Need some advice on Health Insurance Policies
TV ClubHouse: archives: Need some advice on Health Insurance Policies
Spygirl | Tuesday, July 02, 2002 - 08:38 pm     I am shopping for an individual health insurance policy and need some advice. I've heard that more and more doctors are avoiding and not accepting PPOs, they all hate HMOs, so what is left? I heard something about "Managed Indemnity" today, but am still unclear as to whether this is a better option than a PPO. I am looking for a $500 deductible, $10-20 co-pay, with 80/20 coverage. I don't have a doctor at all right now, so it really doesn't matter to me about out of network stuff. Any advice? Tips? Past experiences with individual policies? Or am I out here all alone? |
Wcv63 | Tuesday, July 02, 2002 - 11:07 pm     Spygirl what you are looking for is a very standard policy. Most even have add-ons like vision, dental and presciption plans. I've never heard of Managed Indemnity. Did anyone explain the benefits/drawbacks? I've used a PPO for years. Luckily all my doctors/pediatricians/pharmacies/emergency rooms are participating in my plan. I've had the experience of having to locate and research Group Insurance for a mid-size company and had to do a LOT of work checking out caps, payouts, partial self-funding etc but with an eye towards what was best for both the employees and the company. Are you looking for an individual policy or one associated with employment? Insurance is one of the most complicated things to research because you have to really check the fine text. Look for exclusions and question, question, question. |
Spygirl | Wednesday, July 03, 2002 - 05:47 am     Individual, definitely. The policy at my job *STINKS*...in fact, stinks doesn't do it justice I think after more research last night, I've found good PPO policy from Celtic. What kinds of "red flags" should I look for in the exclusions? |
Wcv63 | Wednesday, July 03, 2002 - 06:02 am     Catastrophic illness, organ transplants, any time frame that the policy needs to be in effect before they will cover ANY claim, restrictions on doctor visits, preventative check-ups. Also check to see what the insurance determines to be "non-vital" or "unnecessary" procedures. You'd be surprised at what they try to get away with. |
Tess | Wednesday, July 03, 2002 - 05:54 pm     I would also check what they cover for preventative medicine and/or what they consider "routine" and if those procedures are covered. Also check what amount you'd be paying for prescriptions. You can pay all the way from nothing to full price, which can be astronomical, and anywhere in between. For instance, I pay $7.00 per prescription per month or the actual cost whichever is lower. DH pays $11.00. I know people who have no prescription coverage at all. Some antibiotics cost $1.00 or more per pill. |
Weinermr | Wednesday, July 03, 2002 - 06:11 pm     Spy, check for restrictions on coverage of "pre-existing" conditions. How long do you have to wait for these items to be covered, or perhaps they are not covered at all. I have reasonably good health coverage through my employer - but I could not exist in an HMO environment. I have had PPO coverage forever, and will stay with it as long as I am allowed to do so. If I want to go to a doctor with a certain specialty I am able, and can choose the doctor, rather than being told who I can go to, or worse, being told that the service is not "necessary". I don't give a &$&$& whether a doctor is in or out of network if I feel it is necessary to go to that particular doctor. Also, as Tess suggests, often prescription drug programs are separate and apart from the medical coverages, so check into that as well. Good luck! |
Spygirl | Thursday, July 04, 2002 - 06:44 am     Thanks everyone! I think I've got the one that fits the best. I paid a little extra for the prescription drug card (10/20) and for some little "extras" like eye exams, fitness program coverage, and some other things. I appreciate all the advice! |
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