David Weinstein of Cherry Hill, New Jersey Explains Your Health Insurance Options
Any form of insurance is an investment. You’re buying a sort of protection that could help you if something goes wrong. By purchasing insurance, you’re protecting your future peace of mind. While you may not make money on health insurance, since you’ll only truly profit if you use more in benefits than you pay, it’s often a sound investment as insurance allows you to protect yourself from catastrophic costs you might occur in case of an accident or a serious medical problem. Most people agree that health insurance is worth the cost.
All health insurance plans are not created equal, however. Some health insurance plans require you to do a lot of the legwork and processing. Some health insurance plans put restrictions on what sorts of providers you can see, and what you have to do before you go. Knowing how health insurance plans work can help you make the most of the policy you’re paying for. I’ve listed a few common types below.
Health maintenance organizations, or HMOs as they’re commonly known, are incredibly prevalent in the United States. Many employers choose HMOs when they’re selecting insurance plans for their members. HMOs do have some benefits. When you see the doctor, for example, the insurance company will pay the doctor directly and you won’t be forced to fill out a claim and wait to be reimbursed. Many people really like this aspect of the HMO system. But HMOs do have some serious drawbacks. For starters, you must see a doctor for most of your care. If you hurt your shoulder and you know an orthopedist could help you, for example, you must see your doctor first before you see the orthopedist. In some HMO systems, your doctor will get a bonus if you do not go to see the specialist and the doctor cares for you alone. This obviously isn’t the best situation for all patients. Additionally, the doctor gets a certain amount of money for every patient that lists that doctor as the primary care doctor. The doctor gets a check whether or not the patient walks through the door. The doctor is rewarded for a full caseload, but has no incentive to provide care. Again, this isn’t always the best system of care.
Preferred provider organizations, or PPOs, are a bit more expensive than standard HMOs, but they do have some benefits that might be worth the added expense. When you enroll in a PPO plan, you’re given a list of doctors to choose from. If you see the doctors on the list, you’ll pay a copayment and have a portion of those visit expenses covered. If you veer off the list and see someone else, you may have a higher copayment and you may have to pay more of the visit expenses yourself. But you do have a lot of control in these plans. You can see whomever you want, without asking first. The doctors also get paid when they see you, rather than getting paid to have you on a list, so they’re motivated to schedule visits and keep them.
Point of service plans, or POSs, are a blending of the HMO and PPO models. When you sign up for a POS, you are asked to choose a doctor to be your primary care provider, and you must see that doctor first when you have a medical concern. You’re also given a list of providers that have an agreement with your medical plan and are considered part of the network. If you choose to leave the network and see someone else, you can do that but you’ll pay more for each visit, and you’ll have to pay the doctor directly and wait for the insurance plan to pay you back. Some people find this to be a bit cumbersome.
There are other forms of insurance available, such as self-funded health plans and indemnity health plans, but these aren’t common and it’s hard to find them in common circulation in the United States. If you are enrolled in one of these plans, take care to read your entire policy and member booklet carefully, so you know exactly how the plan works. Don’t be afraid to call customer service and ask for more information if you don’t understand something.
About the Author: David Weinstein of Cherry Hill, NJ, is a successful businessman with over 25 years of experience in the health care industry. He’s currently working on a new book that will detail the health insurance changes mandated by the recent legislation. David Weinstein enjoys working in the health insurance field and educating people.
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