Published October 2001

Study market, ask questions when choosing insurance

By Kurt Miller
Guest Editorial

Many people get caught up in how much the price of their insurance policy is now. This fixation is misplaced because health insurance is not intended to protect you while you are healthy; rather, it is intended to protect you financially while you are sick. This is the time when the true cost of your policy becomes evident. Here are some things to think about.

Q: Who determines what is medically necessary?

A: Other than routine visits, nothing is covered unless it is deemed “medically necessary.” Many insurance companies take this decision out of the hands of your doctor and place it, instead, with their own staff. The insurance company’s staff has the right to overrule your doctor and deny payment on procedures they decide are unnecessary.

Q: Can you go out-of-network?

A: Many people make a decision on a health insurance plan based on whether or not their family physician is on the list. This decision may cost them their lives. Having access to the best doctors and hospitals can make the difference between life and death when serious ailments are contracted.

Q: If out-of-network options are provided, how are they paid?

A: Many plans offer coverage to out-of-network providers, but they only pay based on in-network rates. A $10,000 in-network procedure in Washington could easily cost $20,000 out-of-network in Los Angeles or New York.

Q: If you get sick, how do you know all possible treatment options are presented to you?

A: Plans that have total control over your health care also have total control over your information. Often, new and/or expensive tests or procedures that may be extremely effective in diagnosing and treating you will never be made known to you.

Q: Has your primary-care physician become your specialist?

A: Even though your HMO may have many specialists in its network, you do not have access to these specialists unless your primary-care physician gives you a referral AND the insurance company approves it.

For these reasons, you should investigate the market, learn all your options, find someone you can trust to guide you and find the plan that fits your needs and budget. Sometimes the “in all cases” health insurance is not nearly as comprehensive as the “just in case” health insurance.

Remember, your auto insurance doesn’t cover oil changes, and you don’t want the quick-lube places doing a major overhaul.

Kurt Miller is a Lynnwood-based agent for Health Insurance of Washington. More information is available at the company’s Web site, http://healthinsuranceofwashington.com.

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