Trying to find the right health insurance can be a daunting task for anyone. This is especially true for the person who is looking for the first time and has to wade through all of the different kinds of policies that are available on the market today. When you start to factor in age, family situation, health history, life style and economic status, the task becomes even harder. Anyone who has ever been in an accident or had an illness that required medical attention knows the value of a good health insurance policy. In our world of advanced technology, the cost of even a few days in the hospital to have a baby can cost almost $30,000.00, more if there are any complications.
Lets look at the difference between two major types of insurance, fee for service insurance and managed health care insurance. These coverages are different in many ways, but they are also similar. Both tyhe fee for service plan and the managed health care plancaver a wide variety of medical, surgical and hospital costs. Most of these plans will cover some prescription drug costs and some may provide for dental coverage and services with other providers such as chiropractic or acupuncture. It is the diferences that need to be examinined when searching for the right medical insurance for you.
If you have a fee for service policy, then it pays the doctor or hospital a specific fee for a specific service that is given to you or your family member. You usually go to the doctor or hospital of your choice and either you or your doctor or hospital will then submit a claim to the insurance company for reimbursement of the bill that you paid. The insurance will only reimburse you for the covered medical expenses that are listed in a summary of benefits that you received when you got the policy. The portion that you pay without being reimbursed is usually about 20 percent of what the insuerer considers to be a reasonable cost for the service. Look carefully at the deductible, the amount that you must pay each year before the insurer starts to reimburse you, the out-of-pocket-maximum that you could be charged and whether your policy has lifetime limits on the benefits paid. You should make sure that the lifetime limit is at least one million dollars.
There are three major types of managed health care plans: health maintenance organizations (HMO), preferred provider organizations (PPO) and point of service (POS). Under these plans the patient usually receives comprehensive health care and there are financial rewards for using the physicians and hospitals in the service. HMOs and PPOs have contracts with doctors and hospitals. They have already negotiated what the fee will be for a procedure and as long as you get your care from one of the group providers, you should not have any extra charges. This does not include any deductible or copayment that may be required at the time of service. The difference between a PPO and a POS plan is that if you have a POS plan you usually have a primary care physician who will coordinate your care with other physicians and the PPO does not.
When you are looking at insurance it is always a good idea to look carefully at the description of the plans. Question any language that you do not understand. Know what the conditions of payment are. Make sure that you have fully reviewed the policy with your employer, a benefits management officer or your state department of insurance to make sure that you understand who is responsible for payment for services.
Lisa Simmons writes about medical insurance and other topcs of similar health nature.