C++ and C+ (Fair)
-
C and C-
(Marginal)
-
D (Very
Vulnerable)
-
E (Under State
Supervision)
-
F (In
Liquidation)
For additional
information, call A.M. Best at 908-439-2200.
Solution To
The Problem
You can ask your
agent to show you a current copy of their company's A.M. Best Report.
Get on the phone and call A.M. Best to find out the real story on any
company before buying a health insurance policy.
Shard
#2
All Health
Insurance Companies Do Not Pay Claims According To The Same Standard:
There are only
three main categories in which claims may be considered for payment:
1. Let the hospital
or doctor decide what the insurance company should pay.
2. Let the insurance
company decide how much they should pay.
3. Let data from an
independent third-party determine the amount paid.
If a hospital or
doctor decides, it's the equivalent of giving them a blank check and
saying, "fill in the blank $________ for how much you want and we'll pay
it." This is called Actual Charges. This is not a common practice with
insurance companies, because they can go broke if they don't place some
restrictions on how much money is coming out of the insurance pool. If
claims payments are not restricted in some way, there would not be
enough money in the insurance pool to help cover the risks of other
policyholders. Proceed with caution when an insurance company claims
they pay actual charges. What is more common is that the majority of
insurance companies decide what they want to pay. When an
insurance company decides how much they choose to pay for a claim, they
use wording like this:
-
We pay
reasonable charges
-
We pay
prevailing charges
-
We pay average
charges
-
We pay
permissible charges
-
We pay regular
charges
The above terms mean
whatever the insurance company says they mean. The company is in control
of determining what the meaning is. This is usually not what the
hospital, doctor or policyholder feels it should be and therefore much
confusion and misunderstandings occur as a result. As long as the
insurance company is in the deciding seat, their standards can change at
any time.
Solution To The
Problem
The insurance
company should use data from an independent third party to make the
determination about how much to pay. There are companies that specialize
in conducting nationwide studies of Usual and Customary Charges by
health care providers in geographic areas throughout the United States.
They publish these findings for insurance company use. Some companies
pay based on these Usual and Customary Charges, but some companies pay
something less, whatever they feel is reasonable, etc. Choose an
insurance plan from a company that pays Usual and Customary Charges
based on data from an independent third party after any deductibles or
co-payments have been met. Ask your insurance agent before buying.
Warning!
Beware of
companies who attempt to fool you by adding extra wording like usual,
customary and reasonable charges. (U,C,R) Adding another word to the
term changes the true meaning and is a loophole for the company to still
decide how much they want to pay for any claim.
Shard #3
All Health
Insurance Plans Do Not Cover Doctors The Same Way:
A policyholder
may be shocked to find that when they need two or more doctors for a
medical procedure, that only one is covered and additional doctors are
not. This goes back to an old English lesson we learned in grade school.
For example, let's take the word surgeon. There is a difference between
surgeon ıs fees and surgeonsı fees. Still confused? Take a closer look.
Notice where the little apostrophes are placed? Nıs means one surgeon.
Nsı means two or more. Most people donıt pay attention to this when an
insurance agent "says" our plan covers surgeon ıs or surgeons' fees,
because both sound the same. An agent may not tell you this means only
"one" is covered and you will be responsible for the charges for any
additional surgeons. You can lose thousands of dollars of your
hard-earned money by overlooking where the little apostrophe is placed.
Solution To
The Problem
Make sure your
health insurance plan covers multiple doctors and does not limit who can
treat you. Make sure your agent explains to you in simple terms how many
are covered. Ask your insurance agent before buying.
Shard
#4
All Health
Insurance Plans Do Not Cover All Medically Necessary Hospital Care :
Some plans will
only cover certain hospital procedures as outlined in the policy. If it
ıs not listed, it ıs not covered unless you see the phrase "and all
other medically necessary hospital expenses". This phrase is important.
Because if a doctor performs a medically necessary procedure that ıs not
on the list, it ıs not covered, leaving you responsible for the
charges.
Solution To
The Problem
Make sure your
health insurance plan covers all other medically necessary hospital
expenses. Ask your agent before buying.
Shard
#5
All Health
Insurance Companies Do Not Treat Pre-Existing Conditions The Same:
If you have been
accepted by a health insurance company, you will normally have a waiting
period before your pre-existing condition is covered. A waiting period
of 24 months is typical for most plans in the industry. Some companies
will give you credit for waiting periods satisfied on your previous
policy and some states even require this benefit. If you have a serious
health condition that is unacceptable, a company may offer you a Rate-up
or an Exclusionary Rider in order to issue your policy. A rate-up means
you ıll be charged more to cover your serious condition. An exclusionary
rider means a specific condition will not be covered. A company should
be upfront with you about any exclusions. If you accept an exclusionary
rider, make sure any major system of your body is not excluded.
Solution To
The Problem
Make sure you
know exactly how your pre-existing conditions are covered and about any
waiting periods. Ask your insurance agent before buying.
Shard
#6
All Health
Insurance Companies Do Not Perform Rate Increases The Same Way:
Some companies
implement rate increases in a way that can single you out for an
increase independently of most other policyholders. They may raise your
rates each year you have a birthday or because you have collected too
much money from the plan. The purpose of a rate increase is to offset
claims loss and inflationary increases. Since all insurance companies
are subject to paying claims and the economy, there will always be a
need for periodic rate increases. However, when this need arises, you
don ıt want to be "singled out" due to your age or health status.
Solution To
The Problem
Make sure you can
NOT be singled out for rate increases on an individual basis. Buy a plan
that performs any necessary rate increases on all the policyholders of
the
same type in your
particular state. Ask your insurance agent before buying.
Shard #7
All Health
Insurance Plans Do Not Provide The Same Dollar Limits:
Many health
insurance companies only provide up to $500,000 for each injury or
illness and a $1 million to $2 million lifetime maximum for all insured
applicants combined. Medical costs are not what they used to be. Don ıt
get stuck with an outdated policy. For example, premature childbirth may
have expenses of $200,000 or more in the first six months alone. If you
encounter a major catastrophic injury or illness, you want to be sure
you ıve got a plan with sufficient dollar limits to cover today ıs
rising medical costs.
Solution To
The Problem
Consumer-oriented
health insurance companies now provide $1,000,000 to $2,000,000 for each
injury or sickness and a $3 million to $5 million lifetime maximum for
the entire family. Choose a plan that is keeping up with the rising
costs of medical care. Ask your agent what the limits are before buying.
Summary
of Report:
Hopefully this
report has helped you become a better educated consumer about health
insurance plans. Choose a health insurance plan based on the quality of
the Company and the Plan first. Then adjust the rates by increasing your
deductible or co-payment amount to make it affordable. If you buy a
cheap plan, you ıll get what you pay for. Don ıt make your buying
decision based on low- cost prescriptions, doctor visits and the monthly
premium payment alone. Find out if you ıll be covered 24 hours a day, on
or off the job, and if the plan is good in any recognized hospital in
the world. Buy from a professional, licensed Agent in whom you can have
complete trust and confidence. Find out how long it takes the company to
pay its claims. Have your Agent explain the general list of exclusions
and limitations on the plan. Get the phone number of your Agent and your
insurance company ıs customer service division for help and assistance.
Finally, stay informed and remember to vote on issues to improve the
health insurance industry.
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