Medical Tourism: Could Medical Tourism Save Your Life?
A growing number of people worldwide are seriously considering a new phenomenon called “Medical Tourism” as an answer to high cost and/or unavailable health care. Others who have already used medical tourism are praising it as a terrific solution to an ongoing problem.
If you don’t live in the US, you may still have some interest in medical tourism–perhaps your health care provider doesn’t cover a procedure you want, or maybe the wait for the procedure is too long. For those people worldwide without health insurance, and with limited access to the health care system, going to another country for a medical procedure could literally save your life.
The cost of medical care here in the United States is high and going higher. However, the World Health Organization ranks the US healthcare system as #37 in the world. We are behind nearly all Europeans nations, Saudi Arabia, Chile, Colombia and Costa Rica.
So, you might survive your medical condition and treatment. But will you survive financially when the medical bills arrive at your door?
For a growing list of reasons, Medical Tourism is an idea whose time has come.
There are two prominent resources for Medical Tourism listed below:
PlanetHospital.com
PlanetHospital began in 2002 as a coordinator of overseas healthcare for the uninsured desiring to travel abroad because they could not obtain or could not afford healthcare in the US or their respective country. Over time, as news of medical tourism spread, carriers, employers and self-insured groups began to ask PlanetHospital to explore ways that would allow PlanetHospital to solve their skyrocketing healthcare cost problem. Consequently, while maintaining their commitment to individual self payers, they expanded into healthcare solutions. As a result, over the past two years, PlanetHospital has developed several products for the marketplace. Most of their products center around four critical needs:
1. Self insured companies and their related partners (such as Stop Loss agencies, TPAs, and MGUs)
2. Uninsured and underinsured individuals
3. Healthcare plans that need to control expenses
4. Immigrants and guest workers who need affordable healthcare while working in the US.
I strongly urge you to spend some time touring their website at: www.planethospital.com
HealthCare Tourism International
HealthCare Trip, a 501 (c) (3) non-profit service of HealthCare Tourism International, was started on April 1, 2006 as a portal and service that connects all people interested in healthcare abroad with safe and effective information and accreditation. In addition, they do not have any financial partnerships or arrangements with for-profit healthcare tourism operators, hospitals, or providers, so that they may maintain a non-partisan approach to safe healthcare services abroad. HCTI is the world's first 501 (c) (3) non-profit organization specifically for health travel safety.
Visit their website at: www.healthcaretrip.org
Medical Tourism includes many of the following specialties in Medicine.
Alternative Medicine
There are many treatment procedures with long histories of success that are not approved and available in the US. For example, German cancer specialists have alternative treatments that are much more successful than traditional American procedures. Other alternative medicine is found in heart disease, for example.
Nursing Home/Long Term Care
In order for Medicare to pay for nursing home care, one must be basically broke (under $2500 in assets). If you do not have Long Term Care insurance, the monthly costs can easily run between $3,000 and $5,000. In other countries, high quality nursing care can be found for less than $50 a day.
Dental
Some of the most popular and widely-used medical procedures are dental procedures. With only half the US population covered by dental insurance, Americans are streaming overseas for high quality, low cost dental care. Medicare does not cover dental work, and elderly people have elderly teeth that require more care than the young.
In certain areas of Prague, Budapest, Bangkok and Tijuana, streets are lined with dental clinics. The savings the patients realize can more than compensate for their travel costs. Teeth caps that range from $750 to $1,000 in the U.S. cost $150 in Mexico. In Budapest, a top-quality crown costs $780, compared with $1,200 to $2,000 in the United States. In Great Britain the average cost of an implant is $3,500, but in Budapest you can get it done for $1,000.
What about the quality of the work? According to the non-profit group Healthcare Tourism International, their surveys of patients found high levels of satisfaction. But that should come as no surprise. A spokesman from the New York University College of Dentistry states that they bring in over 100 dentists a year from 33 countries, train them in advanced procedures, and send them home.
In March 2008, FOX News reporter Lori Lundin blogged about her husband’s dental excursion to El Salvador. The quote they got in the US for the dental work he need was $60,000. They had the work done in a world-class Salvadoran facility for about $19,000. He had the procedures done and experienced no pain, plus they had a tropical vacation while they were there. Lundin figured that the total cost including travel expenses and lodging was $30,000.
Cosmetic Surgery
Tummy tuck, Breast Augmentation/Reduction, facial, liposuction, butt/thigh lifts and other cosmetic procedures can be done through Medical Tourism.
Conventional Treatment
Medical procedures include:
• Fertility
• Orthopedic Surgery
• Heart Surgery
• Bariatric
• Cancer/Radiation
• Eye and vision
• Gynecological
• Lung procedures
• ...and many others
Pharmaceutical purchases
Pharmaceuticals outside the US cost a small fraction of US prices. For the most part, the manufacturer is the same as you would find in an American pharmacy. Countries like India, Brazil and Thailand have huge generic pharmaceutical industries, and many of their companies are importing product into the US. Patients can save hundreds per year by buying drugs outside the US.
Travel benefits
One of the other benefits to medical tourism is that, depending on how long you stay for your medical procedures, you may be able to take in the sights while you are being treated. Imagine yourself on a Costa Rican beach while you wait for your dental work to be completed! Picture yourself attending the Prague Symphony while you are in the city for your medical treatment. Wonderful!
Caveat Emptor
As with any major purchase, you should do extensive research before you spend your money. Do not trust ANYONE just because the letters “MD” are tacked onto his name, or because he’s wearing a white lab coat. Spend the time necessary to thoroughly investigate any medical provider. Then, make an informed decision.
Medical Tourism can be a tremendous money saver for you, and can provide you with world class medical treatment and a memorable vacation. Good luck and good health!
Monday, April 27, 2009
Friday, April 24, 2009
Auto Insurance: Is “Pay-As-You-Drive” The Next Big Thing?
Do you own a car and drive very little? Perhaps your situation is like this:
• You are elderly and only drive to and from the market.
• You live and work in a small town, or work close to your home.
• You travel a lot, and your car is parked at home for days or weeks at a time.
• You are in the military, and deployed outside the US for many months at a time.
• You own a pickup truck that you only use on weekends to run errands. (that’s me)
“Pay-As-You-Drive” (PAYD) is the concept of linking the amount you pay for auto insurance to the number of miles you drive each year. The more you drive, the more you pay. The less you drive, the less you would pay.
Drivers would gain the most savings from Liability and Collision coverage. If a person carried Comprehensive insurance (fire, theft, glass breakage, etc.) on their vehicle, that likely would not change much. A car doesn’t have to be moving for there to be damages under Comprehensive coverage.
There are various ways that insurers would verify mileage under a PAYD program. Some would use GPS tracking systems that automatically tabulate and report mileage. Some use odometer checks or maintenance records.
The concept is becoming more popular in many states. Some insurers are already offering PAYD discount programs in most states. For example, Progressive Insurance and GMAC Insurance presently offer PAYD policies. Progressive ties mileage verification to GPS, and GMAC uses the OnStar system built into many GM automobiles.
PAYD has gained a strong foothold in Europe, with insurers from the UK to Italy offering the program.
Giving people a financial reward for driving less is good ecological and social policy. As with any new program, the devil is in the details, but it is very clear that the “pros” far outweigh the “cons.”
Issues relating to the “Pay-As-You-Drive” concept include:
1. Insurers must give appropriate discounts
2. Discounts must be high enough to motivate people to drive less
3. Miles driven must be monitored without violating people’s privacy
The Brookings Institute issued a report in July 2008 that estimates that the universal adoption of pay-as-you-drive plans would lead to a savings of $270 per vehicle for two-thirds of American households.
Would an annual savings of $270 be a sufficient incentive for the average American to switch to PAYD insurance? The jury is still out.
Check with your insurance company to see if they presently offer PAYD coverage. Or, check with your insurance agent to see if he writes PAYD coverage. You could save some bucks!
• You are elderly and only drive to and from the market.
• You live and work in a small town, or work close to your home.
• You travel a lot, and your car is parked at home for days or weeks at a time.
• You are in the military, and deployed outside the US for many months at a time.
• You own a pickup truck that you only use on weekends to run errands. (that’s me)
“Pay-As-You-Drive” (PAYD) is the concept of linking the amount you pay for auto insurance to the number of miles you drive each year. The more you drive, the more you pay. The less you drive, the less you would pay.
Drivers would gain the most savings from Liability and Collision coverage. If a person carried Comprehensive insurance (fire, theft, glass breakage, etc.) on their vehicle, that likely would not change much. A car doesn’t have to be moving for there to be damages under Comprehensive coverage.
There are various ways that insurers would verify mileage under a PAYD program. Some would use GPS tracking systems that automatically tabulate and report mileage. Some use odometer checks or maintenance records.
The concept is becoming more popular in many states. Some insurers are already offering PAYD discount programs in most states. For example, Progressive Insurance and GMAC Insurance presently offer PAYD policies. Progressive ties mileage verification to GPS, and GMAC uses the OnStar system built into many GM automobiles.
PAYD has gained a strong foothold in Europe, with insurers from the UK to Italy offering the program.
Giving people a financial reward for driving less is good ecological and social policy. As with any new program, the devil is in the details, but it is very clear that the “pros” far outweigh the “cons.”
Issues relating to the “Pay-As-You-Drive” concept include:
1. Insurers must give appropriate discounts
2. Discounts must be high enough to motivate people to drive less
3. Miles driven must be monitored without violating people’s privacy
The Brookings Institute issued a report in July 2008 that estimates that the universal adoption of pay-as-you-drive plans would lead to a savings of $270 per vehicle for two-thirds of American households.
Would an annual savings of $270 be a sufficient incentive for the average American to switch to PAYD insurance? The jury is still out.
Check with your insurance company to see if they presently offer PAYD coverage. Or, check with your insurance agent to see if he writes PAYD coverage. You could save some bucks!
Wednesday, April 22, 2009
Texas Windstorm Insurance: Insanity in the Texas Legislature
Representative John Smithee, (R) Amarillo, has introduced HB911, which would, if passed and signed by the governor, cause the price of windstorm insurance - required of all coastal property owners - to soar by as much as 60 percent. Additionally, it wouldn’t cover nearly as much and for certain properties, it would not be available at all.
Smithee is the Chairman of the House Committee on Insurance. He cites a need to replenish the Texas Windstorm Insurance Association, the state risk pool, after the onslaught of Hurricanes Katrina and Rita in 2005, and Ike in 2008. The Association became the only insurer available for millions of coastal Texans after many insurers pulled out of windstorm coverage after the hurricanes.
The Texas Windstorm Insurance Association currently carries 215,537 policies totaling $58.6 billion in exposure. According to a December 2008 Texas Windstorm Insurance Association status statement, 43,079 of those policies are in Nueces County, with a total exposure of $11.4 billion.
House Bill 911 would, among other things:*
• Assess windstorm insurance rates based on geographical location, meaning coastal residents would pay more than inland residents. Rates could go up 60 percent for current coastal policy holders.
• Require coastal homeowners to purchase federal flood coverage.
• Cap windstorm insurance coverage at $250,000 per residence (homestead), well below the current $1.7 million cap, leaving thousands of homes uninsurable to their current value.
• Exclude coverage for rent houses, second homes, condominiums, apartments or other multi-family units.
• Decrease the maximum coverage for commercial buildings from $4.1 million to $1 million.
• Decrease the maximum coverage for government structures, such as schools and courthouses, from $4.1 million to $2.1 million, meaning those entities would have to use tax dollars to purchase more expensive, private insurance, if it’s available, to make up the difference.
• Create a 60-day waiting period before losses could be sought, as opposed to current policy, which prevents new coverage once a hurricane is in the Gulf of Mexico.
*Source: House Bill 911 and an analysis from the Galveston Windstorm Action Committee Inc.
I have no problem with higher premiums for coastal policyholders. That is simply accurate underwriting. Happens in all types of insurance. But don’t be fooled. If rates go up at the coastal states, they will rise state-wide. Texas is a windy state.
But that’s where my agreements end. The rest of this bill is trash.
Here are the elements of the bill I oppose:
Caps on windstorm coverage - Don’t cap coverage, charge the proper premium amount for the risk.
Requiring coastal property owners to buy Federal Flood insurance - it’s tyranny to force a property owner to insure for flood. If the owners want to remain uninsured, it is their right. That doesn’t mean a lienholder could not require flood insurance as a requirement for a mortgage. But that is a collateral protection issue. The federal government does not have a security position in a homeowner’s property without some mortgage in place (Freddie Mac, Fannie Mae, VA loans, etc.) To require flood insurance is a violation of property rights.
Excluding coverage for non-homestead dwellings, rental homes, apartments and condos - what kind of idiocy is this? There are millions of second homes, rental houses, condos and apartment buildings in the 14 coastal Texas counties. How would making them uninsurable help the situation?
The 60-day “deductible.” Texas law now states that, once a hurricane or named storm enters the Gulf of Mexico, new coverage cannot be purchased. But those storms usually make landfall, if at all, within a few days. In addition, in the peak of the hurricane season, storms are seldom 60 days apart. Look at Katrina and Rita, about 30 days apart. This proposal hurts Texans.
Smithee is from Amarillo, a city over 650 miles from the Texas Gulf Coast. That’s a distance equal to the distance from New York to Charlotte, North Carolina. I know that’s somewhat obscure, but this nut case is a long way from the water. It illustrates just how far out of touch with reality he is.
So, if a bunch of insurers have stopped writing windstorm coverage in Texas, and the Texas Windstorm Insurance Association is the insurer of last resort for many Texans, where are they supposed to go to get insured to value?
This kind of legislative nonsense could bring the Coastal economies to a screeching halt. Lenders would stop lending on properties that could not be insured to value. Insureds with losses could lose everything.
Texans, both inland and coastal, need to bombard their elected representatives with their opinions on this very bad bill and demand that it be rejected.
In the film industry, there is the widely known name of Alan Smithee. It is an official pseudonym used by film directors who wish to disown a project because they were so disgusted with the final product. I can only hope that someone paints the name “Alan Smithee” on this horrid bill.
Smithee is the Chairman of the House Committee on Insurance. He cites a need to replenish the Texas Windstorm Insurance Association, the state risk pool, after the onslaught of Hurricanes Katrina and Rita in 2005, and Ike in 2008. The Association became the only insurer available for millions of coastal Texans after many insurers pulled out of windstorm coverage after the hurricanes.
The Texas Windstorm Insurance Association currently carries 215,537 policies totaling $58.6 billion in exposure. According to a December 2008 Texas Windstorm Insurance Association status statement, 43,079 of those policies are in Nueces County, with a total exposure of $11.4 billion.
House Bill 911 would, among other things:*
• Assess windstorm insurance rates based on geographical location, meaning coastal residents would pay more than inland residents. Rates could go up 60 percent for current coastal policy holders.
• Require coastal homeowners to purchase federal flood coverage.
• Cap windstorm insurance coverage at $250,000 per residence (homestead), well below the current $1.7 million cap, leaving thousands of homes uninsurable to their current value.
• Exclude coverage for rent houses, second homes, condominiums, apartments or other multi-family units.
• Decrease the maximum coverage for commercial buildings from $4.1 million to $1 million.
• Decrease the maximum coverage for government structures, such as schools and courthouses, from $4.1 million to $2.1 million, meaning those entities would have to use tax dollars to purchase more expensive, private insurance, if it’s available, to make up the difference.
• Create a 60-day waiting period before losses could be sought, as opposed to current policy, which prevents new coverage once a hurricane is in the Gulf of Mexico.
*Source: House Bill 911 and an analysis from the Galveston Windstorm Action Committee Inc.
I have no problem with higher premiums for coastal policyholders. That is simply accurate underwriting. Happens in all types of insurance. But don’t be fooled. If rates go up at the coastal states, they will rise state-wide. Texas is a windy state.
But that’s where my agreements end. The rest of this bill is trash.
Here are the elements of the bill I oppose:
Caps on windstorm coverage - Don’t cap coverage, charge the proper premium amount for the risk.
Requiring coastal property owners to buy Federal Flood insurance - it’s tyranny to force a property owner to insure for flood. If the owners want to remain uninsured, it is their right. That doesn’t mean a lienholder could not require flood insurance as a requirement for a mortgage. But that is a collateral protection issue. The federal government does not have a security position in a homeowner’s property without some mortgage in place (Freddie Mac, Fannie Mae, VA loans, etc.) To require flood insurance is a violation of property rights.
Excluding coverage for non-homestead dwellings, rental homes, apartments and condos - what kind of idiocy is this? There are millions of second homes, rental houses, condos and apartment buildings in the 14 coastal Texas counties. How would making them uninsurable help the situation?
The 60-day “deductible.” Texas law now states that, once a hurricane or named storm enters the Gulf of Mexico, new coverage cannot be purchased. But those storms usually make landfall, if at all, within a few days. In addition, in the peak of the hurricane season, storms are seldom 60 days apart. Look at Katrina and Rita, about 30 days apart. This proposal hurts Texans.
Smithee is from Amarillo, a city over 650 miles from the Texas Gulf Coast. That’s a distance equal to the distance from New York to Charlotte, North Carolina. I know that’s somewhat obscure, but this nut case is a long way from the water. It illustrates just how far out of touch with reality he is.
So, if a bunch of insurers have stopped writing windstorm coverage in Texas, and the Texas Windstorm Insurance Association is the insurer of last resort for many Texans, where are they supposed to go to get insured to value?
This kind of legislative nonsense could bring the Coastal economies to a screeching halt. Lenders would stop lending on properties that could not be insured to value. Insureds with losses could lose everything.
Texans, both inland and coastal, need to bombard their elected representatives with their opinions on this very bad bill and demand that it be rejected.
In the film industry, there is the widely known name of Alan Smithee. It is an official pseudonym used by film directors who wish to disown a project because they were so disgusted with the final product. I can only hope that someone paints the name “Alan Smithee” on this horrid bill.
Monday, April 20, 2009
UK Vehicle Breakdown Coverage: Europeans Have The Advantage
You’re all familiar with insurance policies on your auto or commercial vehicle. Those policies exclude mechanical breakdown.
You’re all familiar with Road Service memberships, or Towing and Car Rental Endorsements that you place on your auto policies.
Well, European insurers have bridged the gap between those coverages with a product called “Breakdown Cover.” Breakdown Cover is a full Europe-wide rescue and recovery service for both breakdown and accident. It is not available in the USA..but should be.
Imagine going out for the day with the family to spend time together and your car breaks down on the way. This will ruin your plans and leave you by the road for hours until you can get the car fixed, not to mention costing a fortune. By adding Breakdown Cover to your auto policy, you can ensure that if your vehicle breaks down, you will be back on the road in the shortest amount of time. If your car cannot be fixed at the side of the road, you will be taken back home or to the garage where it will be fixed while you wait.
With Breakdown Cover, no matter what happens, help is less than an hour away.
If your vehicle is immobilized as a result of mechanical breakdown, fire, theft or attempted theft, Breakdown Cover will arrange and pay for:
• roadside repair (including one hour of labor) or recovery to a suitable repairer or your home
• up to one hour of assistance to try to repair the vehicle
• if the vehicle cannot be repaired at the scene, to arrange for it to be taken, with the driver and passengers, to a suitable garage for repair at your cost
• if the vehicle cannot be repaired the same day, it will arrange for:
- the vehicle, transport of the driver and up to six passengers to be taken home or to your destination and, at your request, the vehicle will be taken to a garage of your choice within 15 miles, or alternatively;
- we can provide one nights hotel accommodation for the driver and passengers, or
- a replacement hire vehicle for up to 24 hours
• chauffeur to your home if the sole driver is injured or ill and is unable to drive
• a message service, informing up to two people of your breakdown
• repatriation of driver, car and up to six passengers to your country, following an accident abroad, where the car cannot be repaired in time for your return home.
Don’t Be Misled! This Is More Than Towing Coverage
The main reason people do not add this inexpensive coverage to their Auto policy is that they think it’s just roadside assistance or towing service. But you can see here that Breakdown Cover is much more than towing coverage.
Strategy for Breakdown Cover for European Motorists
1. Call your insurance agent and add this valuable cover to your auto policy.
2. Go to any insurance quote service online and you’ll likely find Breakdown Cover. Simply fill out the online form to get a quote. Once you find the combination of best coverage and best price, purchase the Cover.
3. Once you receive your Breakdown Cover policy, take the time to read it carefully. It’s always best to know your coverage before you need to use it.
You’re all familiar with Road Service memberships, or Towing and Car Rental Endorsements that you place on your auto policies.
Well, European insurers have bridged the gap between those coverages with a product called “Breakdown Cover.” Breakdown Cover is a full Europe-wide rescue and recovery service for both breakdown and accident. It is not available in the USA..but should be.
Imagine going out for the day with the family to spend time together and your car breaks down on the way. This will ruin your plans and leave you by the road for hours until you can get the car fixed, not to mention costing a fortune. By adding Breakdown Cover to your auto policy, you can ensure that if your vehicle breaks down, you will be back on the road in the shortest amount of time. If your car cannot be fixed at the side of the road, you will be taken back home or to the garage where it will be fixed while you wait.
With Breakdown Cover, no matter what happens, help is less than an hour away.
If your vehicle is immobilized as a result of mechanical breakdown, fire, theft or attempted theft, Breakdown Cover will arrange and pay for:
• roadside repair (including one hour of labor) or recovery to a suitable repairer or your home
• up to one hour of assistance to try to repair the vehicle
• if the vehicle cannot be repaired at the scene, to arrange for it to be taken, with the driver and passengers, to a suitable garage for repair at your cost
• if the vehicle cannot be repaired the same day, it will arrange for:
- the vehicle, transport of the driver and up to six passengers to be taken home or to your destination and, at your request, the vehicle will be taken to a garage of your choice within 15 miles, or alternatively;
- we can provide one nights hotel accommodation for the driver and passengers, or
- a replacement hire vehicle for up to 24 hours
• chauffeur to your home if the sole driver is injured or ill and is unable to drive
• a message service, informing up to two people of your breakdown
• repatriation of driver, car and up to six passengers to your country, following an accident abroad, where the car cannot be repaired in time for your return home.
Don’t Be Misled! This Is More Than Towing Coverage
The main reason people do not add this inexpensive coverage to their Auto policy is that they think it’s just roadside assistance or towing service. But you can see here that Breakdown Cover is much more than towing coverage.
Strategy for Breakdown Cover for European Motorists
1. Call your insurance agent and add this valuable cover to your auto policy.
2. Go to any insurance quote service online and you’ll likely find Breakdown Cover. Simply fill out the online form to get a quote. Once you find the combination of best coverage and best price, purchase the Cover.
3. Once you receive your Breakdown Cover policy, take the time to read it carefully. It’s always best to know your coverage before you need to use it.
Thursday, April 16, 2009
Health Insurance: Top Five Strategies to Lower Your Medical Bills By Thousands
It’s a typical health insurance scenario. You or a family member has some medical procedure done. It usually involves a hospital stay. Within a few days or weeks, all of the bills come to you from the doctors, the hospital, the anesthesiologist, the labs, the radiology department, the surgeon...everyone who had a part of your health care event.
If you have health insurance through your employer, you’re usually only concerned about the amount of the bills not covered by the insurance. That would be your deductible amount and any co-pays you might have.
But what if some medical procedures are denied? What if some are underpaid? How do you challenge the determinations of the insurance company examiners?
Those bills can be in the thousands of dollars. For more serious illness and treatment, the bills can be in the hundreds of thousands of dollars.
Unfortunately, many of the bills are incorrect...sometimes wildly incorrect. Billing miscommunication happens daily on all levels. Doctor to patient, doctor to coding staff or billing service, billing service to insurance company, and insurance company to patient. Many miscommunications are due to poor interpretation of the facts. The right hand doesn't know what the left hand is doing.
The patient is caught in the middle, doesn't know who to believe, and being the ultimate bearer of the financial obligation, many times just pays the bill out of frustration. There is no average case, all situations are different, and no two problems are the same.
But, what can be done? How can a regular person...an average American faced with giant medical bills...determine the correct medical charges and get correct medical bills?
Strategy #1: Remain calm.
When calling the insurance company to dispute a payment amount or challenge a denial, insist on obtaining the full name of the person you’re speaking to. If they refuse, ask for a supervisor. I also strongly recommend recording every call. When you call into the insurance company, you’ll regularly hear that “this call may be monitored or recorded for quality purposes.” Don’t you believe it. They are covering their butt in case the claim goes into litigation. Get a recording of your own. Make sure you know the law on recording conversations in your state. You can find that information at: www.insurance-claim-secrets.com/support-files/phonerecordinglaw.pdf
Strategy #2: Become aware of “hot spots” in the health insurance billing process that are the source of many errors.
A major source of errors is the “superbill” filled out by your doctor. It is a long form with row after row of medical procedures, types of tests, diagnoses, types of treatment and codes. If the doctor checks the wrong box it can lead to a claim denial. For instance, a woman may be covered for a mammogram for a typical “wellness checkup doctor visit.” But if the doctor checks a different reason for the visit, the insurer might not cover the mammogram.
If the insurance company denies the claim in that instance, you need to get the doctor’s office visit file notes to see just what the doctor wrote in your file. Send the notes to the insurance company along with the explanation of the doctor visit. This one strategy could turn a claim denial into a claim paid.
Strategy #3: Ask for Credentials
Insurance companies use the term “not medically necessary” frequently in denial letters. This is another way of saying a claims processor is questioning your doctor’s judgment. If you get this denial message, call the insurance company and ask for the name and medical credentials of the person doing the second-guessing. Be cordial and polite, and take good notes. Record the conversation. If you find that the credentials of the claim processor are less than your doctor’s credentials, then send a letter to the insurance company, Certified Mail, requesting a medical review by a doctor with appropriate qualifications. For example, if you have a thyroid problem, ask for review by an endocrinologist, not just the insurance company’s medical director, who may have a completely different medical specialty.
Strategy #4: Separate Multiple Services
Multiple medical services that occur on the same day can also lead to a claim denial, especially if the doctor sends the insurance company two separate bills. So a bill from the doctor for reading an X-ray can get confused with the X-ray procedure that happened on the same day. The insurer may see them as duplicate bills and denies one of them...probably the larger of the two. So, get copies of the bills, highlight the separate charges, include a letter of explanation and send it all into the insurer. You might turn a denial into a payment.
Strategy #5: Retain a Patient Advocate
A Patient Advocate is a person or company that
• Organizes the endless bills, statements and claims forms
• Appeals denials of claims and incorrect payments
• Negotiates settlements with medical providers
The Patient Advocate gathers all the medical bills for a patient, analyzes them for accuracy, works with the insurer and medical provider to get the bills corrected, and negotiates settlement of the bills. They can cut thousands out of incorrect bills.
Finally, remember that everything about a medical bill is negotiable. Medical providers constantly accept negotiated amounts as payment in full. Don’t be the guy that “pays retail”...NEGOTIATE!
You can find out more about Patient Advocates at: www.insurancenightmare.com
If you have health insurance through your employer, you’re usually only concerned about the amount of the bills not covered by the insurance. That would be your deductible amount and any co-pays you might have.
But what if some medical procedures are denied? What if some are underpaid? How do you challenge the determinations of the insurance company examiners?
Those bills can be in the thousands of dollars. For more serious illness and treatment, the bills can be in the hundreds of thousands of dollars.
Unfortunately, many of the bills are incorrect...sometimes wildly incorrect. Billing miscommunication happens daily on all levels. Doctor to patient, doctor to coding staff or billing service, billing service to insurance company, and insurance company to patient. Many miscommunications are due to poor interpretation of the facts. The right hand doesn't know what the left hand is doing.
The patient is caught in the middle, doesn't know who to believe, and being the ultimate bearer of the financial obligation, many times just pays the bill out of frustration. There is no average case, all situations are different, and no two problems are the same.
But, what can be done? How can a regular person...an average American faced with giant medical bills...determine the correct medical charges and get correct medical bills?
Strategy #1: Remain calm.
When calling the insurance company to dispute a payment amount or challenge a denial, insist on obtaining the full name of the person you’re speaking to. If they refuse, ask for a supervisor. I also strongly recommend recording every call. When you call into the insurance company, you’ll regularly hear that “this call may be monitored or recorded for quality purposes.” Don’t you believe it. They are covering their butt in case the claim goes into litigation. Get a recording of your own. Make sure you know the law on recording conversations in your state. You can find that information at: www.insurance-claim-secrets.com/support-files/phonerecordinglaw.pdf
Strategy #2: Become aware of “hot spots” in the health insurance billing process that are the source of many errors.
A major source of errors is the “superbill” filled out by your doctor. It is a long form with row after row of medical procedures, types of tests, diagnoses, types of treatment and codes. If the doctor checks the wrong box it can lead to a claim denial. For instance, a woman may be covered for a mammogram for a typical “wellness checkup doctor visit.” But if the doctor checks a different reason for the visit, the insurer might not cover the mammogram.
If the insurance company denies the claim in that instance, you need to get the doctor’s office visit file notes to see just what the doctor wrote in your file. Send the notes to the insurance company along with the explanation of the doctor visit. This one strategy could turn a claim denial into a claim paid.
Strategy #3: Ask for Credentials
Insurance companies use the term “not medically necessary” frequently in denial letters. This is another way of saying a claims processor is questioning your doctor’s judgment. If you get this denial message, call the insurance company and ask for the name and medical credentials of the person doing the second-guessing. Be cordial and polite, and take good notes. Record the conversation. If you find that the credentials of the claim processor are less than your doctor’s credentials, then send a letter to the insurance company, Certified Mail, requesting a medical review by a doctor with appropriate qualifications. For example, if you have a thyroid problem, ask for review by an endocrinologist, not just the insurance company’s medical director, who may have a completely different medical specialty.
Strategy #4: Separate Multiple Services
Multiple medical services that occur on the same day can also lead to a claim denial, especially if the doctor sends the insurance company two separate bills. So a bill from the doctor for reading an X-ray can get confused with the X-ray procedure that happened on the same day. The insurer may see them as duplicate bills and denies one of them...probably the larger of the two. So, get copies of the bills, highlight the separate charges, include a letter of explanation and send it all into the insurer. You might turn a denial into a payment.
Strategy #5: Retain a Patient Advocate
A Patient Advocate is a person or company that
• Organizes the endless bills, statements and claims forms
• Appeals denials of claims and incorrect payments
• Negotiates settlements with medical providers
The Patient Advocate gathers all the medical bills for a patient, analyzes them for accuracy, works with the insurer and medical provider to get the bills corrected, and negotiates settlement of the bills. They can cut thousands out of incorrect bills.
Finally, remember that everything about a medical bill is negotiable. Medical providers constantly accept negotiated amounts as payment in full. Don’t be the guy that “pays retail”...NEGOTIATE!
You can find out more about Patient Advocates at: www.insurancenightmare.com
Health Care Costs: Patient Advocates Can Save You Thousands
You or a family member may have recently had some health care event, such as a hospitalization. Now, over the coming days, the medical bills will arrive at your home. Every medical provider who contributed to your treatment is going to send a bill, and you are the person who bears the financial obligation for payment. If you have health insurance, the insurer may pay a large percentage of your medical bills.
However, an alarmingly large and growing segment of the American population lives each day without health insurance. Insurance experts estimate that over 48 million Americans are living without health insurance. And that number of uninsured persons is expected to increase quickly as the economy worsens and unemployed workers lose their insurance coverage.
When those bills show up after a health care event, a serious financial crisis happens. That patient, or the patient’s family, has to figure out a way to pay those medical bills. Those bills can be in the thousands of dollars. For more serious illness and treatment, the bills can be in the hundreds of thousands of dollars.
If you make mistakes while taking care of these medical bills, you could put yourself in a financial situation from which you could never recover.
Think for a moment how ridiculous the system is for providing medical services. You go to your medical provider for a visit. No one gives you a price list of services. You are not told how much ANYTHING costs while you’re being treated. Usually you find out the cost of your medical services when they present the bill to you.
Would you agree to buy groceries like that? Would you get your car repaired with that kind of billing arrangement? Of course not! You wouldn’t even bury your dead cat without knowing what it would cost!
But, in medical services, ignorance about billing is the accepted method among most consumers.
Sadly, many of the medical bills are incorrect...sometimes monstrously incorrect. Billing errors happen daily on all levels...Doctor to patient, doctor to coding staff or billing service, billing service to patient.
So, what can be done? How can a regular person...an average American faced with giant medical bills...determine the correct medical charges and get correct medical bills?
Retain a Patient Advocate.
Hardly anyone knows about Patient Advocates. You can be sure that the medical providers and insurance companies will NEVER tell you about them.
Why?
Think about it from an insurance company’s viewpoint. If the patient hires a Patient Advocate, and the Advocate does his job, the chances are good that the insurance company will pay more on the patient’s claim.
Think about it from the medical provider’s viewpoint. If the patient hires a Patient Advocate and the Advocate does his job, the chances are good that the medical provider is going to receive substantially less money for his services.
A Patient Advocate is a person or company that
• Will collect all your bills, claim forms and statements, even if they’re in a “shoebox”
• Analyzes the bills
• Submits appeals for incorrect charges
• Negotiates settlements with medical providers
The Patient Advocate can cut hundreds or thousands of dollars out of incorrect bills.
EVERYTHING in a medical bill is negotiable. Don’t be the sucker that pays the bills without making sure they are accurate. Medical providers negotiate their bills with insurance companies EVERY DAY. Why should you pay more?
NEGOTIATE!!
You can find out more about Patient Advocates at: www.insurancenightmare.com
However, an alarmingly large and growing segment of the American population lives each day without health insurance. Insurance experts estimate that over 48 million Americans are living without health insurance. And that number of uninsured persons is expected to increase quickly as the economy worsens and unemployed workers lose their insurance coverage.
When those bills show up after a health care event, a serious financial crisis happens. That patient, or the patient’s family, has to figure out a way to pay those medical bills. Those bills can be in the thousands of dollars. For more serious illness and treatment, the bills can be in the hundreds of thousands of dollars.
If you make mistakes while taking care of these medical bills, you could put yourself in a financial situation from which you could never recover.
Think for a moment how ridiculous the system is for providing medical services. You go to your medical provider for a visit. No one gives you a price list of services. You are not told how much ANYTHING costs while you’re being treated. Usually you find out the cost of your medical services when they present the bill to you.
Would you agree to buy groceries like that? Would you get your car repaired with that kind of billing arrangement? Of course not! You wouldn’t even bury your dead cat without knowing what it would cost!
But, in medical services, ignorance about billing is the accepted method among most consumers.
Sadly, many of the medical bills are incorrect...sometimes monstrously incorrect. Billing errors happen daily on all levels...Doctor to patient, doctor to coding staff or billing service, billing service to patient.
So, what can be done? How can a regular person...an average American faced with giant medical bills...determine the correct medical charges and get correct medical bills?
Retain a Patient Advocate.
Hardly anyone knows about Patient Advocates. You can be sure that the medical providers and insurance companies will NEVER tell you about them.
Why?
Think about it from an insurance company’s viewpoint. If the patient hires a Patient Advocate, and the Advocate does his job, the chances are good that the insurance company will pay more on the patient’s claim.
Think about it from the medical provider’s viewpoint. If the patient hires a Patient Advocate and the Advocate does his job, the chances are good that the medical provider is going to receive substantially less money for his services.
A Patient Advocate is a person or company that
• Will collect all your bills, claim forms and statements, even if they’re in a “shoebox”
• Analyzes the bills
• Submits appeals for incorrect charges
• Negotiates settlements with medical providers
The Patient Advocate can cut hundreds or thousands of dollars out of incorrect bills.
EVERYTHING in a medical bill is negotiable. Don’t be the sucker that pays the bills without making sure they are accurate. Medical providers negotiate their bills with insurance companies EVERY DAY. Why should you pay more?
NEGOTIATE!!
You can find out more about Patient Advocates at: www.insurancenightmare.com
Sunday, April 12, 2009
Chinese Drywall: Are Your Building Damages And Health Symptoms Covered?
During the recent housing boom of the early 2000s, the Chinese imported over 250,000 tons of drywall to America. Chinese drywall was abundant and cheaper than American drywall, and builders willingly used it in residential and commercial construction. Experts estimate the Chinese product was used in over 100,000 homes and businesses in America.
Much of the importing occurred between 2004 and 2008, as a drywall shortage occurred due to the multiple hurricanes that struck the Gulf Coast states. Consequently, most of the product complaints are coming from building owners in the Southeast and Gulf Coast states.
American drywall is made of gypsum, a mineral mined throughout the world for millennia. It is water soluble and used for drywall and plaster as well as other uses. Chinese drywall is made of fly ash, a waste by-product of burning coal.
Recently, homeowners are reporting that the Chinese wallboard gives off fumes that corrodes copper pipes, blackens silver jewelry and causes health problems for people living near it.
The source of the reactions has not been nailed down (pardon the pun). It could be the fumigants sprayed on the drywall in the manufacturing process. It could be a chemical reaction with the fly ash, its base ingredient. But homeowners complain that the drywall gives off noxious sulfur-smelling fumes that are damaging the homes and causing sickness for their families.
Homeowners and businesses are lining up to file lawsuits against manufacturers, suppliers and builders, claiming damages for both property damage and bodily injury.
Builders are also filing lawsuits against manufacturers and suppliers, stating that they did not know that the building material was inherently defective.
So, the property damages occur when property owners have to remove the Chinese drywall and repair or replace other property damaged by the fumes. Losses also occur when people are unable to continue living in a contaminated dwelling. Bodily injury losses occur when people are sickened and seek medical treatment.
But are the damages covered by property insurance?
No, they are not. A homeowners policy specifically excludes coverage for “faulty, inadequate or defective...materials used in repair, construction, renovation or remodeling.” In a commercial policy, coverage is excluded for “latent defect or a quality in property that causes it to damage or destroy itself.”
Those exclusions are for “first party” coverage, meaning you insuring property you own. But manufacturers, suppliers and builders are wide open for claims on their Products & Completed Operations Liability coverages.
Your strategy is to check to see if the drywall you used is Chinese drywall. Then, carefully document your damages for property damage and bodily injury damage. Then, contact a Personal Injury attorney to explore your options for recovery.
Much of the importing occurred between 2004 and 2008, as a drywall shortage occurred due to the multiple hurricanes that struck the Gulf Coast states. Consequently, most of the product complaints are coming from building owners in the Southeast and Gulf Coast states.
American drywall is made of gypsum, a mineral mined throughout the world for millennia. It is water soluble and used for drywall and plaster as well as other uses. Chinese drywall is made of fly ash, a waste by-product of burning coal.
Recently, homeowners are reporting that the Chinese wallboard gives off fumes that corrodes copper pipes, blackens silver jewelry and causes health problems for people living near it.
The source of the reactions has not been nailed down (pardon the pun). It could be the fumigants sprayed on the drywall in the manufacturing process. It could be a chemical reaction with the fly ash, its base ingredient. But homeowners complain that the drywall gives off noxious sulfur-smelling fumes that are damaging the homes and causing sickness for their families.
Homeowners and businesses are lining up to file lawsuits against manufacturers, suppliers and builders, claiming damages for both property damage and bodily injury.
Builders are also filing lawsuits against manufacturers and suppliers, stating that they did not know that the building material was inherently defective.
So, the property damages occur when property owners have to remove the Chinese drywall and repair or replace other property damaged by the fumes. Losses also occur when people are unable to continue living in a contaminated dwelling. Bodily injury losses occur when people are sickened and seek medical treatment.
But are the damages covered by property insurance?
No, they are not. A homeowners policy specifically excludes coverage for “faulty, inadequate or defective...materials used in repair, construction, renovation or remodeling.” In a commercial policy, coverage is excluded for “latent defect or a quality in property that causes it to damage or destroy itself.”
Those exclusions are for “first party” coverage, meaning you insuring property you own. But manufacturers, suppliers and builders are wide open for claims on their Products & Completed Operations Liability coverages.
Your strategy is to check to see if the drywall you used is Chinese drywall. Then, carefully document your damages for property damage and bodily injury damage. Then, contact a Personal Injury attorney to explore your options for recovery.
Health Insurance With A Warranty?
The health insurance system in America is terminally ill. Americans have the highest health care costs on the planet. You’d think that expenditures like that would result in the healthiest population on the planet.
That is not the case.
For all our costs, the general health of Americans doesn’t stack up well against other Western nations. America has an intolerably high infant mortality rate, as well as a growing list of chronic diseases, including heart disease, diabetes and cancer.
To compound the problem, the economy is crashing, leaving millions more without health insurance. An estimated 48 million Americans are without health insurance. As businesses downsize and close, more Americans lose coverage. This crisis will give Congress and the Obama Administration the political cover to finally nationalize health care in the United States.
But is that the best way to solve the problem?
Some health care providers are innovating in a quest to provide higher quality care while controlling costs. One shining example is the Geisinger Health System in Pennsylvania.
Geisinger Health System serves 43 counties across Pennsylvania, accounting for over 2.6 million patients who are served by over 750 doctors.
Geisinger is perfecting a new method of health care that rewards doctors for taking better care of their patients, rather than the traditional way of paying them for the sheer number of patients they can see and the special treatments they get. So far, Geisinger is finding that quality improvement may actually reduce overall costs.
W. Edwards Deming, the father of Total Quality Improvement, would be proud.
Geisinger has developed a system that incorporates important strategies such as:
• Coordinated primary care - a team of doctors, nurses, technicians and a case manager coordinate all care for each patient, especially those with chronic conditions like heart disease, pulmonary disease or diabetes. They do what is best for the patient, not what is most convenient for the provider.
• Surgery with a warranty - typically, if you have to return for complications from surgery, you incur new health care costs. Not at Geisinger. Starting with cardiac surgery, they began offering a 90-day warranty at the same time they instituted checklists of best practices for surgical procedures. It has lowered readmission rates by44%.
• Electronic health records - the new records system allows doctors and patients to all access the same patient information with a mouse click. Patients and doctors can email each other, schedule appointments and patients can monitor their own progress.
• Patient involvement - encourages preventative health care, such as lifestyle changes.
These are the kinds of innovation that will always be found in the free enterprise system. Geisinger Health System is a for-profit company with revenues over $3 Billion per year. The profit motive is notably absent in all government activity, innovation and efficiency are seldom found there.
I don’t believe that government control of the health care of the nation is a good solution to the myriad problems. For the best example of government-run health care, look at the failures of the Veterans Administration. The Federal government has botched a system that affects only a few million people. We can only dread the day when Washington takes over health care for the entire nation.
That is not the case.
For all our costs, the general health of Americans doesn’t stack up well against other Western nations. America has an intolerably high infant mortality rate, as well as a growing list of chronic diseases, including heart disease, diabetes and cancer.
To compound the problem, the economy is crashing, leaving millions more without health insurance. An estimated 48 million Americans are without health insurance. As businesses downsize and close, more Americans lose coverage. This crisis will give Congress and the Obama Administration the political cover to finally nationalize health care in the United States.
But is that the best way to solve the problem?
Some health care providers are innovating in a quest to provide higher quality care while controlling costs. One shining example is the Geisinger Health System in Pennsylvania.
Geisinger Health System serves 43 counties across Pennsylvania, accounting for over 2.6 million patients who are served by over 750 doctors.
Geisinger is perfecting a new method of health care that rewards doctors for taking better care of their patients, rather than the traditional way of paying them for the sheer number of patients they can see and the special treatments they get. So far, Geisinger is finding that quality improvement may actually reduce overall costs.
W. Edwards Deming, the father of Total Quality Improvement, would be proud.
Geisinger has developed a system that incorporates important strategies such as:
• Coordinated primary care - a team of doctors, nurses, technicians and a case manager coordinate all care for each patient, especially those with chronic conditions like heart disease, pulmonary disease or diabetes. They do what is best for the patient, not what is most convenient for the provider.
• Surgery with a warranty - typically, if you have to return for complications from surgery, you incur new health care costs. Not at Geisinger. Starting with cardiac surgery, they began offering a 90-day warranty at the same time they instituted checklists of best practices for surgical procedures. It has lowered readmission rates by44%.
• Electronic health records - the new records system allows doctors and patients to all access the same patient information with a mouse click. Patients and doctors can email each other, schedule appointments and patients can monitor their own progress.
• Patient involvement - encourages preventative health care, such as lifestyle changes.
These are the kinds of innovation that will always be found in the free enterprise system. Geisinger Health System is a for-profit company with revenues over $3 Billion per year. The profit motive is notably absent in all government activity, innovation and efficiency are seldom found there.
I don’t believe that government control of the health care of the nation is a good solution to the myriad problems. For the best example of government-run health care, look at the failures of the Veterans Administration. The Federal government has botched a system that affects only a few million people. We can only dread the day when Washington takes over health care for the entire nation.
Tuesday, April 7, 2009
Insurance Claims: Hire The Right Restoration Contractor
This article is Chapter Nineteen of my new book, "Commercial Insurance Claim Secrets REVEALED!" The book is presently in manuscript form, and we anticipate a publishing date of June 1, 2009.
* * * *
A restoration contractor is very different than a general contractor. Most general contractors who do remodeling or new construction do not have the skills and knowledge that a restoration contractor has.
For one thing, the restoration contractor is very familiar with the insurance claims process, and how insurance companies pay for repairs. The restoration contractors use similar estimating software to that used by the adjusters and insurance companies. A general contractor who submits an estimate in an unacceptable form to the insurance company or adjuster just annoys them, and slows down your claim.
Another reason to find restoration contractor is that they are usually full service contractors. They will be able to do temporary or emergency cleanup and board up. They will own the equipment for drying and water damage remediation. They are familiar with the kinds of damage that fires, wind and water do to commercial building. Finally, they are experts at writing accurate estimates for these specific kinds of damages.
General contractors who do not make their living in insurance restoration do not have this kind of equipment and experience. Period.
Do a search online for restoration contractors in your area. You can also look in your local Yellow Pages under “Disaster Restoration,” or “Fire Restoration,” or “Water Damage Restoration.” Look for logos in the ads that say “DKI,” or “RIA” These are professional organizations for restoration contractors. You can also go to the following websites to identify restoration contractors in your area.
DKI - Disaster Kleen-up International. Headquartered in Chicago, IL, is a network of the leading independent property damage restoration contractors across North America. You can ask for a referral at 888-735-0800, and also find them at: www.disasterkleenup.com
RIA - The Restoration Industry Association is the leading trade association for cleaning and restoration professionals worldwide, and the foremost authority, trainer and educator in the industry. You can ask for a referral in your area at 800-272-7012, or the website: www.restorationindustry.org
Call at least two restoration contractors, if possible. Ask them to meet you at your business location to inspect the damage within 24 hours of the loss.
Remember this important point…there is NOTHING in your policy that requires you to get two or three estimates. Meeting two contractors is just a smart way to find one that you like best and want to work with. Interview them about their experience and expertise. Check out their references, and ask them for a list of satisfied customer that you can call by phone. Get a copy of their insurance certificate to be sure they have liability and Workers Compensation coverage. Call the insurance companies to confirm coverage. ONLY AFTER THE CONTRACTOR CHECKS OUT should you hire him.
You might see many restoration contractors drop by after a loss to see if they can help you with temporary repairs, like tarps on roofs, board-up, and contents removal. Don’t be annoyed...they are trying to get some new business. Appreciate their effort for what it is. Get written estimates from them BEFORE you sign ANYTHING. They will sometimes tell you that they were sent by the insurance company (maybe true, maybe not), and that it is your responsibility to protect your property from further damage (which is true). They may tell you that they will “direct bill” the insurance company (which they may do).
WARNING!!
Be very careful on contents removal, sometimes known as “pack out.” The more contents they clean, the more money they make. The cost to clean something is usually a fraction of the cost to replace it. However, I have seen restoration contractors charge more to clean an item than it costs to replace it. So, when the restoration contractors are involved, the claim value may be reduced, which benefits the insurance company. That is why many adjusters will bring a restoration contractor with them to the loss location. Remember that many policies pay REPLACEMENT COST, and following major fires, large windstorm and water losses, your damaged possessions could be replaced instead of being cleaned. Every penny that goes for cleaning your contents comes from the contents limit of liability shown on your policy declarations page. So, theoretically, a substantial amount of your insurance money to replace your items could go to the restoration company to only clean the items!! If the restoration contractor cleans a bunch of your property, and you reject it as unusable, there will be less money for replacement of your property.
So, if the adjuster and restoration contractor are all gung-ho to pack-out your property, that’s probably a good idea. Getting your property off the loss site will at least prevent it from further damage. But you should be the person that controls which contractor packs out your property. You should also bet the person that controls what gets cleaned and what gets thrown away. This may take you a significant amount of time to sort through, but that time investment will mean a much larger settlement amount.
Under no circumstances allow the adjuster or restoration contractor to make the determination about what business personal property is repairable or replaceable. The adjuster will typically want to clean items and give them back to you. You own the property...it’s your call. Fight hard about this issue!
ANOTHER WARNING!!
Sometimes, adjusters and insurance companies will tell you that you must use their “approved contractor.” Unless you can find that requirement written into the terms and conditions of your insurance policy, don’t believe it. It’s your property. YOU be the person that makes the decision on which contractor or other vendor to use.
The contract for cleaning and restoration of your property will be between you and the contractor...not the contractor and the insurance company. MAKE SURE YOU ARE IN CONTROL!!
* * * *
A restoration contractor is very different than a general contractor. Most general contractors who do remodeling or new construction do not have the skills and knowledge that a restoration contractor has.
For one thing, the restoration contractor is very familiar with the insurance claims process, and how insurance companies pay for repairs. The restoration contractors use similar estimating software to that used by the adjusters and insurance companies. A general contractor who submits an estimate in an unacceptable form to the insurance company or adjuster just annoys them, and slows down your claim.
Another reason to find restoration contractor is that they are usually full service contractors. They will be able to do temporary or emergency cleanup and board up. They will own the equipment for drying and water damage remediation. They are familiar with the kinds of damage that fires, wind and water do to commercial building. Finally, they are experts at writing accurate estimates for these specific kinds of damages.
General contractors who do not make their living in insurance restoration do not have this kind of equipment and experience. Period.
Do a search online for restoration contractors in your area. You can also look in your local Yellow Pages under “Disaster Restoration,” or “Fire Restoration,” or “Water Damage Restoration.” Look for logos in the ads that say “DKI,” or “RIA” These are professional organizations for restoration contractors. You can also go to the following websites to identify restoration contractors in your area.
DKI - Disaster Kleen-up International. Headquartered in Chicago, IL, is a network of the leading independent property damage restoration contractors across North America. You can ask for a referral at 888-735-0800, and also find them at: www.disasterkleenup.com
RIA - The Restoration Industry Association is the leading trade association for cleaning and restoration professionals worldwide, and the foremost authority, trainer and educator in the industry. You can ask for a referral in your area at 800-272-7012, or the website: www.restorationindustry.org
Call at least two restoration contractors, if possible. Ask them to meet you at your business location to inspect the damage within 24 hours of the loss.
Remember this important point…there is NOTHING in your policy that requires you to get two or three estimates. Meeting two contractors is just a smart way to find one that you like best and want to work with. Interview them about their experience and expertise. Check out their references, and ask them for a list of satisfied customer that you can call by phone. Get a copy of their insurance certificate to be sure they have liability and Workers Compensation coverage. Call the insurance companies to confirm coverage. ONLY AFTER THE CONTRACTOR CHECKS OUT should you hire him.
You might see many restoration contractors drop by after a loss to see if they can help you with temporary repairs, like tarps on roofs, board-up, and contents removal. Don’t be annoyed...they are trying to get some new business. Appreciate their effort for what it is. Get written estimates from them BEFORE you sign ANYTHING. They will sometimes tell you that they were sent by the insurance company (maybe true, maybe not), and that it is your responsibility to protect your property from further damage (which is true). They may tell you that they will “direct bill” the insurance company (which they may do).
WARNING!!
Be very careful on contents removal, sometimes known as “pack out.” The more contents they clean, the more money they make. The cost to clean something is usually a fraction of the cost to replace it. However, I have seen restoration contractors charge more to clean an item than it costs to replace it. So, when the restoration contractors are involved, the claim value may be reduced, which benefits the insurance company. That is why many adjusters will bring a restoration contractor with them to the loss location. Remember that many policies pay REPLACEMENT COST, and following major fires, large windstorm and water losses, your damaged possessions could be replaced instead of being cleaned. Every penny that goes for cleaning your contents comes from the contents limit of liability shown on your policy declarations page. So, theoretically, a substantial amount of your insurance money to replace your items could go to the restoration company to only clean the items!! If the restoration contractor cleans a bunch of your property, and you reject it as unusable, there will be less money for replacement of your property.
So, if the adjuster and restoration contractor are all gung-ho to pack-out your property, that’s probably a good idea. Getting your property off the loss site will at least prevent it from further damage. But you should be the person that controls which contractor packs out your property. You should also bet the person that controls what gets cleaned and what gets thrown away. This may take you a significant amount of time to sort through, but that time investment will mean a much larger settlement amount.
Under no circumstances allow the adjuster or restoration contractor to make the determination about what business personal property is repairable or replaceable. The adjuster will typically want to clean items and give them back to you. You own the property...it’s your call. Fight hard about this issue!
ANOTHER WARNING!!
Sometimes, adjusters and insurance companies will tell you that you must use their “approved contractor.” Unless you can find that requirement written into the terms and conditions of your insurance policy, don’t believe it. It’s your property. YOU be the person that makes the decision on which contractor or other vendor to use.
The contract for cleaning and restoration of your property will be between you and the contractor...not the contractor and the insurance company. MAKE SURE YOU ARE IN CONTROL!!
Workers Compensation Insurance: Is The System Stacked Against Workers?
Perhaps someday I will write an entire book just about Workers Compensation (WC) Insurance. Many experts before me have already done so, and I’m reluctant to plow that ground again. But I do have some comments about WC that you should know.
Workers Compensation Insurance is a very flawed system in every state of the United States. It began with the lofty intentions of politicians in each state who enacted laws to protect injured workers and get them medical benefits and treatment for their injuries. But, like most laws enacted by politicians, there are unintended consequences. Further, business lobbies, insurance companies, trial lawyers and medical lobbyists contribute huge amounts of money to the politicians at both state and Federal levels. Injured workers are individuals for the most part, and don’t have lobbyists.
Would it be too difficult for you to guess which side gets the political favors in Workers Compensation legislation?
Here’s an example of a system stacked against the injured worker. In most states, injured workers are barred from filing lawsuits against employers for their injuries. The injured worker has only the Workers Compensation system in which to receive benefits.
There are two narrow exceptions where the Workers Compensation preemption might not apply, and an employer might be subject to lawsuit:
• The employer intentionally causes injury to an employee. This exception for intentional acts is very narrow. It is not ordinarily enough that an employer creates conditions where there is a very high probability that an employee will be injured. Customarily, the employer must have committed a specific negligent act intended to cause injury to the employee.
• The employer is required to carry Workers Compensation coverage but fails to do so.
In my opinion, the Workers Compensation laws that prohibit lawsuits against employers violates the 7th Amendment, which guarantees citizens a jury trial in civil cases.
The deck may be stacked against injured workers in another way, which is that the injured worker may only seek medical treatment from a list of doctors approved by the employer or his Workers Compensation carrier.
Most injured workers receive medical treatment for their injuries and recover quickly. But whether your injuries are minor or major, the process of filing for benefits and receiving benefits can be complicated and frustrating. Most employees have no real awareness about how the system works, and only become familiar with it once they are sucked into the system by an injury.
If you are an employee who has sustained an injury, you would be well served to consult with a personal injury attorney soon after the injury. Workers Compensation is usually simpler than regular litigation since it takes place in an administrative setting and may have relaxed evidentiary rules. Also, attorney fees are often limited by state statute.
Injured workers typically need to seek legal counsel when they are refused benefits, or are told that they can return to work before they are medically able to work, or are denied disability in spite of disabling injury.
If your employer sends you to a doctor that declares you fit to return to work, even if you do not believe that you are yet able to work again, I recommend consulting a WC attorney before returning to work.
One of the tactics used occasionally by employers is to bring the recovered worker back to a position specially created for that employee to accommodate their injury. Then two or three weeks later, the employer eliminates that position and lays off the employee, ending his eligibility for workers compensation. Presto...no WC claim.
Another tactic is to refer the injured worker to doctors who are more motivated by a long-term business relationship with the WC carrier than accurately diagnosing and treating employees. In that scenario, if the doctor declares too many injured workers to have continuing disability, the carrier will terminate the business relationship and send workers to another doctor who will play the game.
A personal injury attorney specializing in WC can help protect your rights. If you seek counsel from a WC specialist, he or she will typically know the local administrative judges or hearings officers who preside over WC hearings. He will likely also know the doctors and insurance defense attorneys who are trying to block or diminish your claim. An attorney who is plugged in to the WC system in your area is your best resource to help you collect the benefits that you are due.
Workers Compensation Insurance is a very flawed system in every state of the United States. It began with the lofty intentions of politicians in each state who enacted laws to protect injured workers and get them medical benefits and treatment for their injuries. But, like most laws enacted by politicians, there are unintended consequences. Further, business lobbies, insurance companies, trial lawyers and medical lobbyists contribute huge amounts of money to the politicians at both state and Federal levels. Injured workers are individuals for the most part, and don’t have lobbyists.
Would it be too difficult for you to guess which side gets the political favors in Workers Compensation legislation?
Here’s an example of a system stacked against the injured worker. In most states, injured workers are barred from filing lawsuits against employers for their injuries. The injured worker has only the Workers Compensation system in which to receive benefits.
There are two narrow exceptions where the Workers Compensation preemption might not apply, and an employer might be subject to lawsuit:
• The employer intentionally causes injury to an employee. This exception for intentional acts is very narrow. It is not ordinarily enough that an employer creates conditions where there is a very high probability that an employee will be injured. Customarily, the employer must have committed a specific negligent act intended to cause injury to the employee.
• The employer is required to carry Workers Compensation coverage but fails to do so.
In my opinion, the Workers Compensation laws that prohibit lawsuits against employers violates the 7th Amendment, which guarantees citizens a jury trial in civil cases.
The deck may be stacked against injured workers in another way, which is that the injured worker may only seek medical treatment from a list of doctors approved by the employer or his Workers Compensation carrier.
Most injured workers receive medical treatment for their injuries and recover quickly. But whether your injuries are minor or major, the process of filing for benefits and receiving benefits can be complicated and frustrating. Most employees have no real awareness about how the system works, and only become familiar with it once they are sucked into the system by an injury.
If you are an employee who has sustained an injury, you would be well served to consult with a personal injury attorney soon after the injury. Workers Compensation is usually simpler than regular litigation since it takes place in an administrative setting and may have relaxed evidentiary rules. Also, attorney fees are often limited by state statute.
Injured workers typically need to seek legal counsel when they are refused benefits, or are told that they can return to work before they are medically able to work, or are denied disability in spite of disabling injury.
If your employer sends you to a doctor that declares you fit to return to work, even if you do not believe that you are yet able to work again, I recommend consulting a WC attorney before returning to work.
One of the tactics used occasionally by employers is to bring the recovered worker back to a position specially created for that employee to accommodate their injury. Then two or three weeks later, the employer eliminates that position and lays off the employee, ending his eligibility for workers compensation. Presto...no WC claim.
Another tactic is to refer the injured worker to doctors who are more motivated by a long-term business relationship with the WC carrier than accurately diagnosing and treating employees. In that scenario, if the doctor declares too many injured workers to have continuing disability, the carrier will terminate the business relationship and send workers to another doctor who will play the game.
A personal injury attorney specializing in WC can help protect your rights. If you seek counsel from a WC specialist, he or she will typically know the local administrative judges or hearings officers who preside over WC hearings. He will likely also know the doctors and insurance defense attorneys who are trying to block or diminish your claim. An attorney who is plugged in to the WC system in your area is your best resource to help you collect the benefits that you are due.
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