ALT="The Insurance Problem Solver"Why would you ever make friends with health insurance and, really, what does that mean?

Selecting health insurance and buying it has probably always been a mystery to many. For a long time you may have been covered under a family policy through one of your parents’ employers. In fact, you still might be under the Affordable Care Act if you are under 26. Even if you are over 26, you may still feel young and invincibility may be coursing through your veins. You figure that, even though you may be living on your own, you don’t need health insurance. It is just another expense that detracts from the beer and pizza budget, rent, and other expenses that seem more critical now.

But there comes a time, really there does come a time, when at least 3 things happen: (1) beer and pizza fade as the main food groups; (2) you get sick or injured. It may be something fairly minor like the flu, or something more major like a broken limb that requires acute care and later rehabilitation. Hell, it happened to me a few years ago. While I wasn’t 26 when it happened, I got a brain tumor. A very expensive brain tumor. All is well now, but talk about developing a friendship with health insurance! All I can recommend to you is to nurture that friendship – Make friends with health insurance.

The third thing is you realize that when you get sick or injured, your main goal is to get well or rehabilitated. Insurers, by and large, do their best to handle claims correctly, but mistakes and disagreements arise. Usually, the mistakes and disagreements do not rise to the level of lawyers and lawsuits; they can and should be resolved at the lowest competent level. That is where I, The Insurance Problem Solver come in. I’ll run interference for you and take the load off of you so you can focus on getting well.

Make Friends With Health Insurance

Before you can nurture the relationship with health insurance, you have to approach and meet it. Sort of like going to a party alone but hoping that you’ll meet someone.We’ll discuss here some broad categories and characteristics of health insurance to guide you in finding your new friend who/that seems best suited to your needs.

I’m not going to recommend what to buy. However, you should understand the options. It is a lot to take in at once, and my focus as The Insurance Problem Solver is to guide you through the process and to educate you. I am available by phone or email to help if problems arise on the front end, in the middle, or in using the insurance product. Here are some representative varieties of health insurance plans:

  • Health Maintenance Organizations (HMOs). Enrollment in an HMO usually gives an individual a big range of providers from whom to get medical services. Keep in mind, though, that an HMO that is appealing to you may not operate everywhere, so check closely as to its geographic range. Upon initial enrollment in an HMO, you will select a primary care provider (PCP) who coordinates your care during membership in the HMO. An interesting element of HMO membership is that most HMOs emphasize preventive care. HMOs usually authorize visits to specialists only upon the referral of the primary care provider, so in that sense, they may be considered to be more restrictive in the choice of care providers. There are many great ones, many are very economical, but you must be aware of geographic restrictions and the need for a PCP-referral for specialty care.
  • Preferred Provider Organization (PPOs). Enrollment in a PPO allows the member and his or her family to get care from any healthcare provider who is a member of the PPO network, including specialists, without a referral. Ordinarily, there is not a primary care physician (PCP) involved. Although the premiums for PPOs may be greater than for an HMO, individuals who see specialists regularly tend to prefer PPOs because a referral to see one is unnecessary.
  • Point of Service Plans (POS). A Point of Service Plan is sort of a combination of an HMO and a PPO. By that, I mean that the member selects a primary care provider (PCP) for routine care. However, out-of-network providers can be used for other needs subject to paying greater out-of-pocket costs plus a copayment. If affordable for you, a POS Plan provides significant flexibility in the selection of providers.
  • High Deductible Health Plans (HDHP). This is a kind of health plan that is often used in conjunction with a Health Savings Account. As its name suggests, the plan imposes a relatively high deductible that has to be met before the insurance attaches to pay covered claims. It can be attractive to people who wish to avoid high monthly health insurance premiums. But to avoid unwanted surprises if a severe sickness or injury occurs with related high medical expenses, it can be combined with a Health Savings Account (HSA). An HSA allows money to be set aside on a tax-advantaged basis to be used for medical expenses incurred that are lower than the attachment point of the Medical Discount Plan. Again, premiums are much lower than for other forms of health insurance, but the out-of-pocket costs are much higher.

It may take years of buying health insurance, using it, filing claims, and paying for healthcare to finally get you to a point of understanding and making friends with health insurance. Because I am a retired insurance attorney formerly practicing in Tallahassee, I know this subject matter well. I’m not suggesting that you have to know everything; I am suggesting that you consider hiring me, The Insurance Problem Solver to help you navigate the complexities of health insurance if you have a situation causing a headache. Do make friends with health insurance, it will help you in the long run.