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Medical insurance reviews provide results in a timely fashion. Filing a medical claim can be a lengthy process prone to miscommunication and breakdowns in the chain of paperwork. Bringing in an independent review organization can tap into deep reservoirs of medical expertise. The review on this level can determine an objective approval or denial of an insurance claim. The denial will be based on medical fact, however and not on anecdotal evidence.
The Five Key Steps in Medical Insurance Review
The following steps illustrate how a medical claim is reviewed.
· A patient is prescribed a treatment for a condition or injury. The medical opinion of the attending physician along with related charts and information may be submitted or requested in order to request coverage of the insurance claim.
· Medical and physician resources are provided the medical information and asked to review the treatment and prescribed recommendations.
· The medical specialist assigned to the case will provide an unbiased opinion with regard to the treatment.
· An insurance expert reviews the terms of the patient’s coverage as offered by the insurance company. They will offer an unbiased determination with regard to whether the patient is covered for the treatment in question.
· Finally, the two opinions are combined to return an objective recommendation for approval or denial.
On Time Decisions
This process allows for healthcare decisions to be made in a timely and expert fashion. The resource is invaluable for all aspects of the healthcare profession. Patients will receive approval for vital treatment that may be otherwise rejected by a large insurance company that handles its own medical reviews internally and without expert sources.
Anecdotal evidence is never used to deny a claim or pay for an unnecessary treatment. The use of third-party experts and medical specialists provides claim managers with the verification and authentication needed to do not only the right thing, but also the best thing. The medical insurance review process removes the factor of uncertainty that claim managers may face in a world of rising medical costs, complex specialization and treatments.
Avoids Ill-Informed Approvals and Denials
Healthcare costs skyrocket in an atmosphere where a claim manager must err on the side of caution to either pay for unnecessary treatment or deny one that is necessary. Without using an independent review organization, the insurance company may lack the resources to make a decision in a timely fashion.
As illustrated by the five key steps of the review process, experts from both sides of the equation are consulted. Complicated medical technology combined with equally complicated insurance policies and terms can make for a morass of misunderstanding without the right types of expertise. The process also reduces the amount of frustration felt by claim managers, patients and physicians by filtering the claims through the right hands to get the right advice and interpretations.
The more approvals of unnecessary treatments, the higher insurance costs will soar. The medical insurance review process allows a claim manager to make an informed decision and eliminate unnecessary treatments. Patients and physicians rely on insurance coverage to underwrite potential treatments for a multitude of conditions.
An insurance expert understands the complex terminology of a coverage policy. Specialized physicians understand the nature of illness and treatment. The combination of expertise improves the process of treatment review and coverage approval. That means no lengthy waits for vital services and no funding for unnecessary ones.
This process has a dramatic impact in reversing the trend of rising healthcare claim costs. By dramatically reducing these riding costs, an insurance company can save money for their consumers, their shareholders and the healthcare community.
The American economy is sucking a lot of money out of consumers’ pockets due to high gas prices and the general increase in every other consumer good from food to clothing that is associated with high oil prices. However, there is good news on the horizon, and that is that auto insurance rates are being reduced. Despite this reduction, there are several things you should keep in mind when shopping for car insurance to ensure you receive the best rate and coverage for you and your vehicle.
Tip #1 Shop Around
There are so many different auto insurers out there you might think it difficult to find the best insurance at the lowest prices. However, don’t despair because all you have to do is shop around. The easiest way to do this is to go online and search all your favorite car insurers in order to receive a fast and free online quote. Then, you can simply compare the services and prices of the insurers and make the best choice for you. Spending a little time on research might save you hundreds of dollars on car insurance.
Tip #2 Look for the Discounts
You may not have known this, but many auto insurers provide discounts to drivers for good driving behavior and other reasons as well. So, ask about the discounts available through various insurance providers and consider how many you would qualify for. More than likely if you qualify for one or two then your rates could easily drop several hundred dollars per year.
Tip #3 Maintain Your Credit
Unbeknownst to you, your credit score affects your car insurance rate. As a result, you should be sure to maintain your credit score as high as possible in order to not only receive the benefits of good credit, but also to pay lower car insurance premiums. It is really worthwhile, and something you will benefit from economically.
These tips are great ways for you as a consumer to take your car insurance needs into your own hands and find the best provider with the lowest rates and most coverage. When you start doing the research, you will be amazed how much money you can save as well as how many more benefits you can receive. Go ahead and start saving on your auto insurance today, there is no reason to wait.
Do you think you have the best auto insurance coverage just because you’re with a “big name” company?
News flash, you’re probably getting less coverage than you think.
But first let’s talk about accident statistics in the U.S.…
There are about 3 million car-related injuries a year
• 2 million permanent injuries
• 40,000 deaths in the U.S. each year
About 40% of car accident fatalities are related to drinking and driving.
• 30% to speeding
• 33% from a car going off the road
Car accidents are currently the number one killer of people ages 1 to 37.
About 1 in 30 young drivers will be injured in an accident each year.
Young drivers are four times more likely to die in car accidents.
• much more prone to speed
• drive recklessly
• not wear their seat belts
• and drink and drive
There are Approximately 6.4 million accidents each year
Approximately 40,000 people die in auto accidents each year.
You may ask yourself what are the odds of me getting into an accident?
There were 48,366 Transportation accidents in 2002.
• One year odds of You getting in an accident are 1 in 5,953.
• Lifetime odds of You getting in an accident are 1 in 77. Are you the 1 in 77 to get into an accident this year?
Did you know?
Midnight to 3 a.m. on Saturdays and Sundays proved to be the deadliest 3-hour periods throughout 2003?
In 2004 there was a total of 38,253 Fatal Crashes.
• Over 26,756 Driver crash victims
• 10,304 Passenger Victims
• 4,641 Pedestrian Victims
• 725 Pedacyclist Victims
Let’s move on to Insurance Coverage.
Here are the 7 things your auto insurance company should give you but doesn’t!
1. Full replacement cost paid if your new car is totaled in the first year at no additional cost.
2. Towing and roadside assistance included with your policy at no additional charge and no reimbursement required.
3. Bilingual insurance representatives available 24 hours a day 7 days a week to provide policy service or take claim reports.
4. Extension of your policy coverage and limits when driving in Mexico within 100 miles of the U.S. Border.
5. Discounted rates for qualified members of certain occupational groups.
6. Temporary coverage for student children home on holidays at no additional charge.
7. Waiver of collision deductibles if both parties involved in an accident are customers of the same company.
“Different strokes for different folks.”
When it comes to life insurance, it’s important
that you keep that saying in mind.
Most people are familiar with “whole” life insurance.
This is the kind of insurance where you will get back a certain amount of money when it
“matures” at the end of the insured period.
What you may not know is that there is another
form of life insurance called “term” life insurance.
Similar to whole life insurance, when
you get a term life policy, you pay a sum of money (the “premium”) to the insurance
company, and in exchange the company promises to pay out a certain amount of money should
you die during the period for which you are covered under the policy.
In other words, you
are buying insurance coverage for a certain period of time.
But unlike whole life insurance,
you will not get back any money at the end of the insured period when you buy term
You may be saying to yourself, “But won’t I be throwing money down the drain?
After all, I won’t get back a single penny after the insured period!”
Hey, I understand how
you feel. But rest assured that term insurance is still a very idea, and I highly
recommend that you use it to your advantage.
So, why should you still consider term
Well, one advantage of term insurance is that it’s cheap. In fact, for the same
amount of insurance coverage, the premium for a term policy is only a small fraction of the
whole life policy’s premium.
And this is why term policies are a great way for you to make
sure you are sufficiently covered. If you’ve never checked out the premiums of a term life
insurance, I highly suggest that you go do it soon. You’ll be surprised at how cheap it is
to bump up the insurance coverage for yourself!
Plus, you can use the money you save from
the lower premiums to invest in some other areas that can potentially generate higher
returns for you. This strategy is generally known as “buy term and invest the difference”,
and it’s something I recommend that you take into consideration as you do your financial
Before you purchase a pet health care insurance plan for your pet, check the list of the companies approved veterinarians to see if your veterinarian will accept the companies check.
Ask your local veterinarian what type of pet health care insurance plan would best suit your family pet. Ask your local veterinarian to read over the plan and listen to their advice. Talking to your local veterinarian will also help you establish if the insurance company you are considering purchasing your pet health care insurance plan from is reputable.
If you have purchased a pet that is as of yet unaltered you’ll want to look for a pet health care plan that includes neutering and spaying.
Before you pay for a pet health care insurance plan you need to carefully read how the policy handles prescription coverage. Most companies that sell pet health care insurance do not include prescription coverage in their basic medical health care insurance plan. If you are concerned about the cost of any prescription your pet might need during the course of its life you should probably consider buying a prescription coverage rider to complement your pet health care insurance. Although this rider may appear expensive and unnecessary you’ll probably wish you had purchased it if your pet is ever given a prescription for anything. Just like the human counterparts prescriptions are very expensive.
One of things you need to take into consideration when purchasing a pet health care insurance plan is the deductible. The deductible is the amount of money you pay out-of-pocket for veterinarian services rendered that your pet health care insurance plan does not cover. Different pet health care plans require different deductibles. The higher a the deductible you choose the lower your monthly payments to the insurance company but the higher deductible the more out-of-pocket extension had each time you visit the veterinarian’s office/clinic.
Most pet insurance companies have “cap” or limit placed on each pet health care insurance plan. This cap varies from one procedure to the next a broken leg will probably have a different cap then cancer treatments will for your pet. Before you purchase your pet health care insurance plan talk to the company representative about waiting periods. Find out exactly how long it’ll take over the policy to be effective and how long the general wait for claims to be reimbursed is. Most companies have a ten day period between the time they receive the vet bill and when the check gets placed in the mail. Also find out how the refund is processed. Does the pet health care insurance company pay the veterinarian directly or do you have to pay the vet and the company mails the check to you when they receive the bill.
Why you have the company representative on the phone task about any and all exclusions that might be included with your pet health care insurance plan. Specifically ask about any and all pre-existing conditions and hereditary defects that might come up later in your pet’s life. Many pet owners especially, those that have dogs, discover that hereditary defects come into their particular dogs are not covered by their pet health care insurance plan. Some companies will allow you to cover these potential problems with an additional rider. In some cases your local veterinarian will be able to warn you about any exclusions.
If you are considering a comprehensive health care insurance plan ask if the plan covers teen veterinarian visits such as; dental care, immunizations, and heartworm testing. Also ask if the pet health care insurance plan also covers the office call.
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 ardian will be named to assume control of the money for them.