June 21, 2011

Therapy Tuesday: questions to ask your health insurance provider

We are about to begin a new health benefits year and with Grant turning three soon we need to know what our options are for continuing his therapy (in North Carolina, early intervention services are discontinued when children turn three). After discussing the situation with Grant's service coordinator she provided some questions to ask our insurance provider. With her permission I am sharing them with you. If you can think of any additional questions to ask please pass them on to me! 
Below is a list of questions to ask your health insurance company to gather information about what types of services are covered and what is needed to access your insurance coverage.
  1. Is there a deductible I have to meet before you will cover the service?
  2. Where am I right now in meeting my deductible?
  3. How much will I have to pay once I have met the deductible?
  4. Is there a copay I have to pay for services? How much is it?
  1. Do I need to get prior authorization for evaluations or for services?
  2. Do I need a referral from my primary care doctor to get approval for a service
  1. What services does my plan cover? (Occupational Therapy?  Physical Therapy?  Speech Therapy? Counseling or Mental Health Services?)
  2. Will you cover services that take place in the home?
  1. Is there a maximum limit for each claim?
  2. Is there a maximum cap (lifetime) for this policy?
Health Reimbursement Account or Health Savings Account
  1. Is there one of these accounts attached to my insurance coverage?
  2. Am I able to choose what services this money is used for or is it on automatic draft to pay for anything insurance doesn’t cover?
Out-of-Network Benefits
  1. Do I have benefits if I use a provider that is out of network?
  2. Do I have a deductible that is different for out of network services?
  3. How much will I have to pay once I have met the deductible?
  4. Do I have a copay and how much is it?

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