What Are Your Priorities?
First decide which parts of your health care are most important:
Do you already have a primary care doctor or specialist you don't want to leave?
Do you have a strong preference for or against a local hospital?
Do you care which pharmacy you go to, and could you live with being assigned to only one?
Would it be difficult for you to take off work or travel to your primary care doctor's office to deal with restrictions on specialists or the need to have a written referral form?
Are complementary therapies, like accupuncture or chiropractic, important to you?
Don't rely on the plan's directory to decide if your doctor does or does not take the plan - the lists go out of date before they are even printed. And don't assume that you can use a specialist or hospital if they are listed as participating - they may only be available if your primary care doctor is capitated to them or may only be available for certain specialized services that less expensive hospitals don't provide.
A hospital that takes your plan may have in-house doctors - like anesthesiologists or emergency room doctors - who don't, and you may have to pay their extra fees on some plans. Call and ask.
Try not to make decisions based too much on what you need most right now. The purpose of insurance is to spread costs out so the healthy support the care of the sick. You are getting insurance in case you get sick some day.
If you pay too much attention to little details, like whether your drug co-pay is $5 or $10, you may miss the big things, like what kind of rehabilitation is available if you are paralyzed in a car crash. Be especially attentive to mental health care coverage, which you are most likely to find inadequate if you are seriously disabled and can't pay for any costs yourself.
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©2000 Eileen K. Carpenter, MD