Health Insurance - Medical Dictionary

H E A L T H I N S U R A N C E

Health Insurance Provider




The health insurance industry is one of the most intimidating and consumer unfriendly industries in existence. Still, health care is big business for these companies. How do you know what to look for in a health insurance provider and how do you decipher all the verbiage in your health insurance policy? It isn’t easy, but you can educate yourself about the industry, which in turn enables you to choose the right health insurance provider.

There are two things you should realize right off the bat. The first is that health care costs vary greatly from state to state. What one hospital charges for an X-ray in Ohio can be half what the same X-ray would cost at a facility in New Jersey. This practice is a fact, and while it may seem unfair, without national regulations it remains a fact. This is why health insurance providers write different policies based on different states. You can’t do anything about the fact that your policy may be cheaper or more expensive elsewhere, but you should be aware.

For this reason, if you live on the border between two states and could easily obtain health care in one or the other, then it might benefit you to check with health insurance providers in both states. With that said and because that scenario applies to only a small percentage of the population, the average person has little choice but to compare several different quotes from more than one local health insurance provider.

When selecting a health insurance provider, you should be looking for three main things. The first is stability in monthly premiums. If the monthly premiums fluctuate, you cannot only not budget your health care expenses, but you can bet that the provider is being wishy-washy. You should be able to guarantee your rates with an option for renewal each year before being faced with a premium increase.

A quality health insurance provider will also be efficient at claims processing. Nothing is worse than discovering your health insurance provider delays payment to the point that you are receiving collection notices for unpaid medical bills. You also want to know that you do not have to follow up on every single claim multiple times before it is processed. If your current health insurance provider seems to provide poor customer service and claims processing, seek a new provider.

Make sure your health insurance provider is providing you with more than one option when you request quotes. You should not be bullied into one plan or policy and should be presented with verifiable facts about each option. If you are working directly with a provider or company agent, rather than an independent agent, consider looking for a licensed independent agent who can bring you several providers’ quotes and plans to compare.

Lastly, when comparing one health insurance provider to another, compare their list of network physicians and facilities. A small network of doctors and facilities is not a good sign. Doctors and facilities are familiar with most health insurance providers in their area and if they have elected not to do business with them, perhaps they know something you don’t.

A thorough examination of several providers will help you make the right choice. If you notice discrepancies in information you are being provided, contact an independent agent for advice. You can also contact your local health department if you are coming up empty. They can point you in the right direction based on your individual circumstance. Always remember that like other, less complicated service industries, you are the consumer and are entitled to a certain level of respectable service.


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