Doctor's offices are faced with thousands of different types of health insurance plans.  Even in one health insurance company, the plans are very diverse.  They have different copay amounts, different types of plans like HMOs, PPOs, and HSAs.  So, alot of money is spent on administrative costs to sort out how the insurance company will cover a visit to the doctor.  Usually, a doctor's office will call and check your benefits.  They will ask the health insurance company how they cover a certain service.  A customer service rep will let them know your copay, coinsurance, or deductible amount.  However, sometimes either the information is not told correctly by the customer service rep or the doctor's office misinterprets the benefits and collects money from you incorrectly.  The good news is this is often solved with a phone call to the health insurance company to sort out the matter.  A good health insurance company will follow up with the doctor to resolve the issue.

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I've worked in the health insurance industry for over 8 years.  I can definitely help you select a policy.  I think it is only fair you know what types of plans are available to you.  There's everything from plans you shouldn't consider (like discount plans and "saver" plans) to plans that provide great coverage (like PPO's and HSA's).  What is most important is to not just compare plans, but consider overall healthcare expenses, including future unknown expenses.  It's often good to view "what-if" or "worst-case" scenarios so you know what to expect in the event of an unfortunate medical need.  There are hundreds of plans available in Texas.  Once you evaluate your needs, it is easier to filter the plans to make a selection.  The next thing to consider if your body build and medical history.  Some plans look at certain medical conditions more favorably than others.  One company may cover a person with hypertension while another plan completely denies coverage.  We'll look at your medical history, and you can apply for coverage with a company who is more likely to offer you coverage.

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You can just get a policy for your child.  Many people want to make sure their children will have access to quality healthcare even if the parents aren't covered.  Also, some families find it more cost-effective to insure the children on individual plans rather than group employer policies.  If the parents are to remain uninsured, keep in mind the child's future could be affected if the uninsured parents experience unexpected, high medical costs.  Without health insurance, medical collections can affect credit scores.  Having a low credit score can restrict your freedom to change homes or automobiles.  So, child-only plans are great, but family plans are better.  Make sure everyone is covered.

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Your policy was cancelled for non-payment.  Insurance companies are different from other financial services because you are purchasing coverage for future unexpected expenses.  You are not paying a debt.  Therefore, when you miss a payment it is not like if you missed a car payment.  Usually your finance company would call to collect on the payment, and possibly call repeatedly to get you to pay your debt.  Since health insurance is not a debt, there is much less "excitement" when you miss a payment.  Sure, you'll receive a letter and a statement.  If you go past your grace period the health insurance company may not reinstate your policy when you send in your payment.  The grace period is the length of time you have to make your payment without your policy being cancelled.  If you extend past your grace period, the insurance company may or may not reinstate your policy (depending on their guidelines).  If the health insurance company returned your premium, your policy was not reinstated.  When a policy is reinstated you do have to pay all your missed payments.  If your policy was not reinstated, you must apply for a policy as if you are seeking new coverage.  You will be asked questions just like the first time you applied for coverage, and may be denied coverage depending on your medical history.  If you have medical conditions that may cause denial of coverage, it is very important to make your monthly payments for your health insurance policy.  You could lose coverage altogether.  In Texas, we have the Texas Health Risk Pool which grants coverage to anyone who is denied coverage by health insurance companies.  So, you should probably be able to get coverage through the risk pool if you are unable to attain it through private health insurance companies.  However, the risk pool tends to be much more expensive than individual health insurance policies.

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Sometimes what you see is not what you get.  Actually it is often the case.  When you apply for health insurance, you typically apply for the standard rate, or a preferred rate depending on the company and your health.  Often times, you may not qualify for the rate you applied.  The company may counter-offer.  You apply for one rate, the health insurance company reviews your application, and they decide not to offer you coverage at the rate you applied.  Instead, they offer a higher rate (the counter-offer).  Another type of counter-offer is to offer you coverage, but change some of the benefits on the policy of which you applied.  Of course, an insurance company may deny coverage as well.  In this case, they'll offer no coverage at any rate.  Many of the health insurance denial decisions are based on questions on the application.  You should always answer truthful.  It is best to work with an independent agent to help you find a policy from a company who will offer you coverage.  The agent can do the leg work for you by researching how health insurance companies treat your body build and medical history.

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That depends who you ask.  Many people are happy with their health insurance companies, and others are furious.  First, be sure to apply with a company who will offer you coverage.  If you want to get an outside perspective there are surveys and reports published showing how the health insurance companies rank nationwide.  U.S. News and World Report published the best health insurance companies of 2007.  You can view their rankings of plans in Texas HERE.

See how your company stacks up or do some research to see how the company you are considering stacks up against the others.  The companies are rated in several categories.

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This morning Good Morning America on ABC ran a story about a woman named Angela Dispenza.  Angela is on a Medicare Advantage plan.  Medicare Advantage plans are Medicare alternatives offered by private insurance companies.  However, a company cannot just create this alternative and market the plan.  It must be approved by Medicare and Medicare funds these plans through payments to insurance companies.  The story stated Angela was denied coverage normally covered by Medicare.  According to a contact at SecureHorizons this is not the case.  In this case, Medicare would have also denied coverage.  The story never gets too specific only stating towards the end that Angela received the "inpatient rehab" for free by the hospital.  The story painted a picture that having Medicare Advantage was worse than simply having only original Medicare.  Here's what the story did NOT tell you:  The story did NOT tell you that Angela had the option to choose a Medicare Supplement plan that would give her additional coverage beyond the costs Medicare covers, and that Medicare Supplement plans are not managed care plans offered by HMO's.  They failed to mention that insurance companies offered her a plan that was not managed care.  A Medicare Supplement is an additional plan guaranteed to all newcomers to Medicare.  One of these is true:  Either Angela did not have a good insurance agent to explain all her options when she turned 65 <or> Angela reviewed all her options and based on her budget and desire for coverage, she chose the plan she is currently on.  It's not bad to be on a Medicare Advantage plan at all.  They are great for people with low incomes who want lower out-of-pocket costs in exchange for having an insurance company manage their care.  It's a trade-off.  Keep in mind these Medicare Advantage plans often have no additional premium cost, or very little additional premium cost.  Advice:  Get a good insurance agent so you can know your options.  It may seem boring or complicated to you to sit down and sift through your options, but if you need to use your coverage you'll be glad you took the extra few minutes.  Some plans cost more than others, so weigh your options with great thought.  Don't let price alone be a deciding factor.  Run through "what if" scenarios so you know what type of coverage you want to be there for you if you were to become ill.  So many people make insurance decisions about their CURRENT health care costs and needs.  Insurance is for FUTURE needs.  Plan accordingly and you'll be ok.  Don't plan or take the time to understand and you'll be in a world of confusion, frustrated, and possibly flat broke.

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You should always disclose all medical conditions.  There are many reasons.  First, you may think you have a medical condition which will cause you to be denied.  However, all carriers have different guidelines for approving and declining coverage.  You may be able to apply for a policy and be approved even with disclosing your medical condition.  Secondly, there is an entitiy called the Medical Information Bureau (www.mib.com) which health insurance companies use to detect fraud.  Often, they catch it when medical conditions are not disclosed either causing the application process to take longer or causing the application to be rejected.  This leads us to the final reason to disclose medical conditions.  It is considered fraud to not tell the truth on an application for health insurance, and it is illegal to defraud a company when entering into a contract with that company.  Essentially, if fraud is detected, the contract is considered invalid.  Your policy can be rescinded which means you will have any premiums paid returned to you, and the company will take back any monies they paid for claims and will not provide any coverage for you.  It is as if you never had coverage.  So, be honest with an agent up front.  Use an independent agent you trust.  Let them research all the companies in Texas to see if there is one who will offer you coverage.  At the very least, you'll get an honest answer and know all your options.

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When applying for coverage, health insurance companies typically make 1 of these 5 basic decisions:

1.  Approve
2.  Approve, but charge more
3.  Approve, but exclude coverage for a certain condition
4.  Approve, but exclude coverage for a certain condition AND charge more
5.  Deny coverage

You are entering a financial contract with a company to pay for unexpected and routine medical expenses.  Sometimes, a company may offer you coverage, but only if services for a certain condition are not included as covered expenses under the contract.  This allows you to still be able to purchase health insurance, while at the same time protecting the insurance company from the extra risk associated with the medical condition.

Unlike pre-existing waiting periods, the exclusion or waiver period is usually several years and often is for the life of the contract of the policy.  Think of a pre-existing waiting period simply as a short-term feature.  Think of an exclusion or waiver as a long-term feature.

Pre-existing is a feature on EVERY policy, unless you have coverage from a previous carrier with a lapse in coverage less than 63 days.  You'll get credit for your previous coverage, and may have your entire pre-existing waiting period waived.

The exclusion and waiver features are a way for health insurance companies to offer coverage to individuals who they otherwise would not have been able to offer coverage to if they had to cover the specific medical condition in which they would like to exclude coverage.

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You've probably heard the term alot.  In a recent presidential debate, I heard John Edwards say he wanted to make it so health insurance companies could not deny services for pre-existing conditions.  Here's how it works:

Pre-existing condition:  Any condition you received treatment or advice for prior to starting a new health insurance policy.

Pre-existing waiting period:  Typically only for your first year of coverage, the health insurance company will not pay for services that were for a pre-existing condition.  After that first year, they will start covering services for your pre-existing conditions.

Keep in mind this does not mean the health insurance won't cover anything during your pre-existing waiting period... it just means they won't cover things considered to be pre-existing conditions.  This is to protect insurance companies against what is called adverse selection.

Adverse Selection:  The tendency for a higher percentage of persons with current illnesses to purchase health insurance.

Insurance is simply a financial contract designed to protect against future, unexpected costs.  Health insurance is no different.  However, with health insurance many seek to purchase it to cover current costs rather than future, unexpected costs.  This is why pre-existing waiting period exist today.

How the government helps you:  There is a federal law called HIPAA (Health Insurance Portability and Accountability Act).  This law entitles you to receive a policy without a pre-existing stipulation if you are changing policies and did not go without coverage for over 63 days.

So, make sure you are always covered, don't go over 63 days without coverage, and you won't have to worry about pre-existing at all!

www.MyHealthInsuranceGuy.com