Linda Brandwin, R.N. Linda Brandwin is a registered nurse and a medical billing and claims specialist. For the past 10 years she has worked directly with insurance companies to give advice and guidance to the health care consumer. Readers may send email or write Linda Brandwin at 5500 Single Oak Hill Ct., Woodbridge, VA 22192.

Limit insurance choices to simplify process
May 28, 2004

Q: I have a company with 50 employees. Our health insurance premiums have gone sky high. I am shopping around for a new policy and trying to determine which insurance company would be best for us. Is there one, single, simple or easy way to sort through all of this material? It is becoming overwhelming. I want a fairly straightforward kind of policy that will give us solid coverage.

A: Choosing the right health insurance company and plan for you and your employees is not easy. It can be very confusing. The federal government has experienced over a ten percent increase in premiums for three years in a row. There are those in the private sector who have seen even higher increases. Shopping for a health insurance company is more important than ever.

I have found one factor that I believe is one of the key components to determining the best policy for you and your employees. This factor should limit your choices to a manageable few and determine the best policy for you. It is simply looking at the list of health care providers participating with the insurance company.

It is always good to pick an insurance company that provides out-of-network benefits. However, these out-of-network benefits do cost you more out-of-pocket money. Therefore, check the insurance company's in-network health care provider directory. Make sure all of the major hospitals in your area participate with the insurance company. If many of your local hospitals do not participate with an insurance company, there is usually a good reason. For example, the reimbursement to the hospital for their services is too low, it may be too difficult to receive payments, or coverage may be too limited. There could be many other reasons that the hospitals don't participate with an insurance company. But, generally, if the insurance company is not good enough for the hospital, you can be fairly certain it won't be good enough for you either. If a hospital has problems with an insurance company, you can usually bet that you will too. This is not a hard and fast rule. It is simply a hint that may be helpful in deciding what health insurance company to go with.

Along the same lines, you may want to ask your employees for a list of the healthcare providers they use. You certainly won't find every healthcare provider on every insurance directory. But make sure a lot of these providers participate. Also make sure that there are several physicians representing different specialty fields listed in the participating network of the insurance plan. Again, if there is a large absence of healthcare providers in the directory, that should be a red flag for you. There is a reason why physicians will not participate with some insurance companies. Keep this in mind when choosing a health insurance policy.

Of course, there are many other factors you need to look at. Deductibles, prescription benefits, co-pays, wellness and preventative care services, and hospital, surgical and mental health benefits to name just a few. And there are many different types of policies such as PPOs, HMOs, POSs, and MSAs which are medical savings accounts. After you have compared what each insurance company can offer, you will be ready to finally compare the costs. Cost is always the bottom line. But first you need to know what your money is buying.