The Health Insurance Blog

Children and Pregnancy

2008-12-22T21:00:00.001-08:00

So why would anyone want to have their baby at a birth center? Or at home? For me it was about not having to fight to get the birth I wanted. Even more importantly, it was about having childbirth treated as a normal and natural process rather than as an illness. And I certainly didn’t want to expose my newborn baby to hospital germs if it wasn‘t medically necessary. It was about being allowed to “call the shots” rather than being treated like a patient who needed to be rescued. While it is common practice for OB and hospital midwives to expect the mother to lie on her back while pushing, this is not the case in a birth center or at home.

The mother can labor and then push in whatever position feels best for her. Some women prefer to push on all fours while others use a birthing stool or another position. It’s up to the individual mom. She may naturally know what she wants or she may listen to recommendations of her doula and midwife. In addition, she’s allowed to eat and drink as she normally would and isn’t tied down by a monitor or IV. She’s able to move about freely with the midwife or assistant checking the babies heartbeat on an intermittent basis. She may labor in the water or even give birth in the water! (There are special waterproof dopplers to use during waterbirths.) My point is that the choices are hers. She’s allowed to follow her natural instincts regarding childbirth and she is advised when she needs help making those decisions. Make sure you have child health insurance as well, for this is going to come in handy and help monitor expenses.

As a mom who gave birth in a hospital and then a birth center, I can tell you the difference is remarkable. These are just a few of the reasons why I would only go back to a hospital for childbirth if it were medically necessary.

Health Insurance History

2008-12-22T20:52:00.000-08:00

Twenty-five years ago, the majority of the people in the United States had indemnity insurance coverage. An indemnity insurance plan reimburses you for your medical expenses, regardless of who provides the service. In many situations, this amount is limited, therefore, making both the patient and the insurance each responsible for a portion of the bill.

However, today, more than half of all Americans who have family health insurance are enrolled in some kind of managed care plan. These plans allow individuals ways to manage costs, use, and quality of the health care system. Different types of managed care plans work differently and include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Point-of-Service (POS) plans. Chances are you have heard these terms before. But what do they mean….what are the differences between them….and what do these differences mean to you?

Another positive change in the healthcare industry is the introduction of SCHIP (State Children’s Health Insurance Program). This year, the US Congress is looking to increase the scope of SCHIP to provide greater state coverage for all uninsured children.

What is an HMO?

2008-12-22T20:21:00.000-08:00

HMOs are managed care plans that provide care for enrollees by contracting with specific health insurance plans care providers to provide specified benefits. Many HMOs require enrollees to see a primary care physician (PCP) chosen by the member who will refer them to a specialist if deemed necessary.

HMO plans often do not include deductibles, but copays are charged per office. HMO plans typically allow a member to have lower out-of-pocket healthcare costs, but require the member to forego some choice and flexibility with regard to selecting physicians and hospitals.

Additionally, HMOs do not cover non-emergent services received from providers outside the network. HMOs do not require members to submit claims to the insurance carrier.

Short Term Health Insurance

2008-12-22T20:18:00.000-08:00

Short term health insurance provides comprehensive health insurance coverage and guards against the outrageous costs of unexpected medical bills. Short Term Health Insurance can give you piece of mind. Many plans cover physician services, prescriptions, X-ray, laboratory services, inpatient hospital stays, inpatient and outpatient surgeries, skilled nursing facility care and rehabilitation up to a lifetime maximum of $2 million. A major benefit of short term health insurance in Hawaii is it covers a wide variety of needs, from 30 to 365 days (depending on state of residency), and it allows you to use your own doctors and hospitals.

"None of the plans that we are investigating thus far have had an adequately fair process" for dropping policies based on application errors, said DMHC Director Cindy Ehnes.

Health Net's employee bonus program was revealed in the course of a lawsuit by a breast cancer patient who had her health insurance companies dropped by the company after she became sick. The company dropped 1,600 policies between 2000 and 2006, avoiding paying $35.5 million in medical fees.

Ehnes and California Insurance Commissioner Steve Poizner have proposed new regulations that would require health care providers to find that customers deliberately misrepresented information on their applications before dropping their coverage.

What is the Differnce Between Plans?

2008-12-22T20:16:00.000-08:00

How is individual insurance different from group insurance?

Individual health insurance is very different than group health insurance, which is the type of insurance that is offered through an employer. Since laws mandating what types of services must be included in individual policies are often different than those dictating what must be included in group policies, benefits are generally less extensive than what most people would receive through coverage they have through work. Individual consumers may be surprised to learn that some benefits that may be considered “standard' in a group policy, like maternity coverage or substance-abuse treatment, may not be included in an individual plan. Sometimes individual health insurance consumers have the option to pay extra for coverage of additional services like maternity coverage. This extra coverage is referred to as an optional rider.

Cost is often the primary factor for individual health insurance consumers, which is another reason why the benefits included in individual policies are often simpler. In addition, deductibles (the amount you have to pay before insurance benefits begin) and cost-sharing (the fees you pay directly to medical providers at the time of service) are also generally higher.

Individual health insurance companies are much more limited than group insurance companies in their ability to spread risk, so the laws concerning i ndividual health insurance are different in most states. This means that applicants for tonik health insurance will need to complete a brief medical questionnaire when applying for benefits and, unlike a group insurance policy, in most states a company can decide not to cover people with very serious medical conditions (e.g., HIV or cancer), deeming them “uninsurable.”