January 2010

We have probably all heard the expression that “life is what happens when you are making other plans” – well as someone who works in the Neonatal Intensive Care Unit (NICU), I witness this first hand when parents who expected to have a healthy term infant, find themselves face to face with a tiny baby perhaps weighing just over a pound and born as much as four months early. In a situation like this as in any number of other health related life crises, our medical coverage or lack thereof can become a matter of paramount importance. Therefore while your current age and health status may lead you to conclude that good health coverage (or having any coverage at all) is not a priority right now that can change in an instant – so expect the unexpected and prepare for it to the extent that you can! Here are some points to consider in selecting health insurance for yourself and for your family:

• Are you or your family facing any medical issues currently? Ask about the impact of pre-existing conditions on your eligibility for coverage.

• What will your monthly budget allow you to pay for coverage?

• If you are unemployed or do not have coverage through your job, are you eligible to apply for Medicaid or Medicare? Social Security Administration’s website (www.ssa.gov) has information on these programs as well as on eligibility for assistance based on having a disability.

• Are you eligible for coverage under more than one insurance plan? For example through your spouse or under Medicaid or Medicare. One plan would be primary and the other would be secondary; expenses that are not covered by your primary insurance could potentially be billed to the secondary coverage.

• If you can, choose a plan that offers a broad network: that is one that offers a larger choice of providers so that you have less need to go out of network which increases your costs.

• Employers make decisions about what benefits they will include in the plans that they purchase therefore examine your benefits carefully: what are your co-pays, annual deductibles, life time caps? Does your plan have benefits such as prescription coverage, dental coverage, home nursing, durable medical equipment such as oxygen, hospice care?

• Is there a case manager at the insurance company whom you can speak with and who can help you to navigate the system and make the best use of your benefits? Sometimes benefits can be converted to meet a particular medical circumstance - a case manager would be able to explore this option.

• If you are hospitalized, and are concerned about your coverage, ask whether there is a case manager or a social worker who can meet with you to discuss your concerns as well as discharge planning issues.

• If your employer offers flexible spending accounts for health care as well as for dependent care, this can be a very useful benefit with regard to being able to cover out of pocket expenses using pre tax dollars. This benefit also makes it possible for you to continue to see your doctor even if he/she no longer accepts insurance.

• Keep a health coverage file: make a note of who you spoke to, when and what was discussed. Don’t assume that the insurance company is always right, they make mistakes too! Be willing to resubmit claims, to fight denied claims and if necessary to go through the appeals process. Be persistent!

• If you have a choice about which plan to select, talk with family/friends/colleagues and get a sense of what their experience has been. What kind of reputation does the insurance company have in terms of customer service?

Don’t be afraid to ask questions! This is your health.