Posts Tagged ‘ppo insurance’

Dental Insurance Plans Annual Maximum Rollover

Monday, May 31st, 2010

Many people are familiar with the term rollover, but few can associate it with health insurance. Most only apply the term to cell phone use. In this case used time for a month of service is rolled over to the subsequent month. In a rollover dental insurance, unused annual maximum or unused annual benefits are carried over to the next year.

If in a given year that the annual coverage ceilings are met or surpassed, the prior year unused maximum can be tap into. Guardian life Insurance, an Insurance company with over 70,900 dentists and dental professionals within its PPO network, was the first to give insurers the option of the rollover dental insurance .

Maximum Rollover or Maximum Rollover Account gives workers covered under the PPO plan added flexibility of managing their dental cost by moving expenses from one year of unused coverage to other years of extra health cost. Given the priority dental care plays in the competitive employment market, most companies would like to provide added health benefits to their employees without an increase in budget.

Maximum Rollover gives employers that added edge in attracting quality employees that are concerned about good health insurance. Last year those who were insured by Guardian rolled over more than $380 million. Since introduction, Guardian have created over 9 different Maximum Rollover options with limits that are up to 50% less than tradition PPO dental plans.

How Does Maximum Rollover Work

Let’s assume that a dental plan has an annual claims limit of 2000, the highest amount one can claim during a year’s visit to the dentist. If the insured only used $1000, then half of the remaining $1000 unused coverage, in this case $500, is rollover to the subsequent year coverage, bringing the annual claims limit to $2,500.

There is, however, a limit to the annual maximum benefit that can be built up. In the case of Guardian, up to 50%.

In addition, if the insured exclusively used only Preferred Providers or in-network dental specialist and dentist the annual rollover increases by an astonishing $100 to $350.

Since maximum rollover savings can increase continually, this can be a great benefit to employees. What is more unusual about these plans is that there are very few limits for coverage. Companies with groups as small as two people can be covered.

Apart from Guardian, Mutual of Omaha has also introduced a Dental PPO insurance plan with annual maximum rollover or (MRA). To be eligible the insured has to submit a claim that does not exceed the annual maximum.

Learn more about PPO Insurance Plans and how Dental PPO annual rollover works. Also find out about the difference in PPO and HMO insurance plans

How To Dispute Balance Billing From Out-of-Network Doctor

Monday, May 24th, 2010

The patient visit the doctor. The doctor issues a bill to the insurance company. The insurance company pays the doctor a discounted payment and sends you are copy of the bill. The doctor sends an additional bill to you. This controversial and, yes, illegal practice is called Balance Billing. Many states have already pass laws making Balance Billing illegal.

Under Medicare a federal law makes Balance Billing illegal as well. However, Balance Billing still takes place, mainly because the public is largely unaware of it. In the event you receive a bill from you in-network provider to which your insurance company has already issued a discounted payment call your insurer for guidance.

Many of these cases take place with patients who are in an PPO or HMO network and visit an out-of-network physician, specialist or lab. HMO policies restrict you from visiting an out-of-network doctor unless patients have pre-approval or referral from their physician. PPO pays up to 80% of medical cost for services within the network, but in out-of-network patients pays more. Pre-approval or referral in an PPO or HMO network does not necessarily mean that fees will be paid.

Sometimes the provider is looking to be paid more than what the insurer agreed to cover and so sends an additional invoice to the patient. This ugly and surprising side of insurance coverage is Balance Billing. Many times the patient just pays the doctor without negotiating or seeking redress, partly because patients are concern about what this could do to their FICO or credit score. However, there are ways to prevent Balance Billing and to fight against paying the doctor when the insurer has already paid.

Avoiding Balance Billing

The first thing you should do as a plan holder is to stay within your network, except, of course, in the event of emergency. Patients have the tendency to go out-of-network to visit a doctor partly because the doctor may have a good reputation in the community or come highly recommended. Seek advice and find qualified, reputable physicians within your network. That way you are assured that medical costs are covered.

Do not take it lightly. Double check with your physician to ensure that he is within the network. Doctors move in and out of network as the network requires physician to meet certain guidelines set by the insurer. In some cases, even if a hospital or lab is within your network, some of the specialist who treat you may not. Negotiate Prior to Visit

Patient who intend to visit a specialist out-of-network should negotiate fees before receiving treatment. Most doctors within your community will give discount on cash payments. The fee you negotiate should be based on what insurers are anticipated to pay – what they think is usual and customary fees.

For PPOs the insurer could pay as much as 80% of fees, so you can negotiate the price on the remaining 20%. If the doctors charges you much more than the 25% of the total amount your insurer paid, you may be Balance Billed for the difference. Request an estimate from the out-of-network doctor before treatment.

Double check the amount with your insurer to verify what the doctor charges are reasonable. With this information in hand, you now have negotiating power to pay a low fee to the doctor.

In the event you are dissatisfied with the amount the doctor charges you can file an appeal. You will have to contact your state’s insurance office for more information on filing an appeal

Learn more about PPO insurance plans and ways to avoid balance billing from your doctor and to eventually save on health insurance