Health Insurance Policy

A Health insurance policy is a contract between an insurance company and an individual. The contract can be renewable annually or monthly. The type and amount of health care costs that will be covered by the health plan are specified in advance, in the member contract or Evidence of Coverage booklet. The individual policy-holder's payment obligations may take several forms[7]: Premium: The amount the policy-holder pays to the health plan each month to purchase health coverage. Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health plan. It may take several doctor's visits or prescription refills before the policy-holder reaches the deductible and the health plan starts to pay for care. Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays for a particular visit or service. For example, a policy-holder might pay a $45 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained. Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a surgery, while the health plan pays the other 80%. Because there is no upper limit on coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on the actual costs of the services they obtain. Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket. Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The policy-holder may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some plans have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum, and the policy-holder must pay all remaining costs. Out-of-pocket maximums: Similar to coverage limits, except that in this case, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year. Prescription drug plans are a form of insurance offered through many employer benefit plans in the US, where the patient pays a copayment and the prescription drug insurance pays the rest. Some health care providers will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company doesn't pay, as the insurance company pays according to "reasonable" or "customary" charges, which may be less than the provider's usual fee. Health insurance companies also often have a network of providers who agree to accept the reasonable and customary fee and waive the remainder. It will generally cost the patient less to use an in-network provider. Health plan vs. health insurance Historically, HMOs tended to use the term "health plan", while commercial insurance companies used the term "health insurance". A health plan can also refer to a subscription-based medical care arrangement offered through health maintenance organization,HMO, PPO, or POS plan. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review). Inherent problems with insurance Insurance systems must typically deal with two inherent challenges: adverse selection, which affects any voluntary system, and ex-post moral hazard, which affects any insurance system in which a third party bears major responsibility for payment, whether that is an employer or the government. Some national systems with compulsory insurance utilize systems such as risk equalization and community rating to overcome these inherent problems.

Attorneys Fee

Attorney's fee is a chiefly United States term for compensation for legal services performed by an attorney lawyer or law firm for a client, in or out of court. It may be an hourly, flat-rate or contingent fee. Attorney fees are separate from fines, compensatory and punitive damages, and except in Nevada from court costs in a legal case. Surveys suggest that fees range from $150 to $1000 per hour when billed hourly. Under "the American rule" attorney fees are usually not paid by the losing party to the winning party in a case, except at the federal level or for specific statutory reasons.

The phrase is a legal term of art in American jurisprudence in which lawyers are collectively referred to as "attorneys", a wording practice not found in most other legal systems. Attorney's fees or attorneys' fees, depending upon number of attorneys involved, or simplified to attorney fees are the fees, including labor charges and costs, charged by lawyers or their firms for legal services provided by them to their clients. They do not include incidental, non-legal costs e.g. expedited shipping costs for legal documents. Generally Nevada being an exception, attorney fees are tabulated separately from court costs, and are also separate from fines, compensatory and punitive damages, and other monies in a legal case not enumerated as court costs.

The analogous concept has differing names and applicability in common law systems such as in most of the Commonwealth of Nations, and in civil law systems such as those of most of Europe and many former European colonies. For example, in a court case under English law, the fees of solicitors and barristers two types of lawyer are combined with court costs and various other expenses into a combined "costs", while non-court solicitor expenses may be separately billed as per-hour charges and those of barristers as daily brief fees. The losing party in a case in most common law systems pays for the costs including fees of both parties.

State laws or bar association regulations, many of which are based on Rule 1.5 of the American Bar Association's Rules of Professional Conduct, govern the terms under which lawyers can accept fees. Many complaints to ethics boards regarding attorneys revolve around excessive attorney's fees.

In some American jurisdictions, a lawyer for the plaintiff in a civil case can take a case on a contingent fee basis. A contingent fee is a percentage of the monetary judgment or settlement. The contingent fee may be split among several firms who have contractual arrangements amongst themselves for referrals or other assistance. Where a plaintiff loses, the attorney may not receive any money for his or her work. Many countries prohibit contingent fees as unethical. Most jurisdictions in the United States prohibit working for a contingent fee in family law or criminal cases.

In the United States, an up-front fee paid to a lawyer is called a retainer. Money within the retainer is often used to "buy" a certain amount of work. Some contracts provide that when the money from the retainer is gone, the fee is renegotiated. This is to be differentiated between a retainer in Commonwealth states, where a retainer is the contract that is initially signed by a client to engage a lawyer. Money may or may not be paid up front, but the lawyer is still "retained".

The range of fees charged by lawyers varies widely from one city to the next. Most large law firms in the United States bill between $200 and $1,000 per hour for their lawyers' time, though fees charged by smaller firms are much lower. The rate varies tremendously by location as well as the specific area of law practiced. Typically insurance defense firms have lower hourly rates than non-insurance firms, but are compensated by having steady, regular paying work provided. Locations like Salt Lake City will average $150 per hour for an associate's time on a basic case, but will increase for larger firms.

Many surveys of hourly rates are done. The American Intellectual Property Law Association "AIPLA" commissions a survey of its members every 2 years and it publishes these in what it calls a "Report of the Economic Survey". The latest one is dated June 2007. Rates are collected for 14 geographic areas and by associate or partner.  Many courts have followed the rates shown by these AIPLA surveys and they are highly-regarded for Intellectual Property litigation.

The State Bar of Oregon and the Colorado State Bar also have published a survey of rates for various areas of Oregon and Colorado and these are available online.

Perhaps the most widely followed set of rates are what is called the Laffey Matrix that is available from the United States Attorney's Office for the District of Columbia. These have been available since 1982 and are updated each year. The hourly rates are shown by years of experience. For June 1, 2006 to May 31, 2007 the rates are as follows: 20+ years of experience, $425 per hour; 11–19 years, $375; 8–10 years, $305; 4–7 years, $245; 1–3 years, $205; and Paralegals/law clerks $120. The Laffey Matrix appears to be growing in acceptance by many courts throughout the United States, but the matrix must be adjusted to account for higher or lower costs for legal services in other areas.

Hourly rates are increasing almost every year and some lawyers charge substantially higher than the rates shown by the Laffey Matrix. The first American attorney to regularly charge a four-digit hourly fee $1000 and higher was Benjamin Civiletti in late 2005.

With the ongoing recession of the 2000s, corporate clients began driving attorneys increasingly toward alternative fee arrangements, or AFAs. AFAs can include flat fees per matter, fixed fees for a "book" of matters, success bonuses, and other options beyond straight hourly billing.

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