Health Insurance - How do I know which company and plan to choose?

Choosing the right policy and provider is difficult at best and not an experience one looks forward to.  Knowing how to go about it and utilizing just a few important facts can save hours of frustration by quickly narrowing down the choices.

As a licensed professional with years of prospecting experience I know that the cost of the policy is the number one issue in the decision making process for the majority of consumers.  But it shouldn't be.  Remember, you get what you pay for and if it sounds to good to be true, it probably is!  That is not to say that you can't find a reasonably priced policy that provides coverage that fits. 

Make your decision first based on the quality of the company.  The first question should be about the company.  What is their rating?  Insurance company's are rated for their financial conditions.  There are 16 standard ratings varying from S (Suspended) to A+ and A++. (Superior)  While I am sure that there are reliable company's that bear a B- to a B++ rating I would not personally purchase a policy from a company with a rating of less than an A-. (Excellent)

Often people are unaware that when they leave the state and sometimes even the county, they are not covered.  Is it state specific? Is the next question to ask.  Does the policy go where I go? Will I be covered if I go out of state on vacation and need medical attention?  Will I be covered if I go outside of the United States? If I move to another state, will it go with me?  Remember, your health plan should cover you in the worst case scenario.

An often overlooked but extremely important question is How are claims paid?  This is a very tricky one because most often the answer is ambiguously misleading.  There is only one answer to this question and it is very specific.  The answer is "Usual and Customary".  This means that claims are paid based on the provider charges in a given area.  Let me explain by example; the cost of medical treatment for a broken leg in  Prescott, Arizona is very different than the cost of medical treatment for a broken leg in Beverly Hills, California.  Claims paid on a basis of "usual and customary" are not decided upon by the insurance company the decision is made by a third neutral party; the provider. 

If the answer to this question is anything other than "usual and customary" or if it includes any wordage like "reasonable, allowable, average, permissable, negotiated or limited fee schedule then you should know that this means that the company makes the decision themselves on what amount of the charge will be paid.  This could leave you with an unexpected bill.  Let me explain by example; if you have an 80/20 plan and a procedure cost 10,000 you expect that you will be responsible for 20% ($2,000) but a few weeks later you receive a bill in the mail for $4000.  You think this must be some kind of mistake, it's not.  The company pays claims based on an "allowable and customary" amount or "usual. customary and reasonable" amount which means they decided that only $8000 of that total bill was reasonable or they only allow $8000 of the total claim to be covered so they paid 80% of the $8000 and you are responsible for the rest.

Many companies offer only "cookie cutter" plans or plans that are specifically laid out and offer no flexibility in choosing the benefits.  They have 2 or 3 plans that vary in price and coverage but they are specific and offer no coverage in individually specific areas.  If this type of plan works for you then just be certain what exactly is and isn't covered.  Ask a bold question; What isn't covered in the plan? You don't want to find out when it's to late if you are diagnosed with diabetes that your plan does not cover it!  The perfect plan should offer benefits specific to your needs while still covering the unexpected, if a plan is specifically drawn out the same for everyone chances are it has as many holes as swiss cheese  

Next, you will want a company that provides the greatest flexibility in choosing doctors and hospitals.  Be sure that you have easy access to specialists and other doctors you might want to see.  If your spouse or child was diagnosed with a disease that required specific treatment you would want the best possible treatment available and you would want to know that your insurance company was behind you, as they should be.  Be sure that the best hospitals and clinics are covered by their networks.  Be specific, ask; Will I be covered if I seek treatment at Johns Hopkins?  Does your network cover treatment at the Mayo Clinics? Do you require Pre-Certification or a Referral before I seek treatment?  The last thing you want is to be told who, where and when you can seek treatment for your dying child.  You want to be able to choose the best.

Finally, be sure to go to your states insurance website and check on the insurance company you are considering as well as the selling agent.

I'd be happy to answer any questions for you without pressure to purchase and I can be reached by email at acooper@mw-ins.com or through my website at www.amycooper.mw-ins.com