If the claim is turned down, Melbinger suggests finding a lawyer or other representative to handle the claim. Another way to gain more flexibility about your health insurance, Leone advises, is to become self-employed. This can give you the latitude to pick a plan that's better tailored to your needs than one provided to many people through an employer. HMOs are more oriented toward watching the pocketbook than traditional insurance companies were. With HMOs, your primary care physician will refer you to a specialist for other treatment, but they have to have it pre-authorized, they have to weigh the cost of one treatment versus another, they have to submit a plan of treatment that has to be cost effective and has to be showing results.
Physical therapy is a classic one.
They will cover physical therapy as long as the person is showing improvement, but it's a difficult case to make to them that the physical therapy might not be showing improvement but is slowing degeneration. It's short-sighted because the lack of physical therapy may lead to hospitalization, which is a much more expensive ordeal. He concedes that HMOs are showing an awareness of the importance of preventive medicine. Most health insurance plans are not designed to cover costs for nursing home or in-home care. Long-term insurance is a special kind of coverage that will help meet costs of daily care.