Q:I have a son who has specific medical needs and all of the new health care changes have made choosing a health care plan very complicated. How do I select a good plan for my family and what do I need to look for? – Shawna, Scottsdale
A:Choosing health insurance can be daunting, especially for families that have complex and unique health care needs. In today’s rapidly evolving environment, it’s important to do research before making a decision on a health care provider and product. Investing some time and energy upfront will save money and potential problems in the long run.
Here are some tips to consider:
• Don’t assume that just because you keep the same provider your coverage will be the same. Insurance products change year to year.
• Check to see if your child’s primary care provider (general pediatrician) is in the network for the insurance plan you are considering. You can find this online in the insurance company’s Provider Directory, which should note whether the physician is covered in your specific plan. Spot-check for your own primary care physicians and any specialists, too.
• Dig even deeper if your child sees pediatric subspecialists to learn what your coverage will be and what requirements the plan has in place for referrals.
• Note that many insurers are creating more products that are “narrow networks,” which simply means that they provide a limited choice of providers in their network.
• Narrow network plans are often attractive for their lower premiums. However, they may ultimately increase the total cost of care if you or your child needs to see a specialist that is not included in the health plan’s network or if your child is hospitalized and the only place they can get the care they need is not in the network.
• Read the fine print. Make sure you understand the provisions (if any) for out-of-network benefits. Some insurance products do not cover any charges if the provider is out-of-network, meaning you’ll be responsible for all charges.
• Be sure to consider the overall value of the plan, taking into consideration your family’s needs and health care usage. If your child has chronic health problems, it could be more cost-efficient to purchase a plan with a higher monthly premium but covers a greater share of the health care costs through a lower deductible, co-insurance or co-payment.
All of this can be summed up in a few simple words: confirm – don’t assume. I’ve talked with countless parents who signed up for plans they hadn’t fully vetted, which led to high costs and headaches later down the road. The good news is that there are expanded opportunities through CoverAZ.org for obtaining coverage, and your children can no longer be denied coverage for pre-existing conditions.
Laura Handy-Oldham is the Director, Patient Access at Phoenix Children’s Hospital, Arizona’s largest and most widely recognized children’s hospital. If you need help sorting out health insurance coverage, contact Phoenix Children’s Hospital at 602-933-2000 or [email protected]