Short-Term Health Insurance

What Is Short-Term Health Insurance?

Some insurance policies offer policies designed to tide people through short lapses in health insurance coverage. These policies are called short-term or temporary health insurance policies.

While it may be possible for you to find a short-term health insurance policy that will cover you for up to 36 months, most of these policies are limited to 12 months of coverage or less. Short-term policies are ideal for healthy people who are going through some kind of transition - for example, recent college graduates waiting for health insurance benefits at their first job to begin. The operative term here is "healthy" - short-term health insurance policies are underwritten, which means that the insurance company must be satisfied that you are not likely to make many claims for the duration of the policy.

Read on to find out more about short-term health insurance, including how much it costs and what it covers.

How Much Does It Cost?

Short-term health insurance tends to be significantly cheaper than other types of insurance, including COBRA continuation coverage. Some people may qualify for comprehensive coverage for less than $100/month. This is why some people who lose their job-based insurance choose short-term policies rather than electing COBRA. However, if you fail to elect and exhaust your COBRA continuation coverage, you will lose several consumer rights - including your right to coverage of any preexisting medical conditions, and your right to purchase a permanent individual health insurance policy at a later date.

If you do decide to buy a short-term health insurance policy, make sure you understand what you are getting for your money. If you find a policy for $50/month, but it has a $3000 deductible per injury or illness, you will be paying for virtually all of your medical expenses out of pocket. Such a policy would only protect you if you suffered an extremely costly injury or illness. Make sure you read your policy papers and understand what your likely out-of-pocket expenses will be.

What Is Covered?

Short-term policies generally do not cover routine preventative care or preexisting conditions. However, if you become ill or injured while covered under a short-term health insurance policy, any emergency services, hospitalization, diagnostic test, or follow-up visit charges you incur should be covered under your policy. As long as your health care expenses can be linked to a specific illness or injury suffered during the term of coverage, you should be covered.

Elective Surgeries - What Elective Surgeries are Covered By Health Insurance?

Health Insurance Companies Will Cover Surgeries They Deem Medically Necessary -- And That Varies

Emergency surgery that saves lives is clearly not optional. But elective surgery -- which often improves your quality of life, rather than saves it -- is, by definition, a choice, not a mandate. Because health insurance companies typically base their coverage decisions on the necessity of a procedure, this distinction becomes quite important when it's time to pay up.

Elective surgery is often perceived as strictly cosmetic, a procedure done only to improve a patient's appearance. But breast implants, face lift, liposuction and vision correction surgeries are only some of the operations considered optional. Elective surgeries also include hip replacements, cataracts, heart procedures such as implanting pacemakers and clearing arteries with angioplasty;and sterilizations such as vasectomies and tubal ligations.

In general, insurance companies will cover procedures they deem medically necessary. But what is judged medically necessary can vary from plan to plan.

Types of Elective Surgeries

According to the Centers for Disease Control and Prevention (CDC), more than 31 million outpatient surgeries are performed each year. The CDC does not distinguish how many of these operations are elective, but many might be considered so because they are not performed in an emergency setting.

Elective surgeries include:

• Biopsies or exploratory surgery, which is used to diagnose an illness or determine how advanced it is.
• Gynecological, which includes procedures such as hysterectomies (removal of the uterus and/or ovaries).
• Musculoskeletal, to replace deteriorated joints.
• Refractive, to repair vision defects; often referred to as LASIK, which is one form.
• Plastic, including procedures to reconstruct breasts or other body parts affected by illness or injury.
• Cardiovascular, which improves the heart's function.

Doctors may regard some of these surgeries -- while technically elective --  as key to improving your quality of life. Other procedures they may not.

Definition of Need Varies

Central to the distinction between elective and non-elective surgery is the definition of need. This definition affects insurance carriers' decisions to cover a procedure or deny a claim.

A patient might think that she needs breast reduction surgery, for example, to reduce the bodily pain and stress that can result from having large breasts, but her insurance company might disagree and refuse to pay for it.

Few, however, would judge a biopsy procedure to test for the presence of cancer as optional.

And breast implant surgery for cosmetic purposes that would not typically be covered often might be if it is related to reconstruction during breast cancer treatment.

Insurers' Guidelines Vary

Some insurance companies will cover a surgery that, while technically unnecessary, will save the company money down the line and perhaps avert an illness.

Some examples:

• Vision correction, which negates the need for future eyeglass and contact lens prescriptions.
• Sterilization, which negates the need for future birth control prescriptions or procedures.
• Weight-loss surgery, which can help an obese person avoid future weight-related illnesses.
• A nose job (rhinoplasty), which can correct breathing problems.

Find Out What Your Insurer Covers

How can you know for certain what your individual health policy covers? Ask.

You can check the coverage summary booklet that is provided by your insurer. If you don't have one, your insurer can supply you with one.

And you can get guidance from a plan representative. The numbers and addresses should be on your insurance card.

Paying for Surgery

If your insurance company balks at paying for elective surgery you think you need, be persistent. You can appeal its decision.

If the answer is still no, you might consider seeking a payment plan. Some doctors or medical facilities will let you finance elective surgeries, paying a portion up front and the rest over a period of time.

Health Insurance Basics

Question: How can I make sure the treatment I need is covered by my health insurance?

Answer: Know your insurance policy, understand your options and talk with your doctor.

"People make the assumption if the doctor orders it, it's going to be covered," says J.P. Wieske of the Council for Affordable Insurance, an insurance industry lobbying group.

Doctors view your condition through a medical perspective, though, not from an insurance standpoint. Since they see patients who have a variety of insurance providers, they're often not as aware of the coverage provided by a particular company or plan as patients are -- or should be.

Insurance policies are geared toward a broad population, so covered items are based on standard medical procedures for the average patient. Patients, though, have more alternatives -- and more successes -- in negotiating healthcare costs and benefits than many realize.

Some approaches you might consider using:

Ask about alternatives: Will a similar test or treatment that is covered by your insurance be just as effective as one that is not?

Talk with your doctor's office: Half of the 10% to 17% of patients who bargained to reduce the cost of medication, a healthcare provider's fee or hospitalization were successful, according to a 2002 Harris Interactive poll. You're usually better off talking with an office manager or social worker than the medical provider. Success is even more likely if you speak with someone in person, rather than on the phone, and don't take no for an answer on the first round, according to the National Endowment for Financial Education.

Appeal to the insurance coverage:  Ask your doctor for the medical codes of the recommended procedures, and investigate your insurance company's appeal process. If you're turned down, your next step is to seek an independent review through your state department of insurance for which you will pay a maximum of $25. These reviews -- available in most states -- favor the consumer over the insurance company more than one-third of the time, according to Wieske. Sometimes an insurance company will go ahead and approve the coverage rather than go through the review process.

Investigate clinical trials: If you're a candidate for a clinical trial, its sponsors probably will cover the cost of many tests, procedures, prescriptions and doctor visits. If not, and if your insurance company defines the trial as experimental, it may not cover medical appointments and other routine care it would pay for if you weren't enrolled. Twenty-two states have laws mandating some insurance coverage for health care provided by clinical trials.

Get a second opinion: Another physician may suggest alternate treatments, or he or she may confirm the advice of your primary doctor. Many insurance providers pay for second opinions, but check with yours to see if any special procedures should be followed. Your doctor, trustworthy friends or relatives, university teaching hospitals and medical societies can provide you with names of medical professionals.

If all else fails, suggest a payment plan: If the treatment is essential and not covered by insurance, ask your doctor's office to work with you to pay the bill over a period of time.