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Managed Care Update Questions To Ask When Choosing A Plan




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Managed Care Update


Managed Care Update

Questions To Ask When Choosing A Plan


In last week’s article I explained exactly what managed care is, and asked you to ask yourself some questions before making the switch to an HMO (Health Maintenance Organization).


Ask yourself — Do I already go to a family doctor that I want to keep seeing? A pediatrician? A gynecologist?


Because you want to know if the managed care plan will include your doctor, gynecologist, and pediatrician in its network.


Ask yourself — Are my family and I usually healthy, so that we only need occasional check-ups or office visits for minor problems?


Because you want to know if the managed care plan will give you checkups and office visits with only a small co-payment (usually $25 or less).


Ask yourself — Does anyone in my family have a serious health illness or disability that requires a doctor who specializes in our kind of problem?


Because you want to know if the managed care plan will include specialists with time to take new patients, in the kind of care you need, or even the specialist that you already use.


Ask yourself — Is any member of my family planning to have a baby this year?


Because you want to know if the managed care plan will include obstetricians with time to take new patients, who will admit to the hospital of your choice for delivery. The hospital should be one you can get to quickly.


Ask yourself — How far am I willing and able to go to a doctor for urgent care? When I am sick? For a checkup? When my child is sick?


Because you want to know if the managed care plan includes doctors, pediatricians, and hospitals that you can get to easily when you are feeling sick or traveling with a sick child.


Ask yourself — Will anyone in my family need frequent outpatient mental health visits?


Because you want to know if the managed care plan will cover as many outpatient mental health visits as you need in a year, and give you a choice of therapists.


As yourself — Does any family member need to take prescription medicine everyday?


Because you want to know if the managed care plan will cover the medicines you need, charge only a low co-payment for each prescription, and allow you to use a drugstore you can get to. For Medicaid managed care recipients there are no co-payments for prescriptions.


Remember these questions before choosing your health plan.


Those of you who are presently on Medicaid will have to go to managed care in the near future. But, remember, you do have a choice in which plan you take. That is why these questions are important.


(Zandra Myers is the managed care specialist at the Jewish Community Council of the Rockaway Peninsula. If you have questions or need assistance, contact Myers at the JCC, 10-11 Nameoke street, Far Rockaway, or email at zkmyers@hotmail.com)







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