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Understanding the Medical Insurance Review Process – The Five Key May 9th, 2011

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Understanding the Medical Insurance Review Process – The Five Key Steps in Medical Insurance Review

Medical insurance reviews provide results in a timely fashion. Filing a medical claim can be a lengthy process prone to miscommunication and breakdowns in the chain of paperwork. Bringing in an independent review organization can tap into deep reservoirs of medical expertise. The review on this level can determine an objective approval or denial of an insurance claim. The denial will be based on medical fact, however and not on anecdotal evidence.

The Five Key Steps in Medical Insurance Review

The following steps illustrate how a medical claim is reviewed.

A patient is prescribed a treatment for a condition or injury. The medical opinion of the attending physician along with related charts and information may be submitted or requested in order to request coverage of the insurance claim.
Medical and physician resources are provided the medical information and asked to review the treatment and prescribed recommendations.
The medical specialist assigned to the case will provide an unbiased opinion with regard to the treatment.
An insurance expert reviews the terms of the patients coverage as offered by the insurance company. They will offer an unbiased determination with regard to whether the patient is covered for the treatment in question.
Finally, the two opinions are combined to return an objective recommendation for approval or denial.

On Time Decisions

This process allows for healthcare decisions to be made in a timely and expert fashion. The resource is invaluable for all aspects of the healthcare profession. Patients will receive approval for vital treatment that may be otherwise rejected by a large insurance company that handles its own medical reviews internally and without expert sources.

Anecdotal evidence is never used to deny a claim or pay for an unnecessary treatment. The use of third-party experts and medical specialists provides claim managers with the verification and authentication needed to do not only the right thing, but also the best thing. The medical insurance review process removes the factor of uncertainty that claim managers may face in a world of rising medical costs, complex specialization and treatments.

Avoids Ill-Informed Approvals and Denials

Healthcare costs skyrocket in an atmosphere where a claim manager must err on the side of caution to either pay for unnecessary treatment or deny one that is necessary. Without using an independent review organization, the insurance company may lack the resources to make a decision in a timely fashion.

As illustrated by the five key steps of the review process, experts from both sides of the equation are consulted. Complicated medical technology combined with equally complicated insurance policies and terms can make for a morass of misunderstanding without the right types of expertise. The process also reduces the amount of frustration felt by claim managers, patients and physicians by filtering the claims through the right hands to get the right advice and interpretations.

Fiscal Responsibility

The more approvals of unnecessary treatments, the higher insurance costs will soar. The medical insurance review process allows a claim manager to make an informed decision and eliminate unnecessary treatments. Patients and physicians rely on insurance coverage to underwrite potential treatments for a multitude of conditions.

An insurance expert understands the complex terminology of a coverage policy. Specialized physicians understand the nature of illness and treatment. The combination of expertise improves the process of treatment review and coverage approval. That means no lengthy waits for vital services and no funding for unnecessary ones.

This process has a dramatic impact in reversing the trend of rising healthcare claim costs. By dramatically reducing these riding costs, an insurance company can save money for their consumers, their shareholders and the healthcare community.

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Trend: Companies Strengthen Stance Against Smoking May 2nd, 2011

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Companies today are increasingly looking for ways to cut expenses and improve profit margins. Among their greatest expenses are fringe benefit costs associated with employee health care.

As such, many are looking at how the lifestyle habits of their employees – such as smoking – are affecting their bottom line.

Medical care and lost productivity cost employers about $3,856 per smoker per year, according to the Centers for Disease Control and Prevention. Men who smoke pay $15,800 more for medical care over their lifetimes and miss four workdays more per year than nonsmoking men; female smokers shell out $17,500 more in lifetime medical expenses and miss two days more from work than women who do not smoke, according to the CDC.

Some companies refuse to hire smokers or demand that their employees quit smoking or lose their jobs. Others are setting policies restricting smoking on or around company property and offering bonuses or other incentives for employees to quit smoking.

For those who want to quit but have failed with various cessation methods, one company says it has a unique solution that may help them kick the habit for good.

Safer Smokes Inc. offers a smoke called Bravo that has all of the characteristics of a tobacco cigarette with three key differences: no nicotine, no tobacco and none of the dangerous carcinogens derived from the additives found in commercial tobacco cigarettes. In lieu of tobacco, Bravo smokes are made with enzyme-treated lettuce leaves.

“You give up the nicotine and harmful tobacco without having to give up the physical behavior of smoking,” said Dr. Puzant Torigian, chairman and founder of Safer Smokes. “Once the nicotine leaves your system, the urge to smoke leaves you as well, and you smoke your way out of the habit just like you smoked your way into it.”

“For smokers challenged to quit the habit or quit the job, the key is to find a cessation strategy that works for them,” Torigian said. “Of all the choices on the market, Bravo is the only product available today that lets you quit the nicotine and tobacco habit immediately while you smoke your way out of the habit gradually.”

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Travel Insurance April 22nd, 2011

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Are you considering about traveling overseas? It is something quite common these days. A trip overseas can be a great experience a once in a lifetime adventure. It would be a great tragedy if something went wrong, so its better to be prepared. Not only will it beneficial to you but your loved ones.

Besides the obvious things to have when you travel like passports, and tickets, you should get travel insurance. It is something many people might over look, but it is essential when traveling overseas. But dont go for the cheapest insurance you can find. Make sure you find a policy that will cater to all your needs and take care of you incase anything happens to you or your family. Look around at different policies and see what is out there.

You should know what is in the policy and what is not included. Read what the policy covers. A good example is terrorism; some insurance policies can not include those kinds of incidents to be claimable. Find out about this and other incidents that are claimable and not. You should ask as many questions that you want, dont be shy if you dont exactly understand what is said in the policy, and ask before you sign it. Make sure that your insurer knows and cover adventure activities, like water rafting or things of that nature. Make sure you can participate in those types of activities before getting the insurance because sometimes they arent covered in some polices. Ask if you can claim for your luggage if it is left unattended, you should know all the little deatiles.

So save yourself some unforeseen trouble and get travel insurance. Because you never know what will and can happen. Anything is possible. So be prepared, youll be glad you did.

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Tips to Save on Car Insurance April 18th, 2011

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We all wish to make savings in our life. Cars included. Myriad insurance companies offer varying premium rates depending on their policy coverage. So it is important that you get the best Insurance package for your car.

These tips will help you how to manage your Car Insurance budget within limits.

Making Comparisons: The costs of at least three to six insurance companies will give you a fair idea of the costs involved with different policies. Seek the advise of colleagues, friends, relatives. Besides from costs involved, the track record of the companies matter a lot.

The standing, strength and financial position of the company need to be looked into. Request for higher deductibles – It’s the amount one pays prior to making any claim for the accident. The complete coverage and collision is sold along with the deductibles. The more the deductibles the less the premium rate. By increasing the deductible say from $300 to $600 will invariable reduce the cost to 20 to 35 percent.

Old Cars – Drop Collision and Comprehensive Coverage – It is better to drop the collision and comprehensive coverage if the car is worth less than 10 times your premium in the current market. One way to reduce the cost is buying the auto coverage from the existing insurance and insurance coverage from existing carrier.

No to Double Health Coverage – Avoid health coverage with auto policy provided you have enough health insurance. This is one way of reducing costs.

A Good Credit Card Record – This has multiple benefits – helps to file claims if the credit score is less. A good credit score will also help in settling the accident with the help of the company.

Low Profile Car Discount – Fancy and trendy cars with high maintenance costs higher rate and attract thieves as well. A low budget, low profile car will help a lot with insurer discounts to boost.

Mileage Counts – More discounts can be obtained by driving less than the national average mileage recorded per year.

Avoid double health coverage- If you think that you have enough health insurance, and then avoid health coverage with your auto policy. This will help you to reduce the cost.

Maintain a good credit record- Insurers are using the credit history while determining the price of insurance. Statistically, the lower your credit score, the more you are likely to file claims. A person with a good credit score is more likely to settle the accident without the support of the company. Try to maintain a good credit record.

Discounts with low profile car- Cars that are expensive to repair or attractive to thieves will have a higher rate. Consider buying a low profile or average car as it your insurer might come up with discounts for such a car.

Low Mileage Pays – Obtain some discount on premiums by driving less than the national average mileage recorded per year.

All about Group Discount – It’s all about a group taking insurance plan collectively. Be it an employer, business group or associations. Check for such plans.

Safety Discount – Discounts are also offered if the car is fitted with safety items like air bag, automatic seat belts, anti lock brakes. So make safety pay for you.

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Things To Look For When Choosing An Individual Health Insurance April 12th, 2011

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Things To Look For When Choosing An Individual Health Insurance Company

There are a plethora of Health Insurance providers online, most offering fairly competitive policies at decent rates. The sheer amount of choice makes it confusing when you’re trying to decide between companies, and if you don’t know what to look for you may miss out on a good deal, or worse, be stung by hidden costs or not receive the cover you paid for.

The first thing to look for when choosing an insurance company is to make sure that the terms and conditions are stated in a manner that is clear and easy to understand. A good company won’t try to befuddle you with jargon. Don’t be afraid to clarify certain points, and to get those clarifications in writing. This can save you a lot of pain and hassle in the long run.

You also want to make very sure that your company is not offering policies which they will then cancel if you get sick. It does sound ridiculous, but some companies will cancel policies if the holder becomes ill. Make sure the policy is guaranteed renewable and non cancellable. A company that tries to dump it’s holders when they need the policy they paid for is unlikely to be a good insurance partner to you in the long run.

Look for a cancellation period when you’re considering signing up, a period during which time if you change your mind you can receive a refund and cancel the policy with no penalty. A good company does not make money by tying people into policies they don’t want.

Finally, check with consumer institutes as to the companies reputation. Stay away from companies that appear deluged with complaints, they are unlikely to serve you any better than they served their previous customers. Talk to friends and family, and get an idea of the experiences they have had. Much can be learned from word of mouth information.

Above all, take your time. Choosing a health insurance provider is an important decision, and not one you should feel rushed about.

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THE TOP FIVE HEALTH INSURANCE PLANS April 3rd, 2011

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Since competition in terms of health insurance is on the rise, it is
no wonder that more and more forms of health insurance are
being designed. Among these, there are few that are popular and
they are briefly described below.

Individual Insurance: Ensuring a person individually is a common
mode of insurance. One may be selective about what s/he wants
in a plan through this process. Accordingly, one has required
premium is calculated, and the insurance plan takes effect.

Group Insurance: Another type of insurance is the group
arrangement. Through this type of insurance, one is compelled to
abide by what others are going for, and this is dependent on the
insurance providers. They are the ones that decide what is
feasible to include in a plan, and on that basis, a group insurance
can take place.

Indemnity Plan: This plan allows one to go to any doctor when one
needs to; there are no restrictions on this, and it is believed to be
more of a traditional plan. One does not need permission to go to
a particular health care provider. However, usually what happens
is that the member pays 20% of the total fee for treatment while
the insurance provider pays 80%. In addition to this, there is a
period through which one pays up in this manner, and then the
company takes over paying the whole 100%.

HMO: The Health Maintenance Organization is one that allows a
member to select a particular doctor off the panel. It is these
selected doctors that will deal will with members’ problems. The
selected doctor is the one that will be approached for checkups of
any kind, and if there are problems with a member that cannot be
handled by him or her, the member is referred to specialists.

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The importance of mortgage life insurance March 29th, 2011

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Lets face it mention things mortgage life insurance in fact anything personal finance related – and we all know that it is as dull as dishwater. However, without things like mortgage life cover – life could be a lot harder financially.

So, what is mortgage life insurance and what is so great about it?

In a nutshell, in the event of you or your partner dying, mortgage life insurance can mean that the difference between keeping a roof over your head or ending up having your home repossessed a frightening thought.

And while many of us find organising something like life insurance a sombre business as it makes us face our mortality, it is the fair and right thing to do for your partner and any next of kin to make sure that your finances are in order in the event of your death.

So why do you need mortgage life insurance cover? A mortgage life insurance policy runs for a fixed policy term most people take it put to run concurrent with their mortgage. Should you die before the end of the term period, the policy can help pay off outstanding balance of the mortgage on your home. This will be in the form of a cash sum.

This means that your dependants will not have the financial worry of trying to find the mortgage repayments in the event of your death. Neither will they have to worry about selling up and maybe downsizing in order to keep a roof over their heads the last things that you would want to put them through.

The good thing about mortgage life insurance is that you only pay for the cover that you need so as the amount outstanding on your mortgage decreases, you are only paying out for the level of cover you require.

Mortgage life policies are available on a single or joint life basis. If you have a joint life policy, the amount is paid out on the first claim only. You can decide how long you want the policy to run for and as we mentioned before, most people have it to run concurrent with their mortgage and in most cases you can have additional benefits such as critical illness cover for an additional premium.

With critical Illness benefit the policy pays out either on death or on the diagnosis of a specified critical illness (such as certain cancers, triple artery bypass) – whichever occurs first. Check with your chosen insurance provider as to what illnesses are covered, as they can vary from insurer to insurer.

If the policy is paid out before the end of the policy term, it ceases. And if the policy is in force at the end of the term, it will have no cash in value.

If you are looking for mortgage life insurance, then do shop around and do not automatically accept the first quotation you get. Premiums as well as terms of the policy and other benefits can vary wildly from provider to provider and you could be surprised just how cheap mortgage life insurance can be, without any compromise on cover.

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The Best Kept Secret About Life Insurance March 24th, 2011

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Do you love someone enough to spend your hard earned dollars on a life insurance premium — month after month?

Because the real benefit of a life insurance policy isn’t for you. It’s for those you love… but after you’ve gone.

Life insurance is money paid to those who rely on you right now to provide a secure standard of living. They can lose this in a heartbeat.

Life insurance is money when needed the most… with no income tax or publicity.

Buying a life insurance policy is challenging because it isn’t an easy subject matter to begin with.

Most people get confused about how it works and whom they can trust enough to make the purchase.

And there’s a large number of companies and sales agents all clamoring for your attention.

This article will help to clarify a huge misconception about term life insurance. Also, I’ll introduce you to what many knowledgable professionals consider to be the best kept secret in a life insurance policy.

Buy term and invest the difference is a phrase touted by those … including many life insurance agents … who have absolutely no idea how much harm it’s implementation can cause.

The principle theory is you no longer need life insurance when you reach a certain age such as 55, 60 or 65.

Supposedly your kids have finished school and are doing just fine earning their own income. And you and your spouse are living comfortably on retirement savings and social security.

On the surface and to the naive, this might appear reasonable.

Now, it’s easy to pick apart this hypothesis, but let’s focus instead on the real problem with this scenario.

We are living longer than ever before. We may not be enjoying it very much due to poor health but, nevertheless, we’re hanging on.

Life insurance companies know this better than anyone. In fact, most of them now use age 115 has a factor when calculating life insurance policy premiums.

You hear about retirees who are forced to find work at McDonald’s or Wal-Mart. Have you ever joined a seniors chat room on the Internet and witnessed the concerns most of them have about running out of money before they die?

Many of these seniors are frightened to death. And what about the millions of babyboomers right behind them.

An intelligently purchased life insurance policy can be the saving grace for those you love the most.

Now, let me set the record straight. I have nothing against term life insurance. For over 24 years I’ve personally sold millions of dollars worth.

What bothers me … and what I believe to be criminal … is when term life insurance is sold under false pretenses.

Let’s use a simple example.

A 35 year old nonsmoking male in excellent health can buy a $500,000 term life insurance policy for about $700 per year.

The premium is guaranteed to be $700 for 30 years. Some companies will be a little cheaper and some a little more expensive.

The buy term and invest the difference advocate would compare this to a $500,000 whole life insurance policy at $3,650 per year. Once again, some companies will be higher and some lower.

Theoretically, you have $2,950 to invest each year for 30 years. I say theoretically because in the real world you would never consistently invest $2,950 each year.

Not the same way you would commit to a life insurance policy premium.

How do I know this? Call it human nature based on lots of experience.

But, let’s give you the benefit of the doubt and say you actually do invest according to this hypothetical plan. What rate of return are you going to make over 30 years? 5% … 8% … 10 percent?

By the way, this question opens up another can of worms. The psychology of investing. But, we’ll save that controversy for another time.

For arguments sake let’s assume you get an 8% compounded rate of return each year for 30 years. This comes to $360,920.41.

Okay… so now you’re 65 years old and you have $360,920.41. But guess what?

When you reach 66 your $500,000 term life insurance policy will lapse without value because the annual premium becomes $21,180.

Yep, you read that right! It jumps from $700 to over 21 thousand dollars.

At age 70, it’s $31,430. At age 75, it’s $52,970.

There’s no way on earth you’ll pay this premium. Problem is… you aren’t dead yet!

You have paid $21,000 over a 30 year timeframe to have a $500,000 life insurance policy during a period of time when the odds are you would never die anyway.

Under normal circumstances you will die somewhere around age 80 — give or take. Your loved one’s investment account still won’t be worth $500,000.

What’s more, she will have to pay income tax on the investment gains. Remember, life insurance proceeds are income tax free.

Permit me to repeat myself. I am not against term life insurance … as long it’s purchased with an eye towards the reality of future expectations.

If your term life insurance policy is issued by a highly rated company with a broad selection of products, you will have ample opportunity to convert the term into something more permanent over the course of the 30 years in our example.

Keep in mind your age determines the length of time the term policy will have a guaranteed level premium.

You may not be able to get more than a 10 year guarantee if you are over 50 years of age.

So, exactly what is the best kept secret in a life insurance policy?

It is a universal life insurance policy that guarantees the death benefit regardless of investment performance.

Universal life is the most flexible type of policy on the market. The premium is higher than term, but lower than whole life. There are several on the market, so you must be careful.

If you decide to buy term because of budget constraints, then be certain to buy from a company that also offers universal life.

This gives you the chance to slowly convert the term into universal with the same company over the length of the term guarantee.

As your budget permits convert term into universal.

One word of caution. Long term interest rates are critical to the performance of universal life insurance.

Because they’ve been depressed for several years and will likely continue so, you must get the universal life with an unconditional death benefit guarantee.

Here’s an example using our 30 year old male. The $500,000 universal life insurance policy premium is $2,871 per year. This compares with the already discussed $700 term and $3,650 whole life premiums.

Let’s say you really do decide life insurance isn’t important when you reach 65. By that time, you would have paid $86,130 in total premiums.

Down a rat hole like the term plan? Nope!

The cash surrender value would be at least $85,501. It might well be over $100,000 based on the actual competitive interest rates credited to the policy over the 30 years.

When you buy the right type of universal life you guarantee the death benefit for as long as necessary… plus you have the ability to recover your expense if you wish to cash it in.

You can benefit from the best of both worlds when you use the best kept secret in a life insurance policy.

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Term Life Insurance With No Exam March 18th, 2011

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Everyone wants a painless and easy approach when it comes to purchasing life insurance. That can actually be a reality if you know what to look for when shopping for life insurance. The painless part has every thing to do with the cost. Term life insurance is by far the least expensive of all forms of life insurance. Easy has everything to do with making a life insurance purchase that is simple and time saving. That points to purchasing insurance that requires no medical exam. These are called the non-medical limits by most insurance companies. Thats the good news. The bad news is that the non-medical limits get very restrictive as you get older. Life insurance companies need examinations to underwrite policies as we get older.

If painless and easy is your goal then it behooves you to shop for the largest face amount of life insurance that you can purchase without a physical exam. The medical insurance bureau is used by almost all life insurance companies to investigate the medical background of all of its applicants. The MIB may have medical information on an applicant that may eventually require a medical examination or a rejection of the application. Do not seek a non-medical insurance policy to hide a pre-existing condition. A future claim may be denied because of misrepresentation on the application.

Try the marketplace and research the non-medical limits. If you are in good health and have no pre-existing condition then a life insurance purchase without an exam is a definite time saver and will make life easy for you and the insurance company. Make sure that you divulge all of your medical history on the application as well as your primary care physician. Annual physical exams and regular medical check ups are viewed as a positive by life insurance underwriters. There you have it. You have enough information to implement a painless and easy strategy for your next term life insurance purchase.

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Term life insurance: Money-saving tips (they do exist)! March 6th, 2011

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Term life insurance is the most affordable way to protect your familys future. As inexpensive as term life insurance is, there are money-saving tips that will ensure you are paying only what you need. Get the most value for your dollar by checking out the following helpful tips that will save you money while still getting great protection.

1. Get coverage early the sooner you buy life insurance the less your annual premiums:
Some people are gamblers by nature and choose to take their chances by skipping out on life insurance. Although it is unlikely you’ll die during your working years, you’re not insuring for what’s likely to happen but instead, for the worst-case scenario. That’s why term life insurance costs less the younger you are. It is also why you should buy it sooner rather than laterbecause you’ll be providing financial security without spending a lot of money for it.

For example, if we look at the cost to purchase a $250,000 Term 10 life insurance policy youll see how delaying purchasing a policy by just a few years could cost you more in annual premiums.

For male non-smokers*:
A 35 year-old may get quotes for as little as $195 per year for a 10-year total cost of $1,950.
A 40 year-old may get quotes for as little as $263 per year for a 10-year total cost of $2,630.
A 45 year-old may get quotes for as little as $373 per year for a 10-year total cost of $3,730.

For female non-smokers*:
A 35 year-old may get quotes for as little as $165 per year for a 10-year total cost of $1,650.
A 40 year-old may get quotes for as little as $210 per year for a 10-year total cost of $2,100.
A 45 year-old may get quotes for as little as $270 per year for a 10-year total cost of $2,700.

* Lowest quote online from February 2006 for a Term 10 policy, one of the most popular life insurance products in Canada. Premiums shown are the rates if paid annually.

2. When your age isnt really your age:
Your next birthday may be 6 months away but in the eyes of most life insurers youve already hit that next magical number. When you get a life insurance quote, the rate you are given is based on the age you are closest to which, 50 per cent of the time is your age at your next birthday. Its a term called Age Nearest, and that half-year price increase could really add up. See the difference yourself.

For male non-smokers*:

A 39 year-old may get quotes for as little as $248 per year for a 10-year total cost of $2,480
A 40 year-old may get quotes for as little as $263 per year for a 10-year total cost of $2,630.

A savings of $150

A 44 year-old may get quotes for as little as $345 per year for a 10-year total cost of $3,450.
A 45 year-old may get quotes for as little as $373 per year for a 10-year total cost of $3,730.

A savings of $280

For a female non-smoker*:

A 39 year-old may get quotes for as little as $200 per year for a 10-year total cost of $2,000
A 40 year-old may get quotes for as little as $210 per year for a 10-year total cost of $2,100.

A savings of $100

A 44 year-old may get quotes for as little as $255 per year for a 10-year total cost of $2,550.
A 45 year-old may get quotes for as little as $270 per year for a 10-year total cost of $2,700.

A savings of $150

* Lowest quote online in January 2006 for a Term 10 policy. Premiums shown are the rates if paid annually.

3. If youre a smoker ask about incentive programs aimed at helping you quit:
While not all life insurance companies offer incentive programs to help you quit, some do and could save you money if you are thinking about buying life insurance and quitting smoking. For example, one such company will refund you an amount equal to the difference between the premiums you already paid as a smoker and those you would have paid had you not smoked. Whats more, once you quit smoking, this same company will adjust your premiums to non-smoker rates based on the age you were when you purchased the policy, not the age you are at the time you quit!

4. Check out your payment/billing options:
Many life insurance life insurance companies offer discounts to consumers who pay their annual premiums up front. If you have the money handy, you could save up to 10 per cent of your policys premium each year. For example:

A 35 year-old male with $250,000 in coverage can pay $195 up front per year for life insurance coverage. If paid in monthly installments, however, the annual premium jumps to about $215. Paying up front can save this person $20 per year!

A 40 year-old male with $250,000 in coverage can pay $263 up front per year for life insurance coverage. If paid in monthly installments, however, the annual premium jumps to about $288. Paying up front can save this person $25 per year!

A 45 year-old male with $250,000 in coverage can pay $373 up front per year for life insurance coverage. If paid in monthly installments, however, the annual premium jumps to about $407. Paying up front can save this person $34 per year!

Life insurance made even more affordable:
With these money-saving tips in hand, Term Life insurance is more affordable than ever. There is no better time than now to get the coverage you and your family need.