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Showing posts with label Medical. Show all posts
Showing posts with label Medical. Show all posts

Thursday, April 12, 2012

Life Insurance – Medical history increases the cost for 66% of applicants


Lucky applicants for life insurance can be insured within 48 hours and at the premium quoted - but 2 in 3 applicants are faced with delays plus the prospect of having their premium loaded.

So who are the lucky ones? Basically, you'll have to be as fit as a flea with no family history of serious illness, under 45, in an office type job and probably applying for less than £250,000 cover. For everyone else there is going to be some hassle.

When an insurer provides an initial quote for life insurance, all they know is your age, sex and smoking status. They use these details to make an initial prediction of how long you are likely to live and on that basis they give you an initial quotation. They call it their “Standard Terms”.

If you want to progress your application you'll have a multi-page application to complete. This isn't as daunting as it may seem, as most online operators take your details over the phone and send you a copy of the completed application for you to check over. But the questions are extensive and if you miss out anything that later turns out to be significant, your insurance may well be invalidated. So be warned and take care!

The insurers use your application details to look out for anything that signals current or future concerns about your health or life style. Besides the obvious questions that reveal health problems, they also evaluate your weight, alcohol and nicotine intake, and any potentially inherited health problems. So if your father died of a heart attack or mother died from breast cancer, they'll be concerned.

Then there's your life style. If you're in a type of job where accidents do happen, construction jobs are a good example, or you are involved in any form of dangerous sport or flying, your premium is in line for loading. They'll even want to know whether you regularly travel to countries that are known to represent health risks for visitors. And whilst the law doesn't allow discrimination against same sex relationships, the insurance companies will almost always insist on a medical for these applicants.

Insurers freely admit that the number of questions they ask is increasing. They claim it's to reduce the number of claims they refuse. Whilst that may be partly true, the trend has also coincided with an increase in the proportion of applicants who are seeing their premiums loaded. Some years ago it was nearer 40% - today's for some insurers the level is virtually 66%.

How much extra might you be asked to pay? That's a bit like how long is a piece of string. But to give you a feel, a woman aged 40 receiving medical treatment for post-natal depression was recently faced with a 50% loading on an initial quotation of £7.60. A woman whose mother had breast cancer similarly faced a 50 % loading. Seriously overweight people can also expect loadings of 50% to 100% or even refusal.

Faced with a loading what can you do? It's important to appreciate that the insurance companies giving the cheapest initial quote are also likely to have particularly choosey medical criteria. That's how they keep their quoted prices low. So if you're faced with a loading, the best advice is shop around, Try one of the more expensive providers like Friends Provident who are sometimes a bit more lenient.

Whilst this may sound overly complicated, remember that over the years, an extra £10 a month on a 25 year policy represents £3,000 of your hard earned money. If you don't have the experience or time to do this, and after few of us do, speak to an online life insurance broker.

Competition is high on the Internet and online brokers will normally reduce your premium by cutting their commission. Their systems are also well versed in finding alternative providers to alleviate loading problems. So keep things simple. Let your keyboard fingers do the walking and let the online broker do all the hard work!


Thursday, April 5, 2012

How to Appeal When Your Medical Insurance Declines Your Claim


If you are like most people, when your medical insurance declines your claim, you are left feeling helpless and frustrated. After all, if you need health care and your insurance is saying you don’t, you have two choices – appealing your claim or paying for the treatment out of pocket.

Most claims are declined for specific reasons and causes. The most likely cause for your health plan to deny your claim is a direct consequence of missing data. Before appealing your denied claim, you can verify that by assuring any and all pre-authorization requests were filled out with accurate patient information.

For example, is your social security number correctly listed? Does the doctor have the most current copy of your health plan’s identification card? Does your doctor have the most up to date copy of diagnosis and procedure codes in order to fill out the forms correctly?

By verifying that you have submitted the good documentation to the physician and they in turn submitted good documentation the health plan, you are ready to move to the next level. When it comes to dealing with your health insurance company, think paranoid.

Document every phone call, every contact person and every piece of information you are given. It only takes one break down in communication to cause a problem; by documenting all of your communication with the insurance company, you are pre-preparing for any appeals case.

If you are facing an appeals claim for treatment coverage, be sure you’ve reviewed the appeals process in your company’s health insurance handbook. Most patients overlook reading through the handbooks their insurance company will provide. Plan requirements and appeal processes are detailed in these handbooks and you should make sure that your plan covers any treatment you are going to receive before the treatment is received, if possible.

When An Appeal Is Necessary

Since every plan should have a clear appeals process, you should follow it explicitly. You should talk to your doctor about appealing the claim so they can provide supporting documentation and expertise as needed. Remember, most insurance claims must be appealed within a limited amount of time, so if you wait six weeks after a denial and you only have 60 days to appeal; you may already be out of time.

You should always appeal internally to your insurance provider before going to an external source such as a government or state appeals process. Most appeals have a process that goes as follows:

· Phone Complaint
· Written Complaint
· Written Appeal

This is another area where you should be very specific citing the coverage rules of your plan as well as documenting each contact you have with the insurance company. While the insurance carrier will approve the majority of valid appeals; there has been documented cases of insurance fraud and health plans that do not play by the rules. By documenting response times and any required response times; a patient can exhaust their option against the insurance carrier for a valid appeal and then take it to the next level.

Laws in many states govern an appeal to a state or federal insurance oversight process; these requirements often allow for an external, expert review of the appeal. By providing accurate documentation and detailed medical support from your physical, a board of qualified experts can then judge your case on an individual basis. If an external appeal validates the claim and overturns the denial, then your insurance company will not be able to deny the claim.
Knowledge of your health plan, your doctor’s knowledge of procedures and a detailed review of the appeals process are your best tools to getting the approval of the treatment you need. Do not overlook the details, keep accurate documentation and review your coverage plans if you have any questions. Remember, there are always options.


Wednesday, April 4, 2012

How The Health Insurance Industry Fights the High Costs of Medical Care


For many families, finding affordable health insurance is a task akin to the search for the Holy Grail. Depending on where in the country you live, a family health insurance plan can cost as much as $800-$1000 per month. Even when you split that cost between employee and employer, that's a major chunk of nearly anyone's monthly budget. And while it's popular to swear under your breath at the greed of the health insurance industry, a look at the cost of medical care is an eye-opening shock for many people. The expenses associated with a broken arm, for instance, can easily mount into several thousands of dollars.

** The Health Insurance Industry has a stake in keeping people healthy.

The high cost of health insurance is the direct result of the high cost of medical care. It's a simple matter of economics. The more it costs to take care of each subscriber, the more the insurance companies have to charge all their subscribers. This cost/expense ratio is what has made most health insurance companies embrace the idea of providing preventive care to their subscribers. It's a simple matter of business sense - healthy people don't cost the insurance companies a lot of money.

Accidents may be the first type of medical need that springs to mind when people consider buying health insurance, the major insurance companies all agree that accidents aren't the major cost drain on medical resources. That place is reserved for chronic illnesses like diabetes, heart disease, cancer and high blood pressure. Because of this, it makes good business sense for health insurance companies to encourage their subscribers to adopt preventive health strategies. That pays off in special benefits for health conscious consumers.

** Preventive Health Benefits Help Keep Costs Low

Among the benefits that have become commonplace for major health insurance providers are routine physicals, medical screenings for all subscribers, discounts on health club and gym memberships, payment of dues for weight loss groups and lowered subscription fees for non-smokers.

Some health insurance companies and HMO's go even further in their preventive efforts. Because of the high risk of serious injury or fatality for infants in automobile accidents, Fallon Community Health Plan of Massachusetts has for years teamed with local organizations to provide free infant car seats to families with newborns. In the same spirit of prevention, many HMOs offer free stress management and stress reduction workshops to all subscribers because stress has been identified as a leading risk factor in nearly every major illness.

** Seeking a Cure
The quest for affordable health care has also prompted health insurance companies and HMOs to help fun research and health initiatives all over the country. The health insurance industry underwrites millions of dollars of medical research annually in an effort to lower the costs of health care. Their dollars fund grants to enroll low income and other hard to insure populations, and to offer eye, dental and health care to inner city and poor rural populations. The industry estimates that routine preventive eye and dental care, as well as routine medical screenings and physicals can identify illnesses at early stages and prevent conditions and costs from escalating out of reach.

** Get the Most from Your Health Insurance
You pay for it - you should certainly get the most possible benefit from your health insurance plan. Here are some suggestions for ways that you can make your health insurance plan work for you:



  • - Join a gym.
    Check the benefits that your HMO or health insurance plan offers. Chances are good that one of them is a discount good on membership at a local gym or health club. Get fit - it saves THEM money... but it saves YOUR life.


  • - Lose weight.
    Take advantage of nutritional counseling and memberships in weight loss support groups to get down to your ideal weight. Added bonus? Many health insurance plans offer a lower tier cost for subscribers who are at healthy weights.


  • - Quit smoking.
    Non-smokers are another group that often enjoy lower health insurance premiums. Many HMOs and health insurance providers offer free smoking cessation programs to help you get smoke free and healthy.


  • - Attend medical screenings and health fairs.
    Many health insurance providers sponsor 'wellness fairs' where you can have your blood pressure tested, get free medical screenings and learn about alternative medical techniques like massage therapy, acupuncture and yoga. Take advantage of special events to learn more and get healthy.



It may be popular to demonize the health insurance industry, but today more than ever, the health insurance industry has a stake in keeping you healthy. Find out what your health insurance company has to offer you by visiting their web site, or calling customer service.


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