Managing Health Appointments and Insurance

February 2013

Managing Health Insurance
Manage your healthcare appointments/history/records. This website has an excellent set of checklists and forms.

U.S. Department of Health and Human Services
Access a question builder to help you prepare for your next doctor’s appointment.

Insurance

Know your own plan

1. Services covered
2. Participating healthcare providers and locations covered. In network versus out of network.
3. Limits on the number of times certain services are covered and length of time you can use each service
4. Cost-sharing, such as co-insurance, co-payments and deductibles.
5. Coverage of inpatient care vs. outpatient care
6. Are referrals and pre-approvals/pre-authorizations required and for what services
7. Who is responsible for obtaining the referral
8. What additional programs and services are available (i.e., disease management, wellness programs, exercise programs, chronic care programs, alternative medical therapies, preventive care, mail pharmacy)

 Know other benefits available

1. Flexible spending account
2. Health savings account
3. Health reimbursement account

During open enrollment period, consider, in addition to

1. Are PCP and specialists in the network of plan
2. Will the plan allow me to continue using the healthcare providers I am now using to treat my child?
3. Will special services for my child be covered, like physical therapy, or mental health visits?
4. Does the child’s doctor have the final say in referring to a specialist?
5. Cost benefit of plans with high premiums or high deductibles
6. Lifetime benefit maximums