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Rules on Reviewing Health Plans

–Rules on Reviewing Health Plans–


The Five Hoodle Benchmarks

So what exactly are the benchmarks we look at to rate or compare our health plan?  Great question and it’s one we put quite a bit of though into.  We’ve been around health insurance plans for decades now (please send letters of condolence to address on About Us page) so we have a pretty good idea of what criteria people use to judge health plans.  We’ve narrowed it down to 5 that come up again and again.  Let’s take a look.


Money Matters

People generally aren’t too concerned about price differences between bags of sugar (it’s cheap) but health insurance is quite different.  Price is the major issue right now due to the ever increasing cost associated with this type of coverage.  The rates have skyrocketed for the better part of a decade now and health insurance has gone from a manageable expense to a driving factor for breaking budgets.  It really is critical in reviewing a health plan and it’s front and center on the Hoodles review site.


What’s my Copay

Next us (partially based on importance) is Benefits.  When you actually need to use the health plan, how does it pay out?  Keep in mind that this category may move opposite of the Price one (price goes up, benefits are better, etc) but it may not and that’s a sign of good or bad plans respectively.  Either way, the health plan review should give an estimation of expected benefits for a given price point.  Hidden charges or confusing deductibles will start to show in this category.


Doctor Doctor

Next up is the Doctor Network which refers to the doctors you’re allowed to use with a given plan.  Let’s face it, most plans today are PPO or HMO which means they have a list of doctors that participate.  One way carriers have used to keep costs lower is to move towards limited networks with fewer (or cheaper if we’re cynical…which we are) doctors that participate.  This means that the benefits and price might be great but you’re allowed to see only doctors with degrees from the Cayman Islands (no offense, Cayman).  It’s good to know this up front with a health plan review.


Dial 1 for Irritation

Next up is Customer Service.  A good licensed agent can help with many needs but let’s say you need to call the carrier direct to address a membership issue.  A good health plan review needs to address this interaction as it can greatly affect your satisfaction with a given health plan.  Second tier carriers tend to go light on the customer service employment and it can be exhausting to navigate their process.  We need to know that up front.


It’s your Responsibility to Pay…

Finally, the last criteria we use to review a health plan is Claims Processing which can actually be quite different than the customer service section above.  Did they process the claims correctly?  How long did it take?  Was the claim written in hieroglypics?  All good questions and any self-respecting health plan comparison should include this.

Those are the five main categories to look at. Next, we’ll talk a little more about the practical approach to both submitting and reading health plan reviews.  It’s a “average” approach meaning that we want to look away from the polar ends and land somewhere in the middle for a good representation

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