American Academy of Family Physicians Says it’s Important Parents Understand Their Healthcare Plans
[9/27/07]
No matter what type of health insurance you have the American Academy of Family Physicians says it is important that you completely understand the nature and the details of your healthcare insurance plan.
The Academy says that most patients who have group medical insurance from an employer, have a managed care plan and do not even know that, nor know what the rules of the healthcare plan are. Family physicians say they see countless numbers of patients who admit to never having read the packet of information that came with their health insurance plans. A big mistake according to the Academy. They want to urge all people with medical insurance to take the time to understand their healthcare plans. A recent report released by the Academy said that patients especially need to be sure they are clear on the rules governing their particular healthcare insurance plan as they relate to 4 specific areas: Doctors, Hospital Visits, Specialists, and Prescription Medications.
Hospitals and Doctors.
In a managed care health insurance plan you are dealing with a group of doctors who have contracted with your health insurance company to provide healthcare services to you. This group is often referred to as a network of providers. Even though the providers are under contract with your insurance company, your insurance company may not pay the full amount of the fees charged for services. You are responsible to pay the doctor in full the amount that the insurance company does not pay. Be sure you understand the limitations of payments on your health insurance policy. This way you will not receive a bill from your doctor and exclaim – “I thought I was covered for that”. In some types of health insurance plans you may be entitled to see doctors outside of the network, but you will almost surely pay more out of pocket if you do so.
The same is true of hospitals. Under a managed care plan your insurance company contracts with specific hospitals. Your costs may not be reimbursed if you are treated at a hospital outside of your plans network. Be sure your doctor is aware of this when he refers you to a hospital.
Specialists
Again so you are not hit with unexpected bills, the Academy suggests you clearly understand your healthcare insurance plans rules regarding specialists. Some health insurance plans, specifically HMO’s will not pay for a visit to a specialist, without a referral from your primary care physician.
Medications
If your health insurance provides prescription drug coverage it almost certainly will have a drug formulary. A drug formulary is a list of available medications from which your doctor can prescribe. If he prescribes a medication that is not on the list, you will have to pay more for it - or select an approved medication instead unless he can prove to the insurance company that that drug is “medically necessary”
The Academy says that most patients who have group medical insurance from an employer, have a managed care plan and do not even know that, nor know what the rules of the healthcare plan are. Family physicians say they see countless numbers of patients who admit to never having read the packet of information that came with their health insurance plans. A big mistake according to the Academy. They want to urge all people with medical insurance to take the time to understand their healthcare plans. A recent report released by the Academy said that patients especially need to be sure they are clear on the rules governing their particular healthcare insurance plan as they relate to 4 specific areas: Doctors, Hospital Visits, Specialists, and Prescription Medications.
Hospitals and Doctors.
In a managed care health insurance plan you are dealing with a group of doctors who have contracted with your health insurance company to provide healthcare services to you. This group is often referred to as a network of providers. Even though the providers are under contract with your insurance company, your insurance company may not pay the full amount of the fees charged for services. You are responsible to pay the doctor in full the amount that the insurance company does not pay. Be sure you understand the limitations of payments on your health insurance policy. This way you will not receive a bill from your doctor and exclaim – “I thought I was covered for that”. In some types of health insurance plans you may be entitled to see doctors outside of the network, but you will almost surely pay more out of pocket if you do so.
The same is true of hospitals. Under a managed care plan your insurance company contracts with specific hospitals. Your costs may not be reimbursed if you are treated at a hospital outside of your plans network. Be sure your doctor is aware of this when he refers you to a hospital.
Specialists
Again so you are not hit with unexpected bills, the Academy suggests you clearly understand your healthcare insurance plans rules regarding specialists. Some health insurance plans, specifically HMO’s will not pay for a visit to a specialist, without a referral from your primary care physician.
Medications
If your health insurance provides prescription drug coverage it almost certainly will have a drug formulary. A drug formulary is a list of available medications from which your doctor can prescribe. If he prescribes a medication that is not on the list, you will have to pay more for it - or select an approved medication instead unless he can prove to the insurance company that that drug is “medically necessary”
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