Getting an insurance is one of those ‘life’ requirements that you should be looking into early in your career, especially now when you are still able to work and earn money. in addition to being better able to pay for the insurance, younger individuals also pay less. This is one of the principles of insurance. Since younger people are less likely to die, they are given cheaper rates as compared to older individuals.

Insurance protect financially you and your family in the future. Depending on the kind of insurance that you will choose to get, insurance can even provide for your health concerns, for your retirement and even for your death and burial.

But while it is important that we are protected against any unexpected eventualities, some people still shy away of availing insurance on their own, preferring their companies to do it for them. Like legal matters, all those insurance mumbo jumbo tend to confuse and sometimes even frighten people.

Here are some of he frequently asked questions about insurance.

What are the kinds of insurance?
There are two major types of insurance. The life and the non-life insurance. The life insurance, as the name suggests, protects the family of the person in case something happens to him. When a person who is insured dies, the money that he insured will be given to the beneficiary that he has chosen.

The non-life insurance is an insurance that protects properties. Under this category, there are several different types. There car insurances, which protect automobiles from wreckage in case of accidents; property insurance, which protects properties especially houses from fire and other forms of destruction; deposit insurance, which most banks have in order to protect their depositors from losing their money in case the bank suffers financial setbacks; and health insurance, which helps in covering for medical and hospital costs. Among the various non-life insurance, the most popular is the health and car insurance.

Some insurance also provide for the future. Some of the insurances are retirement plans and death plans, which covers for burial costs.

What is the difference between a premium and a face amount?
Premium refers to the amount that you have to pay every year for the insurance. Some insurance companies also offer to divide the premium into monthly installments to help their clients. The face amount on the other hand is the amount that you have insured yourself into. For example, if the face amount in your policy is set at $500,000, then your beneficiary will receive $500,000 when you die.

What do you mean by double indemnity?
Some insurance policy offer an accidental clause that would double the face amount in case death has been established as accidental. This is done to protect the insured’s family in case of an untimely death. Double indemnity means that the face amount will be doubled when death is accidental.

Is the beneficiary always the legal spouse?
No. Contrary to popular opinion, it is not always the spouse who is the beneficiary. It is up to the person to choose, who he names as beneficiary. It can be any member of the family as long as insurable interest is established. If in case, the children are named beneficiaries and are still not in legal ages, a guardian will be named to assume control of the money for them.

Ian King makes it easy to find and understand insurance, quickly and easily. To learn the essential keys to insurance that you must know visit insurance agent ethics and for more info on life insurance visit life insurance protection.

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In the UK around 7 million people spend around ?3 billion a year on medical insurance. One in seven policies are taken out by individuals with the balance being put in place by their employers. The problem is that Medical Insurance is complex and few policyholders take the time to really study the details of their cover. As a result, many misunderstand what will be covered. If you expect medical insurance to pay every health claim, you’re mistaken.

Medical Insurance is designed to provide protection for curable, short-term health problems and allow policyholders to jump the NHS queues to see consultants, be diagnosed, receive surgery or be treated. That sounds fine, but before you buy you need to appreciate the treatments and situations that fall outside the scope of the cover.

But first a word of warning. This article does not relate to any specific policy and the terms and conditions issued by individual insurers do vary. So please ensure you also check your policy documents. After reading this article, you’ll know what to look out for!

Sorry - it’s a chronic condition

If a condition can be cured and is not a long-term problem, your insurance company will classify it as acute and should meet the cost. If your problem is incurable or it’s a problem that, despite appropriate treatment, will be with you for a long time, then your insurance company will classify it as chronic - and no, you won’t be covered.

But deciding whether a condition is acute or chronic is fraught with problems. It’s rarely a black and white decision and this can lead to a major area of conflict between policyholder and insurer.

It’s clear that asthma and diabetes are chronic conditions as you’re almost certain to suffer from them for the rest of your life. So those categories of illness are not covered.

Problems arise when Doctors initially consider a patients’ condition to be curable, but the condition later deteriorates and the medical team changes its’ mind, it’s now become incurable. This can sometimes happen, especially in the treatment of certain types of cancer.

In these circumstances, the condition is initially defined as acute and is therefore insured, but deteriorates and becomes chronic - and outside the terms of cover. This is possible as insurers retain the right to reclassify a condition from acute to chronic during treatment.

Sorry - it’s too long term
The insurance company will not pay out for long term treatment. But you need to check your policy documents to see how they define “long-term”. You can find the situation where a course of drugs extends for say 12 months, but the insurer will only pay for ten months.

Sorry - it’s preventative
Your insurance is designed to pay for the treatment and cure of conditions when they arise. It is not designed to pay for treatments that are used to prevent an illness.

Again, the problem of definition arises. Sometimes it is arguable whether a treatment is preventative or a cure. Take the drug Herceptin for example. This drug can be used in the early stages of breast cancer. Research shows that Herceptin can halve the incidence of cancer returning for women who have a particularly virulent form of the cancer known as HER2. In this situation, is Herceptin offering a cure or is it a preventative?

Insurance companies are split on the debate. Norwich Union, WPA, BUPA and Standard Life Healthcare will pay for Herceptin for HER2 patients whereas Legal and General and Axa PPP will not.

Sorry - the drug is not approved
Two of the main attractions for taking out medical insurance are: to jump the queues at the NHS, and to get the latest treatments and drugs. But there’s a rider.

The Institute for Health and Clinical Excellence exists to approve the use of new drugs by the NHS in England and Wales. Until that body has approved the drug your insurer is unlikely to pay for its use. The problem is that the Institute’s brief is to perform a cost/benefit analysis to ensure that the financial benefits to the nation from using the drug, outweigh the costs of using it in the NHS. A difficult brief and it has placed the Institute under scrutiny for the extended delays in drug approval.

The compromise hit on by the Financial Ombudsman is that if your medical policy won’t pay for the use of experimental treatments, then it should meet the cost of an approved conventional treatment with the policyholder footing the bill for the balance if the experimental treatment is more expensive.

Sorry - it’s a pre-existing condition

The basic principle is that if you are already suffering from a condition when you start a policy, then that condition “pre-exists” the policy and any claims for its treatment are invalid.

For this reason, insurance companies insist you complete an exhaustive questionnaire before they agree to insure you. After all they need a clear picture of your medical condition before they quote. For many applications, the insurer will, with your approval, also write to your GP for specific details of your medical history. They like to have a complete picture.

So lets say some years ago you twisted your knee playing tennis. It appeared to recover but now it turns out that you have a torn cruciate ligament and it needs to be operated on. Your medical insurance company could argue that the ligament damage was a pre-existing condition and you have to pay for the operation.

Some insurers try to accommodate these grey areas with a moratorium provision within your policy. These provisions typically say that so long as you have been symptom free for two years relating to any condition you’ve suffered from within the last 5 years, they will pay for subsequent treatment. Not all policies have these moratorium provisions and the time periods do vary between insurers. You should carefully read your policy.

Sorry - its not covered

Medical Insurance is an annual contract - just like your car insurance. So when it comes to renewal, your insurer is at liberty to review not only your premium but also change the conditions on which your cover is provided.

Therefore, if your policy comes up for renewal mid way through a course of treatment, it’s possible to find that your new policy no longer covers that particular treatment. This means that you will have to foot the bill for the balance of the treatment.

Furthermore, with ongoing advances in medical research, more and more conditions are becoming treatable. This progress has the effect of shifting back the dividing line between chronic and acute conditions.

This hits the insurers’ pocket in two ways. With more conditions being reclassified as acute, the number of claims is increasing. And there’s also a trend for new treatments to cost more - Herceptin being a good example. The net result is that the insurers are finding themselves having to pay out far more. This is inevitably passed back to you through increased renewal premiums. And in an attempt to reduce their risk exposure, insurers have a tendency to adjust their definitions and exclusions. This means that you must read your renewal notice closely before you decide to renew.

So if you’re tempted to buy Medical Insurance, be aware that everything is not always black and white. If you’ve got insurance and need treatment, you’re well advised to contact your insurer without delay and get them to confirm that they will meet the cost of your proposed treatment.

Michael writes for Brokers Online who offer most UK financial services including Health insurance

Health Insurance Topics

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Time and again new practices invest countless hours and money focused on office space, equipment, software and staffing only to open their doors for business and find significant delays in getting adequate insurance reimbursements. More often than not, the problem could’ve be allayed by addressing the insurance credentialing process early and thoroughly - creating the necessary relationships with insurance carriers. Here are a few considerations to keep in mind as you address the insurance credentialing process.

Timing - Start Early!

Plan on starting the insurance credentialing process early - at minimum allow at least six months before you see your first patient. Carriers will often take as much as 3-4 months to review documents and make a determination, even if everything is in order. If there are errors, missing information or a question about submitted documentation, several more weeks or even months can be added to the process. This six month allowance, starting from the time credentials are submitted, usually gives enough time to address problems should they arise. If too little time is granted before the practice opens, and you begin seeing patients before insurance credentialing is complete, you are open to the risk of getting an “out of network” rate, reimbursements might be sent to the patient, or, worst case scenario, you may not get paid at all.

Identify Target Carriers

To define which insurances you might credential with, consider your practice location and patient demographics. Will a significant percentage have Medicare or Medicaid? Is there a particular company or business in the area that employs a large portion of the surrounding population? A quick call to their human resources office to inquire what insurances they currently offer employees (as well as possible changes the near future) can be a good indicator of the carriers you’ll want to consider.

Also, check with colleagues, other providers, clinics and even larger hospitals in the area and ask who their most common payors are. Inquire about which payors are best to work with - who reimburses in a timely manner, which offer the largest enrollments, and which carriers might be at capacity with other providers in your specialty.

As you identify which insurance carriers might be most popular in the area, make a list of the top 10 or 15. Then, think about what other providers are saying and pare that list down to the top 7 or 8. This will be your short list of where to go next. Don’t go overboard and choose too many from the start - if nothing else, you’ll run yourself ragged in keeping up with the submissions.

Contact Insurance Carriers

With your list of 7 or 8, prepare to spend at least an afternoon (or more) on the phone with the provider services offices of each of your target carriers.

One of your first questions might be to ask if they are accepting new practices in your specialty in your area. More often than not there’s no problem here, but don’t be discouraged if they say no - just keep moving down the list and prepare to check back with them later for an opening. (Just remember, if several carriers on your list indicate they are closed to new providers, you might want to reassess your location before moving forward - finding multiple carriers closed to new practices in the same area is a strong indicator that there’s a lot of competition in the neighborhood.)

If the carrier is receptive to new providers, make sure you get all pertinent information about the process - i.e. names, addresses, phone numbers, timing, required forms, and so on. Don’t forget to ask about online submission too, as many carriers today allow you to provide all information online and mail in the supporting documentation.

**Remember that carriers won’t start the insurance credentialing process until you’ve established a practice phone number and address (a PO Boxes are not acceptable). If you’ve established a practice address but haven’t moved in yet, carriers can usually send the forms to an alternate address, but you’ll still have to identify the location to get things going.

Submitting Credentials

Now that you’ve completed your research and identified which insurance carriers you’re going to file with, you’ll need to compile and submit all of your information. Most will generally require you provide the following:

Updated resume

Personal demographic information

Practice and business information

State and federal DEA numbers

State licensing and registration information

Evidence of education - i.e. Diploma or ECFMG certificate

Malpractice insurance information

Information on any disciplinary actions

While this can be a lot, there is some good news - since most carriers ask for the same information, once the first submission is complete, you can just transcribe all the details from one form to the next. You will also benefit enormously in the future by storing copies of these documents in a safe place. As your practice matures and you seek to credential with other insurances, you’ll have this same repository of information readily available.

Once you’ve completed the application, don’t forget to double check everything. In fact triple check it and have someone else look over it as well. Don’t expect carriers to correct an obvious mistake for you - it’s not their responsibility, and, frankly, they just won’t. The importance of double and triple checking cannot be stressed enough as the entire process can be help up by a month or more from the slightest mistake.

Finally, after your information has been submitted, allow an appropriate amount of time (1-2 weeks for mailed submissions) and follow up with the provider services office to confirm receipt. If you were able to obtain a contact name in your early research call them directly. Once receipt is confirmed don’t hesitate to follow up again in say, 3-4 weeks to see if they’ve reviewed it yet or if they found any problems. If everything’s on track, plan on checking back in another 3-4 weeks until the process is complete. This can save a lot of turnaround time if you can learn over the phone there was some sort of hold up. As alluded to above, expect this part of the process to take several months - credentialing offices are often centralized and may be reviewing hundreds of submissions for many different areas at any given time. If there’s no movement after several months, you consider stepping up your calls to a weekly basis.

Hopefully your hard work and phone calls has paid off and you’ve made it through the insurance credentialing process in just a few short months with your original list of 7 or 8 carriers. If you’re up for the challenge yet again, consider going back to your longer list of 10-15 and start the process all over again with the remaining carriers.

A few shortcuts

Here are a couple of shortcuts to credentialing not mentioned above.

Hire professional assistance: There are many different organizations that can help with the insurance credentialing process. If you’ve contracted with a practice management company this process is often covered already. If you’re considering a medical billing company to manage your insurance and patient billing they certainly should have the experience with carriers to provide at least some guidance, if not manage the process for you. Also, there are a few professional insurance credentialing companies that specialize in this process for new practices but they can often come at a high price.

Universal Credentialing DataSource: The Council for Affordable Quality Healthcare has developed an online service intended to eliminate the need for multiple insurance credentialing submissions. In short, you complete one form for all of their participating insurance carriers and you authorize who will receive your information. The CAQH Universal Credentialing DataSource is located at: http://www.caqh.org/

Summary

The insurance credentialing process is critical to getting your practice off to a good start - and ensuring a quicker transition to profitability. While it can be time consuming, an early start will give you the chance to address problems should they arise. Just be patient and keep these tips in mind and you’ll get through it:

Start early - expect the process to take up to 6 months

Choose a target list - don’t try for every carrier out there

Double check your work before you send it in

Follow up regularly and keep the process moving

Don’t be overwhelmed - it’s just paperwork.

For more information on medical billing and medical billing companies, visit Diversity Medical Billng Services. Diversity is a full service medical billing company offering customized medical billing solutions to practices across the US. You can also find more Medical Billing Articles and Information in our Medical Billing Knowledge Center.

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