Shopping for Health Insurance

A Health Care Article Contributed by Wendy Ledbetter

It's okay to shop around for health insurance

There is sometimes a preconceived notion that health insurance offered by an employer is the best and most affordable available, and should be accepted without question. But as health care changes, so do the options and responsibilities of the patient. A company-supported insurance could be the best choice, but it's okay to question the benefits of a particular plan, check out other plans, and take a less traditional route - if that route better meets your family's needs.

Learn the language of health insurance

When the terminology begins to fly, it's okay to ask questions. Remember the old adage, "the only stupid question is the one not asked? " It's just as true of insurance. When a health insurance agent begins dropping words that are unfamiliar, ask them to stop and explain. Keep asking until you're sure you understand.

Meanwhile, don't depend solely on your insurance agent for information. A little independent research can even bring up some questions you should ask. An insurance agent - who will make a commission by selling you a policy - will not likely point out the shortcomings of a particular plan. It's up to you, the consumer, to figure out what questions to ask.

Health insurance terms

Most policies will include a list of terms used and their meanings. Some of the more common terms include:

An exclusion period is a predetermined amount of time in which specific illnesses are not covered by the health insurance plan. This often refers to preexisting illnesses.

Catastrophic illness is a serious illness, usually resulting in expensive and long-term medical care. Some health insurance plans have a limit to the amount paid for any catastrophic illness.

The primary care physician is the doctor normally used by the insured. This is typically a medical doctor involved in a private or family practice. Most health insurance plans require a referral from the primary physician if the services of a different doctor are needed - for a second opinion, surgery consultation or specialized treatment. The costs could be excluded by the insurance provider without a referral.

A copayment is the amount paid by the insured for a specific service. For example, a $20 copayment could be required for a typical office visit. The insured pays the $20 and the insurance company picks up the rest, regardless of the total charge. The cost sharing refers to the amount paid by the insured.

Treatment options are the choices available when more than one method of treatment is generally accepted in the medical community. A health insurance provider might retain the right to approve the selected course of action, depending on predetermined criteria. In some cases, cost could play a role, or the provider might make the decision based on typical outcomes of various methods.

Preapproval is sometimes required, especially for surgeries and procedures planned in advance. If the health insurance provider is not alerted ahead of time for the preapproval, the claim could be denied.