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Knowing coverage key to individual health care policies

Craig Hall, The Business Times:

“In my experience, most people look at two things when purchasing an individual health care policy,” says Bill Brown, an agent selling who has been health policies since the early 1970’s, “And that is to concern themselves with the parts of the policy they will use the most; prescriptions and doctor office visits.” And Brown says that this overlooks what could be the most costly event which is a medical emergency that puts the patient through a surgery, a lengthy hospital stay, or extended outpatient care and treatments.

These are the types of occasions where the insured can experience by far their highest costs, as they tend to roll up all of the maximum expenses a policy has in place between the deductable and out-of-pocket expenses. “It is simply a matter of risks versus cash flow,” says Brown.

Brown goes on to say that this is not the only part of the process where individuals need an agent’s involvement. “All the applications for health insurance are very similar and ask the same types of questions,” says Brown, “But an agent can help you answer properly so that the insurance company does not come back to you with a much higher rate or deny you coverage.” Most of the confusion in the questionnaire is in regards to pre-existing conditions or treatments, from either not accurately recalling when these things occurred, or from trying to keep something from the insurance company.

“Making sure you give the company complete and accurate information will prevent them from coming back to haunt you if you make a claim,” adds Brown, “Because the insurance company is going to search its database, other vendor databases and the Medical Information Bureau to minimize their risk.” Most companies will look at a five year history for pre-existing conditions, and will possibly deny any claims in the first year of a policy for a pre-existing condition. Also, if a claim is disputed, insurance companies will use a patient’s full medical records, including doctors’ notes, to find a provable event and possibly deny coverage. “I would bet that 99.9% of the people insured have seen their full medical records that include their doctors’ notes and full medical information,” added Brown.

While this economy is indeed difficult on policyholders, there is a way to save money and that may indeed be found by purchasing an individual policy. “The fact is that employers are having the same problems with insurance costs as their employees, doubly so because many of them are insured through the companies they own,” says Brown. Companies are trying to work around the cash flow versus risk formula, and in some case cases companies are dropping offering coverage altogether. The increased costs also limit what companies can afford to offer, and that is where shopping for an individual policy is best for you.

Just be sure to use an agent says Brown, as the process can be confusing. “Your agent is there not only to assist you in negotiating the system and to help you fully understand what you are buying, but to also be a back up to intercede on your behalf with your insurance company to resolve issues and disputes. Just because the prevailing attitude with Obamacare makes consumers think that you buy a policy and everything is covered, does not make it so.”


Since June of 2000, Craig Hall has been the owner/publisher of the Grand Valley Business Times. He can reached at 970-424-5133 or publisher@thebusinesstimes.com
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Posted by on Sep 16 2011. Filed under Focus On. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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