NASHVILLE PREMIER HEALTH INSURANCE AGENCY

So, I was shopping for Health Insurance -- went round & round and got nowhere. Brian returned my call right away and patiently listened to me then offered answers to all my questions. What a professional! And a master problem solver. I highly recommend Brian for easing the difficulty & confusion surrounding the Health Insurance conundrum!

~ Anne G. ~

They answered my call on a holiday week, was beyond empathetic, kind and professional. He is a great option for getting coverage and for taking care of any of your healthcare insurance needs! 

~ Abigail B.~

I think we have all ask the question "what is health insurance?" at some point in our lives. Not you? OK. Actually, I think most people haven't asked this question either because they believe they already know what it is!

It's not that complicated. It works like any other insurance. You pay to protect yourself against unexpected bills from an unexpected event. With health insurance it would cover sickness or an injury, right? Then why do you want it to pay for your annual wellness check?? Huh? Does your car insurance pay for maintenance or safety checks on your car? No? Hmmmm. 

So, it really isn't like any other insurance. When health insurance was "first born" many decades ago it was actually just a cash payout to the ill or injured employee so they could survive until they got back to work. They were expected to cover their own medical bills believe it or not. But, over the decades as the nation has gone through various financial ups and downs the government sought to regulate the industry and there have been many changes to the old fashioned health insurance plan. This is where the ever popular HMO was spawned. 

When I was growing up health insurance was something no one ever needed to discuss. It was provided at most jobs, FREE! And if there was a cost it was nominal. I remember having a job at a gas station in the small town where I grew up and THEY provided me with health insurance. And even if someone did not have insurance very few people ever went bankrupt because of it. In fact I probably can't think of any family or friends that experienced a financial catastrophe due to medical bills in the 80s. I'm not saying that it didn't happen it was just very uncommon. 

The deductibles were in the hundreds and you can see your primary care doctor as often as needed. But, that has changed greatly, especially over the last decade. Deductibles can be in as much as $8500 and you may get no benefits from your plan until you meet that deductible. 

When someone is looking for their own coverage for the first time it can be a bit surprising how much insurance plans differ from their familiar employer plans. But, not all plans are the same. You will find that there are options available in Tennessee that come pretty close to the group plans you are used to and they can be more affordable than you might think.

First lets clear up what each of these are. A PPO, or Preferred Provider Organization, is a type of plan that lets you choose your provider within a "preferred network." 

The providers in that network have contracted with the insurance company to provide specific services at preset rates. Essentially, because the insurance company will sending patients to the provider the provider agrees to charge less to those patients. So essentially they get a discount; both the insurance company and the patients in the event they have to pay for their services as part of their deductible.

They way a PPO is structured the patients can choose the provider of their choice, in or out of network and the benefits are generally the same. However, because the out of network provider is not contracted at the same rates as the PPO providers the patient may have more out of pocket costs. And there may be a larger deductible to meet out of network or the benefits restricted to a certain dollar amount. Just be sure to read your policy.

One of the biggest benefits of a PPO is that you can travel to top medical centers in your state or around the US to seek out specialists. With HMOs you are usually restricted to a very specific network close to where you live.

HMOs or Health Management Organizations came about through legislation in an attempt to control costs for the insurance companies. This was the advent of the PCP or primary care physician (which is assigned to you) and the need to get approval or a  "referral" to see a specialists. 

Essentially the patients were choosing expensive specialists instead of their primary doctor and it was costing the insurance companies big. So now you would need to get permission to see a dermatologist or podiatrist if you wanted to use your insurance to cover the cost. Otherwise, it would be completely out of pocket for you.

I have read that HMOs tend to be more affordable due to the restrictions and control the insurance companies can exert over the use of the plan benefits. I have not see this to be true. Especially over the last decade. The heavy regulations enacted in 2010 have driven up premiums and deductibles across the board.

It may have been true when the self-insured had more freedom of choice, but the best way to find an affordable plan is to find a health based plan that can get you into a low-risk pool.

Healthcare needs and your budget should be the guiding factors in choosing a health insurance plan. 

If you or someone in your family has an ongoing medical condition that would require medications, therapies or hospitalization, there are very specific plans in which you  want to enroll. These plans have no waiting periods or pre-existing condition exclusions.

You could enroll on these plans and immediately continue with your medical care. No waiting periods. 

The only restriction is that you must enroll during the open enrollment period which lasts around 4-6 weeks each year.

You may qualify for an exception to the enrollment period during the year if you lost your insurance, got  married, etc.

For those that do not have pre-existing conditions there are also exellent options through the open market. You can purchase individual plans (vs. a group plan through an employer) directly from insurance companies.

These plans can be customized to meet your specific needs. You can adjust benefits, coverage and add ancillary coverage such as dental, vision, life insurance, disablity and more.

These types of plans come in many forms so it is important to inform your agent of your specific needs. 

One of the major benefits of buying a plan on your own is that you can choose bigger provider networks. There are several benefits to this. One of which you can choose your own doctor instead of having one assigned to you and you can travel to other states to received treatment or top facilities that may not be accesible near your home.

Whatever your needs are it is important that you ask your agent about all of the available options in your area. Not all plans are right for everyone.