Choosing a Health Care Plan

Choosing the health care plan that's best for you and your family can be confusing, to say the least. Managed care plans operate on the assumption that your primary care provider (PCP) can effectively treat most of your ailments, but studies suggest that an allergist/immunologist is more effective in treating patients with allergies or asthma. An allergist is a doctor who specializes in allergic and immunologic diseases. If possible, it's best to see an allergist in addition to your regular PCP.

With managed care plans, however, it's not always possible to freely choose your health care provider. A managed care plan may restrict which doctors you can see, deny certain medications or medical devices, set limits on doctor visits, or penalize you for pre-existing health conditions.

Be sure to carefully read over every available health care plan before deciding on one. Try to plan for unforeseen medical problems. If you pick the least expensive plan, it may end up costing you much more in the long-run if an unexpected medical problem arises.

When reviewing the plan, find out which doctors you'll be able to visit, what kind of services are covered, and what medicines are covered (formulary lists). Consider the effective dates, co-payment requirements, deductibles, and pre-existing condition limitations. Many insurance companies now reimburse for environmental control products with a store receipt and Medical Necessity Form from the prescribing physician.

In many plans, your PCP must approve your visit to a specialist before you can see an allergist. Your health care plan should include information about how you can contest your PCP's decision if you are denied the right to see a specialist. It's also a good idea to request information on point of service options that would allow you to visit the allergist of your choice for a small fee in addition to the regular premium.

Take the time to study all aspects of a health care plan, and do not sign up for it until you are sure that's it's the best one for your needs.