How to Choose a Carrier.

Health Care Reform has leveled the playing field as far as coverage benefits and eligibility goes. Plans are standardized and fall into four distinct benefit levels (Bronze, Silver, Gold, and Platinum) and must be actuarially equivalent. Pre- existing conditions no longer restrict your access to coverage or result in higher premiums. By removing these two critical elements, what’s left to compare? Plenty!

As the second open enrollment period approaches, you will soon decide to stay with your current carrier, choose a new carrier, or enroll in a plan for the first time. As you compare carriers, there are several things to consider before making a decision.

Note: There are different criteria when choosing your plan type (Bronze, Silver, Gold, or Platinum).Plan type is best determined by the amount of medical treatment anticipated, the provider network, and your share of costs (premium plus out-of-pocket costs).
But carrier choice matters, too. An insurance company has a responsibility to pay your claims promptly, provide you with easy to understand plan information, supply an ID card, offer billing options and carryout your requests efficiently. How well they perform and meet these obligations could save you time and money.

Here are some things to consider:

1. How is the carrier rated? A.M. Best is one of several rating services used to measure a company’s financial stability. Included in that rating is the ability to pay claims. A score of A- or better is an indication the company has an excellent ability to meet their ongoing obligations to policyholders.
2. What is the extent of the carrier’s provider network? Call your doctors to see if they participate in the carrier’s plan. But also consider things in the event of major illness or accident. Where would you want to be treated and by whom? Make sure those facilities and providers are in the carrier’s network.
3. What provider search tools are offered by the carrier? Some search tools require no less than a PhD to figure them out. The more complicated the search process, the greater chance for an error and inaccurate results.
4. Does the carrier’s pharmacy formulary drug list cover your medications? Carriers don’t cover all medications prescribed. These lists are often available on carrier web sites.
5. What is the coverage out-of-state and out-of-country? If you have children away at school or trips abroad are planned this could be an important consideration. Coverage and provider access varies among carriers.
6. How long does it take for customer service to answer the phone? During the first open enrollment some carriers never did! If you think you found a plan and carrier you like, call their customer service line and see how quickly they answer and how friendly and knowledgeable they are.
7. How long does it take to process a claim? This may not be as easy to obtain, but many carriers have this posted on their web site. It won’t be long before a rating system is in place where you can compare this data among carriers. Is the member correspondence clear? One of the major complaints last year was the vague literature provided by carriers. If you are currently covered you will be receiving a renewal packet later this year from your carrier. Review it carefully and write down any questions or concerns you have. Then call their customer service line and see how informed their front line people are. If their own people aren’t clear, there’s a problem.
8. Is the member correspondence clear? One of the major complaints last year was the vague literature provided by carriers. If you are currently covered you will be receiving a renewal packet later this year from your carrier. Review it carefully and write down any questions or concerns you have. Then call their customer service line and see how informed their front line people are. If their own people aren’t clear, there’s a problem.
9. What is your provider’s opinion of the carrier? A provider’s opinion can give you insight as to how efficient the communication is with a doctor’s office and how authorizations are handled. When you call your doctor’s office to check on their network participation, ask them their opinion about the carrier(s). You’ll get some very honest answers.

This year’s open enrollment period kicks off November 15 and runs through February 15, 2015. For more information about open enrollment, refer to my last blog posting by clicking here.

Phil Dougherty
OnlyHealthInsurance