Primary Health Care For Your Family

Family-Health-Teams

Primary health care, also known as PHC, comprises of all the basic services that are offered to individuals and families for their wellbeing. So whether you need a general check-up or you have suffered from a twisted ankle, your first point of contact would be with one of these professional care-givers. They will help you with your lifestyle habits, manage chronic diseases and provide preventive measures to keep your body and mind healthy.

PHC forms an integral part of society. Whether they are looking for a physician, pharmacist, dentist or nurse, many families prefer to go to a medical profession that they can visit on a regular basis rather than go to something who they do not know for their basic wellness. Since it the first point of contact between a patient and the healthcare system, it is necessary for these services to be available in every community, allowing the individual to be more aware of their basic medical needs.

The Role of PHC

The role of a primary physician will vary depending on various environmental and economic factors along with their specific area of practice. However, some of the common roles of a physician include:

• Providing constant and comprehensive care to the patient
• Guiding the patient through the various social welfare schemes that are present
• Referring them to specialists and other hospitals or clinics whenever required
• Coordinating different kinds of services for the patient so as to provide them with the best combination at a given time
• Considering the different economic situations that are prevailing and the situation of a particular patient and giving them the best medical and wellness treatment plans based on this

New-Age PHC

With the development of this form of care, the role of your regular physician has not expanded in a large way in order to allow you a number of services conveniently. Teams of professionals offer different services so that you have the best medical opinions for any condition that needs to be treated. Sharing of information is also made easy so that your different providers have access to all your important information, allowing them to diagnose and treat you better. Patients are now also encouraged to play a bigger role in their own fitness so that they have control over their well being. And all this is available right at a community level so that it still stays personal and comfortable for every member of the family.

Share This
Share on FacebookShare on Google+Tweet about this on TwitterShare on LinkedInPin on Pinterest

Consumer Guide To Individual Health Insurance

Consumer-Guide-To-Individual-Health-Insurance

Health Insurance marketplace offers a wide range of affordable health plans for you to choose from. Whether you are self-employed, or looking for coverage over and above what your employer currently offers, there is a plan that will likely meet your needs. Federal regulations require that health plans operating under the Affordable Care Act (ACA) meet certain access requirements. In California, those requirements include timely access to healthcare providers, as well as geographic access standards.

Here is a general guide to individual health insurance that you can refer to when choosing a plan. And do not forget these important dates regarding open enrollment for 2016.

Provider Networks

When selecting a health insurance plan, it is important to verify the plan’s provider network of doctors, hospitals, nurse practitioners, therapists, and other health care providers. It is equally important to understand what is not covered as well. Understanding your plan’s provider network helps you save money, receive better care, avoid unexpected fees and costs, and be happier with the care you receive.

Out-of-Network Care

You are not restricted to health care providers in your network, but should you decide to use one outside of your network, health insurance will cover less resulting in a higher out-of-pocket cost for you, except in the case of emergencies.

Provider No Longer in Network

If your health care provider leaves your network, you will generally need to find a new doctor inside the network, and most plans will assist you in doing so. As a rule, a health plan’s continuity of care policy allows a patient to continue care with a doctor no longer in the network for a certain period of time at the lower cost-sharing rate.

Cost-Sharing Requirements

Each plan has different cost-sharing requirements. Typically, your overall share of costs is a combination of the premiums you pay plus any other co-payments, co-insurance or deductibles for which you are financially responsible.

How to Find a Doctor

In most cases, the plan you choose will have a list of doctors who accept your insurance. The Medical Board of California offers some great tips on choosing a doctor:

  • Ask friends, family or co-workers about physicians they like.
  • Ask your county medical society or association for names of physicians in your area.
  • Once you have some names, call and ask if the doctor is accepting new patients and whether they accept your insurance plan.
  • Check with the Medical Board to verify the physician has a current California license.
  • Meet with the physician and consider having a physical done to determine if this is the doctor for you and your family.
Share This
Share on FacebookShare on Google+Tweet about this on TwitterShare on LinkedInPin on Pinterest

What To Do If Your Healthcare Application Is Stuck

What-To-Do-If-Your-Healthcare-Application-Is-Stuck

Studies show that ER costs make up the biggest portion of amounts owed from insured and uninsured patients struggling to pay medical bills!

In Network or Not?

Did you know that about 66% of emergency room doctors are independent contractors who may or may not be in your insurance plan? And in a practice called balance billing, any out-of-network provider or lab can bill you for whatever your insurance does not cover. You might receive bills from several entities, some of which you never even met!

What is an out-of-network provider mean? This is a healthcare professional that does not have a contract with an insurance plan. Therefore, the provider does not have to accept the insurance’s allowable amount as payment in full.

The Ambulance

Think about the ambulance too. If the ambulance company that takes you to the ER does not hold a contract with your insurance, you could be on the hook for more than $2,000.00 depending on where you live in relation to the ER and what level of care your receive prior to arriving at the hospital. Plus, if your insurance company concludes that an ER visit wasn’t warranted, you might owe even more money.

To avoid these nasty surprises, consider the following strategies:

Insurance Policy

It might sound rudimentary because it is. Ask your insurer what the plan does and does not cover in the event of emergency care. This includes the ER copay, coinsurance, and deductible – in and out-of-network. Many patients are surprised to learn there are different values for out-of-network care. Some plans even have a tiered payment system. Find out which area hospitals are in network with your insurance. Check with the hospital to see which ER doctors are in network in your insurance plan.

Find out how your plan defines a medically necessary ambulance ride and what is required to appeal a non-payment decision.

EMTs decide which hospital they will take you too but you can request a particular one. Request an in-network doctor when the admission forms are completed. Be aware, however, your insurance may deny the charge if you request a hospital further away and could have been treated at a location nearest you.

Out-of-Network Bills

If you get a bill for out-of-network charges that you could not prevent because of the emergency, then it’s time to get to work. Ask your insurer if they’ll cover the costs at the in-network rate. Contact the providers and ask what the insurance has already paid and ask them to settle for that or negotiate for a lower amount.

About a quarter of US states have consumer protection laws that restrict providers from balance billing in certain care situations like emergencies. Some laws apply only to certain health plans or certain providers. Contact your state’s insurance department for specifics.

If all this fails, contact your insurance to determine what must be submitted to file an appeal and time limits for filing. Generally, documentation from the provider(s) will be required. In the case of an out-of-network situation, ask the doctor to provide a letter attesting to a good faith effort was made to utilize a contracted provider and no equitable access to such provider existed.

It’s not easy blending thoughts of payment with a medical emergency but it is something you can prepare for.

Share This
Share on FacebookShare on Google+Tweet about this on TwitterShare on LinkedInPin on Pinterest

Health Insurance Portability and Accountability

Choice is always good. In a globalized world, the consumer has a plethora of choices in everything, from airlines to automobiles. This is why nowadays even airlines make an announcement after the passengers land: “We know you have a choice. Thanks for flying with us!”

It’s rather simple. You have a choice – if you don’t like the product or service, switch! The same goes for health insurance policies as well. In India, people have woken up to the promise of health insurance, which has led to a proliferation of health insurance providers across the board. Because of this wide variety available, the policyholder doesn’t need to stick to an insurance provider if they feel dissatisfied with the services.

The Insurance Regulatory and Development Authority of India (IRDA) has a novel scheme for disgruntled policyholders to switch providers: health insurance portability. Now, what do we mean by this? Let’s elaborate.

What is health insurance portability?

Health insurance portability is the manner through which a health insurance policyholder can transfer his/her existing policies from the current provider to a new one. Portability offers a way for customers to opt for better service and product. That way, an insurance provider cannot take them for granted.

Reasons for porting

When and why should you port a health insurance policy to a different provider? Here are some pointers to help you decide:

  • Quality of Service
    If you feel that the standards of service offered by a policyholder is not at par with what they promised while logging you in, may be it’s time to move on. Often, an insurance provider will promise the moon while getting a customer on board in the eagerness of cracking a deal, but gradually, reality strikes and the customer realizes that it was all hogwash. There’s no point continuing a bitter relationship, right?
  • Increased Benefits
    There might be a point when you realize the cover offered to you by your current health insurance provider is not sufficient, and after talking to them it seems clear that that’s the best they can do. Under the circumstances, it may be wise to switch to a provider that can offer the additional cover/ benefits.
  • Expensive
    There is really no point in paying more for a service/ benefit that is available for a much lesser price with a competing provider. If you feel the competition offers a better product at lesser cost, it is time to make that switch.
  • Specialization
    Health insurance policies are offered by general insurance companies as well specialized health insurance providers. If it is felt that with the current provider, the attention is more on non-health policies, switching to a specialized health insurance company may suit your needs better.
  • Relocation
    When you relocate to a new city, you need to have the same services and cover as before. But your existing insurance provider may not have as better access or as many network hospitals in the city. It might then make sense to port to a provider who has those services in your city.
  • Claim Settlement
    This is important. Some companies take ages to clear a claim. Before you land up in such a situation, it’s important to know whether your insurance provider has any such reputation. If that is the case, port out.
  • Transparency
    Often there are hidden clauses and conditions in the contract which the policyholder is not aware of. Such hidden clauses rear their ugly head during emergencies, and you do not know where to go. Time to move to a provider with more transparency in their dealings.

Now that we have a fair idea when to opt for portability, it is also important to know the benefits. What does a policyholder gain out of it? Well, here it goes:

Benefits of portability

  • Customization
    While porting to a new provider, it becomes easier to customize the features to one’s specific needs and requirements. You can add nominees, even go for additional cover or benefits.
  • Continuity Benefits
    When you change your health insurance company, there is no reason to lose the benefits you had accrued with your previous provider. According to IRDA, your new insurer has to give you the benefits accumulated with previous insurer.
  • New Sum Insured
    IRDA says your new insurer has to insure you at least up to the sum insured under the old policy. In most cases, the existing sum insured is added to the accrued bonus to give the new sum assured. The No Claim Bonus is also added to the new sum insured.

Better service, affordable premiums, transparency Portability takes care of the inconveniences associated with your earlier health insurer, owing to which you made the switch in the first place.

Yes, portability is a major advantage to those health insurance policyholders who are unhappy with their current insurance provider. But it’s also important to know the conditions and criteria for portability to occur.

Conditions for portability

  1. The policy can be ported only at the juncture of renewal. The new insurance period will be with the new company
  2. Apart from waiting period credit, all the other terms of the new policy will be at the discretion of the new insurance company
  3. The process has to be initiated by the policyholder at least 45 days before renewal:
    • Write to your existing provider requesting a shift
    • Specify the new insurer you want to shift your policy too
    • Ensure that the policy is renewed without a break (there is a 30-day grace period if porting is under process)

In short, if you are disappointed with your health insurance policy, portability is a good option that offers a recourse – if the above conditions are met. Now, let’s get into the most important part.

How to port?

Porting Process:

  • Application for portability should be made at least 45 days before the renewal date of the existing policy, on the portability form
  • The company will then send your portability form and all the policy related documents
  • The new insurer will take a decision on accepting the policy within 15 days

Other documents include all previous policies, claim experience, proof of age and others. If any other documents are required, the new insurance company may ask for it.

… One more thing!

These are some small pointers that go a long way in ensuring that the transition is smooth and a happy one:

  1. Read all the terms and conditions, product features, brochures of the new company before deciding
  2. Do know that the new company can decide to hike the premium, at its discretion
  3. Check the claim settlement ratio
  4. Needless to say, check for good customer support and service
Share This
Share on FacebookShare on Google+Tweet about this on TwitterShare on LinkedInPin on Pinterest

How To Pick The Right Health Insurance Plan

One of the best ways of safeguarding your personal well-being is by having a health insurance plan. Due to the large number of companies that offer this type of insurance policy, choosing the right one can be a daunting task. Here are five tips to help you find the best plan on the market today.

Check the Networks of Different Plans

If you have a select group of doctors whom you prefer, ask them which insurance networks they are part of. You can also use one of the many accredited online directories to know the networks that each plan on your list has. On the other hand, if you just relocated to a new city and you do not have a preferred doctor yet, choose a plan that has a large network of health practitioners.

Know the Maximum Premium Budget

Consider your average monthly expenses to know the amount of money that you can spend on the policy without compromising your financial capability. Low premiums often result in high out-of-pocket costs. Hence, what appears to be the cheapest plan may really be the most expensive, as you will be forced to pay for most of the services. One of the best ways of choosing the right premium is by estimating the total amount of money that you spent on health care last year, including out-of-pocket expenses and premiums. Then, choose a plan that has similar monthly deductibles, pays, and premiums. A high premium plan will save you thousands of dollars on out-of-pocket costs if you require expensive procedures or frequent medical care services.

Look for Additional Benefits

In a bid to attract more clients, insurance companies usually offer policies that have additional benefits apart from medical coverage. Based on this fact, it is wise to check the summary of benefits of each policy on your list until you find one that has your preferred scope of services. For instance, some policies provide better coverage for mental health and physical therapy care while others have more comprehensive emergency coverage.

Research Plan Structure

Once you have an estimate of your monthly premium, your next step is determining your ideal plan structure. Some of the most common plans are HMO, EPO, POS, and PPO. The plan that you select will determine which doctors you can see and your costs. More often than not, plans that have referrals, such as POS and HMO, require that you first consult a primary care physician before booking an appointment with a specialist. If you already have a network of doctors that you prefer to see, eschew plans that they do not take.

Compare Out-of-Pocket Costs

Your preferred health insurance plan should clearly indicate the services that you will be required to pay for and the amount. The sum amount includes coinsurance, co-pay, and deductible. A plan that has low out-of-pocket costs is an ideal choice if you regularly need emergency services, take expensive medications, have scheduled upcoming surgery, or were recently diagnosed with a chronic condition such as cancer or diabetes.

Finally, make sure that the health insurance company is legally accredited, reputable, and reliable to cushion yourself from any inconveniences.

Share This
Share on FacebookShare on Google+Tweet about this on TwitterShare on LinkedInPin on Pinterest

Understanding Your Health Insurance Policy

The clauses that are related to limitations and exclusions may seem complicated at first but it is crucial to understand these before signing up. There could be some exclusions and limitations that may not affect you or your family at all while some may be important depending on your health history and hereditary family history. So while what is excluded for one person may not make a difference, it might make a huge impact for another. That is why it is important to understand what these are and how they impact and relate to you as an individual and to your family in general.

Exclusions are those conditions or expenses that are not covered by the insurance company. In such cases, the claimant will have to share a pre-specified portion of the expenses in the claim if it should ever arise. Some insurance companies will also impose a sub limit that is within the sum insured overall. Exclusions are those expenses that the insurance company need not pay for. The IRDA has standardized this with a list of expenses. There are also different waiting periods for different conditions.

One of the common exclusions for health insurance are pre-existing diseases. This is because the entire premise of insurance is based on uncertainty so if there is a disease that you are already suffering from, it will not come under the insurance. Usually, you can get insurance companies to cover you for a pre-existing disease after a specified waiting period is over.

Another thing that is excluded is pregnancy and expenses related to childbirth and later vaccinations. There could be a waiting period for pregnancy as well, after which there are some benefits that could be availed. Other things that are excluded from a health insurance policy are cosmetic surgeries, dental surgeries, alternative treatments such as Ayurveda and homeopathy, etc.

Sub-limits are another factor which should be carefully looked into at the outset before investing in an insurance policy. A sub-limit is related to exclusions that are associated with doctors’ fees, ambulance costs, rent for hospital rooms, etc. Knowing your sub limits keeps you prepared in case of an emergency so you know exactly what will be covered and what you will have to pay for out of your own pocket.

There are policies which seem to have a whole list of exclusions and sub-limits and there are those that have a moderate amount of them. So knowing what is excluded and what is not will help you make a better decision regarding which health insurance to choose. This can be done easily by doing a systematic and meticulous comparison of health insurance policies taken from different websites or from the agents directly. Knowledge is power and knowing this beforehand helps you in better planning your future and that of your family.

Share This
Share on FacebookShare on Google+Tweet about this on TwitterShare on LinkedInPin on Pinterest