Irda On Health Insurance Cashless Dispute

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The Insurance Regulatory and Development Authority (IRDA) Friday said the issue of offering cashless treatment under health insurance policies issued by the four government-owned general insurers ‘is getting resolved’. IRDA Chairman J. Hari Narayan said that prior to dispute there were only 300 government owned insurers as compared to 400 now.
The four government-owned non life insurers had earlier delisted major hospital chains from offering cashless hospitalization facility for their health insurance policy holders on the ground that the hospitals are over charging the patients.
He was in Chennai to launch the country’s first health cum life insurance product introduced by the city-based Star Health and Allied Insurance Company Ltd partnering with private life insurer Shriram Life Insurance Company Ltd. when he clarified.
There are talks of creation of separate regulator for the healthcare sector. Also, Confederation of Indian Industry (CII) has said none of the major super speciality hospitals have signed with the Raksha TPA (third party administrator).
CIIs members are waiting for a response from the insurers and the TPA since the meeting Raksha in Delhi. As on August 12, the hospitals in Delhi have worked out the packaged rates for 42 procedures and submitted to the TPA.
Once cashless is restored in the empanelled hospitals, in the second phase, hospitals and insurers along with other stakeholders of the health insurance ecosystem and the competent authority would work on a classification of hospitals, which would be agreeable to all.

The other side:

Shivinder M. Singh, managing director, Fortis Healthcare said ‘There will always be a differential in the levels of care and services provided by hospitals for a single type of illness. This differential is a function of structures, processes and outcomes. A scientific analysis of all these parameters is essential to grade hospitals.’
Sanjeev Bagai, CEO, Batra Hospital and Medical Research Centre said, ‘This grading or categorization of hospitals should then translate into pricing of procedures in each grade. Premature conceptualization or inference of this complex process must be avoided’. It is essential that a comprehensive exercise be undertaken of grading hospitals based on their infrastructure, clinical expertise, technology base, clinical outcomes, competency of para-clinical man power, accreditation and standards of care is done.

How Much Does Health Insurance Cost Per Month

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For many non-insured people, the question of how much does a health insurance policy cost today can make or break their decision to pick a plan. It must be emphasized that insurance is a necessity in our times especially with the rising costs of health care.

Even if you have to take the cheapest plan with basic coverage, take it for indeed it is better to have health insurance to help shoulder the costs of medical care than to have no protection at all. Besides, many factors will affect the cost of your insurance plan such that you might be persuaded to think that indeed the premiums you pay are worth every penny.

Factors Affecting Costs

Health insurance plans are not islands unto themselves. Just like other aspects of modern life, it is dependent on varying degrees on the economic and political environment as well as on the applicant’s personal circumstances and preferences.

On one hand, economic and political factors include use of insurance plans amongst people and advances in medical science and medical technology. As modern medicine finds newer and better ways to prolong the lives of human beings, insurance costs will rise to meet the consumer demand. And with the proposed health care reform, we may see a shift towards greater burden on consumers of insurance plans.

On the other hand, personal circumstances will also affect the cost of the insurance policy. These personal factors will include:

– Age – As you age, your premiums will increase.

– Gender – Women will pay for higher premiums than their male counterparts

– Medical history – Your past and present health can either swing the favor of premiums for or against you.

– Lifestyle choices – Alcohol consumption, smoking habits, use of street drugs and obesity will affect the costs of the plan

– Place of residence – Each state has its own insurance laws especially where coverage and caps are concerned

– Types of plan preferred – Comprehensive plans are more expensive to pay for than scheduled benefits plans. Fee-for-service plans, preferred provider organizations, point-of-service plans and health maintenance organizations all have their costs.

The insurance company will evaluate all these factors before providing you with a quote.

Actual Costs

As can be expected, each individual’s insurance quotes will vary depending on the personal factors. If the 2008 figures for the United States is the basis, an average individual will spend around $5,000 while an average family of four will spend up to $18,000 on health insurance policies per annum.

Unfortunately, health insurance rates now cost more than compact cars. However, you have to remember that a compact car will not provide financial protection in times of medical emergencies, unlike the health insurance policy.

It cannot be denied that health insurance costs are on the slight rise. You may grumble about it but the fact still remains that health insurance is an essential part of modern life.

Allay Fears Of Comparing Health Insurance

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Experts keep telling us compare different health insurance policies if you are interested in getting cheap health insurance in Australia. But at the first look all of them seem the same so what exactly do you need to compare, how to filter and sort so that you choose the right health insurance policy. Today we shall try to allay a few of these questions and few other fears you may have that prevent you from comparing health insurances.

Marketing tactics

Most of us feel that this so-called comparison is just a marketing tactic for data mining. Essentially the company wants to collect your contact details so that they can have their sales team call you and pester you into taking one of their policies. Well this isnt entirely true; most comparison sites wont even ask you for any contact details. But yes they will ask for some important information like your age and type of cover you need amongst a few other questions. This will help them show you the relevant policies available and the premium payable for the same. You can then filter it and sort it anyway you like.

User-friendly application

Most of the sites do the filtering and sorting for you. Once you have keyed in the information it will take you to the results page where most or almost all of the policies suitable for you are listed. You can then eliminate or filter them according to your specific needs.

For instance select the level of cover based on your personal requirements, if you are looking for comprehensive then choose comprehensive as your level of cover
Similarly if you are looking for health funds, choose that option and you will get a list of health funds to compare
The monthly budget slider will help you indicate the amount of premium you can afford or are willing to pay
If you are looking to cover specific treatments, tick those you want to cover in the hospital cover and extra cover menu

Each time you adjust the filter options results will get updated automatically till you have selected all options that you think are relevant. With this filter application it is easier to compare policies.
Making comparisons

Check for the Canstar rating (your best bet to get cheap health insurance in Australia that provides best value for the money). Check pricing information if it covers treatments you were searching cover for, also remember to check exclusions.

Understanding Health Insurance Claims And Policies

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Health Insurance policy helps you in your medical crisis offering the benefit of cashless hospitalization and quality treatment If the process is duly followed it becomes easier to get claim settlement. However, many times there may be a situation when claim is denied due to non coverage of the disease under the policy and treatment not being covered by the policy. Such situations may leave you badly frustrated. So, it is always better to gather knowledge of how health insurance claims are processed, how and why are they accepted and rejected and what are the different types of health insurance claims.

Types of Health Insurance Claims

Basically there are three types of health insurance claims:
Cashless Claims
Reimbursement Claims
Pre and post hospitalization claims

a. Cashless claims: As the name suggests, cashless claims mean where the claim is settled without you paying any cash to the hospitals to avail treatment. This happens if the hospital where you are undergoing treatment is a network hospital and you have aptly followed all the procedures to avail cashless treatment.

b. Reimbursement Claims: In this type of health insurance claim the hospital bill needs to be settled by the insured as most probably the hospital in which you are availing treatment is not on the network of the insurance company. Once you settle the bills with the hospital you need to submit the documents as required by your insurance provider and file a reimbursement claim. If all the documents are duly submitted then the money spent up to your coverage extent on the treatment is reimbursed.

c. Pre and post hospitalization claims: Most of the health insurance policies provide coverage to pre-hospitalization expenses for 30 days and post hospitalization expenses for 60 days. You need to submit the original bills to claim the expenses.

Under what circumstances my claims can be rejected?
Most of the time, the claims are rejected because of improper communication between the insured and the insurance company. Always pay heed to the following before filing a claim for availed treatment:

Does my policy cover the treatment for the disease diagnosed?
Do I need to get prior approval before getting hospitalized?
Have I submitted all the required documents and prescriptions as mentioned in the policy document?
Have I timely submitted the documents or not?

What if my claim is genuine but still being rejected by the insurance provider?
You can always take a legal route if you think that your claim is wrongly rejected.

Best Health Insurance Agent For Hsa Qualified Health Plans

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A lot of people have asked us, what is it that makes HSA for America so special? Well, HSA for America which is the largest online health insurance agency specializing in plans that work with health savings accounts. We specialize in plans that work with HSAs.

Most health insurance agents, despite the fact that more people are getting HSA plans than are getting non-HSA plans, the typical health insurance agent is resistant to that change and there are a couple of reasons. One is that we all get into our habits and their habit is presenting conventional co-pay plans, but the bigger reason is that health insurance agents get paid commission for selling health insurance policies and the more expensive the premium is, the more commission they get paid.

HSA premiums are about 40% less than conventional co-pay plans so the agent earns a much lower commission and thus some don’t want to tell you about it, but that’s our focus is HSA plans, and our focus is finding ways to save our customers money. We show you how you can get discounts on prescription drugs, on lab testing, how you can have any medical bill over $200.00 renegotiated at no cost to you to see if they can lower the actual price you’re being charged and basically, we’re just trying to not only save you money, but to make the process easy.

So on our website at www.HSAforAmerica.com, there’s information on all the available plans, you can run instant quotes, you can compare different plans, compare rates with different deductibles and really find the plan that works best for you and that’s what this is all about. We’re all about helping you go out into the marketplace and really choose for yourself what will work best rather than being sold a plan that’s maybe best for the insurance agent, but not necessarily for you.

For more information on how to save money with HSA qualified health plans as well as many other money saving tips and strategies, go to www.HSAforAmerica.com. There you will find more information not only about Health Savings Accounts and high deductible health plans, but also many other ways to seriously reduce your health care expenses and enjoy all the benefits of a truly comprehensive health plan.