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The Structure of Maximizing Your Health Insurance Benefits

Introduction

Continued from Previous Page

The Structure of This Book

In order to make this book as easy as possible to use and to understand, I've written it with a focus on practical concerns-a "how to" approach-rather than on theoretical or statistical issues. Thus, many theoretical issues have been discussed only in general terms rather than in detail.

Technical terminology has been kept to a minimum, and only those terms that are regularly used in the health insurance field to communicate with consumers have been included. In addition, each technical term has been printed in bold print the first time it appears in the book. Complex terms are illustrated by examples, and each term is followed by an explanation.

To allow readers to learn how to deal with health insurance problems as quickly as possible, I've divided the book into four separate parts. Each part deals with a different issue, and each of the chapters within a particular part has its own focus.

Part I, "The Basic Tools," presents an overview of the cur rent health insurance system. It deals with the technical lan guage of health insurance and with ways to help prevent health insurance claim problems from occurring. In addition, it shows readers how to develop a system to deal with problems that do occur. Part II, "Health Insurance Plans," offers a detailed dis cussion of traditional individual and group health insurance plans, self-funded plans, HMOs and other types of managed care plans, Medical Savings Accounts, and other health insur ance programs.

Part III, "Medicare and Medicare-Related Programs," deals with Medicare, Medigap policies, secondary insurance policies, and Medicare HMOs. Part IV, "Specialized Situations," in cludes a discussion of mechanisms for continuing health insurance coverage through COBRA, the new Portability and Accountability Act, and conversion options. It also focuses on programs designed for children and adults with disabilities and special health care needs, and reviews issues related to coverage for home health care, nursing homes, and other types of long-term care. The Conclusion deals with the future of the health insurance system in America.

There are two appendixes, as well. They are intended to help readers find answers to specific questions and to obtain additional information and advice. Appendix A offers answers to ten frequently asked questions about health insurance. Appendix B includes a list of sources of up-to-date information about various aspects of the health insurance system and a list of organizations and agencies that can provide advice in relation to specific health insurance problems.

In addition, there are tables throughout the book that summarize basic information. A glossary follows the appendixes and lists technical terms and phrases, along with a definition for each.

While it's not necessary to read the chapters in this book in the order in which they're presented, Part I (Chapters 1, 2, and 3) serves as an introduction to technical terms and general issues. It will help you establish an effective system for dealing with claims. Thus, those chapters are particularly important. Beyond that, however, if you think that a specific chapter may not relate to your needs, you can turn to the chapters that deal with those issues that are of immediate concern and return to the other sections when the issues concern you more directly.

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