Redefining Health

  • No Comments

What we can’t define, we can’t find; for our definition determines our destination. One of humanity’s greatest debacle is the allegiance to history as a standard for the present and the future. Humanity is so much indebted to old thoughts to the point where, thinking something new seems like a disloyalty to the legends of old. History should not be a status quo or an imperative standard for the present and the future, but an inspiration for the correction of the present and the redirection of the future for a better destiny for mankind. With respect to achieving health for all in the 21st century, humanity must outgrow old thoughts and ways, to the expounding of new methods, approaches, ideologies, and strategies in securing health for mankind. “The significant problems we are facing cannot be solved at the same level of thinking we where at when we created them.

In the past, health was defined as having both body and mind working in good order, free from diseases and pains. If this assertion has been unable to provide humanity with insight on securing health for humanity, then it is expedient for humanity to think out of the status quo. There is no way humanity can resolve the health challenges of the 21st century except in the courage of exploring the unknown. With respect to the 21st century health plan, health is defined as an integrated state of being, of the human body, soul, and spirit functioning in absolute soundness. Thus, health is not necessarily the absence of pains or physical symptoms of sicknesses and diseases. There are individuals with no symptoms of pains, sickness and diseases, yet they are close to their grave. There are equally people who died without having any physical symptoms of pains or disease. Though they seemed to be fine, yet they died suddenly because they were not healthy.

Health is much more than the absence of pains or disease, but an integrated state of being with the human body, soul, and spirit functioning in absolute soundness. Health is an integrated effect with a cause; which implies, health is not a coincidence or an accidental occurrence but the resultant effect of the relative functioning of the human body, soul and spirit in absolute soundness. Let me make this clear, health is not a challenge we can resolve by our shallow efforts. That is why despite all human efforts in achieving health, health has remained a severe challenge. To achieve health for all in the 21st century, humanity must stop joking. We must realize that, we are dealing with a challenge which if not resolved, billions of humans may be wiped out before the end of this century. For health to be achieved in the 21st century, humanity must adopt a more comprehensive and integrated approach taking into consideration the total human being; body, soul and spirit. I hope by now we are civilized enough to know that the human being is not an animal but a complex being with three related dimensions (body, soul and spirit).Any health plan which focuses only on one dimension of the human being will end in failure. A human being must improve in his body, soul and spirit to enjoy health.

Insight on the Human Being:

The human being is the most complex specie in all of existence. Until now, little has been discovered about the human being. What is in existence as information concerning the human being is but “skeleton”. The human being is a world yet unexploited. The ignorance about the totality and the truism of the human being is the greatest challenge to human evolution and progress. The full understanding of the truism of the human being will be the end of human misery and frustration. The human being is essentially a supernatural being, possessing a soul and living inside a body. This assertion is a universal truth agreed upon by all Universalists and equally confirmed in the universal lab manual or the divine constitution. The spirit of man is the ‘real estate’ of man, with the soul as the intermediary between the spirit of man and the body. The human spirit possesses the science of life, which defines humans as having the supremacy over all external factors.

When this consciousness is transferred to the human soul and body, human immunity and resistance against sicknesses and diseases is enhanced. The fact that the human body is the only visible dimension of the human being does not define the body as the sole constituent of man. Limiting the human being to just his physical body can be the most tragic error. Humans are not animals. The most tragic academic mistake is that of classifying humans and animals under the same group. This academic mistake is due to the limited perspective about the human being. This perspective considers the human body as the sole constituent of man. This academic mistake has produced a low mentality and consciousness among humans. Today, humans live and behave as animals because of this error. Humans even suffer the same fate as animals. The day has finally come to eradicate this human ignorance.

Health versus healing

One of the errors humanity has made for several centuries is that of substituting health for healing. This error has lasted for so long that humanity has unconsciously resorted to healing programs in the name of health programs.
Healing itself being the gradual recovery of a sick or diseased human is different from health, which is a state of absolute soundness (body, soul and spirit). Substituting health for healing makes humanity more reactive than pro-active. When we focus on health, we become more pro-active and preventive than reactive.

Focusing on healing entails allowing the human being to first of all be attacked by sickness and disease before looking for her recovery. While health involves pro-active investment to have a human being sound in body, soul and spirit as an integrated effort towards freedom from sicknesses and diseases. Healing is a recovering and a relief from pains but health is a state of being. One can be healed today and sick tomorrow but health implies, an individual is sound in body, soul and spirit. Friend, healing as to health is relatively cheap and sometimes easy to come by, but health is a breakthrough which demands a lot of focus and concentration on one’s body, soul and spirit conditions.

With respect to the 21st century health plan, sickness and disease is considered as an effected state of being, caused by a deficiency in one’s body, soul and spirit condition. This implies, an individual is unhealthy, sick and diseased as long as there exists a deficiency in his/her body, soul, and spirit condition. This explains why people sometime die without any sort of outward sickness or pains. The issue is that, we think a sick person must be under some kind of pains. There are people looking relatively OK, but terribly sick. This is because not all diseases are physical. Body sicknesses can be easily diagnosed, but sicknesses of the soul and of the spirit can not be diagnosed through any medical means. Thus, for a person to be termed healthy, such must maintain a relative state of soundness in body, soul and spirit. Equal and relative functioning of the human body, soul and spirit in perfect harmony and soundness is the everlasting access to health.

Most of what is described as health centres today are but healing centres yet to arrive the full status of a health centre. A healing centre is any centre, be it medical, psychiatric or religious centre where the sick and diseased are cater for or ministered to. While a health centre is a centre of integrated science, where profound and prolific insight on the human being (body, soul and spirit) are communicated and imparted; so as to empower humans both in their body, soul and spirit to forever triumph over sicknesses and diseases. Such a centre must be a research centre which progressively researches on both academic, scientific and insightful divine information and intelligence needed for human supremacy over sicknesses and diseases. Healing requires medication but health requires much more than medication. The greatest investment in health realization is information.

I am not talking here of ordinary knowledge; I am talking of advanced academic, scientific and divine knowledge containing the truth which unveils the truism of the human being (body, soul and spirit) with all their relative needs and demands. Thus, when you find a true health centre, you will see a place where the total science of the human being is unveiled, with teachers and doctors who are inter-comprehensive, possessing rare insight on the total science of human existence and functionality. Presently, such centres are non existent. This is the greatest challenge of the 21st century.

The entire world is doted with healing centres catering and administering to the sick and diseased without any investment in their education with respect to achieving health. This has led to the situation we have today of human beings constantly victimized and perpetually dependent on drugs and other healing mediums without ever graduating to health. You may ask what my proposition is: my proposition is for every healing centre to combine her efforts of relieving those who are sick and diseased with educating the people on health sciences. This is the only way we can triumph over sicknesses and diseases in the 21st century. Healing – Health = a victimized human, one perpetually dependent on drugs, instead of the truism of health.

It seems to me that, humanity is losing faith on pursuing total health. We have been cowed by numerous health challenges to the point where, we are instead studying how to function in abnormalities. The general slogan in most places today is how to live with AIDS, malaria, or any other disease. Such cowardly approach and attitude can not be rewarded with insight on human triumph over sicknesses and diseases. While seeking for better ways in relieving the sick and the diseased, we should not fail to embark on continuous research, so as to uncover the truth which will forever empower humans to triumph over sicknesses and diseases. This is the challenge of the 21st century.

It was believed that, no one could ever reach the summit of Mount Everest; thousands attempted and failed; and their failure reinforced the belief of the world. When the world slept in their pessimism, a man by name Edmond Hilary forced the world to change their belief; by getting to the top of Mount Everest. It was equally believed that a metal object could not fly. The Wright brothers equally forced the world to change their belief by their invention of the aero plane. The world presently believes that total health is impossible for the human being. I believe we are that generation to change that assertion. Let’s muster enough courage and faith. We can make it. Health is an integrated state of being, with the human body, soul and spirit functioning in absolute soundness.

Health Care Fraud

  • No Comments

Today, health care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or endeavor touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.

Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

– “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

– The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

– The National Health Care Anti-Fraud Association (NHCAA) reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. [NHCAA, web-site] NHCAA was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David Hyman, professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from payor to payor – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.

Providers use specific codes to report conditions treated (ICD-9) and services rendered (CPT-4 and HCPCS). These codes are used when seeking compensation from payors for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs recognize – not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed, payors of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased pre- and post-payment audits of selected providers to detect fraud, and have created consortiums and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

With such efforts in 1996, we got the Health Insurance Portability and Accountability Act (HIPAA). It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse. HIPAA purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.

In 2009, the Health Care Fraud Enforcement Act appeared on the scene. This act has recently been introduced by Congress with promises that it will build on fraud prevention efforts and strengthen the governments’ capacity to investigate and prosecute waste, fraud and abuse in both government and private health insurance by sentencing increases; redefining health care fraud offense; improving whistleblower claims; creating common-sense mental state requirement for health care fraud offenses; and increasing funding in federal antifraud spending.

Undoubtedly, law enforcers and prosecutors MUST have the tools to effectively do their jobs. However, these actions alone, without inclusion of some tangible and significant before-the-claim-is-paid actions, will have little impact on reducing the occurrence of the problem.

What’s one person’s fraud (insurer alleging medically unnecessary services) is another person’s savior (provider administering tests to defend against potential lawsuits from legal sharks). Is tort reform a possibility from those pushing for health care reform? Unfortunately, it is not! Support for legislation placing new and onerous requirements on providers in the name of fighting fraud, however, does not appear to be a problem.

If Congress really wants to use its legislative powers to make a difference on the fraud problem they must think outside-the-box of what has already been done in some form or fashion. Focus on some front-end activity that deals with addressing the fraud before it happens. The following are illustrative of steps that could be taken in an effort to stem-the-tide on fraud and abuse:

– DEMAND all payors and providers, suppliers and others only use approved coding systems, where the codes are clearly defined for ALL to know and understand what the specific code means. Prohibit anyone from deviating from the defined meaning when reporting services rendered (providers, suppliers) and adjudicating claims for payment (payors and others). Make violations a strict liability issue.

– REQUIRE that all submitted claims to public and private insurers be signed or annotated in some fashion by the patient (or appropriate representative) affirming they received the reported and billed services. If such affirmation is not present claim isn’t paid. If the claim is later determined to be problematic investigators have the ability to talk with both the provider and the patient…

– REQUIRE that all claims-handlers (especially if they have authority to pay claims), consultants retained by insurers to assist on adjudicating claims, and fraud investigators be certified by a national accrediting company under the purview of the government to exhibit that they have the requisite understanding for recognizing health care fraud, and the knowledge to detect and investigate the fraud in health care claims. If such accreditation is not obtained, then neither the employee nor the consultant would be permitted to touch a health care claim or investigate suspected health care fraud.

– PROHIBIT public and private payors from asserting fraud on claims previously paid where it is established that the payor knew or should have known the claim was improper and should not have been paid. And, in those cases where fraud is established in paid claims any monies collected from providers and suppliers for overpayments be deposited into a national account to fund various fraud and abuse education programs for consumers, insurers, law enforcers, prosecutors, legislators and others; fund front-line investigators for state health care regulatory boards to investigate fraud in their respective jurisdictions; as well as funding other health care related activity.

– PROHIBIT insurers from raising premiums of policyholders based on estimates of the occurrence of fraud. Require insurers to establish a factual basis for purported losses attributed to fraud coupled with showing tangible proof of their efforts to detect and investigate fraud, as well as not paying fraudulent claims.

5. Insurers are victims of health care fraud

Insurers, as a regular course of business, offer reports on fraud to present themselves as victims of fraud by deviant providers and suppliers.

It is disingenuous for insurers to proclaim victim-status when they have the ability to review claims before they are paid, but choose not to because it would impact the flow of the reimbursement system that is under-staffed. Further, for years, insurers have operated within a culture where fraudulent claims were just a part of the cost of doing business. Then, because they were victims of the putative fraud, they pass these losses on to policyholders in the form of higher premiums (despite the duty and ability to review claims before they are paid). Do your premiums continue to rise?

Insurers make a ton of money, and under the cloak of fraud-fighting, are now keeping more of it by alleging fraud in claims to avoid paying legitimate claims, as well as going after monies paid on claims for services performed many years prior from providers too petrified to fight-back. Additionally, many insurers, believing a lack of responsiveness by law enforcers, file civil suits against providers and entities alleging fraud.

6. Increased investigations and prosecutions of health care fraud

Purportedly, the government (and insurers) have assigned more people to investigate fraud, are conducting more investigations, and are prosecuting more fraud offenders.

With the increase in the numbers of investigators, it is not uncommon for law enforcers assigned to work fraud cases to lack the knowledge and understanding for working these types of cases. It is also not uncommon that law enforcers from multiple agencies expend their investigative efforts and numerous man-hours by working on the same fraud case.

Law enforcers, especially at the federal level, may not actively investigate fraud cases unless they have the tacit approval of a prosecutor. Some law enforcers who do not want to work a case, no matter how good it may be, seek out a prosecutor for a declination on cases presented in the most negative light.

Health Care Regulatory Boards are often not seen as a viable member of the investigative team. Boards regularly investigate complaints of inappropriate conduct by licensees under their purview. The major consistency of these boards are licensed providers, typically in active practice, that have the pulse of what is going on in their state.

Insurers, at the insistence of state insurance regulators, created special investigative units to address suspicious claims to facilitate the payment of legitimate claims. Many insurers have recruited ex-law enforcers who have little or no experience on health care matters and/or nurses with no investigative experience to comprise these units.

Reliance is critical for establishing fraud, and often a major hindrance for law enforcers and prosecutors on moving fraud cases forward. Reliance refers to payors relying on information received from providers to be an accurate representation of what was provided in their determination to pay claims. Fraud issues arise when providers misrepresent material facts in submitted claims, e.g. services not rendered, misrepresenting the service provider, etc.

Increased fraud prosecutions and financial recoveries? In the various (federal) prosecutorial jurisdictions in the United States, there are differing loss- thresholds that must be exceeded before the (illegal) activity will be considered for prosecution, e.g. $200,000.00, $1 million. What does this tell fraudsters – steal up to a certain amount, stop and change jurisdictions?

In the end, the health care fraud shell-game is perfect for fringe care-givers and deviant providers and suppliers who jockey for unfettered-access to health care dollars from a payment system incapable or unwilling to employ necessary mechanisms to appropriately address fraud – on the front-end before the claims are paid! These deviant providers and suppliers know that every claim is not looked at before it is paid, and operate knowing that it is then impossible to detect, investigate and prosecute everyone who is committing fraud!

Lucky for us, there are countless experienced and dedicated professionals working in the trenches to combat fraud that persevere in the face of adversity, making a difference one claim/case at a time! These professionals include, but are not limited to: Providers of all disciplines; Regulatory Boards (Insurance and Health Care); Insurance Company Claims Handlers and Special Investigators; Local, State and Federal Law Enforcers; State and Federal Prosecutors; and others.

Steps to Begin Transforming Your Health & Body Today

  • No Comments

While yes, our team is born in a world of intense high athletic goals such as bodybuilding, it is not our goal to support people to become bodybuilders – FAR FROM IT!;-) So you can relax now!! But it IS our goal to share with you why the lessons from our experience of mastering human health & the body, & how developing a bodybuilder “mentality” for your own life can literally skyrocket you into a level of personal health you never thought possible, while showing you the shortcuts in how to get there! Sound good? Heck, it sounds GREAT to us, because we already know how it can CHANGE YOUR LIFE.

If you are serious about stepping into your greatness of feeling & looking great, take 3 minutes & glean our insight, because this is the single-most MISSING LINK that we see people repeatedly leaving out of their game plan to great health & why they continue to fail at achieving quality health for their lives.

When you have had an experience of taking your mental, emotional & physical self to the level that bodybuilding competition requires, as a coach for others it then allows you to see potential for your clients that they could never envision for themselves without you by their side AND TAKE THEM THERE, and that is the beauty of the gift that we REJOICE in offering others in order to achieve optimal health, energy, & joy for their lives. But to get there…to create a successful transformation of your health & body, you HAVE to begin INSIDE with our 5 MUST-HAVE Steps! Yes, that’s right – the focus begins in the MIND. Time & again we see this process work, and it’s our UNIQUE coaching psychology method that sets us apart, & why we are capable of producing jaw-dropping results with the level of motivational mentality we provide. You can have all the knowledge in the world, but if you fail to develop the DESIRE & MINDSET to IMPLEMENT it, you will never succeed.

Want the insider view to our winning approach to learn how to transform your own health & body? We’re here to offer you the scoop because it’s our desire to support you fully to achieve authentic, preventative health from the inside, out in your lifetime. So where do we begin? There is a prolific spiritual author named John Maxwell, maybe you’ve heard of him, maybe you haven’t – but he writes of numerous spiritual topics & speaks on how we create TRUE transformation for our lives. Below we adapt his words for our article today because it’s a brilliant synopsis of just why & how we work with clients to coach them through mastering their personal health, as there are so many levels to the process.

When we discuss transformation of the physical body, to be successful we cannot deny that mind, body & spirit are woven tightly together in our being & therefore EACH needs to be considered – not just one. Often people when wanting to conquer health or healing goals immediately BEGIN at the physical, they think weight loss, nutrition, exercise…but that is their first step to failure because they’re joining the race before they’ve even laced their shoes!! When we fail to address mind & spirit in the health process we eventually lose the vision of why we’re addressing the physical in the first place & sadly fall off course when interest wanes, times get tough, or we lose our way because the how-to’s become unclear or appear out of reach. But if we start INSIDE & work OUTWARDS friends, GAME ON!!

Our 5 Expert Insider Steps to Transforming Your Health & Body

So these 5 KEY STEPS must be addressed in order to achieve a complete & SUCCESSFUL health & body transformation, and they must also be achieved in order as follows…

1. When you change your (health & body) thinking, you change your (health & body) beliefs.

If you think what you’ve been taught is healthy by the mainstream media is where your learning stops, then don’t expect to achieve great illness-free, authentic preventative health because they don’t teach proactive health approach, they teach reactive wait til you get sick & then act health approach. Begin to change your thinking to change your belief system about your body and health potential.

2. When you change your (health & body) beliefs, you change your (health & body) expectations.

Once you begin to expand your thinking, start to also seek out experts in areas of health & body who have shown & continue to show PROVEN ABILITY TO CREATE TRANSFORMATION RESULTS in their own health & body that you would like to emulate. Begin to sponge knowledge from them vs. what mainstream media claims leads to great health results, & you’ll in turn raise the bar on what you expect from your own health. You’ll see your new mentor/s are just ordinary people too like you, who decided to blaze their own health path about the quality of health they wanted to achieve for their life by taking the road less followed for their own health in life, and YOU CAN TOO – if you follow in their footprints.

3. When you change your (health & body) expectations, you change your (health & body) attitude.

Once your mind becomes opened by experts to your new health possibilities, you’ll have a renewed attitude & confidence about your abilities & empowerment around your personal health & begin to realize that anything you put your MIND to, your BODY can achieve -with the right tools in your toolbox. And THAT is exciting!

4. When you change your (health & body) attitude, you change your (health & body) behavior.

Now that you come to the table with a revitalized health attitude of possibilities & an arsenal from your health mentor, your entire being & behavior begins to shift because your mentor connects you with your own personal ability to achieve great results for your health, and as that continues to happen over and over, your self-efficacy GROWS & GROWS around your capabilities to manage your own personal health, as you transition into your own personal mini-health-expert!

5. When you change your (health & body) behavior, YOU CHANGE YOUR LIFE.

Now that you’ve achieved health & body mastery, you will begin to see an entire energetic, mental & emotional shift in your life that FAR EXCEEDS the physical. Yes, you will look & feel great, but the ways optimal health radiate outwards to all facets of your life will be astounding, as you attain a personal joy in life through health that you’ve never experienced before. No pills, no roller coaster of energy, no food cravings, no more blah approach to life, no more hiding from life within your own body,…you emerge a renewed person, ready to take on your full potential in this life.

This list is the perfect example of why health coaching with experienced experts not only WORKS, but offers you AMAZING, permanent results you could never envision or achieve on your own. With the support of your coaches seasoned & proven mentality of success in health & body transformation, you develop a similar mindset, outlook & body of knowledge in order to reach external goals of physical health & body success!

Which Health Insurance Plan Is Best for Me

  • No Comments

Health insurance has proven itself of great help and financial aid in certain cases when events turn out unexpectedly. In times when you are ill and when your health is in grave jeopardy and when finances seem to be incapable to sustain for your care, health insurance is here to the rescue. A good health insurance plan will definitely make things better for you.

Basically, there are two types of health insurance plans. Your first option is the indemnity plans, which includes the fee-for-services and the second is the managed care plans. The differences between these two include the choice offered by the providers, the amount of bills the policy holder has to pay and the services covered by the policy. As you can always hear there is no ultimate or best plan for anyone.

As you can see, there are some plans which may be way better than the others. Some may be good for you and your family’s health and medical care needs. However, amidst the sweet health insurance plan terms presented, there are always certain drawbacks that you may come to consider. The key is, you will have to wisely weigh the benefits. Especially that not among these plans will pay for all the financial damages associated with your care.

The following are a brief description about the health insurance plans that might be fitting for you and your family’s case.

Indemnity Plans

Flexible Spending Plans – These are the types of health insurance plans that are sponsored when you are working for a company, or any employer. These are the care plans inclusive in your employee benefit package. Some of the specific types of benefits included in this plan are the multiple options pre-tax conversion plan, medical plans plus flexible spending accounts, tax conversion plan, and employer credit cafeteria plans. You can always ask your employer of the benefits included in your health care/insurance plans.

Indemnity Health Plans – This type of health insurance plan allows you to choose your own health care providers. You are given the freedom to go to any doctor, medical institution, or other health care providers for a set monthly premium. The insurance plan will reimburse you and your health care provider according to the services rendered. Depending on the health insurance plan policy, there are those that offers limit on individual expenses, and when that expense is reached, the health insurance will cover for the remaining expenses in full. Sometimes, indemnity health insurance plans impose restrictions on services covered and may require prior authorization for hospital care and other expensive services.

Basic and Essential Health Plans – It provides a limited health insurance benefit at a considerably low insurance cost. In opting for this kind of health insurance plan, it is necessary that one should read the policy description giving special focus on covered services. There are plans which may not cover on some basic treatments, certain medical services such as chemotherapy, maternity care or certain prescriptions. Also, rates vary considerably since unlike other plans, premiums consider age, gender, health status, occupation, geographic location, and community rated.

Health Savings Accounts – You own and control the money in your HSA. This is the recent alternative to the old fashioned health insurance plans. These are savings product designed to offer policy holders different way to pay for their health care. This type of insurance plan allows the individual to pay for the current health expenses and also save for untoward future qualified medical and retiree health costs on a tax-free basis. With this health care plan, you decide on how your money is spent. You make all the decisions without relying on any third party or a health insurer. You decide on which investment will help your money grow. However, if you sign up for an HSA, High Deductible Health Plans are required in adjunct to this type of insurance plan.

High Deductible Health Plans – Also called Catastrophic Health Insurance Coverage. It is an inexpensive health insurance plan which is enabled only after a high deductible is met of at least $1,000 for an individual expense and $2,000 for family-related medical expense.

Managed Care Options

Preferred Provider Organizations – This is charged in a fee-for-service basis. The involved health care providers are paid by the insurer on a negotiated fee and schedule. The cost of services are likely lower if the policy holder chooses an out-of-network provider ad generally required to pay the difference between what the provider charges and what the health insurance plan has to pay.

Point of Service – POS health insurance plans are one of the indemnity type options in which the primary health care providers usually make referrals to other providers within the plan. In the event the doctors make referrals which are out of the plan, that plan pays all or most of the bill. However, if you refer yourself to an outside provider, the service charges may also be covered by the plan but the individual may be required to pay the coinsurance.

Health Maintenance Organizations – It offers access to a network of physicians, health care institutions, health care providers, and a variety of health care facilities. You have the freedom to choose for your personal primary care doctor from a list which may be provided by the HMO and this chosen doctor may coordinate with all the other aspects of your health care. You may speak with your chosen primary doctor for further referrals to a specialist. Generally, you are paying fewer out-of-pocket fees with this type of health insurance plan. However, there are certain instances that you may be often charged of the fees or co-payment for services such as doctor visits or prescriptions.

Government-Sponsored Health Insurance

Indian Health Services – This is part of the Department of Health and Human Services Program offering all American Indians the medical assistance at HIS facilities. Also, HIS helps in paying the cost of the health care services utilized at non-HIS facilities.

Medicaid – This is a federal or s state public assistance program created in the year 1965. These are available for the people who may have insufficient resources to pay for the health care services or for private insurance policies. Medicaid is available in all states. Eligibility levels and coverage benefits may vary though.

Medicare – This is a health care program for people aging 65 and older, with certain disabilities that pays part of the cost associated with hospitalization, surgery, home health care, doctor’s bills, and skilled nursing care.

Military Health Care – This type includes the TRICARE or the CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) and CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affair). The Department of Veterans Affair (VA) may also provide this service.

State Children’s Health Insurance Program – This is available to children whose low-income parents were not able to qualify for the Medicaid.
State-Specific Plans – This type of plan is available for low income uninsured individuals.