When a short term medical insurance customer is unhappy, it is usually due to a lack of coordination and poor communication between the policyholder and a service provider within the insurance company or in the health care field. Improving customer satisfaction is really about reducing anxiety. After all, no one will ever be thrilled with the prospect of receiving and paying for their heatth care. But we must focus on reducing unnecessary policyholder anxiety and avoid larger problems through clear communications.
When a claim is not processed, for example, the most likely cause is that no one submitted the clam to the insurer. The policyholder assumed that that the doctor's office submitted the bill; the doctor's office holds that it is the patient's responsibility. No one gets paid and both are frustrated. This scenario describes about four out of every five claims problems.
Another common issue is when a policyholder wants to know in advance if a proposed medical service will be covered under the policy: the insurance company says they will not comment on a theoretical claim until they can review the facts and medical records. The doctor says they do not know if the claim is covered but they will submit it and find out (passing blame on the insurer and the financial risk to the insured). Both parties prefer to "hope" tht the treatment will be covered rather than take responsibility for making the determination on their own. No one takes the time to say "Based on your description of the situation, this procedure is a treatment for a pre-existing medical condition that is not covered by your policy. We need to discuss alternate methods of paying for the treatment proposed".
OnlineAdviser service at MedSave.com provides this type of bridging that can help connect the missing communications between service providers. As a provider of advice only, the focus of this service is on clear communications that can help reduce problems for policyholders and medical providers over the long term. This service has addressed an estimated 50,000 consumer questions about short term medical insurance worldwide over a period of more than a decade. As a result, MedSave.com has become one of the most trusted sources of short term medical insurance in the U.S. and the enrollment support endorsed by http://www.short-term-medical-insurance.com/.
Wednesday, February 13, 2008
Tuesday, February 12, 2008
lesson learned from a failed wellness program
Insurance companies consider obvious health indicator factors like smoking, obesity, and cholesterol when setting health insurance premiums. There is little question that these factors are closely linked with long term health costs so this is a sound actuarial practice when utilized in the right context balancing individual privacy and behavioral management skills. Estimated costs for these risk factors are built into our individual health insurance premiums whether we know it or not. Federal law now allows employers to build behavioral health factors into group health plans as part of a wellness program.
When one company tried to incorporate these cost factors to an employee wellness program, they went about it the wrong way. A news article describes the story of one employer, a heath care company, that proposed charging higher premiums for those with higher behavior risk factors. Employees strongly objected and the plan was dropped. Instead the employer now offers discounts for those who meet behavioral health goals like quitting smoking or lowering cholesterol.It is interesting that the net financial result is the same, yet one approach is palatable and the other clearly is not. Consider this example as a lesson for employee benefits planners.
By charging the same price for all similar state/age/sex applicants regardless of behavioral health factors, short term medical insurance premiums actually favor those with health risks. Yet the system is simple and draws little objection, partly because the premium rates are so low that cost pressures are not as significant as in other health plans.
When one company tried to incorporate these cost factors to an employee wellness program, they went about it the wrong way. A news article describes the story of one employer, a heath care company, that proposed charging higher premiums for those with higher behavior risk factors. Employees strongly objected and the plan was dropped. Instead the employer now offers discounts for those who meet behavioral health goals like quitting smoking or lowering cholesterol.It is interesting that the net financial result is the same, yet one approach is palatable and the other clearly is not. Consider this example as a lesson for employee benefits planners.
By charging the same price for all similar state/age/sex applicants regardless of behavioral health factors, short term medical insurance premiums actually favor those with health risks. Yet the system is simple and draws little objection, partly because the premium rates are so low that cost pressures are not as significant as in other health plans.
Monday, February 11, 2008
health care planning for early retirees
What is the best approach to health care planning for early retirees?
A Cigna executive published a white paper at http://cigna.tekgroup.com/images/56/The%20New%20Health%20Care%20Gap.pdf that basically says that planning for health care for a surge of baby boomer early retirees is a serious matter and that employers and the insurance industry have not yet responded.
It seems that good health care planning under the ideal circumstance could cost a client $10,000 to $20,000 a year less than poor planning in an unfortunate circumstance, so this could be a "make or break" issue for cleints considering early retirement.
Under the best case, an applicant within three years of Medicare eligibility could use a 12 month x 3 year renewable short term medical insurance. This would give the most liberal coverage at the lowest price if pre-existing medical conditions are not an issue. Unfortunately this type of extended coverage is only available in about half of the states. The list is included in the review article at http://medsave.com/articles/Review-of-Secure-12x3-STM.htm. This coverage would typically be priced well under $1000 per month for a typical couple at age 62-64.
At the worst case, in some states with highly regulated individual insurance like New Jersey the same coverage could cost several times more, perhaps more than $3,000 per month.
A Cigna executive published a white paper at http://cigna.tekgroup.com/images/56/The%20New%20Health%20Care%20Gap.pdf that basically says that planning for health care for a surge of baby boomer early retirees is a serious matter and that employers and the insurance industry have not yet responded.
It seems that good health care planning under the ideal circumstance could cost a client $10,000 to $20,000 a year less than poor planning in an unfortunate circumstance, so this could be a "make or break" issue for cleints considering early retirement.
Under the best case, an applicant within three years of Medicare eligibility could use a 12 month x 3 year renewable short term medical insurance. This would give the most liberal coverage at the lowest price if pre-existing medical conditions are not an issue. Unfortunately this type of extended coverage is only available in about half of the states. The list is included in the review article at http://medsave.com/articles/Review-of-Secure-12x3-STM.htm. This coverage would typically be priced well under $1000 per month for a typical couple at age 62-64.
At the worst case, in some states with highly regulated individual insurance like New Jersey the same coverage could cost several times more, perhaps more than $3,000 per month.
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