No matter the season, when it’s time to renew your health insurance, literature can stack up in your mailbox like a pile of autumn leaves.
You can put away the rake. Instead, use the following 10 questions from the American Medical Association (AMA) to help make sense of the literature and pick your health plan.
- Who’s on the plan? If your doctor isn’t, are participating doctors in your area accepting new patients?
- What does the plan cover? Check on:
- Prescription drugs
- Preventive care
- Mental health services
- Second opinions
- Limitations on routine care or hospital stays
- Location of labs and other facilities
- Are pre-existing conditions covered?
- Does your primary care physician have to receive permission from the insurance company to refer you to a specialist?
- Does your physician’s contract with the insurance company prevent him or her from telling you about certain options or procedures?
- How does the plan determine which treatments are “experimental” or “investigational?”
- Will the plan pay for emergency care when the patient is out of town, away from a network provider?
- How often does the list of participating doctors change? Will the doctor you’re seeing this year still be on the plan next year?
- How does the plan cover procedures, like breast reconstruction or cleft palate repair, for “congenital conditions” and “cosmetic” conditions?
- How does the plan define “medically necessary?” Can you appeal if a service is denied?