Health Insurance Portability and Accountability

In 1996 an act called the health insurance portability and accountability act was passed by congress.

Health InsuranceThis act requires all health care transactions to be uniquely identified and helps protect the insurance coverage of those who lose their job or change jobs. The act allows children from the ages of 12 to have privacy as well, even from their own parents. The provider they speak with is limited in regards to the information they can share with the child’s caregiver without the child’s permission. This portion of the act was met with some degree of concern, but ultimately it was decided that it was in the best interest of the children to have some privacy concerning information they should discuss with a doctor, without fear of repercussions at home. This was also the start of transferring healthcare information and history files to electronic data sources instead of traditional paper files kept in medical offices.

One very important aspect of the health insurance portability and accountability act deals with the issue of pre-existing illnesses. Before this act, if someone had a pre-existing illness an insurance company could refuse to cover them. However, the health insurance portability and accountability act contains a portion that states if someone has a medical condition and needs to be covered on a new health insurance plan, the health insurance company cannot refuse to cover them if they have had coverage within a reasonable time frame – typically that means coverage within 63 days of the start of the new insurance plan. If it has been longer than that, the company may be able to refuse to cover a pre-existing illness.

For this reason it is still a good idea to prevent a lapse in insurance coverage if at all possible. For many people the idea of a pre-existing illness not being covered means nothing, but to those who must live with chronic conditions, it can mean the difference between getting the care they need to get better and live comfortable and living in pain every day and potentially getting worse because they are unable to get the care they need due to lack of insurance coverage and inability to pay out of pocket for their medical expenses.

In the past, the only way of storing medical information was by keeping paper files at a doctor’s office.

Unfortunately, this left important patient files at risk to damage from things like fires, floods, and theft. Even under lock and key there was always the possibility that information could fall into the wrong hands without much difficulty. If a group of teenagers broke into the office, for instance, they could have the private information of the entire town in their hands.

The health insurance portability and accountability act set the stage for medical information to be transferred to electronic databases that could easily and quickly be backed up.

If for some reason a database became damaged, the information would still be available if and when needed. This act also stated that there would be penalties given to the providers that did not take every precaution possible to protect the private information of their patients. If computer monitors are viewable to the public or unauthorized personnel can access information with relative ease, action will be taken. The information kept electronically can only be given out with a patient’s consent. Relative information concerning billing and treatment needed may be given out when needed, but standards do apply to the release of this information. The act protects the private information of individuals’ medical needs.

Health Insurance Information

Health insurance exists to help people pay for medical expenses.

Medicare LeadsThese expenses can be impossible to predict because people never know when they are going to get ill or have an emergency come up. The financial impact of these situations can be life changing. If people are unable to pay out of pocket or another form of financing is not available to cover the needed care, they either have to go without or face the financial consequences for years to come. Health insurance aids in the payment of these expenses. It can be purchased privately by an individual, purchased or provided by an employer, or be one of several publically available options generally available through the government. Programs such as Medicare and welfare are forms of health insurance that exists to help people who cannot afford insurance coverage cover their medical needs. With these types of programs, people with more medical needs will receive a greater coverage benefit than people that are generally healthy.

The funds for these public programs are spread out to cover as many people as possible and are paid for by U.S. taxpayers. Health insurance can also cover things such as disability, when a person cannot work, or other necessary care that would not otherwise be provided but is needed by someone.

The number of people covered by insurance has steadily been dropping.

People are unable to find jobs or find jobs that are only part time or do not offer benefits. Sometimes, people find jobs that offer insurance but the premiums are so high that they are unable to afford to pay them and still pay other household bills such as their rent or mortgage payment or other bills. Although health insurance is available to be purchased through insurance companies by individuals directly, the premiums for this are also often extremely high and very few people can afford this. Less than 10% of people with insurance opt to pay for it on their own, without the insurance plan being sponsored by their employer. The two most common types of coverage are health insurance plans offered by employers and the plans offered by the government to help those who can’t get insurance through another means.

It is becoming more and more common for those people that do manage to get health insurance coverage to feel under insured as well. They are able to get some coverage in place but it may not cover preventative care or emergencies, which still leaves the covered person vulnerable to financial hardship and promotes people to ignore medical needs in order to save money. It has been discovered that people without insurance coverage are more likely to live shorter lives than those people who have insurance coverage. Things like preventative care do not get obtained by these people and medical conditions that could be treated if caught early, are allowed to develop to the point that nothing can be done.

Another situation that often occurs is that people do not feel they can retire, even after putting many years of hard work in at a company.

If they company offers insurance, the person often feels they must continue to work so that they can keep affordable insurance coverage. If someone retires, they will often have to find their own insurance and pay entirely out of pocket, which increases premiums drastically. Couples may also be forced to keep the younger or healthier spouse employed to keep insurance for the household when, if it weren’t for the insurance needs, they could both retire and enjoy the remainder of their lives spending time with family and enjoying their hobbies after putting so many years in to the work force.

HMO Basics

It is easy to get confused when the subject of health insurance comes up.

HMO and final expense leadsOne common abbreviation that often confuses people is HMO. HMO stands for health maintenance organization. This organization takes care of managing the care between set groups of providers and insurance benefits provided by a health insurance plan. One point of importance with a health maintenance organization is that no matter what, emergency care will be covered. If you can’t make it to a contracted provider, you can still get the emergency care you need.

Usually if you select an HMO plan you will choose a main doctor to act as your primary care physician. You will go to this doctor for your medical needs and have them guide you for anything else you need, as a standard practice. This doctor needs to refer you for any other services you need for medical care and it must be within the regulations of the HMO plan. This prevents patients from being sent to get unnecessary procedures and also prevents the insurance company from paying for cosmetic procedures that are masked as medical procedures. Having a set network of providers helps control the costs that individuals must deal with because arrangements have been made between the health plan and the provider so that everyone benefits, including the patient.

Often times the providers that are part of a health maintenance organization will have practices that include groups of doctor’s with different specialties. This helps streamline patient care and documentation. You may find a primary care physician in the same building as a pediatric specialist and a mental health specialist so patients can be referred easily to the care they need at any point in time.

An HMO is directly involved, or more involved, with people that have extraordinary needs. Individuals with chronic diseases or cancer diagnosis are going to receive more direct help from the HMO because they need a higher level of medical care than someone that is just being seen for preventative maintenance or a sinus infection. The more minor medical needs will be reviewed as part of a physician review and doesn’t require special attention. However, with sever medical needs, the extra involvement makes sure the patient gets as much care as possible and that the care they receive will help as best medical care is able to help them. A manager will be assigned to the case to make sure that procedures are not overlapping to prevented wasted time and money, improving the patients chances of getting adequate health care in a timely manner, which means they will get better faster and not have to suffer unnecessarily. Many people believe that HMO programs are overly controlling and restrict what a patient can do. However, these people often do not have a full understanding of what a health management organization is or the services they provide to those who utilize them. For many, it is an ideal way to handle health care.

A health maintenance organization regularly reviews the physicians in its network to see how the care they are giving relates to other physicians of the same type.

Is the physician giving more services or less? How is the quality of care? This makes sure only things that are within the standards of the HMO are being executed and covered by the plan and also makes sure that the patients are not being refused services that should be covered. The health management organization exists to protect the patient and the provider both.

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