About health insurance and tips for applying

Health insurance

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

Understanding health insurance plans can be confusing to most consumers. Many don't know where to look or whom to contact for information on the coverage of speech-language pathology services, audiology services and hearing aids, let alone how to interpret the coverage guidelines. ASHA has developed this site to help you, as a consumer, understand your health plan as well as provide further contacts to assist you in understanding and obtaining the coverage you need to receive speech and hearing services.

10 Things You Ought to Know!

Recently, I learned just how challenging enrolling for private medical insurance can be in the  United States. I was going off my group medical insurance and needed private coverage. Through the assistance of my insurance broker, I completed the initial online enrollment form in less than an hour.

That was the easy part.

A week after completing the enrollment form, I got a follow up call to my enrollment form from the “medical department” of the company. I was told this was to verify some of the information on my enrollment form.

And here’s where things got a bit rough.

The woman who interviewed me wanted VERY detailed information on medical claims. Since the specific details she wanted were in my doctor’s medical records, not at home, I was unprepared for her questions. I made every effort to be helpful, but the call rapidly became an unfriendly interrogation.

For almost an hour, I was asked the same questions over and over until I felt like shouting, “Asked and answered!” For most of them I simply replied “I don’t know.” Eventually I asked her to contact my physicians. When she finally did, they checked my records and answered her questions.

By the time I hung up the phone, I felt like I’d gone three rounds with Mike Tyson. I was both frustrated that I couldn’t answer her questions and emotionally exhausted. She treated me like a criminal instead of a person seeking private medical insurance. It wasn’t a good experience!

Because of what happened to me, I did some research. It helped me to compile the following list of ten things I believe anyone enrolling for private medical insurance in the United States should know. I hope this list will help you or someone you know to avoid what happened to me.

10 Tips for Applying For Health Insurance

Before You Apply For Private Health Insurance

1. Do not let your policy expire prior to seeking new coverage. If your policy is being canceled you can go on the Consolidated Omnibus Budget Reconciliation Act (COBRA). This act ensures continuation of group health coverage that otherwise might be terminated.

2. Talk to your physicians about your medical records before you apply. For private insurance, companies can review your medical history as far back as ten years. Therefore, ensure your records are up-to-date and talk with your physician(s) about any health issues that might be red flagged.

3. Buy copies of your medical records. You can also request a copy of your medical records under the Health Insurance Portability and Accountability Act (HIPAA). For more information on HIPAA, go to http://www.privacyrights.org/fs/fs8-med.htm

4. Obtain out what your state’s policies are in relation to private medical insurance. Each state may have certain exceptions or variations regarding coverage. Most will publish this information online. Visit your state’s governmental Web site and search for “private medical insurance ” or “health insurance policies.”

5. Check to see if you have a file with the Medical Information Bureau (MIB). The MIB is a central database of medical information shared by major insurance companies. If the MIB has a file on you, a free copy can be obtained once a year by calling (866) 692-6901, or by visiting the company’s Web site at http://www.mib.com/html/request_your_record.html.%20

6. Consult with a eligible independent insurance broker. An insurance broker will know the private insurance regulations for your state and can help you through the enrollment form process.

7. Buy a copy of your enrollment form and REVIEW it before you send it in. Some companies may refuse a claim or terminate the policy solely because the information in the enrollment form is inaccurate. If you leave something out accidentally, it could cause problems. Read over your enrollment form carefully to be sure you have answered all the questions accurately.

If You Get A Follow Up Call…

8. Answer only the questions asked. Do not volunteer any additional information. Be courteous and remember the interviewer isn’t your friend or your medical doctor. In these kinds of interviews you have NO privacy protection. In addition, the interview will most likely be recorded so think before you respond.

9. If you don’t know the answer to a question, be honest about it. I recommend you get comfortable with saying, “I don’t have that information, please contact my doctor.” When asked specific questions about medical procedures don’t guess, refer them to your doctor(s) and your medical records.

10. Be honest and stick to the facts regarding your medical history. The business you are enrolling to may have access to your MIB file, and already know certain aspects of your medical history. If you are caught lying, you can be denied. Most enrollment forms ask if you have ever been denied medical insurance, and a denial can be an immediate “red flag” on any future enrollment forms.

I hope you find these suggestions helpful. Just remember that when enrolling for private medical insurance in the  United States, the best policy is to adopt the Boy Scout motto of “BE PREPARED!”