12 October, 2009 MSNBC

Medicare doesn’t cover vision and I need glasses. I live in the County of Los Angeles and am 65 years old. With deceased husbands social security and a part time job, I barely meet living expenses. How much income makes me eligible to apply for MediCal Insurance? Thank you for your answers.

Ask anyone in the city about medical coverage and the response in the positive will just surprise you. The awareness about medical cover has not affected people residing in the megalopolis, i.e. those from villages and small towns. There are three sections of people in the city who go for medical insurance. One section buys medical coverage plans to stay safe in terms of medical expenses and to avail other medical benefits. Another section gets insured for tax benefits. And the third are part of a company – the corporate class, who are subjected to medical cover as part of the company policy. In all the three cases, medical insurance does keep all insured at bay from the spiraling medical costs!

Medical insurance benefits offered differ from company to company; most companies offer affordable and cashless Medical Coverage Plans as per the budget of the client, generally in two variants – individual and family. Most medical insurance companies serve customers online; they also have executives who visit the client once the company gets an enquiry. Insurance agents, representing medical insurance companies, also visit or call people to get them insured with medical coverage plans. If you are buying a policy from such agents, check whether they are registered or holding licenses or not.

Even if you belong to the aforementioned sections, excluding the corporate one, it is advisable that you compare medical insurance rates before buying. The variants offered in individual and family medical coverage plans differ in the benefits and budget factor. The more premium you pay the more is the insured sum. Medical insurance rates differ as per the insured sum or as per company. You can also compare medical insurance rates by getting instant medical insurance quotes online. A click of the mouse will help you find an affordable medical cover that fits your health care needs. You can get these quotes for free from all online insurance companies that you come across on the web. Once you have compared the rates and the benefits offered, you can opt for the best and get insured.

Times are changing in small towns too. Licensed Health Insurance Agents visit people, spreading awareness about medical cover and suggesting them to buy one. But the concept is yet to gain momentum there; it may take another decade or decades for maximum people to stay insured with medical cover!

The complicated debate over Health Reform. Sources confirm the interests of health insurance companies behind close doors.

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With ample opportunities for billing errors within today’s complex health care claims and reimbursements systems, it’s a wonder people carrying individual medical insurance don’t spend more time carefully checking each Explanation of Benefit (EOB). The EOB shows what was charged less what the insurer agreed to cover, the balance being what you owe. Checking your EOB is the first line of defense against overpaying on a health insurance claim.

Your EOB may not reveal a lot, but you can check to see that your name, address, and policy information are correct. You should also confirm that you were charged the “allowable” rate set by your insurer and not a penny more. Deductibles can be as high as $10,000, and payment comes entirely from your bank account, which makes group discounts all the more important.

Other common errors the EOB may reveal include: Failing to get credit for a deductible that has been paid, in-network providers classified as out-of-network, legitimate claims denied as “medically unnecessary,” “upcoding” (being charged for more expensive services than you received), and “unbundling” (when a single procedure is broken down and billed as many). At Blue Cross/Blue Shield’s Web site www.bcbs.com/betterknowledge/anti-fraud/explanation-of-benefits.html, there’s a brief tutorial on how to read and double-check an EOB.

According to a 2001 Harvard study, illness and its associated costs are responsible for 50 percent of all bankruptcies, so it literally pays to request itemized bills from hospitals and other service providers. They are your next line of self-defense against overpayment. The problem is making sense of them, which may require hiring a patient advocate.

Lee Taber works for HealthCare Mediation Group auditing itemized bills, coordinating appeals, and, when possible, negotiating reduced payments and workable payment schedules to keep clients from getting a damaging credit rating. While costly mistakes are rare, Taber estimates that 40 to 50 percent of hospital bills contain errors: “The potential for error is high when a bill is 15 pages long and lists every aspirin and other medical supply.”

Advocates receive a percentage of the money they save you. Their cut varies but can run as high as 30 percent. He concisely sums up the benefit of working with an advocate: “If you don’t know what you’re looking for, how would you find it?”

Indeed, visit the Individual Services page at Medical Billing Advocates of America at www.billadvocates.com/ where you can read about a patient who was charged $12 for a “mucus recovery system” a box of tissues.

If paying someone to fix a mess you didn’t make gets you mad, imagine being the victim of medical identity theft. It’s like losing control of your social security number and private financial info, but this is a loss that can be deadly. If a phony claim is made using your benefits, your chart could contain wrong information when you need urgent care. If your benefits are tapped out by an impostor, you’ll have none left for your own care. According to a World Privacy Forum report on the crime, all levels of the medical system may be involved, in addition to organized crime.

When it comes to your individual medical insurance, do your homework and prepare in the event of inflated bills or medical identity theft. It can save your money and your life.

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Our loved ones are precious, and so is their health. That’s why when it comes to family medical insurance, we want to be sure we get a good family health insurance quote so that we can choose the plan that’s right for our situation. That’s where a free family health insurance quote from R. Curtis Insurance can be a great help. By knowing your family’s personal situation, R. Curtis Insurance can give you a family health insurance quote and sort out which plan is right for you.

 

In preparing to review your family health insurance quote from R. Curtis Insurance, it helps to understand the three basic plans of most family medical insurance: Health Maintenance Organization, Preferred Provider Organization, or Point of Service.

 

Health Maintenance Organization- This form of family health insurance plan came into widespread use about 20 years ago as a way to hold down medical costs while providing a range of preventive health care services. A health maintenance organization, or HMO, works well for families that want to keep their out-of-pocket medical costs low and are willing to give up the option to select their own physicians to save money.

 

HMO participants must select a primary care physician, or PCP. This doctor is the physician that families see most of the time for regular check-ups, vaccinations, minor illnesses and injuries. The PCP also serves as the “gatekeeper” for more specialized medical care, since an HMO requires a patient to get a referral from their primary physician in order to see a specialist in the network.

 

The big advantage to families of an HMO is that it keeps your out-of-pocket costs down while offering a wider range of preventive medical care, such as well child check-ups, vaccinations, dental check-ups, vision screening and so on. There’s usually no deductible to fulfill in an HMO plan and the co-payments for office visits and medications are often much lower than in other plans.

 

There is a drawback to an HMO for families, however. With this type of family medical insurance, there’s little or no coverage for medical services obtained outside the HMO network. Should your child suffer an injury while you’re out of town, there will be some coverage for immediate emergency care, but any extensive medical therapy will have to wait until you’re able to see your primary care physician and get a referral.

 

Preferred Provider Organization- This kind of family medical insurance plan, known as a PPO, offers more flexibility in the choice of health care services. With a PPO, the insurance company has made agreements with a network of doctors and hospitals to provide medical services at discounted rates. Participants in a PPO pay a co-payment for each office visit and must fulfill a deductible before the insurance company starts paying for other medical services. As long as the doctor or clinic is within the PPO network, there’s usually no need for additional referrals. However, any out-of-PPO medical care will cost more out of pocket and the insurance company will probably pay less of the total cost.

 

Point of Service- This kind of family medical insurance plan, referred to as POS, combines some of the best features of HMOs and PPOs. Participants still must select a primary care physician from the insurer’s network, but this means that families establish a relationship with one physician who gets to know their particular health care circumstances well. POS plans also provide for more preventive care services, a big advantage for growing families. There’s often no deductible for primary medical care with a POS plan.

 

However, like a PPO, a POS plan pays a larger portion of medical costs only when families use physicians within the network. There’s a deductible required for out-of-network services, and the insurance company pays a smaller portion of out-of-network costs. For more families, this can result in a major financial outlay while waiting for the insurer to process a claim for reimbursement.