Oklahoma Health Insurance: What You Need to Know

6/19/2008

The things you should know when looking for Oklahoma health insurance coverage and the costly no no’s

Know your Agent

Just getting a quote is a very small part of buying insurance.  Your agent should be someone who will spend time with you and offer free consultations.  Today there are many plan options available that have not been offered in the past.  They include the family deductible PPO plans, Indemnity plans, Health Savings Account plans, the no deductible plans, co-pay plans, and 100% plans.  By having many options, your agent is able to design a plan to meet your needs as well as your budget.  Not all policies and companies are alike…i.e… a person with high blood pressure can expect a 25% rate up with many companies.  Some companies will not charge an extra premium but will increase your deductible if you have a claim for high blood pressure.  This could save the average customer hundreds of dollars a year.  Another part of the puzzle is to know how each company is rated. The rating is done by an independent company and can help inform potential customers of the stability of the company. Your agent should be able to provide you with this information.

Establishing a relationship with your agent can provide your family with the safety of knowing that the unexpected has been considered prior to purchasing your insurance coverage.

“According to a recent study done by American Health Insurance plans in 2004,15% of initially submitted applications never make it to underwriting because of incomplete applications.  If you go through this very important process without the help of an agent, you may unnecessarily become one of the 15%.  This can affect your future ability to purchase insurance as well as your credit report.  As you get older, the rate for denial increases dramatically because of health history.  Those in ages 30-39 have a 12% denial rate; 40-49 14.5% denial rate; 50-59 23% denial rate; and 60-64 30% denial rate.” The agent should be able to guide customers through this process with a much higher chance of approval.  These numbers tell us that helping the customer to understand the underwriting requirements of each company is one of the agent’s largest responsibilities to his clients.  Many people become frustrated and do not apply again or make application, only to go through the same process again and again and be denied coverage.    

Know why you are buying insurance

Some people are most concerned about catastrophic medical expenses that would drastically change their life and health, but are willing to pay for the day to day costs as long as they have a stopping place for their medical liabilities.  These people may consider a family deductible plan or a high deductible major medical plan.   This would offer a substantial savings in premium costs.

Others will need help with day to day costs because of prescriptions and doctor costs for themselves or their children, but also need good major medical catastrophic coverage.  Also, some have special needs…ie… maternity, well child care, immunizations, annual physicals, dental or vision, and home health care. Some people need a combination of the two designed specifically to meet their needs.

You insurance agent should be your advocate to learn what your needs are and then find the best major medical plan you can as well as the added options you can afford.

Know the features of the Plan you are buying

 There is more to buying insurance than just knowing the deductible amount, the co-insurance, and the co-pays.  Many plans have deductibles per cause which means you can be subject to unexpected expenses when paying your claim.  Each policy should be checked to see if there are limits on doctor and hospital expenses.  You may have a $5 million major medical plan but it may only pay $100,000 for the doctor or hospital per claim.  Without knowing this, the insurance you bought at a lower premium and saved $20 a month on may cost you $20,000 at the time of a claim.  An agent should provide you with this information before the sale so you can decide if this is a risk you are willing to take.

For the self-employed and individuals in Oklahoma the most common type of plan available is a PPO or Preferred Provider Organization.  The advantage of this plan is that the medical services and supplies are discounted when you use those in the network, in other words, you don’t have to negotiate prices with the health care providers.  A PPO offers flexibility, because you can go outside the PPO but may lose the price advantage when doing so.  In Oklahoma the Health Maintenance Option does not work unless you are in OKC or Tulsa.   A non PPO is another option; however, generally their premiums are higher and the prices are not negotiated.  This means that you will be paying “retail” prices for medical services and you will be on your on to negotiate the cost with the doctor and hospital.

It’s important before you purchase the insurance that you know the pre-existing condition coverage, limitations and exclusions of the policy.  Some companies will wave pre-existing conditions if they are listed on the application.  Some companies will not.  If you are aware of what the companies’ policy is on this issue it will further help you in making a decision.

Know if the doctors and hospitals in your area are included in the plan

People feel most secure if they have a large selection of doctors and hospitals to choose from in their area.  We recently saw the hurricane victims go through a major displacement and many were in need of health care out of their area.  Would your plan be able to take care of you in this emergency situation?  An insurance agent can be your advocate in emergency situations. 

Know the Insurance Company

Insurance companies are not equal and insurance policies are not equal.  One way to evaluate the company is to check its ratings.  AM Best is the oldest and most experienced company since 1899.  For more information call 1(908)439-2200 or you can check their website at www.ambest.com.  This is how the rating system works:

A++ to A+ is Superior

A to A- is Excellent

B++ to B is Very Good

B to B- is Adequate

C++ to C+ is Fair

C to C- is Marginal

D is Very Vulnerable

E is Under State Supervision

F is Liquidation

Anything in the Superior to Excellent range is a good choice.  There may be some companies in the Very Good range that could also meet your needs.  I would never buy from any company below the Very Good range.

Another option is to call the Insurance Commissioner to check on the company for any complaints that have been filed.  All companies will have a few but should not have a long list of unresolved complaints.

This alone will not tell you if the company is paying the claim.  You also need to rely on the agent’s experience with his customers.