Posts Tagged ‘health

01
Mar
10

Health claim denied? Here’s what you need to know.

Health Insurance denials can happen for a number of reasons.  A simple cause can be a billing error from the provider’s office.  If the claim is submitted using the wrong treatment or diagnostic code, the claim can be denied.  More serious reasons can involve treatments considered “experimental” or “pre-existing”.  Both of these reasons can be appealed if you feel the insurance company’s decision is wrong.

If your healthcare claim is denied, you have the right to appeal.  Health Insurance carriers are required to provide an appeals process.  Typically there are a few levels of appeal, each moving more ‘independent’ by involving impartial medical professionals.  Washington State also provides the Patient’s Bill of Rights which provides an independent third-party review of your appeal, if the standard appeals process is unsuccessful.

Washington Health Insurance Agency provides assistance through the appeals process, by walking their health insurance clients through the steps, carefully tracking the appeal deadlines, recommending the best supporting documents, and even participating in the appeal discussion board via conference call on behalf of their clients.

The most important thing to remember is that if you feel the denial is wrong, you have to appeal.  Many people just assume there is nothing they can do.  The New York Times recently reported a story about this very point.

Remember, if you have the right Health Insurance Agent, you don’t have to go through the appeal process alone.

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24
Feb
10

Small Business owners pay too much for health insurance

There’s a huge misconception out there that if you own a business, you get a better deal on health insurance.  The fact is, many “group” health insurance plans come with higher price tags than individual health policies.

For the small business owner with 5-7 employees or less, offering to reimburse employees for their individual health insurance policies through an HRA (Health Reimbursement Arrangement) can prove a significant cost savings to the business, while giving more freedom of health insurance plan choice to their employees.

In addition, the employees ‘own’ their individual plans, which means there’s no need for COBRA coverage if they leave their current employer.  Since businesses smaller than 20 employees do not offer COBRA coverage anyway, individual plans become even more attractive.

The biggest advantage of individual health plans over small group plans is price.  Individual health plans typically offer lower premiums than similar group plans.   The reason is risk.  Individual health insurance in Washington State requires a health risk questionnaire be completed as part of the application process.  The purpose of the health questionnaire is to ‘weed out’ the higher risk applicants with significant health risks.

Most people pass the questionnaire with ease.  When they do, they fall into the same group as everyone else who also passed the same questionnaire, which represents a lower ‘risk’ to the insurance company, thus lowering rates.  (Those who do not pass the health questionnaire are provided the opportunity to sign up on the Washington State Health Insurance Pool, a high-risk pool with significantly higher premiums)  If a business has an employee who does not pass the health questionnaire, then it can still prove less expensive to cover the high risk pool premium for that individual employee versus paying higher group rates for all employees.

Group plans in Washington do not have a health questionnaire, so the insurance company has no way of ‘weeding out’ the unhealthy employees.  The rates have a ‘built in’ risk factor, whether warranted or not, because the insurer has no way of  separating the high risk groups from the low risk.  Groups of 2-50 employees are ‘community rated’ meaning they are in the same risk pool whether their employees have low utilization or high.   Therefore, the small business with healthy employees ends up paying a higher rate because of other businesses who may have employees with expensive high risk chronic health problems.

Offering individual health plans to employees comes with more advantages than just lower price.   They also come with less administration.   Unlike ‘group” plans, there are no ‘renewals’ each year to go through, no minimum participation requirements imposed by insurance carriers, and no minimum employer contribution requirements, either.   Employers still have the ability to define eligibility, probation periods, and can design their health benefit package with more options and flexibility.

The Washington Health Insurance Agency has been providing creative solutions like this to small business owners for years.  Give us a call at 360-464-1622 to find out if you’re paying too much for your health insurance coverage or fill out our business quote form for a free cost comparison at http://www.washingtonhealthinsuranceagency.com/health-insurance-for-business

04
Feb
10

Is Pregnancy a Pre-Existing Condition?

It happens from time to time that I get a call from a woman who is pregnant, and she has no health insurance.  In Washington State, there are programs available through DSHS for pregnant mothers that will pay for costs associated with a pregnancy, including the delivery.  However, many times applicants do not meet the low income requirements to qualify for the State assistance. 

Health Insurance carriers in Washington have 9 month waiting periods for most pre-existing conditions.  This 9 month waiting period is waived if proof of prior credible insurance is provided, but when there’s been a lapse in coverage of more than 2 months, then the new insurance plan will have a 9 month waiting period on ‘pre-existing’ conditions (conditions treated or that should have been treated in the past 6 months) 

Pregnancy has a different set of rules when it comes to the standard pre-existing condtion clause.

Coverage offered by an Employer (also called ‘Group’ insurance) typically DOES NOT consider pregnancy a pre-existing condition.  Maternity and Diabetes are often exempt from the 9 month waiting period and covered without any issue.

Individual health insurance carriers do consider pregnancy a pre-existing condition.  However, they will cover everything except the charges associated with the actual delivery.  All prenatal doctor visits and ultrasound costs leading up to the delivery will be covered, even if there is a 9 month waiting period on the plan. Additionally, these plans will often pay for hospital and physician charges surrounding complications for the mother or newborn, as well as postpartum costs.   

The cost of having a baby can range from as little as $4000 to as much as $20,000 or more if there are complications, premature birth, or an emergency c-section.   Having the right health plan will make sure those costs are covered.  For more information on the best health insurance to have when pregnant, give us a call 360-464-1622 or visit us at www.wahealthagency.com

07
Jan
10

Tyson got a new truck

I received a call recently from a young couple, Tyson and Stacie, who had heard about me from their auto insurance agent.  They were wondering if I could save them some money off their health insurance.  Tyson had a great job working for an excavation company, and his employer paid 100% of his health insurance premiums.  Like many employers, however, they did not pay for his wife’s insurance.  In Tyson’s case, I  found out that $207 was being deducted from his paycheck for Stacie’s health insurance.  He’s paid twice a month, so that meant her health insurance was $414 a month!   After comparing a few plans, I was able to show them how she could buy her own individual health insurance plan for only $175/mo, AND we lowered her deductible by $500.  Tyson quickly figured the savings in his head and exclaimed “I can buy a new truck!” -which I found out later he did just that.  Many people assume the best place (or only place) they can get health insurance is through their employer.  If the employer is paying the premium, then they’re right.  If not, there’s a very good chance they’ll be paying more than they have to.  To find out how much you can save, call us at 360-464-1622 or visit us at www.wahealthagency.com




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