Monday, October 20, 2008

How to Shop for Health Insurance

Buying health insurance is a lot like buying a car. You can purchase your bare bones economy model or you can get a plan that's fully loaded. The question is are you driving a commuter car when you really need a 4WD SUV? Whether you've begun a new job or are shopping for private coverage there are a few questions to ask about your coverage in addition to the price of the premium.

  • You'll know what your deductible is up front. Let's say it's $500.00. Is that per person covered or is that for the entire family? If you have a procedure that isn't covered by your insurance company and you pay for it out of your own pocket does that count toward your deductible? Better to know now than later.

  • Perhaps the insurance company has specified providers in it's network. What happens if you're on vacation and have to use a provider that's out of network? Or if you simply chose to use an out of network physician? Will they pay an out of network physician anything at all or will you foot the entire bill?

  • Do I have to precertify my visits/procedures? Many times you will need to get your doctor's visits precertified. Even if your doctor refers you to another doctor it may need to be precertified. The burden of precertification is on the physician but you've got to let them know that it should be done. Many times you're required to contact the insurance company within hours of an emergency room visit as well, so check your fine print.

  • What's my limit? Just because you have insurance it doesn't mean they'll pay indefinitely. Some of them have very finite limits on the number of hospital days, doctors visits and/or a yearly dollar amount that they will cover.

  • But my doctor said I needed physical therapy, massage treatments, surgery, shots etc. No matter what sort of treatment your doctor recommends, that's no promise that your insurance will pay for it. Make sure it's covered!

  • When your spouse has insurance as well find out how this will affect your coverage. Some companies will act as a primary for you with your spouse's insurance as secondary and some will only act as secondary for you if you have other coverage.

  • If you're shopping for secondary insurance make certain that it will indeed cover the amounts your primary doesn't cover and not small fraction of that amount.

  • What are your copay amounts for regular visits vs. specialtists? What if you just pop in for a B-12 shot and don't see a doctor? Once you hand over your $20 it can be hard to get back.

The most important thing to remember about insurance is that you need to tailor it to your situation. If your spouse has great coverage and this will only pick up the co pays and secondary amounts then your coverage needs will be different than if you were shopping for primary insurance. Evaluate your needs, don't be afraid to ask questions. Don't get stuck with a 15 passenger van when all you needed was a Hyundai!

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