My family has employer-provided health insurance. A few months ago I heard that the company was considering switching to a new carrier. I was horrified. We have a pretty good policy, and I don’t want anything screwing up my coverage.
Open enrollment came and went, but coverage options remained the same and nothing more was said about a new carrier. Whew! What a relief!
Tonight I was informed that the company can save a significant amount of money by switching. Great for the company, but I don’t expect it will be good for my pocketbook. They’re not going to save $75K by giving me better coverage. Before things are final, however, I have the opportunity to make a list of questions – details that the owners might not think to ask.
I need your help so I don’t forget to ask anything important.
My current list is:
- Are the same doctors and hospitals covered on this new plan as on the old one?
- What is the coverage if we choose a physician not on the preferred provider list?
- How long does it take to process claims? How quickly/slowly will my doctors be paid?
- What will the new co-payment be for coverage?
- Currently, if I see more than one doctor on the same day, I owe only one co-pay. How will the new policy handle this situation?
- What will be the annual out-of-pocket individual/family limit?
- What is the coverage on preventive care? What is the annual limit on this benefit? (existing policy is $300 per year)
- Are both adult and childhood vaccines covered?
- Are travel vaccines included under preventive health coverage? Or covered at all?
- How is coverage handled for accidents/illnesses that occur away from home?
- Does this policy cover foreign travel?
- Is the medical necessity of testing left to the discretion of my physician who holds a medical degree, or must he obtain pre-approval from someone who did not attend medical school? ( MRI, ultrasound, CT, lab work, x-rays, etc.)
- Are physician-prescribed orthotics covered for conditions other than diabetes? If so, what are the details on this coverage?
- Are referrals required from our PCP for us to see specialists? If so, will existing referrals be honored, or must new referrals be written?
- Will insurance continue to cover my current prescriptions?
- Are medication decisions left to the discretion of my physician who holds a medical degree, or must he obtain pre-approval from an insurance company employee who did not attend medical school? If some medications require pre-approval, which ones? How long does the approval process take?
- Our current prescription coverage has flat copays of $10/$25/$40. What is the prescription co-pay on this new policy?
- Is it possible to get a copy of the formulary to know which medications are listed in which tier?
- Does money spent on prescriptions count toward our annual out-of-pocket maximum?
I have until tomorrow morning to add to this list.
Can you think of other things I should be asking?
Edit to add:
I’ve also added questions about PT/OT limits/exclusions. Last year we were allowed 20 PT visits annually. This year it dropped to 15 visits/$2000.
I also added a question about surgery coverage. Our current policy will only pay for surgery within two years of diagnosis, which means I might be SOL for having our current insurance pay to fix my shoulder if it ever becomes necessary. A longer time limit under the new plan would be a welcome change.