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Inside this Article
Health Insurance
--Selecting a Policy
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Whether you're trying to decide
which plan to get through your employer (since they often offer several
choices) or you're trying to decide on an individual health plan, you
need to think first about your needs.
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Health Insurance - Do you want a
plan that covers preventive care like annual check-ups?
Remember that most fee-for-service plans don't cover these visits,
but managed care plans do. It is particularly important to consider this
aspect if you have (or are planning to have) children.
Health Insurance - How healthy are you?
If you need a low premium and are healthy,
you might consider a plan with a higher deductible. Keep in mind that
accidents happen, however, and a single hospital stay could wipe out
your savings and put you into debt. Think about how much money you would
be able to put toward medical expenses if it should become necessary.
Health Insurance -
Do you have
a specific doctor or hospital you want to be able to use?
Remember that managed care plans use networks of doctors, and unless
your doctor is in that network you'll pay all or some of the bills
whenever you see him. If a specific doctor (or doctors) is necessary,
you might need a fee-for-service plan.
Health Insurance - How important is
it to you to have easy access to specialists?
Many managed care plans require a referral from your primary care
physician before you can see a specialist. If they don't feel it is
necessary, then you'll be paying for the visit out of your own pocket.
Health Insurance - Mental health
treatment
Some plans cover mental health treatment as well as drug
rehabilitation. Although, some only cover substance abuse if it
co-occurs with mental illness. To get access to these types of services
you may be required to get a referral from your regular doctor first.
Mental health and substance abuse services may also be offered through
an employee assistance program (EAP) if your employer has one.
Health Insurance -Complaints
Most critics of health
insurance complain about HMOs.
They complain about the lack of selection of PCPs and
the red tape that you have to go through when you need a referral. There
is also concern about people being denied referrals or treatments that
are not deemed "medically necessary. Many critics claim that
decisions are made based on profitability rather than true medical need.
An article in the New England Journal of Medicine states that
"Previous studies have documented that cardiac procedures are
performed less frequently in patients enrolled in managed-care plans
than in those with fee-for-service coverage" .
Many states have laws providing the right to an independent medical
review when you are denied coverage for medical procedures.Other criticisms of health
insurance in general stem from the rising costs of premiums,
co-payments, and deductibles. However, these costs also have to keep
pace with the rising cost of medical care itself.
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