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Troubleshooting the Top Three Complaints About Health Insurance

Health insurance: Is there a more frustrating topic these days? Here are three common complaints I hear about health insurance and how to deal with them.

Complaint #1: Rising Premiums
A recent survey conducted by the Kaiser Family Foundation found that premiums will rise 14 percent in the coming year for employees who are getting insurance through work. Solution: Research Your Options
You may be able to minimize the pain by switching to a high-deductible plan linked to a health savings account (HSA). You’ll pay more before benefits kick in (hence the name), but your monthly premium will be lower.

Calculate your likely medical costs for the coming year — deductibles, co-pays, co-insurance and prescription — and compare costs between high deductible and PPO or HMO plans.

If you buy insurance in the private market, compare plans available in your area side-by-side at Healthcare.gov. You may be able to find a comparable plan for less.

Complaint #2: Denied Claims
Billing errors are made more often than not, which is why you should question every denied claim.

Solution: Fight Back
First, check with your doctor’s office or hospital to make sure the services you received were correctly billed. Then, place a call to your insurance company questioning the denial, and ask your physician and/or hospital to place a hold on your bill while you appeal.

You have the right to file a formal appeal with your insurer, and may be eligible for an external appeal with an independent reviewer in cases where your insurer won’t budge. Check with your state insurance department for details.

Complaint #3: Denied Coverage Due to Pre-Existing Condition
Denial of health insurance coverage increased 50 percent between 2007 and 2009 for people with pre-existing conditions. It’s harder than ever to find insurance if you’ve been sick.

Solution: Shop Around
New federally funded high-risk pools have been established for people who can’t get coverage elsewhere. Your state’s department of insurance has details.

You must be uninsured for six months and you’ll have to prove you’ve been denied coverage in the private market. But apply; sometimes people get lucky. Consider working with an agent who knows the market. You can find one on the National Association of Health Underwriters’ website.

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Posted in Managing Your Health Plan