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Today’s News: Fed Moving to Improve Health Insurance Appeals, Life Settlements Have High Fees and Nationwide Insurance Surprises Thieves with Bait Vehicles

Posted in Auto Insurance , Health Insurance , Health Insurance Claims , Life Insurance , Nationwide

August 16th, 2010
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The Fed took its first step on July 22 to ensure consumers who want to file a health insurance appeal have a neutral party to speak with. In other insurance news, research shows that life insurance settlements have high fees and Nationwide Insurance has been surprising auto thieves with their new bait vehicles.

Fed Works to Improve Health Insurance Appeals

The Obama administration has taken the first step necessary to make sure consumers are treated fairly if they are denied a medical claim by their health insurance company. The regulations will be spelled out in a two-step process.

First, consumers will appeal directly to their insurers. Two, if they are denied a second time, they will work with an independent reviewer for which health plans must pay the costs. Unfortunately, the new federal safeguards won’t be immediately available to most Americans with private coverage since the overhaul law is so much more complicated than previous health insurance laws (Associated Press).

Life Settlements Have High Fees

Cashing out on life insurance policies, also known as taking out a life settlement, has become very popular over the years because it allows senior citizens to sell their policies to investors for thousands of dollars, while the investors receive the full payout after the original policyholder dies.

However, according to the Government Accountability Office, taking part in this practice may be risky for both sellers and buyers due to inconsistent regulation and excessive fees. In particular, senior citizens could get less than they should for their policies (Bloomberg).

Nationwide Insurance Surprises Thieves with Bait Vehicles

Houston law enforcement has partnered with Nationwide Insurance to keep residents safe from the increase of auto theft in the area. To assist with the goals of various policy and sheriff departments, Nationwide has presented bait vehicles (unmarked cars outfitted with special GPS tracking and remote-control immobilizing equipment) that allow officers to monitor cars that have been seized by thieves without the need for a vehicle pursuit.

According to Nationwide, vehicle theft rates have dropped in almost every region where the auto insurance company has placed vehicles. So far, over 55 bait vehicles are in service or in progress in 17 states (Business Wire).

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NAIC Study Shows Half of Americans Lack Confidence When Choosing Insurance

Posted in Auto Insurance , Auto Insurance Claims , Health Insurance Claims

April 12th, 2010
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If you feel some discomfort with the responsibility of choosing your insurance, you’re not alone, according to the National Association of Insurance Commissioners (NAIC). A recent study conducted by the association found that only 45 percent of Americans feel confident when making insurance decisions.

Americans Don’t Understand the Basics of Insurance

The study conducted by NAIC discovered a lot about what Americans do and don’t understand about health insurance and auto insurance. What was most interesting, however, is that 60 percent of those surveyed failed to properly answer the following questions:

Does auto insurance cover personal property stolen from your car? (no)
At what age do most people become eligible for Medicare? (65 years old)
Can credit scores affect your auto premium? (yes)

Another interesting find from the study was that 86 percent of respondents said they don’t understand all of the terms being used in the current discussion on health care reform.

It’s Not All Your Fault You Don’t Understand

While it’s up to us to take time and read insurance forms before we sign them, NAIC suggest that it’s not all our faults that we don’t understand what’s going on in the world of insurance. The NAIC chief executive officer explained that being overwhelmed with new and conflicting information very often confuses us when trying to understand insurance, especially in relation to our nation’s health insurance and health care policies.

The NAIC suggests that in order to get up to speed, it’s important to do your homework, something that could help you improve your insurance IQ. If you’re not sure how you measure up, see which of the following you know in comparison to other Americans:

55 percent of all Americans don’t understand what a pre-existing condition is.
53 percent of Americans think they can only make changes to their group health insurance coverage during open enrollment.
16 percent have no idea when changes to group health coverage can be made.

So how do you measure up? Did you know the answers to the above questions? If not, it may be time to strengthen your own insurance IQ so that you don’t find yourself lacking confidence in choosing the right coverage like so many Americans.

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FAQ: What if My Health Insurance Claim is Denied?

Posted in Health Insurance , Health Insurance Claims

October 6th, 2009
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Return to the Denied Health Insurance Learning Center >>>

If you are in the position of having your health insurance claims denied, do not give up without a fight. Although it may feel as if you have reached a complete halt with your medical insurance provider, do not take their denial as the final word. By following a few simple steps, you may actually stand a good chance of getting properly reimbursed for your medical care.

Fighting Your Denial

As a member of a health care plan, it is important that you fully educate yourself to get the lay of the land. You need to verse yourself on exactly what your insurance company covers as well as investigate the local laws, as there are state and federal laws in place for how insurance companies need to legally handle complaints and appeals when a health insurance claim has been denied.

Once you are armed with knowledge, organize your paperwork including your research, the insurance company’s Explanation Of Benefits form they sent with your denied claim and a copy of the policy. Call the insurance company, speak professionally and provide all the evidence to make your case. This phone call may do the trick, but it is still important that you take detailed notes regarding the conversation, what was said, whom you spoke to and the date and time of the conversation.

If verbal communication has failed and your health insurance claim is still being denied, put your complaint in writing. What you need to construct is a “written appeal” of the denied health insurance claim. The best defense is to clearly address the exact cause of denial that was in the Explanation of Benefits letter. For example, if your health insurance claim was denied as it was deemed “unnecessary,” then include a copy of your medical records to prove otherwise. Be prompt when filing your denial claim as there is often a cut-off date for when written appeals can be made.

At this time over 43 states have a Patients Bill of Rights when it comes to managing their health insurance. If your claim is still denied, you can request an independent review. According to Parade Magazine, it is important to take the appeal process to the final level: “Although success rates differ from state to state, consumers tend to prevail in these challenges about 50% of the time.”

Learn How to Get Insured Again! >>>

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How Are Health Insurance Claims Handled?

Posted in Health Insurance , Health Insurance Claims

September 21st, 2009
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Health insurance is indeed a blessing, but sometimes it can be a real headache, too, when your health insurance provider denies a claim you’ve made, or there’s some sort of problem with a health insurance claim that you’ve filed.

The handling of health insurance claims is usually problem-free, but for those times when it’s not, you need to know what to do.

Handling health insurance claims works in a few ways.

Option One: The Doctor’s Office Submits Claims

The most common method for handling health insurance claims, and far and away the easiest one for health insurance plan members, is that the health insurance claim be submitted directly to the health insurance provider by the doctor or medical facility that you’ve visited. You simply walk in to your appointment or visit, fill out a form or two, or sometimes just show your health insurance identification card, and then see your doctor or other medical professional. After that you just walk away while the people who work in the doctor’s office or medical facility submit a payment claim to the insurance agency.

Option Two: You Submit Claims Directly

A less frequent scenario is one where you have to pay for your visit to a doctor or other medical professional yourself, and then have to submit a health insurance claim to your provider. When this happens you need to have your itemized receipt from the doctor or medical facility which you visited, and then submit it along with your health insurance claim paperwork. It is critical that you have the right paperwork for the health insurance claim that you’re making.

If you have any questions about filing a health insurance claim, be sure to consult with a representative of your health insurance provider. They are paid to answer your questions and help you.

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Potential Problems with a Health Insurance Claim

Posted in Health Insurance , Health Insurance Claims

September 15th, 2009
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Just about everyone has heard a horror story about difficult experiences with a health insurance claim. There have been large numbers of media stories about people who have been denied coverage for very obscure interpretations of what a health insurance policy does and does not pay for. If you’re lucky, you will never have to experience them or anything like them, however, there is always the chance that your health insurance provider will surprise you (and not in a good way) with a denial of your health insurance claim.

Handling a Insurance Claim Problems

Dealing with a potential health insurance claim problems is a lot like dealing with the care and maintenance of your own body: be proactive. You need to be on the lookout for potential health insurance claim problems before they happen. How do you do that? First, by making sure that you are truly knowledgeable about your health insurance policy. By reading your health care plan brochure or information thoroughly, you will know what it covers and what it doesn’t, and hence will avoid a lot of unpleasant surprises. You should also make sure the doctor or medical facility you’re dealing with understands what your health insurance company covers. If they don’t, you could be left holding the bag for some expensive procedures, and that could really take a bite out of your bank account.

The good news is that many potential health insurance claim problems can be avoided simply by avoiding common mistakes. After that, another important tactic for avoiding any potential health insurance claim problems is to make sure you keep all your paperwork in order, and that it’s as detailed as possible. If you can prove that you followed your health insurance company’s policies, it will be that much easier to settle a claim later.Remember, no one will protect your interests and finances as well as you.

Learn How to Get Insured Again! >>>

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Health Insurance Claims FAQ

Posted in Health Insurance , Health Insurance Claims

September 2nd, 2009
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The health care system in the United States is not exactly known for being a smooth, well-oiled machine. It’s big, bulky and unbelievably expensive — and getting more so every day. One aspect of the nation’s mish-mash of health care plans and programs is the claim filing process. Sometimes it’s easy, other times it’s a complicated mess that can turn into a huge hassle for the person submitting the claim.

We’ve answered some common questions about filing health insurance forms below:

Who submits my forms?

The vast majority of the time, claims to your health insurance provider will be submitted by your doctor’s office or by the medical facility you visited. You won’t have to do a thing except show your health insurance identification card.

If you do have to submit your own health insurance claim to your provider, you need to submit an itemized copy of the receipt you got from the doctor or medical facility you visited.

What about my co-pay?

Sometimes a co-payment is required for the visit or procedure. In most cases, you simply pay it and you’re done. Be sure to keep your receipt with you, just in case.

Most health insurance claims are really this easy.

What if my bill comes and it’s wrong?

Generally speaking, if there is a discrepancy between your bill and what your health insurance provider thinks it’s expected to pay, you will have to pay the doctor or medical facility for the bill. After that, you have to file a health insurance claim and work it out with your health insurance provider.

Health insurance claims can be tricky, and complicated, and very difficult to resolve. However, the vast majority of health insurance claims are processed easily and efficiently and do not result in any kind of hassle. If you have questions about filing your health insurance claims, be sure to consult with a representative from your health insurance provider. They are paid to explain health insurance claims and other policy issues to you.

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Elective Surgery and My Insurance Coverage

Posted in Health Insurance , Health Insurance Claims

August 28th, 2009
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elective surgery insurance coverage

Typically, health insurance companies will pay for elective surgery they deem as life saving. Cancerous tissue removal, angioplasty, vision correction and gastric bypass surgeries are all types of elective surgeries that doctors can (and often do) qualify as necessity for improving or maintaining your quality of life.

It is up to the policies of your insurance company to decide what elective surgeries they will cover. Many times insurance companies will opt to pay for elective surgeries that may not be deemed immediately necessary but can prevent further illness and expenses down the road. Some examples include cataract removal that will prevent the cost of eye wear in the future, sterilization which reduces the cost of birth control, gastric bypass and other weight loss procedures to prevent future complications associated with obesity such as diabetes and heart problems, and nose jobs to help correct breathing problems.

The laws that mandate health insurance coverage differ from state to state. Health insurance providers handle their elective surgery claims differently. It is vital you know your rights and responsibilities as a policyholder, as health insurance companies generally base their coverage decisions on the necessity of a procedure. It is the term “necessity” that can make or break you when it becomes time for them to pay for the operation.

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Out of Pocket Expenses Series: Common Out of Pocket Expenses

Posted in Health Insurance , Health Insurance Claims

August 24th, 2009
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For many years, health insurance has been a major concern not only for the government, but for the individual families and people struggling to afford to manage the expenses. Even those with comprehensive health insurance need to have even more funds available to handle medical expenses as there are still some common out of pocket expenses that need to be paid for by the policyholder in order to get certain medications or treatment.

Out of pocket health care costs are defined as additional expenses accrued by the policyholder as the overall cost passes the maximum limit imposed by the House bill that is currently in place. Because out of pocket expenses are determined by a dollar amount, not by actual treatment, nearly anything can qualify as an out of pocket expense. That includes amounts paid for prescriptions, co-payments, doctor visits, private patient status in a hospital, as well as surgery, setting broken arms and emergency room visits.

Another common out of pocket expense for those with health insurance are denied claim submissions. If you have medical insurance and seek care only to later have your provider reject your claim, you are still legally responsibly for those expenses and must pay the person that issued the treatment you sought or face legal repercussions.

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What Are Health Insurance Claims?

Posted in Health Insurance , Health Insurance Claims

August 6th, 2009
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When you file a health insurance claim, you are seeking payment of services rendered on your behalf by a doctor or medical facility. Let’s say you wake up one morning and notice a lump in your arm. You have health insurance, so rather than hoping it will just go away because you’re afraid of how much it will cost to have it looked at, you can do the smart thing and go visit your doctor to have it examined. Your doctor decides to perform a biopsy and do some blood tests while she’s at it. All told, the bill for your visit comes to $1,000. Normally, your doctor’s office will submit the health insurance claim to your insurance provider, and you don’t have to do a thing. Sometimes, however, you have to pay upfront and then get reimbursed. When you file a health insurance claim with your health insurance provider, you are seeking to be reimbursed for the money you laid out.

When it comes to health insurance claims, there’s a lot of processes on how to properly file a health insurance claim, and this will differ from health insurance provider to health insurance provider. To understand how your health insurance claim process works, be sure to consult with a representative of your health insurance provider.

Protecting yourself is one of the most basic instincts you act on. One thing you should do to protect yourself, if you haven’t yet, is getting health insurance. With health insurance, you are protecting your health and your life itself by ensuring that you will have access to affordable health care – health care that you will absolutely need should you become sick or gravely injured. What’s more, if you have a family of growing children, you will need to get them health insurance too. One critical aspect of the health insurance process is the filing of a health insurance claim.

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How to File a Health Insurance Claim

Posted in Health Insurance , Health Insurance Claims

July 9th, 2009
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If you’ve got health insurance then you know that filing a claim is a critical step in your health insurance process. If you don’t have health care insurance, and are unfamiliar with what filing a claim means, don’t be intimidated. Filing a health insurance claim can have a lot of steps involved in it, but is not particularly hard to understand. Of course, there are exceptions to every rule, and in some cases filing a health insurance claim can be difficult, complicated, and above all frustrating.

When you have health insurance, many times you go to the doctor or medical facility and they file it for you. Or, you’re simply told what your co-pay is going to be – if there’s one at all – you pay it and that’s all there is. Other times, however, you have to file your own claim with your health insurance company. When that happens, you need to show your health insurance company your receipt. Make sure that it is itemized. Chances are it will be, but if it’s not you could be in for a hassle.

You also need to get the proper claims form from your health insurance company. Many times these forms are included in your health insurance welcome brochure, along with all kinds of different information. If it’s not, there’s probably a good chance you can find the proper claims form on your health insurance provider’s website.

Once you’ve got the right form, all you have to do is fill it out and submit it to your insurance company, along with the receipt for the bill in question.

Filing a health insurance claim is supposed to be easy – but sometimes it’s not. Before you fill out a claim, feel free to call your health insurance provider and ask them any questions you might have. It’s their job to explain how it all works.

If you’re not happy with your health insurance company, Go Insurance Rates can help you make the switch by providing free health insurance rate quotes in a matter of minutes. You could be on your way to a great health care plan and affordable rates.