Private Health Insurance

[FeeFee]

(Massachusetts)

I am thinking of buying a private health insurance and found one that seems to suit me well, but there's something that I cannot understand.

The agent told me that I can quit the program any time, there's no waiting period before a claim can be made, and the yearly maximum amount covered by the plan is not pro-rated.

So I asked her if I can join the plan and pay my first month premium (less than $100), go do a root canal, file my claim, and then quit. She says I can do that, but anything higher than $500 must be approved beforehand, therefore a root canal procedure will require pre-approval. Since the plan says that a root canal procedure is covered, so I should be fine.

This really does not make any sense to me and I am trying to see if there's anything flaky. Any suggestion? Thanks.

[cbg]

Sounds right to me.

[TIMMAAYY]

"Requires Pre-Approval" - you may not get "approval".

[cbg]

The procedure sounds right. Timmaayy is correct that you are not guaranteed approval, but if there's a valid reason for it, it is more likely than not.

[TIMMAAYY]

I'm just thinking that for an $800 + root canal, and Lord help you if you add a $500 crown to it... the insurance company may be hiding a loophole.

[FeeFee]

That's one of my suspicions too, but if the policy states that a root canal procedure is covered, can they not approve it? I've pretty much read everything available on their web site and can't find any loop hole, but this is just too good to be true.

[TIMMAAYY]

Call and ask about the procedure as required for "pre approval". Let us know how it turned out.

I've not seen a dental plan that allowed that kind of coverage, but more power to you if they do. I have done this for people on group plans with maternity... since they can't pre X it out...basically doing what you decribed above ( sign up, have the baby, cancel the insurance for small group ).