Selecting a Policy

Personal Considerations   |    Questions to Ask    |   Insurance Definitions

Questions to ask about a health insurance plan:

• What kind of policy is this, i.e. read the description of the policy
  
  
• Can I choose or retain a specialist (e.g. physiatrist) as my primary care physician (PCP)
  
  
• Is there coverage for specialists including those with SCI expertise
  
  
• Does the plan provide out-of- network referrals or standing referrals to specialists or specialty care centers
  
  
• Are physicians’ offices and related health facilities accessible
  
  
• What services are and are not covered (i.e. its inclusions, limitations and exclusions): inpatient and outpatient rehabilitation, home health assistance, mental health care, medical transportation (This information is often in obscure places within a policy such as within definitions)
  
  
• What are the policies regarding deductibles, co-payments, prescription and durable medical equipment coverage, long-term, community-based services
  
  
• Are there case management services for people with SCI/D
  
  
• Does the plan offer a help line or advice line for assistance; if so, who staffs this line
  
  
• What are the requirements for pre-certification or authorization for preventive, routine, elective, urgent and emergency care
  
  
• Does the plan have lifetime caps, i.e. a maximum amount of dollars that will be paid for a condition or for particular services such as rehabilitation, personal assistance or equipment needs
  
  
• Is there a clearly explained process for you to file a complaint; are you eligible to receive reimbursement when seeking a second opinion, if and when you believe you are not receiving necessary and/or appropriate services

Consumer Rights
Forms of Insurance
Selecting a Policy
Insurance Maze
Are You Uninsured?
Resources
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