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Tips for using Health Insurance; what Insurance companies do not want you to know 2012

Updated on July 23, 2012

Copyright ©LillyLG Productions all rights reserved July 2012. Cloning, mixing, matching, or copying without a link back to this page is prohibited.

Having Rights means also Having responsibility

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If your nose is to the wall, make sure your Insurance Agent helps you, if not, the Insurance commissioner of your State will take consumer complaints in writingFinding a Good Agent, Good Insurance Company, and Physician can be a full time jobMedical Providers - Make sure they are in Network and if only part is remember SAPSGo, Walk, make sure your Agent and Insurance company are doing their best for youThe Will of the People is to have Affordable Healthcare
If your nose is to the wall, make sure your Insurance Agent helps you, if not, the Insurance commissioner of your State will take consumer complaints in writing
If your nose is to the wall, make sure your Insurance Agent helps you, if not, the Insurance commissioner of your State will take consumer complaints in writing | Source
Finding a Good Agent, Good Insurance Company, and Physician can be a full time job
Finding a Good Agent, Good Insurance Company, and Physician can be a full time job | Source
Medical Providers - Make sure they are in Network and if only part is remember SAPS
Medical Providers - Make sure they are in Network and if only part is remember SAPS | Source
Go, Walk, make sure your Agent and Insurance company are doing their best for you
Go, Walk, make sure your Agent and Insurance company are doing their best for you | Source
The Will of the People is to have Affordable Healthcare
The Will of the People is to have Affordable Healthcare | Source

In 2007, when Presidential hopefuls were polling US Citizens about Health Care

In 2007, Lilly was an active participant on Yahoo Answers. At that time, it was an enjoyable forum for people world wide to Ask and Answer Questions about topics ranging from Pet Care, to Cooking, the Environment, and more.

Yahoo Answers was very popular, and due to the large audience, famous people, scientists, teachers, accountants and politicians would use the site on a regular basis.

During 2007, the then Senator Clinton; a Presidential runner asked Yahoo Answerers to give their ideas, and horror stories of either having Insurance and not getting what they needed to use it, and experiences for those who simply could not afford, or afford to use Insurance.

The response was overwhelming.

In just hours, there were thousands of Answers, and as many heart rending stories of the personal hell individuals and families experienced. There was also an enormous response of ideas for a Healthcare plan for Americans.

Since Lilly has been mostly uninsured most of her life, or had insurance she could not afford to use, she also participated by Answering Senator Clinton's Question. (Total 38,020)

In 2007, almost every American was screaming for changes into a broken healthcare system. It was the first time the average American had been given a forum to speak freely about anything having to do with the Federal Government under the Bush, Cheney and Rice rule.

In 2012 , when Americans have a foot in the door of Affordable Healthcare

Today in 2012 - political jokers and the ultra wealthy have turned The Will of the People into something to club our Commander in Chief with.

The Affordable Health Care Act was not created by President Barack Obama, it was an answer to hundreds of thousands of cries for fairness, and accessibility to everyone who may need the care of a health care provider. The AHA in it's entirety has been a work in progress with many Democrats and Republicans working to put it together.

Because of the political hurrah, many Americans are complying with the Affordable Health Care Act, purchasing plans, and doing their best to make it work for them.

On the other hand, Insurance companies are bringing in money hand over fist, and many do not comply with the AHA (Affordable Health Care Act), because although it has enriched them beyond belief, they are waiting for the Insured to ask for their Rights under the AHA.

If they do not force the Insurance companies to comply, or the Health care provider who is attempting to help their patients do not force compliance, it is worse than ever.

Before 2005, when being a Democrat was not considered the same as being a communist, the Democratic party was known for being more caring toward individuals.

Our Country had basically a two party system. Now, new republicans, who have learned how to express themselves, ranting and raving against Democrats as a whole. They do not believe Democrats have a right to exist.

Politicians and their monied supporters, have mined the Churches, and other believers into thinking they are in a war against welfare recipients and the less fortunate. They have taught a hatred against our Commander in Cheif and President Barack Obama. Unfortunately they are unable to see any of the good the Obama's and their cabinet has done, nor any changes that have occurred since he has been President.

Sadly, Americans who would benefit the most, are helping the ultra wealthy to destroy their own American dreams, and looking in the wrong places for their enemy.

Today, in 2012, our Nation is no longer allowed to function for anyone but the ultra-wealthy. Instead, it is poorer, and less educated people who would benefit the most from these programs, and who are being convinced that the only American thing to do is to kill their own dreams, and they do not even realize it.

While the Insured do have rights, they need to be more aware of what those rights are, and Lilly has included tips to make being Insured in 2012 workable, if not affordable.

Tip #1 On making the Affordable Healthcare Act work for you - The Insured - Buying Health Insurance

Your Health Insurance Agent / Broker / Agency

  • Make sure your agent, broker and agency are licensed in the State you are purchasing insurance from.
  • Confirm an Agent through the Better Business Bureau. Most Agents are self-employeed, while working under a main broker
  • If you buy online, insist on one person to help you through the life of your policy.
  • Keep an electronic and/or paper record of all promises made by Agent regarding your policy.
  • When you know you have a Good Agent, and you have purchased insurance through his/her recommendation, it is advisable to give written (by fax/email) Authorization to the Insurance company, for your Agent to communicate with your Insurance company re; Claims, Premiums, Rates, and Address changes. (HIPPA law requires written authorization for any person besides the Primary insured to discuss any part or all of the policy).

Tip #2 On making the Affordable Healthcare Act (AHA) work for you - the Insured - Insurance Carrier

You have chosen an Insurance broker / agent / agency, and they have recommended a company for you; the Insured to purchase your policy from:

  • The Insured has a certain amount of time to look the policy over, to make sure it really meets all the needs of the individuals and/or family members to be insured.
  • IMPORTANT: Make sure all information has been keyed in or submitted correctly. A wrong date of birth, address, or answer to the initial underwriting could be the difference on whether claims are paid, or not, and many other things that could go wrong if all personal, and medical information is not correctly submitted when applying for coverage.
  • Laws vary from State to State on how long a newly insured person has to decide on keeping or cancelling the new policy. Stay in communication with your Agent, to make sure you are within the allowed limits for a complete refund and withdrawl from the newly purchased policy.
  • If you move, are going to move, travel out of State from your main home, fax, or mail the information to your Insurance carrier
  • After appying for Insurance, if you have not heard from anyone in 3 business days, make sure your Agent is keeping up with the process of your Application. Many times the Insurance company underwriters are going to want more information to complete the policy.
  • If you are leaving one Insurance company for the new one, include the Credible Coverage Certificate from your former company, with your new Application. This will prevent an elimination or other Rider from being applied to your policy. The same with COBRA, if you are in between insurance, let the company you are going to know. This may change your Effective Date of new Insurance.
  • Check with the Insurance Commissioners, and Consumer divisions of Insurance of the State your Insurance Company does business in, and your State as well, for complaints, and ratings on service.
  • You may be eligible for State suplimented policies, or other Group policies, your good Agent should know this, and find the best way for the Insured to go.

Tip #3 On making the Affordable Healthcare Act (AHA) work for you - the Insured - Provider

The Health Insurance Provider is the medical provider, doctors, nurses, pharmacies, chiropractors, therapist, medical equipment, eye doctors, etc.

  • Before you decide on a Health Insurance policy, make sure your Primary Care Physician, and the Hospital / Clinic she attends, are all in this policies Network.
  • If you love your Healthcare Providers, make sure they accept the Insurance you are thinking of buying.
  • Before using your Provider for surgery, or any other proceedures, find out their policy for submitting claims, and if they are willing to help get claims coded correctly, and if they demand payment ahead of time. This would mean as with most Prescription Plans, the Insured pays for the drugs, and then after the insured's deductible is met, a percentage is reimbursed.
  • Find out how fast your Provider will turn over unpaid claims to collection. Some claims can take months or years to get straightened out, make sure your provider is willing to wait, and help you fight for the Insurance company to pay claims.

Tip #4 On making the Affordable Healthcare Act (AHA) work for you the Insured - the Insured

In 2012, North Americans are in a partial phase of the AHA (Affordable Healthcare Act), and by 2014, the Insured, are going to have more rights and availablity than ever before.

Although you; the Insured, has secured a wonderful Insurance Agent, and have thouroughly read every line, each *, and all of the small print of your Policy, keep in mind that you; The Insured are ultimately responsible for making sure all parties act in accordance with the present Healthcare Law, and States provisions for Healthcare Providers, and Insurance Companies.

If the Insured cancelled a policy in May, but did not double-check their bank drafts, or have not received a finalization notice, which should include a Credible Coverage Certificate, then your Insurance may not have been cancelled.

  • Riders - There are several types of Riders, which are amendments to an Insurance Policy which excludes certain treatments, or may eliminate a member from the Policy. Some States in North America have adopted even greater protections for consumers against some types of Riders. By 2014, Insurance companies will not be able to include riders to policies
  • Riders and Claims: If you have accepted an Insurance Policy with Riders, it is possible that you will be paying premiums on a policy that holds -0- service for you. According to an Insurance Policy, a Rider is not supposed to lessen or degrade the rights of the Insured or her policy...In some cases all Claims submitted by an Insured with a Rider, will be rejected as if they had to do with the Rider. (An Example: Left Knee replacement. Rider on the Left Knee for 2 years, and no claims against it. Your Claim is for Ear Ache, the Claim will be denied automatically as if it were related to the Left Knee. This is the start of your Claim being denied, re-submitted, and Appeals filed with the Claims division of your Insurance Company.
  • Claims - Claims are also referred to HICFA, and UB2. A claim can be an itemized receipt from a Health Club or gym. ALL INFORMATION MUST BE CORRECT & MATCH WHAT THE INSURANCE COMPANY HAS ON THE INSURED. Many Insurance claims are denied for simple errors. One of the most common errors are names being misspelled, next is the Insurance Policy Number missing or keyed wrong. Last is mis-coding, or discounts not being applied correctly. An Insurance company has 30 days to pay a claim. An incorrect or duplicate claim can cause a claim to be delayed for months and even a year or more.
  • E.O.B. (Explanation of Benefits): If you or a family member under your Insurance Policy goes to a Doctor, Pharmacist or any other Medical or Medical equipment provider, you should recieve and E.O.B. or an Explanation of Benefits. This is where the Medical Provider has sent the Insurance Company a bill for their services against your Insurance Policy, and it is important that all of the information provided is correct. If you went for your annual or semi-annal wellness check up, and the provider codes this incorrectly, the charges will be markedly different. IF you do not get an E.O.B. within a week or so of service, then your Mailing Address could be wrong. Get in touch with your Insurance Company, and then your Provider. The E.O.B. will have dollar amounts or not listed. This is not a Bill!.
  • If anyone but the Primary Insured is going to work with the Insurance Company regarding Claims, Benefits, Premiums, Riders, or any other thing, a written authorization must be sent in by Fax / Email / or Writing, for any other person to be able to discuss the Policy with the Insurance Company. An authorization can be given temporarily for one incident, or a complete Power of Attorney can be put into the file of the Insured.
  • Cancellations, Changes, or Withdraws: Remember: All cancellations must be in writing, and must be sent to the Insurance Company, and received by them in a way that is legible and clear. When you decide to Cancel your policy, and stop and automatic payment, keep in mind it will take a while to stop an automatic bank payment. Re-read your policy, and /or be in touch with your Agent to confirm what is needed and in how much time. If they tell you a phone call will suffice, tell them you still want that confirmation in writing.
  • When a Primary insured wants to leave, but other Members will remain, this is called a Dependent Swap, this keeps the policy intact while removing the Primary and changing the Policy.
  • Sometimes, getting a Short Term Health policy will give the Insured the time they need to either purchase a Health Insurance Policy, or for school, or awaiting Insurance from an employer.


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    • LillyGrillzit profile imageAUTHOR

      Lori J Latimer 

      6 years ago from The River Valley, Arkansas

      Jillian, thank you. Thanks for coming by for a read.

    • Jillian Barclay profile image

      Jillian Barclay 

      6 years ago from California, USA

      I think everyone should read this! What a wealth of information!


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