Health Insurance
My experience with the Mail Handler’s Benefit Plan (MHBP) health insurance system has been one of a minefield of raising premiums, increased co-payments, physicians added and dropped daily from the accepted “in-network” list (a compilation of who’s who in the approved for payment list of doctors, specialists, clinics, hospitals, medicines, etc), medicines added and dropped daily, procedures added and dropped daily, and so on.
My plan with the MHBP health insurance system is a family policy. This was necessary even though my husband was age qualified and had Medicare parts A and B. The Medicare health insurance system excludes more procedures than it covers. Thus, a family policy was needed for the additional coverage.
Since I am still working full time, my policy is the primary health insurance system to be billed for my husband’s office visits and treatments. This system will be reversed when I retire and then Medicare will become the primary insurance. While this is an accepted practice; my insurance being first to pay and then Medicare billed as secondary, most medical facilities continue to reverse this process based on my husband’s age, 80 years old. This creates numerous hours of unnecessary corrective phone calls and paperwork.
MHBP has aligned itself with the Coventry health insurance system. This means that if one of our physicians is registered with MHBP and not with Coventry, or the other way around, he/she may, or may not, get paid the higher in network rate depending on who processes the medical claims at the insurance system headquarters.
Another area of confusion and aggravation is the health insurance system’s approval of hospitals and hospital services. A local hospital may be approved for in network payment, with a large co-payment fee. But, the local hospital’s out-patient clinics may not be covered. Also, many of the services provided at the hospital may not be covered depending on whether the emergency room physician is a registered in network doctor or not. Any medication they give you during an emergency room visit generally must be paid for by you, the patient. If you are admitted to the hospital for surgery, that process may be covered. However, in the state of Maryland, where I live, any anesthesia is not covered and all anesthesiologists do not accept insurance payments. Again, the patient must pay the full bill. You could submit an out of pocket claim for reimbursement, but you must first meet the out of pocket individual limit, usually somewhere in the neighborhood of $3500; way more than the anesthesiologist’s billing.
Another MHBP health insurance system process that comes with its own set of headaches is getting a prescription filled. I take Lipitor and Nexium daily. These prescriptions are written for 90 days at a time with one or two refills. Therefore, I must mail the prescriptions to Caremark to be filled. I could use a local pharmacy, but at a much higher co-payment. If I wait until the refill date to re-order, my on hand supply may not last the 10 days until the refill arrives, so I will need to pay an additional shipping fee to get the medication on time. This is something I would not have to incur if I were allowed to use the local pharmacy. CVS has purchased the Caremark prescription chain, but I cannot use CVS to fill a 90 day prescription; I must still use the mail order process of this health insurance system.
Every year that I have had the MHBP health insurance system the premiums have gone up; the co-payments have increased; and the paperwork has become more detailed in order to get the medical providers their payments. So, why do I stay with MHBP? Because, when looking into the dozens of other health insurance systems available to me, this one plan still covers more procedures and is accepted at more facilities, with an affordable premium cost. Yes, this insurance system is, by no means, perfect, but it is a better alternative to rotating doctors at an HMO or having no insurance at all.
http://www.evarumi.com/business-finance/insurance/choosing-an-ltc-insurance-carrier
March 23 2011 | Healthcare | No Comments »