AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Question Dear Ms. Woolsteen,
I am sorry to bother you again. I am very interested about what you wrote about the health industry as a whole. As my knowledge is very limited on this issue, I'd really appreciate if you could clarify the points mentioned below.
-How can a company make money from "Long Term Care" plans?
-Would you please tell more about the payments in direct deposits to the providers accounts? Do you mean the problem is that the payment goes directly into the doctors checking account?
Many thanks in advance.
Best Regards,
Baris Unal
Answer Hi, I don't think I can offer to much on the Long Term Care plans. I personally "think" and it is just my opinion, but I could be wrong, perhaps because Medicare is involved and where there is government money involved is probably a plus for the company wanting to make money. With personal healthcare, the insurance company has to rely on the individual as a whole to make their premium payments. Then a lot of people feel they are getting cheated because they do not understand that along with the premium payment, they still have copays, coinsurance and deductibles to meet/pay, themselves. Again, with employer group health insurance, at least the insurance company has the employer making a good part of the premium payment.
As far as the payments that go to providers from Medicare. As far as I know, they make automatic deposits to the providers instead of paper checks. I have seen on the clerical end that, when there are electronic transactions the paperwork that is suppose to follow sometimes doesn't. Therefore, there is a good chance that the Medicare payment is not getting posted to the individual's account. The person posting probably does not have access to the provider's bank accounts to see Medicare deposits have been received.
Therefore, it may go unnoticed untile either the insured/patient realizes it and/or if you have a person following up on outstanding Accounts Receivables and calling Medicare's automated system to see if a payment was ever made.
Again, these are just things I have seen happen and personal opinions. You may want to ask someone else about selling Long Term Care policies are much more attractive to the Insurance Industry.
