The worst possible time to find out what your health insurance does and does not 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.
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.
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 are buying your health insurance through a group, such as your employer, you are 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 do not 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 are 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 are 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.
Got a Question? Ask.
Ask the community a question about this article:
Frequently Asked Questions
Health insurance????
By: coriandermay | 26-08-2008
my parents have been asking me and telling me so often about health insurance it gets quite aggrivating cause they ask about it so often.........right now I am working at a daycare and am really getting like 30 or less hours a week which isn't much for minimun wage of 7.25/hour....... I wanted to know if it is possible to work 2 jobs working about part time hours for both or at least one of them and be able to get health insurance especially with working a daycare job. I had looked a little online to see what was out there but havn't gotten far and not exactly sure what to look for but I do not want to pay alot for it either if I have to pay for it myself since I am not getting a big paycheck.......... what do u guys suggest??
Comments on United Benefits of America
By: Vickie | 25-08-2008
I'd like any comments on a health care company called United Benefits of America. They have been calling me several times each day and I'm not getting a good feeling about this company.
US health insurance optio sec 125
By: IanSalter | 18-08-2008
Your employer is a small business and does not offer pretax health insurance premium payments under sec 125 what can you do to pay premiums pretax?
Medication
By: NIP1 | 11-07-2008
Who may change patient medication? Are insurance companies allowed to change patients meds, without a Doctors approval?
Define a group administrators job as it relates to ...
By: Deaconesswalton | 06-07-2008
Define a group administrators job as it relates to employer groups with health insurance.
Anyone in Rochester NY know of a health insurance ...
By: Ivy | 29-06-2008
Anyone in Rochester NY know of a health insurance for people with ESRD?
Q&A Powered by:
Latest Health Articles
Learn To Identify Acute Granulocytic Leukemia Symptoms
By: Shane Hester | 06/10/2008
Are you aware of acute granulocytic leukemia symptoms? Being aware of acute granulocytic leukemia symptoms and taking action if they are present can and does save lives.
Knee Pain Relief : How to Find the Best Football Knee Brace
By: Daniel Sims | 06/10/2008
Football players play in a rough sport. That is obvious. Knee injuries do happen, and we are offering you some information here that will help you decide on which knee brace is best for your needs. Do not keep your knees waiting, read this article to learn more.
3 Ways to Spot Dangerous Fad Diet
By: Jayson Hunter | 06/10/2008
Fad Diets are causing individuals to become very frustrated with weight loss. Fad Diets are screwing with metabolisms and sometimes causing weight gain instead of weight loss. Learn the 3 keys to identify a dangerous fad diet.
Do You Want To Lose 15 Pounds Fast
By: Garen Arnold | 06/10/2008
Losing weight is a lifestyle change. If you are serious about weight loss you can lose 15 pounds fast
Plastic Surgeons: Tips for Choosing One
By: Abigail Aaronson | 06/10/2008
One of the most crucial steps before getting plastic surgery is choosing the right plastic surgeon, and one you can trust. Make sure you do your homework and choose a doctor with experience and extensive training.
Products for Your Face Anti Aging Needs
By: Lance Bleakley | 06/10/2008
Aging itself isn't so bad-it's the signs of aging that get to us the most. No one wants to be reminded of how old they are by the appearance of crow's feet, sagging skin, wrinkles, and other unsightly signs of the passing years. Unfortunately, that is how the process works but luckily there are plenty of quality anti aging face products you can turn to.
Male Plastic Surgery: Things to Note
By: Abigail Aaronson | 06/10/2008
Vanity is not restricted to women alone. More males are getting plastic surgery to improve their overall appearance. Here are some things to keep in mind when choosing one of the more popular cosmetic surgical procedures that men are opting for.
Breast Lift Can Transform Your Looks
By: Abigail Aaronson | 06/10/2008
Pregnancy, nursing and aging can make even the firmest of breasts start to droop. A breast lift can transform your looks, giving you a firmer, perky and more attractive bust. Find out what is involved in breast lift surgery and the recovery process.
Health 
