Health Insurance Professionals, Companies, and Carriers

Selecting health insurance for a small business is a somewhat complex task, at best. Whichever health insurance program you pick, it must match your company's needs and resources, so it is best to choose a self-employed health insurance professional that can guide you, and provide you the best information to enable you to make the best and most informed decision.

Health insurance professionals are:

Agents work on behalf of the company marketing and selling their products, and are paid commission based on sales.

Brokers are licensed and represent a number of different company's products, usually compensated by the insurance company the sale is placed with. The broker must provide on-going service to clients of the company.

Consultants evaluate group needs, design plans, and recommend the most reasonable company. The consultant is paid through the contract with the employer group. The contract outlines fees and servicing for the company.

When choosing a company or carrier, you should make an informed decision based on the plans offered, the company or carrier's reputation, the agent's reliability (talk to people who use this company), the company's stability, and length of time in business.

The New York State Department of Insurance publishes compliant ranking for health insurance providers that includes records of grievances, appeals for medical necessity, and department complaints which you can access through the following website: http://www.ins.state.ny.us

To find out about the financial stability of the company, ask for a copy of its ratings through A.M. Best & Co, Duff & Phelps, or Standard and Poor's. For additional information, contact the New York State Insurance Department, as they issue the carrier's licenses, and monitor their carrier's operations.

You should also make note that insurers are required by law to disclose information on coverage parameters, utilization, review policies, prior authorization requirements, premiums, cost sharing, payment methods, responsibilities, grievances procedures, how to acquire emergency services, as well as procedures for selecting, changing, or accessing providers.

As the owner of a policy from any health insurance company, you have certain rights. Most insurance contracts now have grievance conditions and clauses built in. This is useful if a provider denies access to a referral or judges, a benefit not covered under the signed policy agreement. The procedure must be outlined in the agreement and must be provided to the policyholder as written notice.

You, as a policyholder, with a built in grievance procedure have the right to complain and have your complaint reviewed.