Rising health costs today mean that we are increasingly moving away from traditional types of health insurance and the original fee-for-service health insurance plan is rapidly being replaced by various other plans including HMO (health maintenance organization) plans, PPO (preferred provider organization) plans and POS (point of service) plans.
Basically fee-for-service health insurance plans are intended to cover unanticipated medical bills due to injury and illness and give policy holders substantial freedom in choosing where treatment is sought and by whom such treatment is given. Fee-for-service policy holders are also usually responsible for making payment for their treatment and subsequently claiming back the cost from their insurer.
The newer plans by contrast are focused far more upon routine health care with the objective of eliminating unnecessary costs by keeping policy holders well and spotting conditions at a very early stage when they are hopefully simple to treat. These plans ease administration for policy holders but at the same time remove much of the freedom to decide where and from whom treatment may be received.
The majority of people today will be covered by the newer types of health insurance instead of by traditional fee-for-service plans primarily not only because of their reduced cost but also because there is a lot less administration when it comes to making claims on your policy. In addition, an increasing number of employers who offer group health insurance plan membership to their employees are also selecting these newer types of plan. Nonetheless, there is still a substantial number of people who like the freedom of choice which a fee-for-service policy gives them and it is here where you may wish to look at major medical insurance.
Fee-for-service policies provide three types of coverage; basic health insurance, major medical insurance and comprehensive insurance.
Basic health insurance policies will vary from one health insurer to the next but will generally cover hospital treatment (plus room and board), some hospital services (such as x-rays and medication), surgery (whether performed in hospital or at another recognized surgery center) and some doctors visits.
Major medical insurance policies by contrast are intended to cover the treatment of long-term and high cost illnesses and injuries as well as in and out-patient bills associated with such illnesses and injuries.
Comprehensive insurance cover is simply a policy which encompasses both basic and major medical coverage.
Not surprisingly major medical insurance is a very popular choice as the majority of people are quite happy to pay the day to day expense of health care but are concerned about how they would cope in the event of a significant illness or injury which might involve large medical expense which could drag on for weeks, months or even years.
Regrettably, the security and choice which is provided by major medical insurance is reflected in the cost of fee-for-service policies in general and so it is becoming more and more of an option which many people would like to select but which is just too expensive.
Currently, many major medical insurance policies state that the costs of experimental, cosmetic, or investigative procedures are not covered. Yet, your health plan may actually cover these types of procedures. You just have to follow a few steps and prove that there is, indeed, medical data and justification to warrant coverage for these services.
Most health insurance companies choose not to cover cosmetic or investigative procedures, such as rhinoplasty, because they are typically uncommon medical practices or new, experimental treatments that do not yet have validated results. These procedures are generally referred to as "elective" procedures, deemed so by doctors and insurance providers because they are rarely medically necessary. To be considered medically necessary, the services must be generally accepted by the medical community, have proven results, and be relatively less expensive than alternative treatments. Health insurance providers are reluctant to supply coverage for expensive, unrecognized, or new medical treatments. (www.howstuffworks.com/elective-procedure.htm)
While many cosmetic procedures are labeled as vanity surgeries, a large number of investigative, elective procedures have nothing at all to do with vanity, such as angioplasty or hip replacement. The angioplasty procedure uses a balloon to open a blocked coronary artery and improve blood flow to the heart. It is considered an elective procedure because, although it will likely prevent a future heart attack, angioplasty is not a life-saving procedure. Similarly, a hip replacement may improve quality of life, but it is not a procedure performed to save a person's life. (www.health.howstuffworks.com/elective-procedure.htm)
Sometimes physicians do find cases in which elective procedures are medically necessary. To get these types of procedures covered, HealthSymphony (www.healthsymphony.com/bluenote4.htm), a comprehensive health insurance Web site, offers some suggestions on steps you can take get the services you want. You must provide the insurance company with sufficient medical data about the procedure to justify its coverage. This requires research. You need to find at least two articles from respected medical journals that provide the results of studies performed regarding the procedure. You also need to obtain a statement of medical necessity from the physician who is requesting the treatment. If your doctor truly believes that the procedure is necessary to improve your health and quality of life, the chance of receiving coverage from your health insurance provider greatly increases. All of the information you gather will be presented for consideration in front of the medical board and medical director of the health plan.
The information you provide initially may not be enough, and coverage for these experimental and cosmetic procedures may still be denied. In this case, you should contact your insurance company directly and state your case. Do this by writing an appeal letter, and include statements regarding the necessity of the procedure from your physician or surgeon. You will also want to provide all relevant test results and x-rays to help prove your case. (www.healthsymphony.com/appealing.htm)
Because of unfamiliarity and lack of validated test results, many medical procedures are labeled "elective procedures," and are therefore unqualified for coverage by most health insurance policies. But, if you provide sufficient evidence and appropriate test results, your health insurance provider may consider supplying coverage.
Both Donald Saunders & Jim Waltrip are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
Donald Saunders has sinced written about articles on various topics from Health Insurance, Forex Training and Diabetes Treatment. MedicalHealthInsuranceToday.com provides information on all aspects of health insurance including and. Donald Saunders's top article generates over 165000 views. to your Favourites.
Jim Waltrip has sinced written about articles on various topics from Health Insurance, Auto Insurance and Liability Insurance. US Insurance Online CEO Jim Waltrip is a self-taught software developer and entrepreneur with a passion for building things: teams of employees, software, and new systems. Jim started the company with business partner Ryan Patterson in May 2005. The recen. Jim Waltrip's top article generates over 12100 views. to your Favourites.