurance plans offering coverage for common preventive treatments and procedures like wellness exams, vaccinations, heartworm protection, neutering, teeth cleaning, prescription flea control and many more.Aside from wellness coverage, also check the broad coverage for illnesses. Policies should include coverage for prescription drugs, dental illness, allergies and diabetes. Also check if your pet has insurance coverage even if it is away from home. A good pet insurance should cover your pet no matter where you are.Also check if it is possible to have your own veterinarian. Some pet owners would rather have their own veterinarian including veterinary specialists such as oncologists, neurologists, and allergists.If pet health insurance is not for you and your pet, there are other options that you can choose from to keep your pet healthy.You can check with your veterinarian. There are some hospitals that offer wellness packages. They offer discount prices on vaccinations, spay/neuters and similar medical attention. Some even have geriatric health check up packages you can check on.Discount programs like Pet Assure is another option. This national program offers 25 percent savings on veterinary services. They can sometimes offer as much as 50 percent on pet supplies. They have a network of participating veterinarians and pet vendors where you can take advantage of their services and discounts.Some human and non-profit organizations offer financial aid to pet owners. Some veterinary offices even keep an emergency fund for pets in the event they have an emergency situation. But even if there is an option like this, pet owners should still primarily provide or cover financial cost brought about by emergency situations.Pet health insurance is something that can help pet owners provide the best possible care for their pets in time of need.However, health insurance is not the only option that pet owners have. Still the most important thing is tender loving care.
THE PROBLEM – MIS-INFORMATIONIf you’ve ever caught a political ad where a politician is talking with someone and that person is claiming that after having health coverage for many years, their insurance company cancelled their coverage when they became sick. During one election period, some politician brought out a woman who had been smoking for forty years and had been told she had stage four lung cancer. She said to the audience that her insurance company had denied treatment for her but more than likely it was too late to treat stage four cancer successfully. This type of mis-information is to no one’s advantage except maybe the politician running for office.LACK OF UNDERSTANDINGOver a twenty year career working in the health insurance arena, I’ve heard many, and varied, stories about problems getting their health claims paid – in fact I doubt that there’s a story I haven’t heard. And it never fails – these situations often arise because of the lack of understanding, confusion and misconceptions that that most insured individuals have about their health insurance coverage.The health insurance topic has many shades of gray, caused by the different types of insurance and plan designs and the complex issues that have a unique effect on the coverage. No matter whether I turn on the TV or radio, speak with individuals or read about the issues, it’s clear that many people are stumped about how health insurance works. After years of watching the health care debate rage in the halls of Congress, it’s clear that even politicians who are working on the problem may not completely comprehend the processes, issues and the implications of this big business known as health insurance. Even those who prepare your medical bills as well as the insurance representatives who deal with your claims payments, may not have a clear understanding of the billing process or your plan.HERE’S THE DEALFirst, a brief explanation on a couple of very basic issues – the difference between group and individual health insurance coverage and when, and under what circumstances, insured consumers may lose their coverage. Both of these topics show up in the media and are constantly bandied by individuals and politicians. The comments I hear indicate that people who have health insurance, and carry the coverage for years, are dropped by the insurance company (or certain treatment or procedures are denied) when they become sick. In some cases this is true but it’s important to understand how and why this can occur and the different types of health insurance that impacts a loss of coverage. So…lets’ talk turkey!Group health insurance is coverage for employees, and their eligible dependents, that can only be obtained through an employer-sponsored plan. This type of coverage may have within the plan guidelines, the following:* A pre-existing period, that must be satisfied, before claims for a particular pre-existing condition is covered.
* Once the pre-existing period has been satisfied, all claims for eligible and medically necessary treatment and/or services are covered (up to the applicable limits, maximums or exclusions).
* Medically necessary treatment for an illness or injury, that is not a pre-existing condition or an exclusion under the plan, is generally covered on the coverage effective date.
* Annual, service or lifetime limits, maximums or exclusions as defined in the plan document.
* Most plans have some kind of service or dollar limitations or exclusions on certain treatment or servic built into their plan design.
* Under these limits, certain services/treatment can be denied for the balance of the plan year once the service or annual limits have been reached.
* Service limitations may specifically limit or deny treatment obtained from certain types of providers (such as naturopathic or homeopathic providers).
* Treatment that is excluded under the plan will not be covered, even when the treatment is determined to be medically necessary.
* Once a lifetime plan maximum has been reached, no further claims will be paid under the plan.Individual health insurance, on the other hand, is a type of health insurance where an individual purchases health insurance coverage directly through an insurance company (non-employer sponsored). This is not COBRA coverage, but in fact health coverage purchased where a group plan may not be available to the individual. These types of plans may be costly and have limitations that may not go away with time. Generally….* Individuals who participate in individual plans may be required to go through a physical examination and must answer a pre-existing questionnaire prior to being granted coverage.
* Coverage for treatment for specific pre-existing conditions may be denied for the life of the policy but other conditions, that are not pre-existing, may be covered (up to the applicable limits, maximums or exclusions).
* If upon the receipt of a claim or inquiry for coverage, it is determined that the treatment is related to a pre-existing condition, that was not revealed on the pre-existing questionnaire, the insurance company can cancel coverage or refuse to pay for the treatment, even if the individual has been insured and paying premiums for some time.NOT A BLACK AND WHITE ISSUEAs you can see, cancellation of health insurance coverage is not a black and white issue. There are many variables and blanket statements by politicians and others who lack an understanding of health insurance processes and nuances are not always accurate and cause a lot of confusion. Those who make these broad assertions should understand what they are stating. But more importantly, insured individuals should be committed to understanding how their health coverage works instead of relying on the statements of others.WHAT CAN I DO?Take the time to read your insurance policy. “Oh sure,” you say, “I’ll never remember it all, if I even understand it in the first place.” And that’s true but after reading that document, you will have an idea of what to do or who to call when you have a medical/dental situation that occurs. Instead of being saddled with more out-of-pocket costs that necessary, you will understand enough to know who to call, what to ask and when to intervene. So dear readers…..take that first step and read – then contact your insurance company and ask for clarifications on points that you’re not sure about. You will then find yourself in the driver’s seat, instead of the other way around.Lynne Lucio, The Insurance Decoder – copyright 2010