Private Health Insurance - Questions to Ask

Private Health Insurance - Questions to Ask When zeroing in on a particular provider, some of the information you need to know may not be provided on their Internet site or initial paperwork. However, there are some specific questions you should always ask when considering any kind of private health insurance plan. Specifically, you want to know what services and benefits are included. The list should at a minimum include the following: · Major medical equipment · Mental care · Physical therapy and rehabilitation · Laboratory testing · Drug coverage · Hospital and doctor care Keep in mind that while many providers will list these services, they may also include detail to cap their overall costs associated with you. This will come in the form of a lifetime ceiling, i.e. a limit on how much the provider will ever pay for you in total. The ceiling is usually something around $1 million or so, which may seem like a lot, but in a serious medical situation it can be reached very quickly. Sometimes this limit is instead a cap within a time period such as a year. Frequently, providers also put limits on specific treatments and equipment. Chronic conditions or specialized care have significant costs and, while providers may cover the first round, they are not interested in continuing care coverage. The result means that initial expenses are covered, but thousands of dollars in ongoing care are not. In terms of drug coverage, many providers are trying to reduce their costs by restricting their customers to generic drugs and/or an approved list of lower cost brands. While good for the provider, it can mean that the drug you need is not covered, or you get a generic that is less effective. Any typically specialized care or surgery will usually require some kind of pre-approval before you can go forward. It is good to know what types of treatments are in this category with a private health insurance provider before starting coverage. While many providers won’t tell you up front which services they frequently deny, you can get an idea from your state regulating agency based on the type of complaints they receive about a particular provider. Buyer Beware If you do settle on a plan that seems to work for your needs, make sure to read all the documentation before beginning the agreement. Very often the fine print will illuminate situations where coverage is not provided. You don’t want to find this out when you actually need the care and have been paying the premiums for some time already. Further, make sure to secure a plan where your rates are stable. Similar to credit card companies, some insurers offer private health insurance plans with what are called teaser rates, only to increase them later once you are locked in. A specific rate lock-in will make sure you pay the same cost for the duration of the annual contract. Avoid fly-by-night operations. There are a lot of companies that seem to offer very affordable insurance but are nowhere to be found when a claim needs to be filed. Go with companies that have been established for a while and won’t disappear when you suddenly need to file paperwork.