Private Health Insurance: A Sense of Dissatisfaction

The three C's, customization, consumerization and customer-satisfaction, seem to be at the core of the business mantra for every service provider. The health insurance provider industry is no exception to this rule. With an increasing concern among the tax payers of US regarding the number of people uninsured in the country, there is a burgeoning market for the providers. Even though, this seems to be a buyer's market, there seems to be a lot of dissatisfaction among the people with the red tape and bureaucracy involved in claims processing, exclusions and limitations. Based on a survey conducted a couple of years ago, only 1 in 4 Americans said, they are "very satisfied" with their medical coverage. In general, the consent was that the people were dissatisfied with the bureaucracy of the provider, rather than the health plan itself.

Taking a closer look at the Indemnity PlansLet us now try to take a microscopic view of the intricacies of the two major types of health insurance: Indemnity vis-à-vis the Managed Care. The Indemnity is the traditional fee-for-service plan allowing more flexibility in terms of choosing your physicians and health care providers in lieu of an annual deductible amount. This is also referred to as the typical private or individual health insurance plan, tailored to the person's situation. Exclusions are defined when you buy your policy for your particular scenario. Due to the personalization nature of the policy and the subsequent risk exposure to the insurer, this comes with a higher price tag.

Exploring the intricacies of a Managed Care PlanA Managed Care plan will typically restrict the individual to visiting in-network set of physicians, hospitals and health care providers. This encompasses the Group Health Insurance plan, usually extended as part of an employer benefit. A single policy is designed for a big group of individuals belonging to different age groups and with varied medical conditions. Due to the economies of scale, in terms of risk distribution, these plans have lower premiums and out-of-pocket expenses than the private health insurance plan. There are three variations of the Managed Care plans: PPO (Preferred Provider Organization), HMO (Health Maintenance Organization) and POS (Point-of-Service). The in-line exclusions of these plans are a major concern, which are probably not always evident to the policy holder till the unforeseen happens. The provisions in the policy are decided between the insurer and the policy owner (typically your employer). Due to the restrictions imposed to visit doctors registered with the plan, you may come across a situation where you do not have a doctor to treat your specific illness. Simple surgeries and diagnostic tests can add up to thousands of dollars in medical expenditures due to the exclusions. In the long run, the lower premiums may not actually save your money due to these occasional exclusions/limitations. Thus, it always becomes an annoyance for the consumer to choose a well-rounded managed care plan that covers all or most of the medical diseases and/or illnesses. The bureaucracy and red tape involved in these policies to obtain authorizations and referrals even for the slightest of variations, for cost control measures always lead to a lot of dissatisfaction. Typically, you are also required to go through a primary care physician (PCP) for any of your treatment needs and may not be able to get your treatment done with the doctor of your choice to avoid excessive costs to the insurer.

Private Health Insurance gives you the freedom of choice!Comparing the two major variations, private health insurance seems to be the option to get the peace of mind for your healthcare needs. With the rising discontent among policy holders, this seems to be a more economically viable option for the long run depending on your health conditions. It is all about the "freedom of choice" and the flexibility to guarantee you the best medical care. The exclusions are defined at the onset of the contract based on your specific requirements and if you can afford the extra dollars, you actually get the perfect "sleep-at-night" coverage! Unlike group coverage, the provisions are negotiated by the policy holder and depending on the financial ability the policy can be designed as comprehensive as possible. In addition to the customized health care, the next most important advantage is the flexibility to choose your own doctor or specialist and the hospital of your choice. Private health insurance is a surging business in the United States because of the freedom that policy holders have in choosing what they want and how they want to be insured. You can secure yourself against any financial devastation for any and every imaginable health condition.

Consider your priorities for a secured health insurance, make an informed decision!

In order for a person to have a secured life, the right health insurance will give the shield for any medical emergency. The comparative analysis is very much subjective and varies from one individual to another. Considering the issues highlighted in this article, here are some other pointers to keep in mind in choosing the side between a managed care vis-à-vis private health insurance plan. Consider the quality of care with the doctors in your policy. In times of distress, mental peace is probably the most important thing you are looking for and with a private health insurance plan; you can easily switch physicians, if you are not satisfied with the service. With the restrictions imposed in a managed care policy, you should give it a second thought by considering the list of in-network doctors and health care providers. Consider the lifetime payout on the policy, which is the maximum reimbursement offered by the policy for your whole life. Lower premiums are not the end of the world, it is a decision you need to make for your life, so you actually maybe better off paying the higher premiums of a private health insurance plan as opposed to rapid depletion of a managed care lifetime payout. Consider the delicate balance between the paying out too much on your out-of-pocket expenses vis-à-vis the risk of your exposure to a serious illness. If you feel, you are more prone to getting infected, you might be better off taking up the more expensive individual health insurance option to save you money in the long-term. Provisions for emergency care, is another major factor to be considered in choosing your health insurance. Typically, some of the managed care plans have been occasionally criticized due to the requirement of primary care physician's approval for an emergency care. You must definitely put your step down on this one, as emergency care is something you do not want to jeopardize due to higher premiums on the policy. Last but not the least, are the pre-requisites defined in the policy before you are eligible for getting medical attention. Keep in mind; if you are not feeling well, you deserve the right to visit your doctor, do not let the limitations in your health insurance policy scare you away from getting your treatment. Occasionally, people have compared buying a private health insurance policy to buying a Rolls Royce, but wouldn't you rather enjoy the tranquility of a peaceful ride rather than traversing the rough terrains with the restrictions put in by the managed care policies? It is a rhetorical question!

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Mr. Ariful Anam
Email: ariful@rediffmail.com
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