Health Insurance What if I Have to Go to the Hospital? 

What if I Have to Go to the Hospital?

The time to find out what rules your plan has on hospital care is before you need it.

Planned Hospitalizations 

Unless it is a medical emergency, your health plan or primary care doctor will probably have to give advance approval (preadmission certification) for you to go to the hospital. Otherwise, the cost of your hospital care may not be covered. Ask these questions:

  • What hospitals are part of the plan network?
  • Is there a limit on how long I can stay in the hospital?
  • Who decides when I am to be discharged?
  • Will needed followup care, such as nursing home or home health care, be covered by the plan?
  • If I
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How Can I Get the Most from My Plan Health Insurance? 

How Can I Get the Most from My Plan?

You will get the best care if you:

Stay Informed

  • Read your health insurance policy and member handbook. Make sure you understand them, especially the information on benefits, coverage, and limits. Sales materials or plan summaries cannot give you the full picture.
  • See if your plan has a magazine or newsletter. It can be a good source of information on how the plan works and on important policies that affect your care.
  • Talk to your health benefits officer at work to learn more about your policy.
  • Ask how the plan will notify you of changes in the network of providers or covered services while you are part of the plan.

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How Do I Find Out About Quality Health Insurance?

How Do I Find Out About Quality?

Quality is hard to measure, but more and more information is becoming available. There are certain things you can look for and questions you can ask. Whatever kind of plan you are considering, you can check out individual doctors and hospitals.

Many managed care plans are regulated by Federal and State agencies. Indemnity plans are regulated by State insurance commissions. Your State Department of Health or insurance commission can tell you about any plan you are interested in.

You can also find out if the managed care plan you are interested in has been “accredited,” meaning that it meets certain standards of independent organizations. Some States require accreditation if plans serve special groups, … Read More

What Plan Benefits Are Offered?

What Plan Benefits Are Offered?

Most plans provide basic medical coverage, but the details are what counts. The best plan for someone else may not be the best plan for you. For each plan you are considering, find out how it handles:

  • Physical exams and health screenings.
  • Care by specialists.
  • Hospitalization and emergency care.
  • Prescription drugs.
  • Vision care.
  • Dental services.

Also ask about:

  • Care and counseling for mental health.
  • Services for drug and alcohol abuse.
  • Obstetrical-gynecological care and family planning services.
  • Ongoing care for chronic (long-term) diseases, conditions, or disabilities.
  • Physical therapy and other rehabilitative care.
  • Home health, nursing home, and hospice care.
  • Chiropractic or alternative health care, such as acupuncture.
  • Experimental treatments.

Some plans offer members health education and … Read More

Choosing a Health Plan

Health care in America is changing rapidly. Twenty–five years ago, most people in the United States had indemnity insurance coverage. A person with indemnity insurance could go to any doctor, hospital, or other provider (which would bill for each service given), and the insurance and the patient would each pay part of the bill.

But today, more than half of all Americans who have health insurance are enrolled in some kind of managed care plan, an organized way of both providing services and paying for them. Different types of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point–of–service (POS) plans.

You’ve probably heard these terms before. But what do they mean, and … Read More