Friday, February 8, 2013

Common Insurance Company Tricks

Having a personal injury lawyer is usually essential these days. Sadly, insurance companies have strategies that are not legal but certainly aren't ethical. They will use these tricks and strategies to reduce the award you deserve or even have it dismissed altogether. First, they will assure you that you don't need an attorney because they are willing to give you a fair settlement. They'll then proceed to deceive and take advantage of you in order to save money.
One of the first things an insurance company will do is give you an offer that is less than they know you can get. They will tell you that it is the most you can expect and that if you hire an attorney you will lose 1/3 of that paying the lawyer's fee. You can usually figure that anything they offer will be ten to seventy percent less than a judge and/or jury would give you if you hired an attorney and took the case to court. If you agree they will make you sign a release before they cut you a check. This exempts them from any future claims for any reason. Most lawyers will only allow you to sign something like this once fair compensation is paid.

Choosing a Health Plan

Health insurance is something we don't want to have to use, but something we need to have. According to Kathleen A. Dobie, of, a "large percentage of bankruptcies in the US are at least due partially to medical bills."
Having health insurance doesn't mean unlimited coverage though. A report by the Labor Department reported by Catherine Rampell of the NY Times, of business sponsored health plans in 2009, found coverage limited for treatments such as kidney dialysis and diabetes management, as well as pregnancy and mental health.
Fortunately, under ObamaCare, starting in 2013, some of that will change. Some ten categories of essential health benefits that insurers must provide include maternity, prescription, mental health and rehabilitation--- but according to each state's specifics in every category. Starting in 2014, insurer's will be restricted from placing caps on annual or lifetime limits. has the full list of benefits. Out of pocket expenses will also have a maximum deductible.
Each state will iron out its own details based on other models such as the largest insurance provider's small group policy for that state. What one state may consider essential, another state may not--- such as certain treatments or prescription drugs.

The Future of Employee Assistance Program (EAP) Networks

A debate is taking place in the Employee Assistance Program (EAP) industry over the effectiveness of specialized EAP/Wellnesscompanies and national insurance companies with large integrated EAP/behavioral health networks. The EAP industry has long made the assumption that the Specialty EAP/Wellness companies provide higher quality services and yield better Returns On Investment (ROI). However, insurance company EAP's have gained significant market share of the EAP industry.
Specialized EAP/Wellness companies provide small local networks of EAP counselors, management consultants and highly experienced account managers that have a deep understanding of specific company cultures, needs and expectations. Many of the large national insurance companies have large significantly discounted EAP and integrated behavioral health networks with high levels of member geographic access and include most of the same providers as the specialty EAP companies.
The ROI of both network types are difficult to measure accurately. However, both Specialty EAP companies and insurance company EAP's are mitigating their weaknesses and leveraging their strengths to compete in the EAP and Wellness market.

Tuesday, December 11, 2012

Health Care Reform Must Include Successful Business Models I.E. Stop - Loss Insurance

SB 1431, the measure to increase stop-loss limits and change other items for self-funded plans, is off the table this year but could be revisited next year.
"SB 1431 would have required employers to self-insure at least $45,000 per employee per year before seeking reimbursement for costs above that amount from the stop-loss carrier. This arbitrary dollar amount would have made this type of health care coverage too financially risky for many firms that choose this type of coverage", says Mark Christian, Director of Legislative Affairs for AIA, California Council.
Health care plans are termed fully funded and self-funded plans. A fully funded plan charges the same premium whether few claims, or several are made. Subsequent premium increases for the following year are based on group and pooled company claims experience. Self-funded plans pay claims as they are incurred. Raising stop-loss limits for self funded plans would jeopardize the existence of one of the industry's best-cost reduction methods- self-funding.
Don't Shoot the Messenger
Kevin De León, (D-Los Angeles) had introduced SB 1431, which would place some limits on stop-loss insurance. California Insurance Commissioner Dave Jones, speaking at a committee hearing, said stop-loss insurance threatens the success of the state's benefit exchange.
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