Insurance World

Whether you are seeking health insurance through your employer or on your own you will be offered a variety of plans. In order to make the proper decision about which plan is right for you it is important to know the basic characteristics of the most popular types of health insurance. After this it is wise to get many quotes on health insurance and compare them. This is a free way to compare plans and prices.

Fee for service

For many years the fee for service plan was very popular and widely used type of health insurance. The insured pays a monthly fee. A deductible is applied to the cost of the services. Some services related to healthy living or emergency services may be exempted from the deductible. Once the deductible has been met the insured and the insurance company share the cost of services. For most companies the split may be 80/20 or 70/30. The company pays eighty or seventy percent, the insured pays twenty or thirty percent. There will be a cap on the total amount of money the insurance company will pay in a lifetime.

Health Maintenance Organization (HMO)

HMOs have become increasingly more common in the last decade. Again, the insured pays a premium which makes him/her a member of the HMO. As a member of the group the member is entitled to visit any of the doctors who are part of the group. These doctors may all work together in an HMO facility or may work in individual clinics as part of a group of doctors under contract to the HMO. Members may have to pay what is called co-pay when they visit the doctor. No paperwork is necessary to validate the claims of an HMO member; however, members may wait longer for non-emergency appointments than they would with a fee for service insurance program. An HMO generally requires its members to have a primary care physician who then refers the member to a specialist if needed.

Preferred Provide Organizations (PPO)

The PPO, a blend of the fee for service model and the HMO model, is a fast growing sector of health insurance. As with an HMO there is a network of doctors from which the insured chooses his/her physician. This physician is responsible for designating the need for specialized care. A co-payment will be required when an office or hospital visit is made. There will also be a deductible and medical expenses will be divided at an agreed upon scale between the insured and the insurance company operating the PPO. A person may choose to use a doctor who is outside of the network. Expenses incurred for medical care outside the network will make the patient’s share higher.

Please collect as many quotes as possible in order to compare services and rates. This is a free way to learn a lot about all of your options.

Copyright 2006 Donovan Baldwin

There are two primary types of dental health care benefits. You may get dental insurance, or sign up for a discount dental plan. There are differences between the two of which you should be aware.

Dental insurance is sometimes difficult to get and somewhat expensive. This is because of the nature of dental health care. It tends to be somewhat predictable and structured over time. Because of this and other considerations, fees tend to be high relative to the savings. In many cases, the cost to you, the consumer, would be greater than the normal costs of the dental care itself.

This is a lose-lose situation. If the dental insurance company lowers its fees (premiums), it may wind up paying out more in claims. In other types of insurance, the insurance company bets, if you will, that you will stay healthy more than you will get sick. They make that same bet with a huge number of people. Statistics show that they are right more often than not, so, they get to keep a lot of the money they take in. Those who need to use the health insurance win, because they can get high cost services at lower prices if and when they need it. Even those who never use the services win in a sense because they have the comfort of knowing that should they need these services, they will be able to afford them.

Over the last several years, another type of dental health benefit has appeared. This is the discount dental plan. This more affordable dental plan is generally relatively inexpensive for both the member and the company, as well as providing some business benefit to the healthcare provider – the dentist.

It is easiest to think of the discount dental plan as a sort of club. Shopping clubs such as Sam’s Club are somewhat similar. For a membership fee, the member gets to purchase goods and/or services at a cost lower than would be paid without the membership.

The “club” managers find dentists who agree to provide their regular services at reduced rates for members. These reduced rates may be expresses in terms of a percentage off what is referred to as the provider’s “normal and customary” fees, or a specific price lower than the normal and customary fees may be agreed upon.

Unlike insurance, where claims may have to be filed, participation percentages computed, prior authorization may have to be obtained, among other bureaucratic procedures, most discount dental plans are active upon receipt of the first membership fee, which is normally paid monthly. The member is now able to search through the participating providers, find the one they want to see, and make an appointment.

One other difference with discount dental plans is the payment.

Under an insurance policy, the patient is generally responsible for a deductible amount, and then, once that deductible has been met, will pay a percentage of the following bills until another limit has been met, and then the insurance company will assume responsibility for paying all additional charges. At the provider’s office, they may ask for payment upfront letting the patient deal with getting the insurance company to pay its share, or, the provider may bill the insurance company for its share and then bill the patient for the portion not covered.

Additionally, particularly in the last few years, the insurance companies have begun to assume part of the decision making process for the provider and the consumer. They have begun to require prior authorization for certain procedures or for referrals to other specialists or health care providers.

Discount dental plans, however, generally agree that you, the member, and the provider (dentist) will determine the course of treatment, including referrals. In fact, their main area of interest is in making certain that the provider bills you at the agreed upon rates for the services rendered. Be aware, however, that under most dental plans, you are responsible for the provider’s fees at the time of service. You may be paying a lot less than you would have, but you must still pay.

Everybody wins with an affordable dental plan. The plan wins because they are getting paid a monthly fee for linking consumer to provider. The member wins because they can get the dental services they need for themselves or their family at discounted, sometimes greatly discounted, prices.

How does the provider win? Well, the provider is in business just like an attorney accountant, or auto mechanic. They need customers to keep their business going. Since many dentists are limited by law and custom from pursuing normal advertising methods, they find their main source of customers, i.e. patients, comes from three main sources; the telephone book, word-of-mouth, and some sort of referral service. The discount dental plan serves as a referral service. Their list of providers is much shorter than the yellow pages generally, and someone who is getting a discount at a certain dentist’s office will most likely return to that dentist.

Once someone becomes a satisfied patient at a particular dentist’s office, they will begin bringing in family members and recommending the services at that office to friends, extended family, and coworkers. So, you see, in a way, becoming a provider for an affordable dental plan is actually almost like buying advertising for the dentist.

As you have seen there are differences between discount dental plans and dental insurance. As in anything, if you are going to bear the cost yourself, it would be good to shop around to determine whether one or the other is best for you and then shop within that group for what appears to be the best deal. If you are employed, check first to see if your company offers either dental insurance or a discount dental plan as a health care benefit. Getting some sort of coverage or benefit through your company will usually be cheaper. In fact, if they do NOT offer any sort of dental coverage and you find a good policy or plan, tell the benefits people at your company. They may be able to not only arrange for that to be a cheaper way to go for you, but this may be something that several other people at your company could use.