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Beyond the Box Office Screen—Medical Insurance Companies’ Corporate Structure
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Medical insurance means health and financial security. You will be able to avail the medical services you need especially in times of emergencies and when you do not have enough cash at hand. It also translates to savings since you will no longer shoulder your medical expenses once your policy has been approved and declared effective.
Medical insurance policy of varying coverage can be obtained in different ways. If you are currently employed, you do not need to apply for an individual policy for you are automatically enrolled in the group medical insurance policy sponsored by your employer. If you are not currently employed, let us say you have your own business or you are an ordinary individual, you need to apply for a self-employed or individual medical insurance policy, respectively.
Whatever type of plans you want to get or medical coverage you want to avail, different medical insurance policies just come from one entity—and that is, a medical insurance company. They are the ones providing the medical coverage stated on each type of your medical health insurance policy. They are also in charge of the processing and approval or denial of every policy application from their clients.
We have already read articles before about how to get the best medical insurance companies that offer the coverage you really need. What if we shift our discussion to other aspects of medical insurance companies?
Since you already understand what the best medical insurance companies for you are, it is now time to understand their overall operations. This will shed light on how the premiums of their policies are set as well as appreciate the persons or groups influencing their medical coverage and service.
Probably you will notice that there are hundreds of medical insurance companies operating in the United States. However, their operational structures have still something in common. Read on the preceding sections and familiarize yourself with the in-charge departments and their respective functions.
Executive and Administrative Department
This is spearheaded by the medical insurance company himself who is in-charge of the overall operations of the company. All major and important decisions are made in this level such as reorganization within the company ranks. The decisions made by this department may either directly or indirectly affect the premium charges for their policy.
Marketing Department
This department is tasked to handle public relations and advertising matters of the medical insurance companies. The marketability of their medical policies as well as their advertising decisions may affect the medical plans they will be offering in the future.
Agency Department
This department is concerned with the employment, training, and compensation of the insurance company’s sales force that is composed of medical insurance agents. It also provides additional customer service to insurance agents assigned on field work.
Underwriting Department
This department is in-charge of the review of individual medical histories of the policy applicants and decides whether they should receive coverage or not. They usually set the plan rates based on the geographic, demographic, and risk classifications summarized by the actuarial section which is composed of mathematicians and statisticians.
Finance Department
It is spearheaded by the company treasurer which is tasked to handle and manage the medical insurance companies’ investments. The flow of investments and its performance in the market may actually affect the premium settings of your policy.
Claims Department
This department facilitates the payment of all medical bills submitted either by the policyholder himself or his attending physician. They often work with the physicians or hospital’s concerns to settle the claims.
Understanding the corporate structure of various medical insurance companies as well as appreciating their respective functions will answer your queries on how they process your policy papers and approve your medical claims.
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