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HEALTH INSURANCE

House approves health care bill

>> The House of Representatives passed a comprehensive health care bill on November 7 in a close vote along party lines. The Senate may not vote on a bill until next year.

Despite strong resistance, the House measure includes a "public option," which refers to a provision that allows people to buy health insurance from the federal government, as well as from private insurance companies. The public option in the House bill is weaker than the "robust" version favored by Speaker Nancy Pelosi. To deal with similar resistance in the Senate, Majority Leader Harry Reid is shepherding a bill that allows  states that don't want a public option to opt out.

Did you get the right code?

>> If your medical insurance covers preventive care, that means going in for a check-up, which costs nothing. Right? Not necessarily. Your doctor might perform an uncovered procedure while you’re there and just report your visit and the procedure.  Possible result: You pay. Why? Because insurance payments are governed by a system of codes. If your doctor or staff member forgets to include the code for a check-up, the insurance company is within its rights to refuse payment.

Self-defense: Make it habit to ask your doctor if he will code your visit for an examination or procedure that is covered by your insurance

What to watch out for

>> Buying health insurance is like major surgery—mistakes can be painful and expensive. Here’s a short list of things to watch out for:

• Make sure the company is licensed in your state. Sounds like something you can take for granted. But no. There are dozens of companies selling in states where they have no legal right to sell, and many are fakes pushing fraudulent policies.

Self-defense: Check www.naic.org for a list of companies licensed to do business in your state.

• Check on the company’s financial health. You want your company to be there when you need it, not out of business.

Self-defense: Check on the one you’re considering or already have at www.ambest.com.

• Don’t just look at the stated price. Check deductibles and co-pay amounts to see how much protection you’re getting for your money.

Self-defense: Check www.ehealthinsurance.com for an easy way to compare plans.

• Check on how long the introductory price will hold. You don’t want to buy what looks like a bargain only to discover that the price jumps up after six months.

Self-defense: When you get a promise of how long an initial price will hold, ask for the promise in writing and attach a copy to the policy before you sign.

• Make sure your plan is rated as one of the best. An easy way to find out: Go to customersupport@ncqa.org. You’ll get a list of top-rated companies in your state. Then check to see if the plan you like—or the plan you have—delivers the features you want

Small-company risk

>> With unemployment at 9 percent, nearly everyone knows about the danger of losing his or her company-sponsored health insurance. But if you work for a small company—one with fewer than 10 employees—the risk is even higher. According to a survey by the Kaiser Family Foundation, only 49 percent of such companies offer health benefits. And many that do offer them have increased deductibles, reduced benefits, or changed workers’ schedules so they fall below the number of hours needed for health benefits. And many companies, large and small, are replacing older employees with younger ones who are cheaper to insure.

Self-defense: If you work for a small company and still have health insurance, have a talk with your employer about how long he or she can cover you—especially if a spouse you may have does not work for a large company with health insurance

Get ready—it’s coming

>> Most people never heard of them, but according to an article in The New England Journal of Medicine (Vol 346, No. 23), “defined contribution” health care plans represent “the beginning of a new era in health insurance in the United States.” Defined contribution means that an employer gives each employee a definite amount of money to spend on health care in any way the employee sees fit. If the employee’s expenses rise above that amount, there’s usually a high deductible until the employer’s plan cuts in. Experts expect defined contribution plans to grow, because they shift some of the cost of health care to employees. On the other hand, the employer must offer a wide choice of plans, which raises administrative costs. Even so, these plans may catch on as medical costs continue to rise.

Self-defense: Ask your company’s human resources person if your employer plans to shift to a defined contribution plan. Then decide if you still want to work there. For more information: www.insure.com/articles/healthinsurance/defined-contribution.html

The wrong helath insurance code can cost you.

 

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Copyright © 2009 Richard Evans and Andrew Bromberg