Identifying Your Health Plan Providers

MK | January 1, 2010

Q: Does this company have a license, are you a member of the Better Business Bureau, and what is the name on the insurance card. Also, do you have a phone number?

A: Today's health insurance plans, including all of those listed at MedSave.com, are commonly compiled from of a handful of independent or related companies that offer specific specialized services. To answer your question, it is necessary to identify each provider separately. This information should be included in the enrollment brochure or Web page for each health plan.

In most cases there are five separate companies you will find when considering a health plan here at MedSave.com include:
1) MedSave.com
2) OnlineAdviser
3) the health plan administrator
4) the insurance company
5) the preferred provider network

MedSave.com is a Web site that compiles listings and reviews of low cost insurance plans and not an insurance company, does not have a license, is not a member of the Better Business Bureau and is not listed on the insurance card.

OnlineAdviser is a personal Web-based support service for a wide range of online transactions, including MedSave.com. Again, like MedSave.com, OnlineAdviser is not an insurance company, does not have a license, is not a member of the Better Business Bureau and is not listed on the insurance card. Neither MedSave.com nor OnlineAdviser service offer telephone support.

Each health plan has a plan administrator that is a member of the BBB. More information on the BBB membership is available by clicking on the "BBB Online Reliability" logo of any Web page that advertises BBB membership. The plan administrator handles most member contact after enrollment including billing, claims, issuance of policies and ID cards, and telephone support. The plan administrator is the company that has access to your personal and financial information. For this reason, it is important to use a health plan with a strong consumer reputation and a clear BBB record. Those featured prominently at MedSave.com, including "HPA", "IMG", "Careington", "SAS", and "Coordinated Benefits", all fit this description. The telephone number is listed in the policy, on the ID card, and at MedSave.com on the "Support" page.

Most health plans - including all that use the word "insurance - use the financial backing of an insurance company. However it is important to distinguish that some common health plans are uninsured benefit plans. The insurance company does not have direct contact with health plan members but state laws require that the insurance company use licensed agents to handle sales functions, especially when sales are handled in a traditional off-line manner like face to face enrollment or solicitations by mail. Each of the other companies listed here has licensed agents to handle appropriate sales functions. The name of the insurance company for each health plan and agent is listed on the brochure, the Web site, in the policy and on the ID card for each health plan. However, it is becoming increasingly common to omit the telephone number to avoid confusing customers - neither the insurance company nor its agents have access to customer records and do not handle "day-to-day" transactions. Neither the insurance company nor its agents have ongoing access to your personal information, although some information may be provided as needed on a limited basis. For these reasons, insurance companies and its agents are generally not BBB members. In some cases, the insurance company can change while the health plan seems to continue. For example "American Health Shield" and "Secure STM" have changed insurance companies while the administrator remained the same. The insurance company guarantee the provisions of the contract and therefore a sense of financial stability. In all cases, the insurer should have a strong financial rating and the agent should be independently insured for errors and omissions.

The provider networks, often known as "PPOs" are independent from both the insurance company and the plan administrator. The PPO is the primary contact for locating and pre-authorization of health plan benefits. For example, "Private Health Care Systems Inc." (commonly known as PHCS) is among the most recognized names in health plans today. Yet this company actually does not issue any health plans or provide any insurance. Most major medical health plans have at least two PPO providers - one for hospital and doctors and another for prescription drugs. Some plans offer their members a choice of PPO providers.

We understand that all of this can be overwhelming at first to health plan members. The rapid pace of change in the health insurance industry and the implementation of burdensome federal law known as "HIPAA" makes it even more difficult. Still, we think is is important to understand who is providing the services in your health plan. We can help with questions about specific health plans; just make sure to include the name of your health plan (or are considering) and your state of residence.

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