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Short Term Medical Insurance: Facts and Fallicies

July 27, 2011 admin Leave a comment Medical articles

The rapid growth of short term medical insurance in the United States has taken many by surprise and caused some confusion among consumers, the health care industry and insurance regulators. The recent popularity of this coverage is driven primarily by lower costs and easy online enrollment. In addition, insurers have taken steps to make short term medical insurance look more like regular long term coverage by adding policy features and extending maximum coverage periods. The number of short term medical policies issued online grew dramatically from less than 100,000 in 1997 to several million policies today. Short term medical insurance is the most popular type of health insurance issued to individual health plan applicants today. Many of these applicants have never been counseled by a qualified insurance adviser so the potential of problems related to misunderstandings is increased. This article is meant to highlight many of the areas of misunderstanding but is not meant to replace the advise of a qualified personal adviser or a careful reading of your insurance policy.

Background and History
Health insurance managers noticed through the 1980s and 1990s that most people who enrolled in individual health insurance plans kept that insurance for less than a year. Many people paid considerably more in premium for the legal right to renew their coverage year after year as long as the health plan remained in business. This is called “non-cancelable” coverage. That coverage option added as much as 35% to the cost of health insurance and was not necessary for more than 90% of the health plan’s members. Since cost has been the primary driver of health plan sales, insurance companies were eager to promote lower cost policies that expired after a certain length of time. These plans are especially popular with recent college graduates, people between jobs and those starting a new small business.

What is Covered
All short term medical insurance policies cover “ordinary and necessary medical expenses” as defined by the policy. This is the most generous definition of coverage in use among health plans today and basically means something that is prescribed by your doctor in accordance with American Medical Association standards. These policies cover medical expenses only. Dental expenses and ordinary vision care are not considered medical expenses. Most policies cover prescription drug expenses the same as any other medical expense. Most policies have a maximum coverage limit of $1 million to $5 million for catastrophic claims.

What is Not Covered
Short term medical insurance does not cover pre-existing medical conditions, no matter how long ago you had symptoms and treatment. If you had ear infections five years ago that were completely cured, a new ear infection will not be covered under a new short term medical insurance policy. Maternity expenses are not covered. All short term medical insurance policies have a per person deductible that is not paid. Some policies also have a co-insurance that could add to the uncovered expenses.

Quality of Coverage
Considering the fact that these are “indemnity” type plans offering liberal coverage with any doctor or hospital anywhere in the country, short term medical insurance is considered to be among the highest quality health insurance plans in use today. The obvious limitations of pre-existing conditions and overall length of coverage under a policy are the blatantly obvious restrictions on quality of coverage.

Length of Coverage
Most short term medical insurance policies are issued for six months at a time. The shortest policy is 15 days but most insurance companies require a purchase of at least 30 days coverage. Some plans may be available for up to three years. It is possible to enroll in one six month plan after another to achieve to total overall length of coverage needed. A few states require members to switch health plans every 12 months in order to continue to use this type of coverage.

Cost
Short term medical insurance averages about half of the price of regular health insurance. The price is based on , age, location of residence and policy details like deductible, co-insurance, optional coverage selected and the method that you choose to pay the premiums. Since coverage is based on age, a 64 year old might expect to pay $300 per month while a 24 year old might pay less than $60 per month.

Eligibility
Not everyone qualifies for this type of coverage. Eligibility is not guaranteed by any state or federal law. Certain groups do not qualify: 1) residents of MA, NJ, NY, and VT, 2) people with significant prior medical conditions, and 3) applicants over age 64. Applicants who have difficulty qualifying for a specific short term medical insurance should check the article “Short Tem Medical Insurance for Special Situations” posted at www.MedSave.com for possible alternatives.

Legal Issues
Short term medical insurance is exempt from many federal and state laws that pertain to other health plans like HIPPA and some mandated benefits like maternity coverage. This is another reason for the lower costs.

COBRA
Short term medical insurance is not COBRA coverage and is not subject to COBRA health insurance laws. Many people use short term medical insurance as a lower cost alternative to COBRA coverage. For more information on this topic and a list of Frequently asked questions about COBRA coverage and COBRA alternative coverage, see www.COBRAplan.com .

Health Savings Accounts
Short term medical insurance policies are probably not intended to be used with health savings accounts, although there is no tax reference for or against this position. Some applicants have used high deductible short term medical insurance policies with a health savings account, but they do so at their own tax risk because the insurance companies have stated that the plans are not HSA-qualified. Future federal legislation might open up this possibility.

Choice of Providers
Most states have a handful of short term medical policies available to individuals. Some states have only one or two companies that offer this coverage. A state-by state listing of the most popular short term medical insurance plans can be found at www.MedSave.com.

Preferred Provider Organizations (PPO)
Most health insurance plan in the US use preferred provider organizations to manage costs. Short term medical insurance plans do not use PPOs. You may use any doctor or hospital of your choice anywhere in the US. Some plans like Assurant include Canada and Mexico. Assurant and Celtic are the only short term medical insurance plans to offer optional access to the Preferred Health Care Systems national PPO network. ( www.PHCS.com ). There is no cost for this option, and it might help save some out-of-pocket costs for bills that are lower than the policy deductible.

Payment Methods
Most people pay month to month through pre-authorized debit or credit card payments. Canceling coverage is simply a matter of withdrawing the payment authorization. Significant discounts in price are available by pre-paying months n advance but there is no refund offered if you cancel early.

Popular Insurance Companies
American Health Shield is the most popular national plan for young people under age 30, according to statistics compiled by Freedom Benefits Association and OnlineAdviser service. Assurant Health (www.FreedomBenefits.net), formerly known as Time Insurance and Fortis Health, is the nation’s most popular plan for applicants over age 40. An interesting point about Assurant is that the company does not allow its online enrollment Web site to be listed alongside of competitors for fear of adverse selection based on price without considering the quality differences between plans. Many people would argue that the primary benefit of online insurance enrollment is the ability to compare price and coverage quickly. Other interesting options are Celtic Insurance (www.CelticEnrollment.com) and Select STM from Health Plan Administrators (HPA). Blue Cross Blue Shield Associations offer this coverage. Links to regional Blue Cross / Blue Shield Association Web sites and contact information can also be found on the state pages at www.MedSave.com .

Online Support
Most short term medical insurance policies are issued online at sites like www.MedSave.com. Online enrollment is fast, reliable and secure. Policies and ID cards are either printed out at the time of enrollment or mailed on the next business day. Enrollment support for any of the plans mentioned in this article is available online or toll-free telephone through OnlineAdviser service.

About the author: Tony Novak, MBA, MT, has personally handled questions from more than 200,000 users of OnlineAdviser service over a period of more than seven years; many of these questions were about short term medical insurance. “OnlineAdviser” is a trademark of Freedom Benefits Association.

Tags: health tips, medical fallicies, medical info, medical insurance, medical tips |

Massachusetts Medical Society to raise awareness of men’s health issues

July 27, 2011 admin Leave a comment Medical articles

Waltham, MA –The Massachusetts Medical Society (MMS) announced today that the organization will expand beyond its role of simply raising awareness of the poor state of men’s health to one of identifying specific prevention and treatment strategies to improve men’s physical, psychological, and emotional health.

Citing such facts as one in five men will suffer a heart attack before age 65, that nine out of 10 fatal workplace accidents claim the lives of men, and that men account for four out of five suicides, the Medical Society’s Committee on Men’s Health is bringing a new focus to the subject of men’s health. It seeks to educate primary care providers, family physicians, and mental health professionals about the need to improve the diagnosis, treatment and maintenance plans for their male patients. Among the topics to be addressed at this year’s symposium are substance abuse, cardiovascular disease, prostate cancer, men and domestic violence, psychological development, erectile dysfunction, and psychosocial issues of gay men.

The 2nd Annual Massachusetts Medical Society Symposium on Men’s Health, to take place Wednesday, June 16 at the Society’s Waltham Headquarters, is a full-day event and one of many continuing medical education programs offered by the Massachusetts Medical Society for physicians and health care professionals. The Society’s first conference on men’s health occurred last year, to call attention to the critical condition of men’s health in America.

Highlighting the 2004 symposium is keynote speaker Randall W. Maxey, M.D., Ph.D., president of the National Medical Association (NMA), the nation’s oldest and largest organization representing African American physicians and health professionals and the voice of more than 25,000 African American physicians and their patients. Dr. Maxey, a nephrologist in private practice in Los Angeles, will speak to the issue of “Eliminating Disparities in Health Care.”

The issue of men’s health came to the forefront some four years ago with a national survey by Harris and Associates for The Commonwealth Fund, a private health research foundation. The survey discovered that one-fourth of men didn’t see a physician in the year prior to the survey, three times the rate for women, and that one-third of men didn’t have a regular doctor to see when sick or in need of medical advice. A year later, the Centers for Disease Control published findings that said men make fewer visits to physicians, hospital outpatient and emergency departments than do women.

The significance of the findings were clear: that a “disconnect” exists between men and the health care system. Thus, men often don’t get or don’t seek preventive care for potentially life-threatening conditions so common in men 40 and older, such as hypertension, heart disease, diabetes, colon and prostate cancer.

The Massachusetts Medical Society, with more than 18,000 physicians and student members, is dedicated to educating and advocating for the physicians and patients of Massachusetts. Founded in 1781, the MMS is the oldest continuously operating medical society in the country. The Society owns and publishes The New England Journal of Medicine, the Journal Watch family of professional newsletters, and AIDS Clinical Care, and produces HealthNews, a consumer health publication. For more information, visit www.massmed.org.

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Medical Malpractice concern

July 27, 2011 admin Leave a comment Medical articles

PHILADELPHIA, PA  -— The medical malpractice crisis gripping Pennsylvania has sown widespread discontent among doctors in high-risk specialties, affecting the quality of health care their patients receive, according to a new study released today by The Project on Medical Liability in Pennsylvania and funded by The Pew Charitable Trusts. Malpractice concerns could be harmful to the physician-patient relationship, as the interplay between financial and market pressures changes how physicians approach their work, the study says.

“Physician satisfaction is often neglected or discounted as self-serving in policy debates,” the authors say. “In this paper we outline a framework for understanding why physician satisfaction matters for patient care and what factors influence it. Professional dissatisfaction deserves policy attention if it has damaging consequences for patients.”

Nearly 40 percent of Pennsylvania high-risk specialists surveyed in 2003 were dissatisfied with the practice of medicine, twice as high as the national rate in 1999. Studies have shown that satisfied physicians tend to be more attentive to their patients and have higher levels of satisfaction among their patients. But dissatisfied physicians have been linked to riskier prescribing practices or engaging in “defensive medicine” when treating patients.

“Our findings suggest that the malpractice crisis in Pennsylvania is decreasing specialist physicians’ satisfaction with medical practice in ways that may affect the quality of care. The relationship may be cumulative, with an acute malpractice crisis acting as a ‘last straw’ among the physicians who are most affected by it,” the report’s authors conclude.

The report, “Caring For Patients In A Malpractice Crisis: Physician Satisfaction and Quality Of Care,” is part of a special section published in “Health Affairs” containing several other articles showing the complexity of the medical malpractice crisis.

According to the American Medical Association, about two-thirds of U.S. states are now in the midst of a malpractice crisis or showing signs of trouble. Nowhere is the problem more acute than in Pennsylvania, where several insurers have left the market and premiums for coverage through the remaining insurers have increased dramatically. To investigate the effects of the malpractice crisis on patient care, the authors conducted a series of interviews with representatives from Pennsylvania physician groups, hospitals, and insurers, followed by a mail survey of 824 Pennsylvania physicians in high-risk specialties (emergency medicine physicians, general surgeons, neurosurgeons, OB/GYNs, orthopedic surgeons, and radiologists).

KEY FINDINGS

Pervasive Job Dissatisfaction
Nearly 40 percent of the Pennsylvania high-risk specialists surveyed in 2003 were dissatisfied with the practice of medicine. OB/GYNs were most likely to report dissatisfaction. Career satisfaction among Pennsylvania high-risk specialists was much lower than a 1999 national sample—39 percent compared to 19 percent.

Low Marks for Pennsylvania
Seventy percent of specialists said that they would be very or somewhat likely to recommend their specialty to someone graduating from medical school today, but only 15 percent were willing to recommend practicing in Pennsylvania. Nearly half responded that they were not at all likely to recommend Pennsylvania. Specialists who had strong personal ties to the state (either grew up or attended medical school in Pennsylvania) were no more likely than those who did not to recommend practicing here.

Income Squeeze
Rising liability insurance premiums and static or declining reimbursements are putting physicians in an income bind. Specialists surveyed who felt heavily burdened by malpractice insurance costs were least likely to report satisfaction with their practice. Asked to characterize their current professional liability insurance premium levels, 40 percent of specialists described their premiums as an “extreme burden,” 40 percent said that they were a “major burden,” 12 percent called them a “minor burden,” and 2 percent said that they were “not at all a burden.”

Fraying Relations with Patients
Liability pressures may affect physicians’ satisfaction and the quality of care by impinging upon the physician/patient relationship. Just over half of surveyed specialists denied that malpractice concerns made them less candid with their patients, but a sizable minority felt that they did. Physicians who felt “wounded” by the malpractice system and those with high premium burdens were significantly more likely to report such changes in patient relations. Three-fourths of specialists agreed with the statement, “Because of concerns about malpractice liability, I view every patient as a potential malpractice lawsuit.”

Limited Autonomy
The malpractice crisis may also be affecting physicians’ satisfaction by eroding their sense of control. Survey reports indicated that the liability environment impedes specialists’ perceived ability to deliver needed services in the way they would like. Ninety-one percent of specialists surveyed said that the malpractice system limits doctors’ ability to provide the highest-quality medical care.

Cutting Back on Care
Many specialists surveyed reported that their practice or hospital was taking steps to reduce overhead costs, and nearly two-thirds reported that their practice or hospital would likely reduce the number of clinical staff over the next two years because of liability costs. Nearly three-fourths indicated that their practice or hospital would likely reduce the number of administrative staff, and a similar percentage reported that their practice or hospital would cancel or delay capital improvements because of liability costs.

OUTLOOK

According to the report, rising liability expenses in a severe malpractice crisis impose costs on patients. Some costs are economic—state governments may divert tax dollars toward subsidies for malpractice insurance premiums, and health insurance costs may increase if provider reimbursement is raised in response to increased overhead. But other costs come in the form of lower quality and availability of health services. As the human face of such changes, physicians’ behavior—particularly their anxieties and discontent—should become a critical policy focus, the report recommends.

State legislatures typically focus on three strategies to respond to a malpractice crisis: insurance subsidies, stricter insurance regulation, and reforms to the tort liability system. Overall, these reform strategies are responsive to physician dissatisfaction, the report says, but their efficacy as a cure for the tort crisis and protection for recurring crises is open to question. The core objective of such reforms should not be to restore physicians’ job satisfaction, but to improve the malpractice system’s performance in compensating patients and promoting high-quality care. If a byproduct of reform is higher professional satisfaction, it’s the patients who stand the most to gain, the report says.

The full report and other research by the Project on Medical Liability in Pennsylvania may be found at www.medliabilitypa.org

About The Project on Medical Liability in Pennsylvania:
The goal of the two-year, $3.2 million Project on Medical Liability in Pennsylvania is to provide Pennsylvania policy makers with objective information about the medical liability system; to broaden participation in the medical liability debate to include new constituencies and perspectives; and to focus attention on the relationship between medical liability and the overall health and prosperity of the Commonwealth. The Project is working with leading health policy experts from across the nation and will continue to publish both original research based on new data and expert analyses. The Project will generate information from a broad range of perspectives, without promoting the agenda of any of the stakeholders in the debate.

The other articles in this special edition of “Health Affairs” examine the following:

William Sage, from Columbia Law School, proposes overhauling the structure and financing of malpractice liability insurance. Sage attributes much of the current crisis to a widening gap between first-party health insurance and third-party malpractice insurance. He urges Medicare and Medicaid to play a major role in the medical liability system of the future.

Carol Liebman and Chris Hyman of Columbia Law School examine a program of medical error communication and mediation-based dispute resolution that can improve patient care as well as reduce malpractice litigation. The measure can be adopted voluntarily by hospitals and physicians even if political consensus on legislative reform is lacking.

In a critical review of recent proposals for “medical courts” and “expert screening panels,” Catherine Struve, a professor at the University of Pennsylvania Law School, suggests simpler, more effective ways to help judges and juries make better-informed rulings with respect to both liability and damages.

In a study not part of the Pew research, Harvard’s David Studdert and colleagues review a sample of high-end jury verdicts that were subject to California’s cap on noneconomic damages. They conclude that the cap is unfair to patients who suffer grave injuries involving pain and disfigurement.

The researchers for this report are Michelle M. Mello, an assistant professor of health policy and law, Department of Health Policy and Management, Harvard School of Public Health. David Studdert is an associate professor of law and public health at the Harvard School of Public Health. Catherine DesRoches is a research assistant in that department. Jordon Peugh is a senior research manager at Harris Interactive in New York City, where Kinga Zapert is a vice president. Troyen Brennan is a professor of law and public health, Department of Health Policy and Management, Harvard School of Public Health, and a professor of medicine in the Department of Medicine, Harvard Medical School. William Sage is a professor of law at Columbia Law School in New York City.

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Five Tips for Getting the Most From Your Short Term Medical Insurance

July 27, 2011 admin Leave a comment Medical articles, Medical Ideas

 

Each year more than 10 million people buy short term medical insurance plans. Some use it while between jobs. Others use it in place of regular (but more expensive) health insurance. Short term medical insurance can be a fantastic value because it combines liberal high quality “freedom of choice” type health coverage at much lower cost than traditional medical insurance plans. But knowing these few tips about this type of coverage will help you get even more for your money.

VALUE TIP 1: USE PPO NETWORK PROVIDERS
Although these insurance plans cover your treatment received from any doctor or hospital in the U.S. and Canada, it may pay you to use a participating network provider. You can find participating providers nationwide at http://www.phcs.com. There are three advantages to using a PPO provider; 1) your bill will be discounted under the negotiated network agreement, 2) you do not need to pay the provider at the time service is provided (you may wait until after the claim is processed), and 3) the provider handles all of the claim submission paperwork on your behalf saving you time and possible frustration.

VALUE TIP 2: REAPPLY
Even though the policy expires after 6 months, you may re-apply as often as you wish. Don’t be fooled by insurance company brochures that say you are no longer eligible for this coverage just because you had it in the past. If it is difficult to re-enroll online, then ask your enrollment adviser to manually handle your new enrollment.

VALUE TIP 3: DO NOT PAY MONTHLY
You will save up to 20% of the cost if you pay a single premium rather than opt for monthly billing. Even if you are short on cash, it pays to put the entire charge on your credit card and pay off your credit card over a few months.

VALUE TIP 4: PAY CASH FOR SOME OUT-OF-POCKET ITEMS
STM insurance plans do not cover expenses related to pre-existing medical conditions, so if you take an ongoing prescription medicine or receive ongoing weekly outpatient treatments, these will not be covered under the STM plan. But often the amount you save in insurance expense is more than the cash cost of your current treatment, so it makes sense to pay this out-of-pocket. This may also allow you to feel more comfortable electing a high deductible policy to save even more in premium cost.

VALUE TIP 5: BUY WHEN YOU TRAVEL
If you happen to live in one of the few states that prohibit STM, it is completely legal to purchase insurance when you are traveling to another state. It only takes about two minutes to enroll online and the coverage is valid in your home state for all treatments you may receive after returning home. You can even have you policy and ID cards delivered to your address in a restricted state as long as you list another state as the place of purchase. Also, if you are moving from a place with relatively low health insurance costs (the Midwest states, for example) to a place with high medical costs (California, for example) it is best to buy your coverage before you move. Once issue, the coverage is equally valid in all states and your premium rate will not increase on the policy after you move.

This article courtesy of http://Medical Info101.com.
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