Health Insurance Plans

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When we discuss about rising costs on medical and allied care for senior citizens, we are discussing of a situation where in the means of income are limited but the scopes of expenditure are unlimited. In order to match those two ends, various health insurance plans have been carefully thought in order to fulfill almost all medical and non-medical needs of a senior citizen in consideration of a meager premium.

One of such user-friendly plans is the HMO, with its low premium and high range of services coverage. It is more popular because of the managed- health- care outlook through which the patient or his family member can be rest assured and easily avoid the headache of choosing a good doctor and the other allied services. HMO not only takes care of the expenses of the medical services but also ensures the way that a patient is treated.

Major Health Plan Drawbacks

In a world where there are thousands of unscrupulous people waiting to mis-sell an insurance coverage, finding a great cost-effective medical insurance plan could be a blessing in disguise. With a whole of options available in the market, picking up the correct one can be a tough ask.

If you are a pretty well-educated consumer, you might have an advantage of evading a possible Health Insurance fraud. Being an expert in the field of insurance is not required to avoid frauds, just knowledge of certain technical terms is more enough. These are:

  • Co-Payment- Difference of amount between the Actual Physician charges and Coverage amount that the health insurance plan offers.
  • Premium- The amount of money you pay before your benefits start coming in.
  • Fee for service- A reimbursement-for-claim-forms type of insurance plan.

However, it is always advisable to enquire with your insurance agent or broker in regards to any term that you do not recognize or understand.

Following are some points which may help to indicate towards a faulty insurance plan:

  • Billing for services never requested or received.
  • Copy of Health Insurance Policy doc not received during purchase of policy.
  • Receipt for Cash premium payments not received.
  • Complicate and lengthy paperwork which confuses one to understand the basic coverage.

Protection from Health Insurance Frauds

Following are a number of ways Health Insurance Frauds can be evaded:

  • Demand for a copy of a Health Plan. One should automatically receive the policy documents on purchase of a health plan. It is imperative to go through each and every terms and conditions of the policy before signing it.
  • An Insurance company may be a legal corporate body, however it may still not be licensed to function as an insurance provider. Therefore it is very important for us to ensure that the insurance company is a licensed insurance carrier in the state which in which it operates as well the state where we live in.
  • We also need to see the agentís license copy and verify the same through the Licensing Bureau.

Before finalizing on your insurance policy, please do sufficient comparison with other providers in the market and also verify the financial status of your preferred company.

HMOs in a Nutshell

Though HMOs are one of most preferred insurance plan option, still there are some very pertinent and relevant questions one needs to ask before opting for right HMO.

  • Allowance of emergency medical services without prior approval.
  • Allowance of going in for a second opinion if detected with any fatal disease.
  • Allowance of consulting any physician outside the network if there are no specialists available within the network.
  • Trying out experimental medical options if conventional procedures are not successful. If experimental procedures are denied can a patient go in for an opinion from an independent committee?

The medical insurance that we choose needs to be commensurate with the state legislature. Hence, knowledge of our rights can definitely help us choosing the right health care options for us and our families.


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