Category Archives: Auto Insurance

Health Insurance Help to Lower

Illness for non-work related injuries can be financially devastating. Insurance keeps you protected against disastrous health care expenses and lost wages. There are enormous health insurance plans available day-to-day, the insurance cost and its benefits vary from one plans to another. Before enrolling for a policy, an individual should consult with the insurance agencies, read the policy to get the complete information about the benefits and costs and also the way the plan works.

Today, there are many more kinds of health insurance to choose from than were available just a few years ago. Traditional differences between and among plans do not longer any more. Also, there is been an increased emphasis on the role of consumers in managing their own health care and health care finances. There is a focus on providing information on the cost of care and health care quality-at the level of the physician, physician group, and hospital-to help consumers and employers choose among the many options available to them. The things have changed a lot, when most people in the United States had health insurance has indemnity insurance (also called as fee-for-service or traditional insurance). This type of insurance coverage assumed that the medical provider i.e. doctor or physicians will be paid a fee for each service provided to the patient.

When we talk about health insurance, we usually mean the kind of insurance that pays medical bills, hospital bills, and typically, prescription drug costs. Nowadays, the insurance also covers Medicare and Mediaid that provides health insurance coverage for certain people, senior citizens, people with disabilities and also an individual and families with low income. Today, the online information helps an individual to compare two best insurance policies and choose best among it. The insurance help an individual for financial planning and accordingly choose the best suitable for the family. The policy helps to avoid the burden of expensive medical bills and ensure the penny paid in health plan is paid for your care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive.

In spite of available health insurance help online, unfortunately many Americans are still uninsured or underinsured. Some may be eligible for private or government but may have difficulty in finding the maze of complex rules and insurance jargons. Many more may not even have chosen the plans due to non-affordability coverage or may not be eligible for any. To help you choose right plan, we give you an overview of programs and strategies for seeking free or reduced-cost health care and managing medical debts.

Why does an individual require health insurance?

As the science and medical care advances, the ways of treatment are also increasing simultaneously. The main purpose of health insurance is to help in paying for care. It protects you and your family members in an unexpected serious illness and injury that may be high in cost. Additionally, you are more likely to get regular and routine checkups, if you have an insurance policy. Every individual requires insurance policy because you cannot predict your illness, injury and your high paying medical bills. One must seriously consider the need for health insurance for own and family. We also know that there is interlinking between having health insurance and getting protective health care. The research states that people having health insurance are more likely to have a regular doctor and get care when it is needed.

How should one get health insurance?

Most of the people get health insurance through their employers or company which they belong to. This is formerly known as group insurance. Some individuals don’t have access to group insurance. In this case, one may choose to purchase their own individual health insurance directly from public or privately owned insurance company. Most of the Americans in North America get health insurance through government programs that operate at National, State & Local Levels. Insurance- whether provided by your employer or purchased by you – can be both expensive and complex. To understand better option, you must take health insurance help from the experts and advisors.

Group Insurance:
Group Insurance is basically offered by the employers or else by an organization of which you are a member of union, professional association wherein you may get group coverage. The employee has to choose between several plans been offered by an employer’s including both indemnity insurance and managed care. Some employer may only offer one single plan. Some group plans may also include dental care with the health and medical benefits. Hence, it is a very important decision to be taken by and employee before choosing any insurance benefits offered by employer or an organization. It is also essential to compare plans to find the one that offers the benefits as per your need. Once you choose an insurance plan, you usually cannot switch over to another plan until next open season, usually set once a year.

In group health insurance, employer usually pays portion or all of the premiums. This means your costs for health insurance premiums will be lower than they would be if you paid the entire premium alone.

If you are a member of group insurance offered by an organization, you are benefited from being a member of a large group. You will have to pay lesser premium than an individual would be paying. However, the organization often does not pay a share of premium, meaning you are responsible to pay complete premium by yourself.

Individual Insurance:
In an individual Insurance, you get the coverage directly from the Insurance Company. You don’t have any access to the group insurance offered by an employer or an organization. When you buy you own insurance, you have to pay entire premium rather than sharing with an employer according to Group Insurance. In individual insurance, you do not share any cost of premium with your employer. You should analyze and choose an individual insurance plan that fits your needs at a price that you are willing to pay; you should also consult a tax advisor to find out whether you are eligible for any tax deduction as per the insurance plan.

Insurance variably differs from one company to another within an insurance industry, from one plan to another and one product to another. Hence, choosing right company, right product, right plan are the important criteria before choosing any plans.

Which type of health insurance is right for you?

Whether you choose group insurance or an individual insurance plan, you must carefully compare coverage and costs. You should compare the following important aspects like coverage and benefits, premiums, exclusions and limitations, access to hospitals, doctors, and other providers etc…

Group Health Insurance

The health insurance marketplace is certainly challenging, but count your lucky stars that at least you have choices. To that end, this article is going to explore the pros and cons of group health insurance.

Group Health Insurance Pros

  • Group health premiums are subsidized by the employer. Generally, an employer must contribute at least 50% of the “employee only” premium. As such, if you are the employee, you can likely get a richer health plan for less premium than you would pay in the individual health marketplace. However, the cost to add your dependents to the employer’s plan, may be cost prohibitive. In this case, and assuming that your dependents can qualify, then you may want to put them on an individual health plan.
  • Group health premiums for large families are the same as for small families; whereas in the individual market, you pay a separate premium for every family member. So, if you have a large family, you may be able to get a better deal by adding them to your employer’s plan. As with any insurance change though, don’t make any changes without consulting with an experienced insurance advisor in your state.
  • Group health insurance in most states is guaranteed issue – meaning that you can’t be turned down because of pre-existing health conditions. This is a real blessing if you or a family member has a medical condition that prevents you from qualifying for a individual plan. But, this is a double-edged sword. While being guaranteed issue is a huge benefit for those with pre-existing medical conditions, it does come at a price. This one feature alone accounts for most of the disparity between group and individual insurance premiums. Yes, that is right – in most states, individual health premiums are almost always less expensive than group health premiums.
  • Most group plans cover maternity. So, if you are planning on having more children, you should definitely consider hopping on to a group plan. While you can add a “maternity rider” to individual plans, these riders tend to be expensive, restrictive, and otherwise provide less value than the coverage you can get in a group health plan. That being said, if you are considering having more children, we recommend that you contact a health insurance advisor in your state for advice about what is best for your family. The right answer is different for each unique family.
  • Economies of scale can benefit employees of large employers. It is true that the larger the group, the larger the risk pool is in which to share the risk which CAN result in lower premiums than are available in the individual health market. However, the guaranteed issue “issue” CAN wreak havoc on this type of plan. For example, a large employer with good benefits tends to retain employees for long periods of time. Eventually, the average age of the group starts to creep up and so do premiums. In addition, people with large medical needs (expensive medical conditions) tend to be attracted to large plans because they are guaranteed issue with good coverage. And so, over time, not only is the group’s average age increasing, but the group is also attracting employees with large expected health costs. This is the dilemma that we see with large health plans like the U.S. auto-makers and even government plans. Eventually, those with lots of medical needs begin to outnumber those with little or no needs and so premiums are driven higher and higher.

Group Health Insurance Cons

  • Group health insurance can be more expensive than individual health insurance. ln fact, if you don’t factor in the employer’s contribution towards premiums, then individual plans are almost always more affordable than group plans. However, as we discussed earlier, not every one can qualify for an individual plan.
  • What happens if your employment is terminated (by you or your employer)? Yes, you will likely have some benefit continuation rights (through COBRA or state continuation programs), but these benefits can be very expensive and the term limited. So, eventually, you either have to secure another job with benefits, an individual health plan (assuming you are insurable), or possibly join a government health insurance program for the uninsured (if you are not insurable). Let me emphasize, that you should NEVER be without some form of major medical health insurance. Being without this insurance puts you and your family in serious financial jeopardy. In fact, a recent Harvard University study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.¹ To the same point, every 30 seconds in the United States, someone files for bankruptcy in the aftermath of a serious health problem. Don’t let this happen to you.
  • Group health insurance premiums are rising faster than individual health insurance premiums. Why? Because most group plans are guaranteed issue and since they accept “all comers”, they tend to attract those with high medical costs. On the other hand, most individual health insurance plans are medically underwritten. This means that the insurance company can say “no thanks” to any application that it deems to not be in its interest. Put yourself in their shoes – would sign a contract to provide $30,000 in annual benefits to someone that was only going to pay $3,000 in premiums (for a net loss of $27,000) if you didn’t have to? Hmm…let me me think about that one. The answer is a resounding “NO!”. Because of this underwriting process for individual health insurance, insurance companies can control their risk and more effectively manage their profitability, resulting in more stable prices.

As you can see, there is no clear cut answer as to which type of insurance is the best. The answer depends on a number of factors and is different for every unique situation. The best advice I can give you as you consider your health insurance options — get good advice from an experienced health insurance advisor.

Turned Down For Health Insurance

If you’ve been living without health insurance, you’re not alone. 15.9 percent of all Americans are uninsured as reported by the UHF (United Health Foundation). Sadly, sometimes even when people are trying to be financially and socially responsible they’ll find that they’re unable to qualify for a health insurance policy.

According to survey by U.S. Census Bureau, nearly 60 percent of the population gets health insurance in the form of group policies through their employer. There are other people who get covered by government-sponsored health care, such as children, the elderly, and those with low incomes. Until recently, however, those outside of these groups were largely at the mercy of the policies of for-profit insurance companies when it came to whether they could get coverage.

If initially turned down, ask again or apply with another insurance provider

If you find that you’re in this group that has difficulty getting coverage, the first thing you should do is to try to find out what happened. In some cases, you may be rejected due to an error on the part of the company. If the reasons for your rejection were minor, you may also still be able to get individual insurance through another company. However, if you have a major pre-existing condition such as Cancer or Diabetes, it’s unlikely that any insurance company will consider you a good risk and you’ll have to seek out other options.

State high risk health insurance pools as an option

It is for this reason that a national high-risk insurance pool will be created within 90 days following the passage of the March 2010 Health Care Reform Act for people with existing medical conditions. The pool is backed by $5 billion in federal subsidies, and will offer subsidized premiums to people who have been uninsured for at least six months and have medical problems that have resulted in their being rejected from other insurance options. In some cases these risk pools will be run through the state governments. Either way, the law says that these pools will remain available until the new health care reforms have fully taken effect in 2014.

Prior to this legislation, high risk pools were already available in 34 states and covered 183,000 citizens. From the perspective of someone who wants a policy, the important thing to note is that the quality of coverage offered can vary widely depending on the attitude and policies of the state offering them. Some states are just more generous than others in programs like this, and if you believe that you’re likely to need to use your health care policy regularly, it’ll be worth your while to get a sense of the kind of coverage that your state offers. You should also remember that even though you’ll already be paying higher premiums than a typical insurance plan, you’ll still have to make sure you have enough money in reserve to cover deductibles and co-payments or health care will be as unattainable to you as ever.

In extreme cases, if you find your state’s high risk pool to be a completely unacceptable option, you still have choices but none of them are easy. If you’ve been working at running your own business or at a small business, you may be able to get into a group plan if you can find employment at a large company. In an extreme case, if you know that another state offers a high risk pool option that would work for you, and you have the means to do it (such as family in that area), you could even consider relocating.

Dos and Don’ts When Completing Individual Health Insurance

If you do not have access to a group employer plan then the other option you have is to apply for individual health insurance plan. Individual health insurance application require more information from you then group health insurance plans that you might have had through job. The reason for that is that individual, and that applies to family health plans, are medically underwritten. That means that a person called medical underwriter will go over your medical application and decide if you are a good risk for the insurance company. The main reason for medical underwriting is to keep over all cost for every one low. The more insurance company has to pay out in claims the more they have to charge every one for health insurance to keep the average cost down.

If you have already had a chance to take a look at individual application then you probably know that it can be long. How much of the application you have to fill out depends on your previous medical history. If you are in perfect health then there is not much that you can write on your application other then some basic information. If you are some one who has been to the doctors for lab work, test or takes prescription medication then you would have to include that on your application. Most individual application require you to provide information of your doctor or the last doctor you have been to. If you are not sure of the name of the doctor you can always include the hospital name, clinic name or doctors practice name. When it comes for the dates of your last doctor office visit or any other dates. If you do not remember exact dates, just put down your best estimate.

The most important thing to keep in mind when filling out individual or family application, especially if you do have some medical issues, is to understand this. Until there is a permanent change to health care system and health insurance is not medically underwritten. Insurance company will consider every condition that you have and every medication that you take. The reason for that is that in most states in the US health insurance companies require to cover everything once you are approved. That means that all of your medical conditions and prescription drugs have to be cover by law once you have been approved for coverage. That is if you are approved. I hate to use this analogy because we a talking about human lives, but the simple way to explain health insurance is to compare it to car insurance. For example lets say you get in the minor car accident and you do not have car insurance. Your car is still drivable and it looks like you will need a new bumper and some paint. The next day you go out and purchase car insurance to cover your accident. Well we know it does not work like that. If you could just go out and get car insurance only after you had an accident then no one would pay for car insurance. Why pay if you can just get it after you had an accident. No one would pay for car insurance and car insurance companies would not exist. Then you would be fully responsible for all the damages out of your own pocket. I know I would rather pay that $100 a month just in case something does happen.

Most people do not recognize that health insurance works in the same way. Health insurance companies are not going to approve some one who requires immediate medical assistance. That includes pending follow up visits to the doctor, recent surgery (after a surgery a lot of complications can arise), prescription drugs and anything that is known upfront that could potentially be covered expense. Insurance companies use a “actuarial tables” to underwrite individual applications. If based on what you have put down on the application could potentially cost insurance company money, chances are your application will not be approved.

If health insurance companies automatically approved all the application then it would be the same scenario as with car insurance example, that no one would pay for health insurance. I know I would not, why pay for insurance if I can get it when I get sick. If no one would pay for insurance then there would no insurance companies to cover us for unforeseen large medical expenses. I am certainly not prepared to pay $400,000 or higher for medical emergency.

Getting approved for health insurance could take some preparation. If you are currently taking prescription drugs, find out how to can slowly get off them. I am not a doctor and certainly would never tell anyone to not take drugs that were subscribed by their doctor. I think sometimes great health starts with us, with small daily choice we make. Take care of your body and it will take care of you. When completing application sometimes being too honest can cost you also. That does not mean lying. Going to chiropractor and writing on the application that you have had back pains and you will need to see a specialist. On top of that is that you have not has any health insurance previous is just way to suspicious. It looks like you are trying to get health insurance to get medical care for something that you do not want to pay yourself. Do not make it worse then it is and always phrase everything in the positive. Instead of you writing that you are having back pain, taking Advil and going to chiropractor. Phrase it that you went to chiropractor for maintenance just to realigning your back. I see a lot of people get declined for coverage even though they are in perfect health just because how and what they wrote on the application.

Real people will be looking at your application if you are making it worse then it is or you are volunteering too much information then it is only your fault if you get declined. Your answers should be, everything is fine, just a check up, results were normal. Also before you know that you might be looking for health insurance do not go see your doctor until you do have coverage. If you go to the doctor and they find something “wrong” with you then bye, bye health insurance. Now you are stuck. When at the doctors office, again, be careful what you tell your doctor because it will end up in your medical records. When self diagnosing your self do not volunteer that information to your doctor, it is your doctors job to find if there is an issue. If you have been declined for health insurance there are options available to you so is having or not having health insurance. Having any health insurance plan is infinitely better then not having anything at all. It is a know fact that you will get a better treatment if the hospital knows that you have some way to pay for your medical care and that they are not just working for free taking care of you. The one and the most important thing that you can do is to take care of your health. Eat your broccoli.

Health Insurance in California, Now What

If you are reading this then you probably have been declined for health insurance in the recent past. When you get declined for health insurance it probably has something to do with your medical history. Since California is one of the underwritten states health care companies have the right to declined people for health insurance. Who health insurance company might decline and who it might not all depends on risk assessment using actuarial tables. Anytime when you fill out individual application for health coverage and answer yes on one of the medical questions your application might be manually reviews by one of the underwriters. It is a person who is responsible to reviewing application using actuarial tables. Actuarial tables are statistics done by the insurance companies, hospitals, doctors, researchers that predict the cost of insuring some one with a specific medical history.

Some states like New York, New Jersey and Washington require insurance companies to insure everyone. Those three states do not have medical underwriting and everyone is automatically approved for health coverage. In order to insure everyone with medical history insurance companies increase rates to the point where it becomes un-affordable to most people. What keeps the average monthly premiums low is low utilization of health care. If there are more people with high medical insurance utilization with a specific health insurance company they have to raise the rates for everyone in order to keep up with paying medical claims. That also drives people who do not use health insurance that often to drop health insurance all together and yet driving rates even higher. This leaves no choice for insurance carriers but to drive rates even higher. New York, New Jersey and Washington have highest premiums for medical coverage and a lot of families find health care out of reach.

In California if you have been declined for health coverage you have options. If you out of job or currently on low income you can qualify for Medical and if you have kids they can qualify for a program called Healthy Families. Most states including California have high risk pools that are designed for people who have been declined for individual health insurance. In California this program is called MRMIP. Just the quick search on the Internet will guide to a government website. MRMIP is a program that is managed by the state and your big name medical insurance providers participate in it. Chances are you will be able to keep the same health insurance company if you are already use to them. MRMIP program has limits and it might have a waiting period.

One of the best options might be when it comes to getting the most coverage for your money is through a group plan. In the state of California all group plans by law are required to be a guaranteed issue. That means that there is no medical underwriting. This options requires more work from you. Insurance companies are not just going to let you set up a group plan if you have been declined for individual health insurance. Since insurance companies are required to insurance everyone who is part of the group state requires insurance companies to have rules when it comes to setting up a group plan. Some of the basic requirements change from the insurance company to the insurance company.

The best way to find out is talk to insurance broker. The basics that insurance companies are going to be looking for are that you have to have a reason for starting a group plan other then getting medical insurance. It is illegal to start a group plan just to get health insurance. That means that you have to have a business and that could be anything. To have a group plan you obviously have to have more then just yourself It takes at least two people to start a group plan. All the people that are going to be on the group plan are either have to be the owners of the business or have to be on the payroll. Some insurance companies require either a DE-6 form or six weeks of payroll records. If every one if the owner then you will be required to provide proof of the ownership listing everyone that is going to be on a group plan as the owner. This might not be simple but is is certainly doable and it is definitely worth it if you do not have any coverage and cannot get it on your own.

It is always easier to just blame the insurance company that they have declined you for health coverage. If you have been declined and are looking for health insurance you just have to be more proactive in getting your coverage. Once you work with a broker on getting on the requirements on setting up a group plan then it is forever yours and no one can take that coverage away from you unless you stop paying for it.

California Health Insurance

You have just completed an online form requesting a free health insurance quote and moments later you are being inundated with phone calls from insurance agents hoping to get your business. Try not to become overwhelmed or annoyed by these “pesky sales people” because they are really not telemarketers. Most of them are well-trained state licensed professionals who can really help you make a good decision regarding which health plan is best and most affordable for your individual or group coverage needs.

You may be under the misconception that if you buy your health plan directly from the insurance company, and cut out the “middle person”, you will save money. This is absolutely not the case. In fact, insurance companies rely on agents for most of their business and that’s why they pay them commissions for bringing in customers. It does not cost a consumer one penny more to use a licensed California health insurance agent to obtain their insurance coverage.

There are many differences between California health insurance and other states including how it is applied for.

For example, while Blue Cross and Blue Shield are one company in other states, here in California, each is separate and applied to individually as Anthem Blue Cross of California and Blue Shield of California.

California health insurance law AB 1672 is an improvement over the federal HIPAA law that covers all states in that it includes the following with regard to California group coverage:

1. Individuals with pre-existing medical conditions may change over to a new group health plan without an exclusionary period.

2. It allows small businesses and professional organizations to have access to health plans providing they have between 2 and 50 full time employees.

3. It keeps insurance rates from climbing after a claim is filed.

4. Employees who have health problems may change jobs or health plans without being rated higher for having pre-existing conditions.

That said, the very best health insurance agent for your individual and business needs is an “Independent Agent.” Why? Because they represent multiple insurance carriers, not just one. An independent agent can help you select the most appropriate cost-effective plan offering the most benefits for your dollar as available from the major carriers, rather than feeding you just one company’s line of health plans which may not suit your particular needs. Many people are too complacent and settle for what their current insurance company has to offer. They could use a good independent agent to sort through the many plans available from multiple insurance carriers to find and provide the best choice of options.

Another misunderstanding you may have is that insurance agents set the premium rates for the health insurance plans they sell. Thinking if you shop around you may get a better price for the same plan. Premium rates are based on your age, zip code or county in which you reside and are controlled completely by the insurance companies. Every agent uses the exact same rate guides set by the insurance companies. The condition of your health may affect your premium, which may be rated up after the insurance company’s underwriting department has reviewed your medical records. Again, the insurance company, not the agent, determines that outcome.

Now, let’s talk about the benefits of having a good insurance agent representing you. Most consumers neither know nor understand the benefits of a health plan being offered and need the expertise of an agent to explain the benefits to them in full. For example, do you know what the difference is between an “out-of-pocket maximum” and an “annual deductible?”

An out of pocket maximum is the most you will have to pay in a given year for deductible and coinsurance for covered benefits before your insurance starts to pay 100% of most expenses until the year ends.

An annual deductible is usually the amount you pay each year before your health plan starts paying anything for covered services. Generally, the higher the deductible, the lower the premium. Certain services such as prescription drugs carry separate deductibles. Plans may vary and sometimes benefits will kick in before you have to meet the deductible.

A knowledgeable health insurance agent can be a guide through the maze and help you choose the right plan to meet your needs and budget while obtaining the most benefits for your dollars spent. An agent will also make clear how the benefits for a generic prescription may differ from the benefits for a brand prescription on a particular plan.

After you have a health plan in place, a good, caring agent will remind you to pay your premium on time so the insurance company doesn’t cancel you. Your agent can also be an enormous resource for assistance if you run into a problem with a health insurance claim. Instead of waiting on hold at the insurance company’s 800 number for thirty to forty- five minutes, call your agent and explain your problem and if you have chosen the right agent, you will get help and may save yourself lots of time and frustration, maybe even some money by having an expert in your corner where your best interests come first.

So next time you or someone you know, fills out one of those on-line forms for a health insurance quote and you get several phone calls from health insurance agents wanting your business, be grateful that a professional wants to help you for free to choose the right plan and you’ll have an important friend for life.

My name is Diane Le Montre, License # 0D18343, your California Health Insurance Specialist with more than 25 years experience. I am an Authorized Independent Agent for the major California health insurance companies including Anthem Blue Cross, Blue Shield of California, Health Net, Cigna, Aetna, UnitedHealthcare and Kaiser.

Let me guide you through the maze of obtaining proper health insurance coverage for you, your family or business, with an individual or group plan based upon your specific needs. I will find the best coverage for your insurance dollar by analyzing the various plans of the major insurance companies I represent.

Want to Use Your Health Insurance for Counseling

Why not use your health insurance for counseling? Isn’t that what it is for?

Perhaps.

But using health insurance for mental health services is a little different than other medical issues. Sometimes mental health issues are not covered by your health insurance. Once you use your health insurance for mental health, you will have a mental health diagnosis on file – a mental health disorder/mental health illness must be on the insurance claim in order for insurance to pay for treatment. This will be in your permanent medical record.

Of course you want to consider using your health insurance for counseling, but there are some good reasons for you to consider why you may not want to use your insurance for counseling services.

Why doesn’t my counselor accept my health insurance?

Many counselors choose not to accept health insurance for very good reasons. They want to focus 100% of their time in treating you. If they accept health insurance, there is a lot of extra work involved in accepting insurance, in addition to agreeing to work for a discounted fee. The counselor may spend hours on the phone getting benefit information, authorizations, or following up on claims payments. The counselor has to wait a month for payment from the insurance company. The counselor has to file progress reports with the insurance company. The counselor is required to submit treatment reports and other details about your medical history with the insurance company.

It’s not that counselors don’t like insurance companies, or don’t want you to use your insurance (we have health insurance too!), but many counselors prefer to focus 100% of their time and energy in helping clients, rather than doing paperwork for insurance companies.

But this isn’t the only reason counselors may not be in network with your health insurance company.

The other reasons are more compelling, and you need to consider them BEFORE you decide to use your health insurance.

Many counselors prefer not to work in network with health insurance companies so that they can better protect your confidentiality. Any information (claims, reports, or treatment plans) filed with health insurance leaves the protection of their office and their locked files and your personal, private, emotional information is outside of your counselor’s office. In order for any insurance company to reimburse or pay for counseling (both in network and out of network), you must be considered “ill”. You must be diagnosed with a mental health illness or disorder. If you are not ill enough to warrant a diagnosis, then insurance will not pay for counseling services. If you do qualify for a mental health diagnosis, your illness will be listed in your permanent medical record. Many counselors don’t like this “medical model” of declaring someone ill, so they choose not to accept insurance because they want to focus on their client’s strengths, and not label them as mentally ill.

Do you want to be considered mentally ill? If you have a mental health diagnosis already, because you have been to counseling or psychiatric appointments in the past, find out what your diagnosis on file is. If you already have a mental health diagnosis, this may not be a concern to you, but if not, you may not want this in your medical record.

Counselors also do not like releasing information to others to protect your confidentiality. Once a claim is submitted to the insurance company, who knows how many people take a look at it and rubber stamp it while it travels through the system? If insurance pays for any counseling sessions (in network or out of network), then the insurance company has the right to audit your complete file. They can request copies of counseling notes, assessments, and other personal emotional information to determine if you really are “sick enough” to warrant their payment. They can deny services to you if they think you aren’t sick enough or if they think your counseling is not “medically necessary”.

Additionally, there are many counseling issues that are not even covered by insurance at all. Stress management and anger management are usually not covered. Marriage counseling is usually not covered. Certain medical conditions/mental health conditions may be excluded (such as attention deficit disorder or adjustment disorder). Even if your illness or disorder is covered by your insurance plan, they may limit the number of visits they will cover (sometimes only 20 per year), and they will set a maximum amount they will pay per calendar year or in your lifetime.

Additionally, counselors prefer not to have someone in the insurance company telling them how to treat their clients. Insurance companies can decide what type of counseling is covered, what diagnoses are allowed, and how many times the client needs to come before they are cured. Many counselors prefer to work directly with clients to serve their needs, without interference from an insurance company.

Using your health insurance for counseling services can also affect your security clearance, life insurance rate, employment, or future health insurance coverage.

For the above reasons, I recommend that you be informed about using health insurance for counseling. You may choose to file anyway, but be an informed consumer.

  • Be an informed consumer.
  • Know your mental health diagnosis.
  • Talk to your counselor about the diagnosis.
  • Ask your counselor about your treatment reports.
  • Decide if you have, or want to have, a psychiatric illness.

If you have clinical, severe depression, anxiety, or other issues, then you probably already have a diagnosis.

But if you are stressed, having relationship problems, or trying to figure out your purpose in life, your symptoms may be minor, and you may not want to have a mental health diagnosis in your records.

Once an insurance claim is submitted to your health insurance company, your diagnosis becomes part of your permanent medical record, and can affect future life insurance, preexisting conditions, or the cost of private health insurance.

Jama Thurman is a Licensed Professional Counselor in Manassas, VA. She helps teens and adults who are stressed and anxious find peace and purpose.

You can get a FREE download of her book, How to Find a Counselor at [http://www.howtofindacounselor.com]. This book will help you figure out if you need professional help, how to find it, and whether you want to use your health insurance for payment for counseling services.

Buying Individual Health Insurance

When you’re buying individual health insurance, you’ll probably get overwhelmed by the prices and options of health plans online. Health insurance is now one of the more expensive items in the budgets of many people, but it can also be one of the best decisions you make if you have some know-how selecting the right health plan for you and your family. Here I will give you the 3 Essential Tips that I advise my clients to use when purchasing individual health coverage.

Tip 1: Do not take health insurance advice from someone that is totally unqualified to give you this advice!!

I cannot stress this enough. It amazes me how many sensible people take advice about what health insurance to choose from people who are totally unqualified to give you this critical advice. For example, when I see health insurance messes, (which I see virtually every day) and I ask where they got their health plan information, I inevitably hear things like: “My brother-in- law told me to choose this health plan, he used to work at the hospital.” or “I read an article that says this is the best plan available.” And so on. Everyone’s got an opinion about what health plan you should choose. Just because they are your relative, or involved in some area of health care totally unrelated to insurance, does not mean they know the answers to your individual needs and questions! Work with an insurance specialist BEFORE the problems come up! You have no idea how many clients I have worked with come to me after they chose a health plan online and then have an insurance coverage issue and expect me to fix it, I want to tell them: you should have come to me for help before! Most insurance specialists get paid through insurance carriers, so their services are free to you. USE THEM!!

Tip 2: Determine your actual needs.

The three things to keep in mind when determining your needs are: budget, patterns of doctor and hospital visits, and prescription drug usage. Ask yourself these questions: How frequently do you visit your doctor? Do you go for checkups only or do you go for sick visits? How many times have you been in the hospital in the past 2 years? Do you take regular prescriptions? What are they? Generic or Brands? This is another area where most of my clients neglect. It is not possible to have maximum coverage in all of these areas in any affordable way, maximum coverage for the doctor and hospital plus prescriptions leaves a dent in the budget. However, most health insurance plans offer more than one version of the same plan. For example, say you have “health plan A” that offers maximum coverage for the doctor, maximum coverage for the hospital, and maximum coverage for your prescription drugs. But “health plan A” costs the same as your mortgage. The good news is “Health Plan A” most likely also has customizable options, meaning if after analyzing your needs, you discover that you rarely visit a hospital, you could change “health plan A’ s” hospital coverage to moderate or even minimal which will bring down the premium a great deal. If these options are confusing to you, again, a health insurance specialist will be able to help you. They are already aware of “health plan A’ s” customizable features and can match your needs to the appropriate version of “health plan A”. A health insurance specialist also has access to versions of health plans that aren’t available as options to the average consumer buying health insurance online.

Tip 3: Resist the urge to over-insure!!

After you’ve analyzed your needs, resist the urge to over-insure! One of the most common health insurance messes I see is over-insurance. People think that if they have maximum coverage for doctors, hospitals, and prescriptions, they have “good” insurance. The truth is, most people who will be approved for individual health insurance won’t need all this coverage. Two things I advise my clients to be aware of: Health Care Reform and Stop-Loss. First, Health Care Reform allows for preventive care services to be covered at 100%. For example, if you only get checkups, why enroll in the plan with 100% doctor’s visit coverage? Enroll in the plan with a lower premium and pay a $10 copay for your sick visit. The difference in premium with this small detail is $100’s of dollars! Furthermore, some of these “maximum coverage” health insurance plans exclude things like pregnancy. The last thing you want to do is pay a small fortune for “good” health insurance only to discover it won’t cover something you need it for! Second, most health insurance plans have a stop-loss built into them which basically states that when your out-of-pocket costs reach a certain amount, the plan will cover you at 100% for all services. And you don’t need the “maximum coverage” plan for this benefit. Your health insurance specialist can even customize this stop-loss amount!

Then, select your plan after following My 3 Essential Tips:

1. Do not take health insurance advice from someone unqualified to offer this advice. Seek a health insurance specialist, they have studied and are licensed to offer this advice and they’re free to you. USE THEM!!

2. Consider your actual needs. Ask yourself questions so you know what your specific health plan needs are, that way you can make sure you select a plan that meets them. After all, if you don’t know what you actually need in a plan, how will you know if you’ve come across the right fit?

3. Resist the urge to over-insure! Health Care Reform has changed how many plans work and you may be able to receive ample or superlative coverage without over-insuring. And most importantly, without the hefty premiums!

Know More About Types of Health Insurance

Individual, families, groups, and businesses need customized health insurance plans to ensure that they have to spend minimum out-of-the-pocket money for their healthcare needs. With the implementation of healthcare reforms, the options for buying health insurance are widened.

With the advent of internet technology, the concept of transparency of price is gaining momentum. Insurers in Florida health insurance are facing a compelling need of price transparency when they offer health insurance quotes to their clients. At the same time, application time and waiting time for health insurance has reduced significantly as compared to earlier times.

Types of health insurance plans offered in Florida
Apart from State and Federal governments’ sponsored program including Medicare, Medicaid, etc., there is an option of buying health insurance from private companies. Like many other states, health insurance plans in Florida are offered to the residents in traditional format. These could be classified as:

1. Individual health coverage
2. Family health coverage
3. Group insurance
4. Student health coverage
5. Dental health insurance
6. Low cost insurance
7. Low-income families insurance
8. Short-term insurance
9. Small business insurance

Companies offering health insurance Florida
Below is the list of health insurance companies offering health insurance to the residents of Florida:
• Aetna
• AMS
• Assurant
• Avalon Healthcare
• AvMed Health Plans
• Blue Cross and Blue Shield
• Celtic
• Cigna
• Coventry
• Golden Rule
• Humana One
• IAC
• Solera Dental
• Vista

Types of health plans offered in Florida

A lot of consumer end up having discount coupons, which sometimes are termed as health plans; however, it needs to be understood that these discount coupons are not insurance. To buy affordable health plans in Florida, consumers need to equip themselves with proper knowledge about the same.

Traditional categorization of health coverage in Florida offers indemnity and managed care health plans. Indemnity health plans have the insured file claims for reimbursement. While managed care health plans allow the providers to file claims for the insured person.

Managed care health plans are further categorized as HMO, PPO, and POS.

Impact of the Affordable Care Act on insurance in Florida
• 290,000 small businesses in Florida will be offered tax credits for offering health coverage to their employees.
• Medicare beneficiaries in Florida will be automatically mailed a check of $250 to defray the cost of their prescription drugs.
• Early retirees will be offered reinsurance options.
• Uninsured Floridians with pre-existing condition will have a huge boost with $351 million federal dollars made available to Florida starting July 1 to provide coverage.
• Like many other states, for the first time ever, Florida will have the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.
• 8.8 million Floridians will no longer have to worry about lifetime limits on the coverage.
• Around 1.1 million individuals will not have to worry about getting dropped from coverage when they get sick.
• Children in Florida will be able to stay with their family insurance policy till the age of 26 years.

Costs involved in a health coverage plan in Florida

It is important to understand types of costs involved in a health coverage plan to make sure that Floridians have assessed everything before they finalize a health plan. We talk about the types of costs involved in a health coverage plan:

Premium-premium is the amount of money to be paid on monthly basis. Premium is the main cost that a health plan constitutes. It could vary from person to person and in plan to plan. It mainly depends on the age, gender, and health status of a consumer applying to get health coverage.

Deductible-deductible is the second major cost involved in a health plan. It is the amount of money that a consumer pays before the insurer actually begins to pay for the coverage. With higher deductibles, premium costs are reduced.

Coinsurance – coinsurance, as the name explains itself, is the amount of money that the consumer agrees to pay in percentage of the total cost of medical service after the deductible has been paid. Generally, it is usually 80/20 of the total value where 80% of the cost is paid by the insurance companies while the 20% is by the consumer.

Copay – copay is like coinsurance but it is not represented in percentage but in real value. Moreover, there is no consideration of deductibles in copays. Supposing a consumer needs to pay $70 per visit for the doctor: with copay, consumer will be paying $40 and the remaining $30 will be paid by the insurer. However, this copay facility will have some impact on the premium costs.

All About Affordable Health Insurance

While consumers search for affordable health insurance, they have price in their mind as the top priority. A general conception among the consumers is that cheap health plans should not be costly-the cheapest health plan available in the market is their target. However, this approach is not good. Sometimes, paying for a cheap health insurance plan but still not getting the required level of coverage results only in wastage of money.

With the implementation of the affordable care act, the reach of affordable health plans is set to increase. Or at least, this is what is believed to be the objective of healthcare reforms. However, lots of consumers are still in confusion about how things would work. In this article, we will discuss some detailed options that consumers can try while looking to buy affordable health plans.

To get a hand on affordable health insurance plans, consumers need to take of certain things. First among them is about knowing the options in the particular state of the residence. There are lots of state and federal government-run programs that could be suitable for consumers. Knowing the options is pretty important. Next would be to understand the terms and conditions of all the programs and check the eligibility criteria for each one of them. Further, consumers should know their rights after the implementation of healthcare reforms, and something within a few days, they may qualify for a particular program or could be allowed to avail a particular health insurance plan. If consumers take care of these steps, there is no reason why consumers can’t land on an affordable health plan that could cater to the medical care needs.

Let’s discuss some options related to affordable health insurance plans state-wise:

State-run affordable health insurance programs in California

While considering California, there are three affordable health insurance plans that are run by the state government. Consumers can surely get benefitted by these if they are eligible for the benefits.

• Major Risk Medical Insurance Program (MRMIP)

This program is a very handy one offering limited health benefits to California residents. If consumers are unable to purchase health plans due to a preexisting medical condition, they can see if they qualify for this program and get benefits.

• Healthy Families Program

Healthy Families Program offers Californians with low cost health, dental, and vision coverage. This is mainly geared to children whose parents earn too much to qualify for public assistance. This program is administered by MRMIP.

• Access for Infants and Mothers Program (AIM)

Access for Infants and Mothers Program provides prenatal and preventive care for pregnant women having low income in California. It is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees.

Some facts about affordable health insurance in Florida

While talking about affordable health insurance options in Florida, consumers can think about below mentioned options:

• Floridians who lost employer’s group health insurance may qualify for COBRA continuation coverage in Florida. At the same time, Floridians, who lost group health insurance due to involuntary termination of employment occurring between September 1, 2008 and December 31, 2009 may qualify for a federal tax credit. This credit helps in paying COBRA or state continuation coverage premiums for up to nine months.

• Floridians who had been uninsured for 6 months may be eligible to buy a limited health benefit plan through Cover Florida.

• Florida Medicaid program can be tried by Floridians having low or modest household income. Through this program, pregnant women, families with children, medically needy, elderly, and disabled individuals may get help.

• Florida KidCare program can help the Floridian children under the age of 19 years and not eligible for Medicaid and currently uninsured or underinsured.

• A federal tax credit to help pay for new health coverage to Floridians who lost their health coverage but are receiving benefits from the Trade Adjustment Assistance (TAA) Program. This credit is called the Health Coverage Tax Credit (HCTC). At the same time, Floridians who are retirees and are aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), may qualify for the HCTC.

Some facts about affordable health insurance in Virginia

While talking about affordable health insurance options in Virginia, consumers need to consider their rights:

• Virginians who lost their employer’s group health insurance may apply for COBRA or state continuation coverage in Virginia.

• Virginians must note that they have the right to buy individual health plans from either Anthem Blue Cross Blue Shield or CareFirst Blue Cross Blue Shield.

• Virginia Medicaid program helps Virginians having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, and elderly and disabled individuals are helped.

• Family Access to Medical Insurance Security (FAMIS) helps Virginian children under the age of 18 years having no health insurance.

• In Virginia, the Every Woman’s Life Program offers free breast and cervical cancer screening. Through this program, if women are diagnosed with cancer, they may be eligible for treatment through the Virginia Medicaid Program.

Some facts about affordable health insurance in Texas

While talking about affordable health insurance options in Texas, consumers need to consider their rights:

• Texans who have group insurance in Texas cannot be denied or limited in terms of coverage, nor can be required to pay more, because of the health status. Further, Texans having group health insurance can’t have exclusion of pre-existing conditions.

• In Texas, insurers cannot drop Texans off coverage when they get sick. At the same time, Texans who lost their group health insurance but are HIPAA eligible may apply for COBRA or state continuation coverage in Texas.

• Texas Medicaid program helps Texans having low or modest household income may qualify for free or subsidized health coverage. Through this program, pregnant women, families with children, elderly and disabled individuals are helped. At the same time, if a woman is diagnosed with breast or cervical cancer, she may be eligible for medical care through Medicaid.

• The Texas Children’s Health Insurance Program (CHIP) offers subsidized health coverage for certain uninsured children. Further children in Texas can stay in their parent’s health insurance policy as dependents till the age of 26 years. This clause has been implemented by the healthcare reforms.

• The Texas Breast and Cervical Cancer Control program offers free cancer screening for qualified residents. If a woman is diagnosed with breast or cervical cancer through this program, she may qualify for medical care through Medicaid.

Like this, consumers need to consider state-wise options when they search for affordable health coverage. It goes without saying that shopping around and getting oneself well-equipped with necessary information is pretty much important to make sure consumers have the right kind of health plans.