• Aetna
• Assurant
• Blue Cross and Blue Shield

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• GoldenRule
• Humana Health Benefit Plan of Louisiana

• Supplemental Medigap Insurance
• Medicare Advantage Insurance
• Blue Cross and Blue Shield

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• Humana Health Benefit Plan
• SecureHorizons by UnitedHealthcare
• Universal American
• WellCare

Different Types of Louisiana Health Insurance Policies

What are the types of Insurance?

Fee-for-Service

Fee-for-service is the traditional kind of health care policy. Insurance companies pay fees for the services provided to the insured individuals covered by the policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors at any time. You can go to any hospital in any part of the country.

With fee-for-service, the insurer only pays for part of your doctor and hospital bills. This is what you pay:

• A monthly fee, called a premium.
• A certain amount of money each year, known as the deductible, before the insurance payments begin. In a typical plan, the deductible might be $250 for each person in your family, with a family deductible of $500 when at least two people in the family have reached the individual deductible. The deductible requirement applies each year of the policy. Also, not all health expenses you incur will count toward your deductible. Only those expenses that are covered by the policy will be applied to the deductible. You should refer to the insurance policy to find out which health benefits are covered.
• After you have paid your deductible amount for the year, you share the bill with the insurance company. For example, you might pay 20 percent while the insurer pays 80 percent. Your portion is called coinsurance.

To receive payment for fee-for-service claims, you may have to fill out forms and send them to your insurer. Sometimes your doctor's office will do this for you. You also need to keep receipts for drugs and other medical costs. You are responsible for keeping track of your medical expenses.

There are limits as to how much an insurance company will pay for your claim if both you and your spouse file for it under two different individual plans. A coordination of benefit clause usually limits benefits under two plans to no more than 100 percent of the claim.

There is no standardized method of calculating fee allowances. Each insurer independently establishes its own internal procedure for covered charges. If a non-network provider is used the policyholders may experience much higher out-of-pocket expenses than anticipated because they will be responsible for any charges in excess of the covered or allowed charges, plus their designated co-payments.

What is a "Customary" Fee?

Most fee-for-service plans have a "cap," the most you will have to pay for medical bills in any one year. You reach the cap when your out-of-pocket expenses (for your deductible and your coinsurance) total a certain amount. It may be as low as $1,000 or as high as $5,000. At this point, the insurance company pays the full amount for medical services in excess of the cap for the benefits your policy says it will cover. The cap does not include what you pay for your monthly premium.

Some services are limited or not covered at all. You need to review your policy for preventative health care coverage such as well-child care.

There are two kinds of fee-for-service coverage: basic and major medical. Basic coverage, in most health care plans, pays toward the costs of a hospital room and care while you are in the hospital. It covers some hospital services and supplies, such as x-rays and prescribed medicine. In most policies, basic coverage also pays toward the cost of surgery, whether it is performed in or out of the hospital, and for some doctor visits. Major medical insurance begins to pay for medical services when your basic coverage does not pay. It covers the cost of long, high-cost illnesses or injuries.

Questions to Ask About Fee-for-Service Insurance...

• How much is the monthly premium? What will your total cost be each year? There are individual rates and family rates.
• What does the policy cover? Does it include prescription drugs, out-of-hospital care or home care? Are there limits on the amount or the number of days the company will pay for these services? The best plans cover a broad range of services.
• Are you currently being treated for a medical condition that may not be covered under your new plan? Are there limitations involved in the coverage?
• What is the deductible? Often, you can lower your monthly health insurance premium by buying a policy with a higher yearly deductible amount.
• What is the coinsurance rate? What percent of the allowable services listed on your bills will you have to pay?
• What is the maximum you will pay out of pocket per year? How much will it cost you directly before the insurance company will pay everything else?
• Is there a lifetime maximum cap on the amount the insurer will pay? After the cap has been reached, the insurance company will not pay any more expenses. This is important to know if you or someone in your family has an illness that requires expensive treatments.