The business of health insurance is a big one in the United States, and after all, many people will need medical help sometimes in their lives, and this means having the right methods for paying their medical bills. Health insurance is the means by which customers, or patients, can pay their expenses and be covered in case something happens to them. Getting health insurance for the first time can seem daunting, but someone who understands the basics of health insurance will know what to do and can find the right health care plans for them based on their needs. What are some of the trends of the health insurance business, and what can this tell someone who is looking for their first plan? A health insurance company is always ready and willing to take on new customers, but people should know what to look for first.
Trends in Health Insurance
The industry of health insurance is both huge and very important, so a lot of studies have been done to figure out some recent trends and statistics about it. For example, the Centers for Medicare and Medicaid Services has determined that in the year 2015, the United States spent a massive $3.2 trillion on health care, and this means plenty of work for health insurance companies. What is more, it has been found that since the year 2015, healthcare costs, which includes deductibles and out of pocket costs alike, have gone up 30%, so it may be more important than ever to make sure to get the right health coverage today. In the year 2017, as one example, some $698.3 billion was spent for physicians and clinical services across the United States, and visiting the Emergency Room may cost about $1,233 on average. So, what should someone who is looking for health care know about the basic process? Knowing the basics can be a good start.
The Parties Involved
As explained on Medical Billing and Coding Online, some basic parties to know are the policyholder, the healthcare provider, and the insurance company. The policyholder is the actual patient, or the customer for their health insurance. Also, the healthcare provider is any clinic, nursing home, doctor’s office, or hospital that provides medical care, and when a patient visits such a place, they will pay a deductible, or an out of pocket expense, before their insurance takes over the costs. The insurance company, meanwhile, is simply the company that has qualified patients, or policyholders, on file, and it will pay for their qualifying health care.
After a patient pays their deductible to their healthcare provider, the provider generates a bill, or a healthcare claim, which is a description of all medical services rendered, and sends this to the patient’s healthcare insurance company. Now, the insurance company may take one of three routes. It may accept the bill and pay it if nothing goes wrong. This is the norm. Second, the insurance company may reject the bill and send it back because some of the information was wrong, and the provider’s coders will have to fix any errors and send the bill again. Third, the health insurance company may reject the claim because it does not actually cover those services. In this case, the patient will now be responsible for paying all costs out of pocket.
Finding the right health insurance company may be based on both the patient’s location and the state of their health. Someone managing a chronic condition such as diabetes or spinal issues may have higher insurance rates, and someone who is expected to become ill or injured more often due to their lifestyle or age may be more expensive to insure as well. Someone looking for coverage can perform an Internet search in their area, such as “healthcare coverage Broomfield Colorado” or “health insurance San Deigo California” and then find a company, then browse their different packages to find one that suits the customer’s needs and expected rate of illness or injury. Someone who is in good health and is not managing chronic issues may choose a simpler package, and this can lower costs. A senior citizen with an ongoing issue, meanwhile, may invest in a more dedicated package so that they can get maximum coverage whenever they visit the doctor’s office or the hospital.