How to choose a new insurance plan | The Stone Clinic

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How to choose a new insurance plan

There are a few things that you will want to look for when choosing a plan:

  • Choose a PPO plan. HMO plans only allow coverage with select physicians within their network, which restricts which doctor you’re allowed to see for your medical care.
  • Make sure that the plan has out-of-network coverage. Our practice is out-of-network with all insurance plans, so your insurance plan will not reimburse you for our services unless your plan has out-of-network benefits.
  • Choose a plan with a reasonable deductible amount for in-network and out-of-network services. Insurance plans typically will not cover any services until you have paid the deductible amount for the year, so make sure that it is an amount that you will be comfortable paying.
  • Make sure that the plan has reasonable co-pay and coinsurance amounts. After you meet the deductible, the insurance will pay a percentage of the allowed charges and you will also be responsible for a percentage of the remaining amount (coinsurance).  You will receive a higher reimbursement if the percentage of your coinsurance responsibility is lower.
  • Try to avoid plans with daily cap for inpatient/outpatient hospital coverage. The daily cap is the maximum amount that the insurance plan will pay the surgical facility for your surgery, and is usually only around $300 per day. This means, that the patient ends up paying for the majority of the facility fees associated with a surgery. Instead, look for a plan that has a co-pay or coinsurance because it can dramatically decrease your cost.

Unfortunately, there is no “perfect” insurance plan, so you may not find a plan that can meet all of the criteria listed above. Try to choose one that meets as many of the guidelines as possible.

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Stone, K.R., A. Freyer, T. Turek, A.W. Walgenbach, S. Wadhwa, and J. Crues. 2007.