Looking for good insurance!

Get help finding a doctor or discuss questions about/difficulties with your insurance or employer.

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Looking for good insurance!

Postby Hotbrass » Sep 16, 2005 11:13 am

What should I look for in a plan? Prescription plans I'm sure. I went through 2 HGs without insurance but I never used drugs. This time I'm willing to take them so I know this one is going to cost a fortune. Any advice on good companies or important things to have in a plan.
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Postby JennyK » Sep 23, 2005 9:27 am

Where are you in Montana? I am in Helena. Email me or send a private message. Email is jennykal@gmail.com.

As for insurance, I would call around (Blue Cross and New West come to mind) and find out what they can offer and then compare. If it is not through an employer your premiums will probably be through the roof for what is essentially catastrophic-only coverage. At least that is what I have heard.
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Postby aaronsmommy » Sep 28, 2005 2:52 pm

I'm sorry I took so long to reply. There are so many differences in insurance policies. I've looked in to getting insurance for myself, and these are somethings I've thought about. Wow, where to start?

First, you'll need to decide on an HMO vs a PPO policy. If you have a specific doctor & or hospital in mind, you should check to see if they accept the HMO before you choose that kind of policy. If they do, and you decide on an HMO policy, make sure you put down a primary care doctor who is part of the same group/IPA as your OB (this can be changed, but sometimes you have to wait if you want to do that)

Policies differ in a lot of other areas, here are some things that are relevant to hg (you can decide which things seem most important to you)

Office copay - what you pay at an office visit, some policies, you don't pay a copay for a routine ob visit, some you do, so something to check on.

Annual out of pocket maximum (the most you are expected to pay)- most people who are pg, even without hg will reach this maximum, so this is probably the most important number to compare. The only thing is, sometimes things don't count toward this maximum. I had a $500 max with my pg and thought that I had reached it, but then I found out that the 3 x $125 hospital copays didn't count toward that maximum. Go figure.

Co-insurance - this is the percentage of your bill you will pay. If you are going to be hitting your "out of pocket maximum" this number is really irrelevant, and you may be able to pay less for a policy with a high co-insurance, and low out of pocket max.

Annual maximum benefit - most people won't run in to a problem here since it is usually $1million or more, but I know someone who had a $30,000 maximum on her policy. If I had had that, I would have gotten stuck with the $700,000 or so extra - so much for insurance!

Home health care - some policies may not cover it, or may cover only a few visits. I had a copay for my visits with one policy, and not with another.

Pharmacy benefits - if you think you may be using the expensive medications like zofran, this can be really important. Some insurances will only cover a certain number of pills per month, or per refill. You really don't want one that limits your fills per month. If you have a limit per refill, that can add up too (since it is usually something like 15 tabs at a time, which will probably last about 4 or 5 days). There should be generic zofran soon which may drop your copay, but the generic won't be much cheaper for a long time, so don't plan on buying it cheap without coverage.

There are other differences, but I think this hits the more imortant points at least.

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