You Should Ask 5 Questions Before Buying Health Insurance.
Never buy a health insurance policy based on price alone. Here are some of the facts you should consider before making a decision.
Q:
#1 What is the
company rated?
A: A.M. Best
Company, the top insurance rating agency in the world, is the
'go to' source for company information.
The Ratings the A.M Best Company assigns are:
- A++ and A+ (Superior)
- A and A- (Excellent)
- B++ and B+ (Very Good)
- C++ and C+ (Marginal)
- C and C- (Weak)
- D (poor)
- E (under State Control)
- S (Suspended)
You should always check a company's rating before signing a contract by asking an agent for a copy of the current report. Alternately, you can contact A.M. Best at their website, www.ambest.com or call 908-439-2200.
Q:#2 How are the claims paid? Some companies that use
words like Usual, Customary and Reasonable Charges (UCR) to
create loopholes for the company to decide how much it will pay. If the insurance company does not
use "Usual and Customary" charges, look for the following
substitutes and be cautious of how they play claims: Q: #3 Can
you go to any doctor, hospital or specialized health care
facility? Q:
#4 Is your plan portable? Q: #5
Will your plan go where you want it to go? If
you are not covered by Workers' Compensation or similar plan or
law, be sure that you choose a plan that will cover you 24 hours a
day, whether you are working or not. Copyright © 2008
Insurance Quote MT All rights reserved.
Revised:
06/09/08
A:Different methods are used to pay claims. The two most
common methods are "Usual and Customary" and "Reasonable" charges.
"Usual and Customary" charges are based on provider charges in a
given area. They are based on the charge that is the smallest of the
actual charge, the providers usual charge, or the prevailing charge
for that service in a similar location. "Reasonable" charges
give the insurance company flexibility to adjust the "Usual and
Customary" charge if they determine a service charge is unusual.
Reasonable charges are typically less than the usual and customary
charges and only the insurance company knows the actual value.
A: Some Health Insurance Companies
contract only with certain providers, or require a referral to see a
specialist.
Most people want the very best
medical care available that fits their wishes. There is a wide
variety of ways physicians determine treatment plans. You need to
select a doctor whose treatment philosophy matches yours.
Therefore, it is wise to choose a health plan that allows patient
choice in selecting doctors and hospitals.
A:
Some plans may not cover you when outside the USA. Some are even more
restrictive, limiting benefits to
a particular area such as in-state or county. Some plans may
not cover you relocating to another state. The best
approach is to choose a plan that provides world wide coverage. Ask your agent what would happen if 1) you chose to go out
of state for medical treatment and 2) how a medical problem would be
handled if you were in a foreign country. Remember, your health plan
is only as good as it covers you should the worst-case scenario
occur.
A: On the job
injuries are often excluded in coverage, yet many
working Americans are not covered by worker's compensation plans.
Workers with more than one job or have a business on the side are
usually not covered on-the-job by their primary employer's
insurance. Plans that exclude work-related medical problems may:1)
not pay for anything that happens at or because of work and2) put
off paying ANY claim while they "investigate" whether it was work
related or not.