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Health Insurance Tricks to Beware of
We all need health care from time to time, and sometimes we need serious medical help as well, which logically brings us to the necessity of health insurance. What is more, we often don't know when exactly we will need medical help and how much of it we'll require. This element of uncertainty is called risk, and we'll use this notion to explain what health insurance companies tend to do to make more money.
As the purpose of health insurance is basically to spread health care costs among many people, all consumers should be protected from very high costs of health care, and provided with necessary help when needed. However, health insurance system does not always play fair. Insurance companies try to avoid risk in order to boost their profits.
It is common practice of health insurance companies to sell insurance to so called "good risk" customers and try to leave out "bad risk" people. When we are speaking about good risk, we generally mean young people with no health problems. Bad risk refers to older people with health conditions.
For instance, insurance companies may reject your application basing their decision upon your health status. They don't want people to wait till they get sick to purchase health insurance and usually impose a pre-existing condition scheme. By definition, a pre-existing condition is a medical condition which existed before you obtained health insurance. Mind that individual health insurance plans and group plans usually differ in rules applied to pre-existing conditions.
A person with a pre-existing condition can cost an insurance company a lot of money, so they strive to exclude those who have them. In case you have some medical problem which already exists at the time you enroll in your health insurance plan, the insurance company will deny the claims concerning this medical problem.
There is usually a 9-12 month waiting period for pre-existing condition coverage, which means that in case an insurance company offers you coverage, they may not provide coverage for that specific pre-existing medical condition for the specified period of time. Insurance companies may attach riders to your health insurance policy which include a pre-existing condition waiting period or state exclusions of coverage of certain medical conditions or body parts.
Insurance companies may charge you much higher premiums if you belong to the group which is considered risky, for example, if you are older, if your work is related to some dangerous field, or if you have some health conditions.
If you are younger and healthier, insurance companies will create a high-deductible, lower-premium plan for you, and if you are an older person with health conditions, they tend to create much more expensive plans.
Insurance companies impose referrals or prior authorizations on healthcare providers before they can give a patient a diagnostic test, prescribe some medicine or recommend hospitalization , which in many cases delays medical help and care. Healthcare providers are experts who are perfectly capable of determining on their own whether a patient needs a medicine or test or not. Insurers tend to offer such a variety of different insurance plans that doctors, hospitals and their staff have to deal with loads of paperwork, billing etc.
In order to be fully covered, customers often need to pay a very high price. High prices that insurance companies charge can leave many people uninsured or underinsured.
As if it were not enough, there is also health insurance fraud against which it is not always possible to protect yourself. Many people would realize that they have fallen prey to health insurance fraud only when they submit a claim for a medical service which they hope is covered under their policy. Their claim will be denied and unattended health problems will be accompanied with insurance problems.
It is possible to spot some alarming signs when you deal with health insurance companies. Health insurance coverage which seems too good for too low a price will probably be your pain in the future. Always research the credibility of the health insurance company you are going to purchase insurance coverage from. Check with your State Insurance Commission whether the company is licensed for doing business in your state. Call your local hospital and ask whether or not they accept the insurance. Always carefully read the fine print before signing anything.
If a salesperson requires you to pay the total amount of your premium in advance and asks you to pay in cash, it should be a red flag. Protecting yourself from health insurance fraud means doing everything to prevent it from happening.
However, if you have already become a victim of health insurance fraud, act without delay, and contact your State Insurance Commissioner and file a health insurance fraud complaint. They might have other complaints about the company you were unlucky to have purchased your coverage from.
Also contact your bank or Credit Card Company in order to stop any scheduled future automatic payments. You should have all of your cancelled checks or credit card statements as well as a copy of the health insurance contract that you signed. In addition, get a copy of your personal credit report from all three major credit reporting agencies. Contact your local law enforcement agency and report the fraud fact.