Articles & Related Information How to Evaluate a Health Insurance Company © Patricia Foote, May 2000 Does the plan provide for regular, preventive health exams?   Do preexisting medical conditions prevent full coverage? How long do you need to be enrolled before a preexisting condition will be covered?   Does the plan allow you a choice of physicians?   Are there any co-payments?   Which services need pre-approval? Who will authorize this pre-approval and how far in advance of the procedure does it need to be done?   How are participating physicians paid? Is there a capitation policy? (Capitation: a method of payment for health services in which a physician or hospital is paid a fixed per capita amount for each person served, regardless of the actual number or type of services provided to each person.)   Are there "gag clauses" that keep a doctor from recommending treatment or criticizing the plan?   Can you contact specialists directly or do you need a referral?   Does the plan provide a prescription drug benefit?   Does the plan include full reproductive health and pregnancy care?   Does the plan provide treatment for mental health problems? Is there a limit to the number of visits?   What are the deductibles and/or co-payments?   How are treatment decisions reviewed?   Is there an appeals process if a service is denied and what is it?   Are genetic tests covered?   What is the policy on experimental drugs and clinical trials?   What are the restrictions/benefits for emergency procedures?   Is coverage nationwide/worldwide?   What is the "medical-loss ratio" (the amount that the provider actually spends on medical care)?   Does this policy contain a catastrophic illness clause?   Is there a life-time cap on reimbursement payments? What is it? What services are not covered?   Is the insurance company registered and accredited? Contact: Group Health Association of America, 1129 20th St., N.W., Suite 600, Washington, D.C. 20038.   Read the review of managed care in America done by the National Committee for Quality Assurance.   Read "What Cancer Survivors Need to Know About Health Insurance" published by the National Coalition for Cancer Survivorship.   Add your own questions .... Collecting Health Insurance Benefits: Send your claims in on time. Most insurance companies have a time limit for submitting claims.   If you are too tired to work on bills yourself and noone else can do it, consider hiring a health claims processing service to do it for you.   Keep copies of all bills and correspondenced with the insurance company.   Submit bills in the proper order i.e. first to the primary insurer and then to the secondary insurer. Patricia Foote is a trainer for Stanford University's "The Chronic Disease Self-Management Course" and is the author of How Are You? Manage Your Own Medical Journey, available from Amazon.com or local bookstores. July 3, 2009 Genworth Insurance Company - Long Term Care | LTC Insurance Quote | Site Map This web site should be considered an advertisement and is not a contract. Products and services mentioned in this web site are meant to be only valid for distribution in the State of Illinois, United States of America. The intent of this website is to gather consumer requests for product information or quotes, and transfer them in a timely manner to a licensed professional who will contact the consumer directly regarding their specific needs.