Wednesday, October 31, 2012

Problems in Getting Health Insurances Claim

Health is the bigger issue in today's life and people have to be very much cautious to know about their health and related issues. The changed life style, wrong eating habits, excessive junk food and late night working has become the prominent cause of health issues. The major problems like obesity, heart disease, cancer etc silently penetrate into individual's life without giving any early warning signal. It becomes more complicated when these diseases crosses the limit and individual have no other option just to surrender, so it becomes essential to constantly monitor the health and right insurance policy give the big way to meet with such challenges of the life which comes before us, in the form of health problems.

What is a health insurance policy?

Health insurance is the insurance by an individual for the risk of incoming medical expenses. Overall health expenses risk is estimated and calculated among target groups, and individual insurer get a routine financial structure like monthly premium where money is available in certain insurance agreements for the health care benefits payments. This benefit is monitored and administered by the reputed organizations like some government agencies, nonprofit groups and private businesses. A health insurance policy is agreement between insurance company and an individual or the family which is applicable for the citizens of the country for covering health care costs for all the diseases or some major diseases. An individual needs to know certain points which are involved in the health care policies. These are:

Premium: The amount to be paid by the policy holder for getting the health coverage.
Deductible: This includes the amount which policy holder have to pay for the doctor visits and prescriptions before the insurance company pays its share.
Co-payment: this is the amount which is paid by the insured person to get the doctor service for every visit which is solely born by the individual.
Co-insurance: This is the fixed percentage of amount which individual have to pay. This is the percentage of the total cost which is shared by the insured person.
Exclusion: This refers to indicate that insurance policy will cover for which services and insurer have to pay for services which are not covered in the policy.
Coverage limits: This would reveal that the health care policy would cover the health care up to maximum limits, remaining expenditure will be born be the individual policy holder.
Capitation: This is the amount paid by the insurer to the health care provider for the treatment of all the members of the insurer.
prior authorizations: This is the authorization or certification necessary for getting the payment for medical services utilized by the insurer.
Explanation of benefits: this is the document which reveals the medical services covered by the insurance policy provider and payment terms and conditions.
Problems in getting heath insurance claims

It is quite complicated to deal with the problems to potential health insurance claims. It is as tedious as maintaining good care of your body. It is utmost essential to thoroughly read the major prospect of the policy and it is quite necessary to know that what all services are covered in by your policy and what not? At that same time the medical service provider must also know that does your policy covers the given medical treatment services. If it doesn't covers the same then it is not possible to get medical insurance claims It is important for the insurer to procure medical service and the policy papers for getting the quick claims. Some of the private investigations on the matter of the medical problems bring out the facts that the insurer gets huge trouble in getting their medical claims. There are few vital point if they are properly followed then surely an individual will have not much problem in getting the medical insurance claims.

First of all you should know what type of coverage is in your policy.
Get the confirmation from the customer service department for your plan in the writing.
Document your contacts.
If your problem is not resolved or getting delayed then you can take up expedite grievance process.
If your problem is not resolved and the condition is not danger to your health then write letter explaining your concern. This is called filing a grievance. This letter will project your problem and initiated steps you took to solve the problem. It should have the copies of any supporting documentation from doctor or the medical representative.
In addition to filing a grievance with your plan, you can also file a complaint with the Insurance Commissioner's office.

At any point in the dispute of getting the claim, it becomes necessary to select an expert medical insurance claim attorney. He must be able to contact the insurance company before commencing a law suit against them preceding a law suit is a costly and stressful affair and will not result in solving the problem.

I am Chandraprakash Babu, a private investigators in Salem. I spent 15 valuable years of my life in the field of private investigation, corporate investigations, insurance investigations, skip tracing, verification services and business investigation. I worked with corporate risk protection management groups in Salem to provide various investigation services in the above mentioned fields. I started my career as a ground investigator, but later on my dedication and consistent hard work made me to get the prestigious position of Managing Director of a multinational group of corporate risk protection companies.

Monday, October 15, 2012

Senior Health Insurance - Where Did It Go?

Once you retire and no longer receive the benefits of a group insurance plan from your employer it cannot be stressed enough how important senior health insurance is.

At one time seniors were able to rely on government help for health concerns that become almost mandatory as a person ages. Medical services such as eye exams, dental care, prescriptions, hospital care and ambulance transport are no longer all available without charges based on provincial medical insurance. Although there are still some coverage for seniors offered by provincial plans, not everything is covered.

At one time it was all so simple, however now we need to take notice and be aware of the situation regarding health care for seniors. To be part of a group insurance plan in the workplace is ideal, but in most cases when one retires,the group insurance coverage also ends. There will be millions of baby boomers retiring now and continuing into the near future, this means more medical services and needs within the senior population.

Timing Be Aware

After the age of 55, it is more difficult to get certain types of insurance, whether it be group insurance at your workplace, or health insurance from private sources that will cost more. After the age of 70 it is very difficult to find any private supplemental health insurance. As time goes by the need for supplemental health insurance becomes more important. Senior health insurance is more expensive in some situations because of the risks the insurance company consider could be involved, for example an extended illness of the insured costing many thousands of dollars, which the insurance company would have to pay, therefore such situations are considered and included in the cost of the policy. We all know that as we age our health becomes more of a concern, therefore getting adequate insurance for possible needs also becomes a concern.

By using good timing and being aware, you can have supplemental insurance that will benefit you when and if you eventually need it. Once you reach the age of retirement, the government will take care of certain medical issues, however, they are limited and supplemental insurance should be high on your list of necessities for all the coverage you may need in case of long term illness, hospital coverage and medication. In addition, you may need long-term therapy, or in home recovery care, these are what supplemental insurance will cover. Speak to an insurance broker about health insurance products that are specifically designed for the needs of seniors. Some plans are meant to take over where the plan from your employer leaves off when you retire so you avoid having a gap when you are not covered.

What you Should Consider

When preparing yourself for retirement and that much-needed extra medical and health insurance, it is a good idea to consider the following:

Different provinces have different plans and so you need to inform yourself on what is covered before you purchase supplemental insurance.

When you buy supplemental health insurance, the older you are on application, the higher the premiums will be. Once you reach the age of 70 it will be more difficult, if not impossible, to find a supplemental health insurance plan.

medical questionnaire and/or exam will be required to sign up for a health insurance plan. Your premium could vary depending on the state of your health.

You do not need to buy everything offered; you can make choices on what coverage you want.

You can get certain individual medical benefits insurance; or insurance that will cover a number of things such as eye health, dental insurance, hospital coverage and many other options.

Whichever plan you choose, you will pay a monthly premium in exchange for those benefits that you have chosen.
The Importance of Senior Health Insurance

By the time we reach the 'seniors' word, our bodies have been ravaged by the wars of life, and sometimes harsh results are forthcoming, these are the times when we definitely need health insurance. Supplemental health insurance is specifically for those needs, the things the government medical plan does not cover. There are special types of supplemental insurance specifically for the senior population. 
Seniors health insurance is an essential commodity. Speak to an insurance specialist about your options.