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Information on Shopping for Health Insurance

Author: Gareth Owen

Published: 2009-03-18 : (Rev. 2010-10-12)

Synopsis and Key Points:

The most important part of choosing a good health insurance policy for you and your family is to ask the right questions.

Main Digest

The following list of topics can help you compile a list of questions to ask your health insurance provider so that you get the right policy at the right price.

The worst possible time to find out what your health insurance does and doesn't cover is when you need to claim against the policy. One of the most important parts of choosing a good health insurance policy for you and your family is to ask the right questions to discover which plan fits your needs and budget best.

1. Your health insurance policy documents

Ask for a copy of your health plan document so that you can read it through. Even if you're buying your health insurance through a group, such as your employer, you're entitled to have a copy of the complete policy for yourself. Does it explain how to get services and how to appeal coverage decisions with which you don't agree? Does it make clear what your financial responsibilities are? Make a list of questions that arise during your reading so that you can ask them of your health insurance provider.

2. Professional providers and expertise

Many health insurance policies limit you to choosing from a pool of hospitals and professional providers. Are there limitations on the professionals from whom you can seek care? Is there a list of providers that you can reference? Are there provisions for using a health care provider that is not on the approved list

3. What limitations are on your health care providers

Be sure that your health insurance provider has not placed contractual obligations on your health care providers that may interfere with or influence treatment decisions. Are your providers allowed to discuss all of your treatment options with you, even if they're not covered on the plan? Do they pay the provider the same amount regardless of the treatment that they prescribe? Does the plan offer rewards to the providers for keeping their costs low

4. Can you appeal decisions

Every health insurance company should have a formal appeal and grievance procedure to allow you to complain or request a reconsideration of decisions made about your care. Is the appeals procedure clearly defined? To whom can you complain if you're not satisfied with a decision, or an appeal? Is there a formal grievance procedure and a way to report plan physicians and providers if you have a complaint about your care

5. Are your medical records kept confidential

You have a right to expect your medical records and personal details to be kept confidential. Ask your insurance provider about their confidentiality policy. Will your medical records be shared with anyone without your specific permission? What information from your medical records is provided to the payer? In general, the insurance company has no right to receive anything more than diagnosis, prognosis, length of treatment, type of treatment, and cost.

6. Choice of providers

How much choice will you have in the providers that you choose? Are your choices restricted in any way? What credentials does your insurer require of professionals associated with the plan, or for payment by the plan? Will your plan cover alternative or complementary treatments if they are prescribed

7. Who will make treatment decisions

Who will be involved in making your treatment decisions? If it will be anyone other than your health care provider? Do they have the appropriate training to make medical decisions

8. Will I be covered for catastrophic illnesses

Many health insurance policies do not cover the so-called "catastrophic illnesses" like cancer, stroke and heart attack. You may need other insurance cover to insure yourself against those.

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