Health insurance exclusions

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PostPosted: Mon Feb 15, 2010 9:18 am   Post subject: Health insurance exclusions  

Someone had called me to offer Health insurance over the phone. The person didn't seem interested to explain what's not covered under the policy. It will help if someone explains the plan exclusions.


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Birdie_Golmes
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PostPosted: Mon Feb 15, 2010 12:13 pm   Post subject:   

Sure it would if you're interested call them back...but a couple of points I want to make.



1. I (personally) would NEVER buy ins. (or anything else

for that matter) from someone that called me!

2. The person you talked to on the phone most likely is

being paid min. wage, and hasn't a clue how to

answer your question(s)

3. If you need health coverage YOU should contact some

trusted agents and ask them.



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PostPosted: Mon Feb 15, 2010 10:21 pm   Post subject:   

Lori, that's interesting that you would never buy insurance from someone who called you. Like most insurance agents, I would have starved long ago if most people felt like you do. The vast majority of my business comes from me picking up the phone and calling someone.

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PostPosted: Mon Feb 15, 2010 11:38 pm   Post subject:   

Quote:
Lori, that's interesting that you would never buy insurance from someone who called you. Like most insurance agents, I would have starved long ago if most people felt like you do. The vast majority of my business comes from me picking up the phone and calling someone.
You know years (I mean alot) ago I may have...but with the amount of fraud, identity theft etc..no way would I purchase something over the phone that 'I' did not request a call for...now, on the other hand, if someone called and wanted to set up a meeting at their office, then 'maybe' if I was interested I'd go...but you see what I mean ? and the amount of 'mass' telemarketing that goes on now...just (IMO) a dangerous proposal...


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PostPosted: Tue Feb 16, 2010 5:49 am   Post subject:   

Quote:
Like most insurance agents, I would have starved long ago if most people felt like you do.


I'd agree that some of the best offers would come to you through tele-marketing agents, but at the same time I'll accept that it has become a tough choice for us.



Personally, I've experienced sales calls from distant third world nations. Some of them weren't clear about the concept or product that they were selling. On the other hand, some of them seemed pretty confident with a good product knowledge. These were the "good guys" who were always prepared to disclose their true identity and the place from where they were calling.



I was amazed to know that these "good guys" were actually reading out a legal script to me on behalf of a legitimate company or service provider based in the US.



Now, I know that in order to identify a legitimate caller, I'd first need to know the co. or the brand name he's representing. If I'm familiar with the brand name (if the name has it's web presence at least), then only I'd consider accepting his offer over the phone.
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PostPosted: Tue Feb 16, 2010 5:49 am   Post subject: Health Insurance Coverage  

You must be informed about the exclusions in the policy by the insurance company. If they do not want to reveal such information, you must not agree to sign any contract with the company. It is a deciding factor and cannot be ignored. If they do not want talk about it now, you might just be into trouble when you claim your coverage later. Generally the extent of coverage is mentioned in the terms and conditions of the policy. Go through them carefully and understand the policy rules. Generally specific exclusions are specified within the policy like pre-existing conditions. There are many plans that have waiting period for people with pre-existing conditions.



Some common excluded coverage that you need to look out for are Pre-existing conditions, your hospital room's phone and t.v bills, homecare or private nursing expenses, patients with behavioral or learning problem, cosmetic surgeries and alternative and complementary medicine. Finally, most health insurance do not provide coverage for dental and vision care. Your health plan may exclude more than this basic list. However, these basic exclusions vary from plan to plan and its important that you get to know them. So check the exclusion list carefully.

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PostPosted: Tue Feb 16, 2010 8:33 am   Post subject:   

Quote:
Lori, that's interesting that you would never buy insurance from someone who called you. Like most insurance agents, I would have starved long ago if most people felt like you do. The vast majority of my business comes from me picking up the phone and calling someone.




I always look at it this way. If I wanted what you are selling, I would have found it myself. If I wanted to participate in your survey, I would have found it on line. If I wanted to contribute to your cause, I would have given at the office. Now stop calling me at dinner time, waking my kid from his nap. And if you call back once I told you to stop calling, I'm calling the state's attorney general. (That threat even worked with our state's health department conducting a survey - to bad I didn't try it until after 7 phone calls).



I understand everyone has a job, and I am always cordial with them if they are with me. I even let them finish their dog and pony show. But once I tell you no....leave me alone.



Plus I do agree with Lori, now days can you really start giving information over the phone to an unknown person. I call policy holders every day to set up appointments with them. I let them know that I am calling from their insurance company, have their name, policy number, address, phone number and agent's name and still people think I'm trying to sell them something. I can't believe that people still buy things over the phone when they were not the ones calling the business.


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PostPosted: Tue Feb 16, 2010 2:20 pm   Post subject:   

Quote:
I can't believe that people still buy things over the phone when they were not the ones calling the business.
That's my whole point...as to telemarketers---my state has a 'do not call list' I'm registered with that..and boy oh boy when one does sneak thru and call me, that's all I've got to say, "I'm registed with the MO atty generals do not call list" they can't get off the phone quick enough



At the same time, I'm 100% confident that the agents on this board, were totally above board, and there was a time, when you COULD trust someone that called...However, that time is gone (IMO)...


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PostPosted: Wed Feb 17, 2010 6:08 am   Post subject:   

Your policy exclusions would either be presented in your insurance paperwork under a specified section named "Exclusions", or they'd remain scattered all over your policy papers.



Go through the "Exclusions" section first. If you find that the list of exclusions is small then you'd surely need to read through all the terms and conditions in order to make sure that you're not missing out on anything.

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PostPosted: Thu Feb 18, 2010 5:22 am   Post subject:   

The following are usually excluded under a health insurance plan (for both individual and general)-

Vision and hearing aids, dental treatment, home assistance

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PostPosted: Fri Feb 19, 2010 4:40 am   Post subject:   

Group and individual plans always have different rules concerning what the plan can do about preexisting conditions, and it varies widely by state.



If you want a list of common exclusions in a medical expense policy, this is really what you'll normally see.



War and Acts of War. Different policies define war differently; you'll have to look at your contract for your carrier's definition. Most policies use the age-old "war, whether declared or undeclared" definition, and there are more than a few that add things like riot, civil commotion or insurrection, attempted overthrow or usurption of a government (I love that one) and of course, there are still a few that consider terrorism an act of war.



Suicide attempts. Every state has limitation on exclusionary language on coverage for suicide, whether successful or not. In most states, the exclusion is limited to two years, with a few states only one year.



Preexisting Conditions Exclusion (Pre-x): If the policy is issued and contains a pre-x, that exclusion is limited in duration as well. Pre-x can only consider medical problems that have received treatment within 6 months prior to enrollment into the plan. If something's excluded, it must be covered after a period of time after enrollment; anywhere from 6 to 18 months depending on the state.



Treatment Covered Without Cost to the Insured: If an insured, say, received treatment at no cost in a Veteran's hospital, there's no way the private medical plan is going to pay anything.



Out of Network Services: Depending on the type of plan and the type of treatment received, these costs could be excluded.



Failure to Seek Second Opinion/Pre-Authorization: Many plans require that the insured seek these prior to certain procedures and treatment and failure to do so could result in the claim being denied.



Aviation exclusions: Once in a while you'll run into a policy that will exclude coverage for aviation related risks, which can include everything from private pilots to hang gliders to base jumping.



If a medical expense ONLY policy, it will obviously exclude dental, vision, long-term care and assisted living (although MANY MANY MANY policies WILL PAY for home nursing care).



I could probably think of a few more arcane exclusions, but I'm getting tired of this. Can anyone add to the list? Finally, I can't think of any non-mandatory states (like Mass.) that require an insurer to actually issue an individual medical expense policy unless you're talking portability rules. Don't yap at me about HIPAA either- that's just about pre-x.



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PostPosted: Fri Feb 19, 2010 7:14 am   Post subject:   

Behavioral complications and certain kinds of surgeries are also excluded. Cosmetic surgeries and surgeries related with sex change or breast removal are not covered.

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PostPosted: Fri Feb 19, 2010 7:53 am   Post subject: Health insurance.  

Health insurance often do not provide coverage for alternative and complementary medicine. These types of medicine include acupressure, acupuncture, massage, yoga and biofeedback. Abortion is also generally excluded. So check with your policy before you opt for one.

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PostPosted: Tue Feb 23, 2010 5:45 am   Post subject:   

Certain medical treatments that are conducted on an experimental basis are excluded. Likewise certain prescribed as well as non-prescribed drugs are also excluded.

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PostPosted: Wed Feb 24, 2010 12:56 pm   Post subject: Health insurance exclusions  

Some health insurance policies do not cover any illness within 30 days of commencing a policy, except injury arising out of accident.

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