How to Evaluate a Health Insurance Company

Does the plan provide for regular, preventive health exams?   Do preexisting medical conditions prevent full coverage? How long do you need to be enrolled before a preexisting condition will be covered?   Does the plan allow you a choice of physicians?   Are there any co-payments?   Which services need pre-approval? Who will authorize this pre-approval and how far in advance of the procedure does it need to be done?

LTC Insurance: Compare the top companies, and get the best quote for your needs.

• How are participating physicians paid? Is there a capitation policy? (Capitation: a method of payment for health services in which a physician or hospital is paid a fixed per capita amount for each person served, regardless of the actual number or type of services provided to each person.)
   
• Are there "gag clauses" that keep a doctor from recommending treatment or criticizing the plan?
   
• Can you contact specialists directly or do you need a referral?
   
• Does the plan provide a prescription drug benefit?
   
• Does the plan include full reproductive health and pregnancy care?
   
• Does the plan provide treatment for mental health problems? Is there a limit to the number of visits?
   
• What are the deductibles and/or co-payments?
   
• How are treatment decisions reviewed?
   
• Is there an appeals process if a service is denied and what is it?
   
• Are genetic tests covered?
   
• What is the policy on experimental drugs and clinical trials?
   
• What are the restrictions/benefits for emergency procedures?
   
• Is coverage nationwide/worldwide?
   
• What is the "medical-loss ratio" (the amount that the provider actually spends on medical care)?
   
• Does this policy contain a catastrophic illness clause?
   
• Is there a life-time cap on reimbursement payments? What is it? What services are not covered?
   
• Is the insurance company registered and accredited? Contact: Group Health Association of America, 1129 20th St., N.W., Suite 600, Washington, D.C. 20038.
   
• Read the review of managed care in America done by the National Committee for Quality Assurance.
   
• Read "What Cancer Survivors Need to Know About Health Insurance" published by the National Coalition for Cancer Survivorship.
   
• Add your own questions ....

Collecting Health Insurance Benefits:

• Send your claims in on time. Most insurance companies have a time limit for submitting claims.
   
• If you are too tired to work on bills yourself and noone else can do it, consider hiring a health claims processing service to do it for you.
   
• Keep copies of all bills and correspondenced with the insurance company.
   
• Submit bills in the proper order i.e. first to the primary insurer and then to the secondary insurer.