New to insurances (medical/dental) - Tilted Forum Project Discussion Community

-Ever- · 06-21-2007, 04:57 PM

I just wrote up such an elegant post and managed to close the browser tab. Grr!

In a nutshell, my recently-turned 25 year old girlfriend has become proactive with her health and has asked me to do some research on medical and dental insurance for her since I'm the researcher of the house

I'd love to hear a technical breakdown of the two insurances, something along the lines of "For dental, there's PPO and HMO." Next, I'd like to hear what each insurance generally offers and doesn't offer so I can help her make a better decision based on intelligent, well-informed choices. Don't be afraid to get general in what's usually covered or not covered. Does it cover the general practitioner? The dermatologist? The MRI if she hurts her wrist? Her meds if she needs antibiotics? The ER room if she's ill? Again, I'm new and quite humble

Then, I'd love to hear some real-life examples, recommendations, and recommendations against certain providers. I understand that the world of insurance is quite abstract in that it's very case-by-case, but maybe if I can gather enough recommendations towards or against certain well-known providers, I can further make a better decision with a smaller pool of choices.

Some general information about her. 25 years old. Works full time for a wholesale florist, where she's supposed to be med-insurance covered with Kaiser but they're really lacking in their submissions. She wants some dental work done as she was neglected general dental care while growing up. She'd be paying for an individual plan. We live in Southern California.

Thanks for any advice, it's truly appreciated.

The_Jazz · 06-21-2007, 05:27 PM

-Ever-, I guess I'm the most likely to be able to help, but I really can't. What you're asking for is a huge amount of information. I'm a licensed insurance agent in all 50 states, but I don't do health insurance. I can define terms or answer specific questions, but I think that you need to contact some of the plans and compare them yourself.

My only recommendation at this point is that you call an insurance agent that specializes in health coverage and get quotes from them. I can help you with that, but what you've asked for is probably a lot more information than you really actually want.

-Ever- · 06-21-2007, 05:35 PM

I tend to go overboard with these research things

Thanks for your reply The_Jazz. I guess I can sum my "fears" up in a few words here. I understant that different insurances offer different coverages at varying rates. I'd hate to simply dive head-first into one just to realize that she wouldn't be covered if "x" illness overcame her. It's not as simple as her answering "What do you want to be covered for" because, at this stage, we don't even know the general options and offerings, thus this post

I suppose having these questions answered is indeed why the world has insurance agents though - a valuable tool which I totally forgot about while considering the original question.

The_Jazz · 06-21-2007, 05:46 PM

Well, I can definitely answer that question. It's very rare that Disease X is excluded from healthcare coverage. The more popular plans (at least from what Business Insurance says) tend to give a lifetime limit (typically $1,000,000). There are more expensive plans with higher limits or no limits. You shouldn't worry about Disease X being excluded, unless she already has Disease X and knows it. A lot of plans, especially the cheaper ones, have real problems with pre-existing conditions.

Really, the things you need to be more focused on are:

1) price
2) deductibles
3) copayments
4) limit
5) size of network

Again, if you (or anyone else) run into insurance terms that you need help defining, just let me know. If you feel a PM or email is necessary for privacy's sake, that's fine with me too. I won't (can't is more like it) sell you anything, and I'm happy to act as a neutral third party. TFP folks contact me every once in a while with questions, and I'm always happy to help.

-Ever- · 06-21-2007, 05:57 PM

The_Jazz-

The GF just returned from work and we went over your reply together. We both thank you many times for the generosity.

It sounds like she's indeed interested in contacting an agent, and I think we'll go ahead and contact you with any specifics before we purchase something!

Thanks again.

06-21-2007, 04:57 PM	#1 (permalink)
-Ever- Junkie Location: San Francisco	New to insurances (medical/dental) I just wrote up such an elegant post and managed to close the browser tab. Grr! In a nutshell, my recently-turned 25 year old girlfriend has become proactive with her health and has asked me to do some research on medical and dental insurance for her since I'm the researcher of the house I'd love to hear a technical breakdown of the two insurances, something along the lines of "For dental, there's PPO and HMO." Next, I'd like to hear what each insurance generally offers and doesn't offer so I can help her make a better decision based on intelligent, well-informed choices. Don't be afraid to get general in what's usually covered or not covered. Does it cover the general practitioner? The dermatologist? The MRI if she hurts her wrist? Her meds if she needs antibiotics? The ER room if she's ill? Again, I'm new and quite humble Then, I'd love to hear some real-life examples, recommendations, and recommendations against certain providers. I understand that the world of insurance is quite abstract in that it's very case-by-case, but maybe if I can gather enough recommendations towards or against certain well-known providers, I can further make a better decision with a smaller pool of choices. Some general information about her. 25 years old. Works full time for a wholesale florist, where she's supposed to be med-insurance covered with Kaiser but they're really lacking in their submissions. She wants some dental work done as she was neglected general dental care while growing up. She'd be paying for an individual plan. We live in Southern California. Thanks for any advice, it's truly appreciated. __________________ Embracing the goddess energy within yourselves will bring all of you to a new understanding and valuing of life. A vision that inspires you to live and love on planet Earth. Like a priceless jewel buried in dark layers of soil and stone, Earth radiates her brilliant beauty into the caverns of space and time. Perhaps you are aware of those who watch over your home And experience of this place to visit and play with reality. You are becoming aware of yourself as a gamemaster... --Acknowledge your weaknesses-- Last edited by -Ever-; 06-21-2007 at 05:00 PM..

06-21-2007, 05:27 PM	#2 (permalink)
The_Jazz Asshole Administrator Location: Chicago	-Ever-, I guess I'm the most likely to be able to help, but I really can't. What you're asking for is a huge amount of information. I'm a licensed insurance agent in all 50 states, but I don't do health insurance. I can define terms or answer specific questions, but I think that you need to contact some of the plans and compare them yourself. My only recommendation at this point is that you call an insurance agent that specializes in health coverage and get quotes from them. I can help you with that, but what you've asked for is probably a lot more information than you really actually want. __________________ "They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - B. Franklin "There ought to be limits to freedom." - George W. Bush "We have met the enemy and he is us." - Pogo

06-21-2007, 05:35 PM	#3 (permalink)
-Ever- Junkie Location: San Francisco	I tend to go overboard with these research things Thanks for your reply The_Jazz. I guess I can sum my "fears" up in a few words here. I understant that different insurances offer different coverages at varying rates. I'd hate to simply dive head-first into one just to realize that she wouldn't be covered if "x" illness overcame her. It's not as simple as her answering "What do you want to be covered for" because, at this stage, we don't even know the general options and offerings, thus this post I suppose having these questions answered is indeed why the world has insurance agents though - a valuable tool which I totally forgot about while considering the original question. __________________ Embracing the goddess energy within yourselves will bring all of you to a new understanding and valuing of life. A vision that inspires you to live and love on planet Earth. Like a priceless jewel buried in dark layers of soil and stone, Earth radiates her brilliant beauty into the caverns of space and time. Perhaps you are aware of those who watch over your home And experience of this place to visit and play with reality. You are becoming aware of yourself as a gamemaster... --Acknowledge your weaknesses--

06-21-2007, 05:46 PM	#4 (permalink)
The_Jazz Asshole Administrator Location: Chicago	Well, I can definitely answer that question. It's very rare that Disease X is excluded from healthcare coverage. The more popular plans (at least from what Business Insurance says) tend to give a lifetime limit (typically $1,000,000). There are more expensive plans with higher limits or no limits. You shouldn't worry about Disease X being excluded, unless she already has Disease X and knows it. A lot of plans, especially the cheaper ones, have real problems with pre-existing conditions. Really, the things you need to be more focused on are: 1) price 2) deductibles 3) copayments 4) limit 5) size of network Again, if you (or anyone else) run into insurance terms that you need help defining, just let me know. If you feel a PM or email is necessary for privacy's sake, that's fine with me too. I won't (can't is more like it) sell you anything, and I'm happy to act as a neutral third party. TFP folks contact me every once in a while with questions, and I'm always happy to help. __________________ "They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - B. Franklin "There ought to be limits to freedom." - George W. Bush "We have met the enemy and he is us." - Pogo

06-21-2007, 05:57 PM	#5 (permalink)
-Ever- Junkie Location: San Francisco	The_Jazz- The GF just returned from work and we went over your reply together. We both thank you many times for the generosity. It sounds like she's indeed interested in contacting an agent, and I think we'll go ahead and contact you with any specifics before we purchase something! Thanks again. __________________ Embracing the goddess energy within yourselves will bring all of you to a new understanding and valuing of life. A vision that inspires you to live and love on planet Earth. Like a priceless jewel buried in dark layers of soil and stone, Earth radiates her brilliant beauty into the caverns of space and time. Perhaps you are aware of those who watch over your home And experience of this place to visit and play with reality. You are becoming aware of yourself as a gamemaster... --Acknowledge your weaknesses--