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Insurance > Health Insurance
Making sure your health insurance company isn't curbing your medical treatment
THERESA AGOVINO, AP Business Writer. Associated Press.
Copyright Associated Press
Q, How can I ensure that my medical treatment isn't shortchanged by my health plan's financial concerns?
When you're diagnosed with a disease, you should immediately start educating yourself about your condition and the treatments that are considered the best for it, said Arthur Levin, director of the Center for Medical Consumers. Such knowledge will help you understand whether you are receiving good care.
Levin suggests consumers turn for information to nonprofit groups such as the American Heart Association or American Cancer Society. The Internet is full of sites about drugs and diseases, but many are designed to promote a product. Be wary, Levin said.
Nonprofit groups can help you find the best doctors and hospitals in your area to treat your illness, but some of these health care providers might not be in your health insurance network. If you don't believe your network has the best specialists, talk to your employer about possibly widening the circle. Some states have laws that require plans to have a certain number of specialists within a geographic range and who are taking new patients.
Still, you may have to go outside the network and pay out of pocket to see the best doctors. If so, ask the doctor if he or she would accept what your plan pays other similar specialists.
Many plans have a finite number of brand name drugs with an affordable copayment. Most plans do reimburse you for other drugs if your doctor says they are medically necessary, so ask your physician to intervene for you if necessary. If your plan doesn't cover the drugs you need, some pharmaceutical companies provide free drugs in certain circumstances. Again, ask your doctor for help.
If your doctor recommends a treatment he or she deems medically necessary and your plan declines to cover it, you have several options. First ask your plan to review its decision. If it still refuses to pay for the treatment, 43 states offer an independent, outside review process. You can also sue your health provider to get them to pay for the treatment.
Sometimes the problem is that you've selected an inexpensive, limited plan. Karen Pollitz, project director for Georgetown University's Health Policy Institute, suggests purchasing a different plan under when the new enrollment season begins. She says you won't be penalized for your pre-existing condition as long as your coverage doesn't lapse.
Mohit Ghose, spokesman for the America's Health Insurance Plans, said patients should discuss their concerns and problems with a representative from the health plan. He said sometimes they may be able to help get patients into clinical trials for new drugs and treatments where all care is covered.
Ghose also said it is important to choose a health plan with care. Often, less expensive plans offer stricter networks and fewer benefits.
"You have to plan for what might happen," said Ghose.
On the Net: www.medicalconsumers.org www.ahip.net www.georgetown.edu
Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.
People: Levin, Arthur, Ghose, Mohit
Dateline: Undated
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• Insurance > Health Insurance Archive
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