For the seriously ill and their caregivers
Obtaining information from your insurer will be very important. Document the time and date of your phone call and the name of the person with whom you speak. Take detailed notes of the information you are given. The insurance company will only give information to the insured or to the person who has the patient's written authorization.
Below are important questions to ask, along with questions if you choose to go out of your participating provider network.
- Is the Physician or Medical Facility in your network?
- Do I need a referral from my Primary Care Physician or pre-certification?
- Can my specialist be my Primary Care Physician?
- Does the plan cover Physician as well as inpatient and outpatient hospital services and what are the limitations?
- Does your plan offer home health care benefits and what are the maximum benefits for these services?
- Does your plan offer Hospice coverage and what are the limitations?
- Does your plan offer prescription benefits and what are the limitations?
- Are there any procedures, treatments or prescriptions being prescribed
that may be considered “experimental”?
- What care, if any, is available for alternative treatments such as acupuncture and massage?
- What are my time limits to file a claim?
- What are my options if I am told there is no in-network provider for my care?
- What are my time limits to appeal a denial of a claim?
- Can benefits be assigned to the provider?
- What do I have to pay?
- Will the insurance company cover the full amount of the doctor’s bill or only their allowance?
- Will the insurance company’s allowance be based on a schedule of allowances or their usual and customary allowance?
- What percentage of the allowance will the insurance company pay?
- What is the amount of my deductible?
- Is there an out-of-pocket
maximum in my policy?