|
|
|
|
Most consumers have health care coverage from their employer, others from government programs including Medicare, Medicaid, or the Veterans Administration. Even those who have insurance have to pay for some services such as prescription drugs or care from a specialist. Some people who are not insured have to pay for all of their own care.
Managed care plans are run byhealth maintenance organizations (HMOs) or preferred provider organizations (PPOs). Ask your state insurance department (page 91) for information to help compare plans and know how to complain.
Medicare beneficiaries can choose a Medicare HMO. The Health Care Financing Administration (HCFA) offers Medicare Compare, an online computer database at www.medicare.gov. You can use this service to compare HMO benefits in your area. For other information about Medicare, call 1-800 MEDICARE.
For information about nursing homes and other elder care services in your state, call the ElderCare Locator (page 109).
If you do not have insurance,look in your phone book under Medicaid, Social Services, Medical Assistance, Human Services, or Community Service. Or call 1-800-633-4227 to find the right office in your state. 
Health Care
Choosing a Doctor
If you are part of a managed care plan, you will be given a list of providers from which to choose. You can also "go outside of the plan," but you may have to pay a portion or all of the costs.
Talk to friends and associates for recommendations.
State medical and other professional societies often provide lists of providers who have been licensed or certified in your state. Check with your state or local occupational and professional licensing board (page 70) about licensing of doctors, dentists, and other providers. It can also provide information about how to complain.
Health Care
Choosing a Managed Care Plan
If you have a choice among plans, ask:
Do I have the right to go to any doctor, hospital or clinic I choose?
Does the plan cover home care or nursing home care?
Can I go to any pharmacy?
What is the deductible? Are there any co-payments?
Are specialists, including dentists, covered?
Does the plan cover all medications my physician may prescribe?
What do I do if I want to complain about the service or a doctor? Is private arbitration mandatory?
The National Committee for Quality Assurance (NCQA) evaluates and accredits HMOs. It looks at quality, whether the HMO provides appropriate care, the credentials of doctors and other providers, member rights and responsibilities, preventive care services, and medical record keeping.
To check if your HMO has received NCQA accreditation,call 1-888-275-7585. To find out what plans have been accredited in your state and to get a report card on your plan, go to the NCQA web site at www.ncqa.org
Another organization, the Joint Commission on Accreditation of Healthcare Organizations accredits hospitals, nursing homes, and other health care organizations.
File complaints online at www.jcaho.orgor call 1-800-994-6610 for information.
Information sources
For information to complement, not replace, what you receive from your physician, pharmacist, or other professional, here are some helpful web sites:
www.healthfinder.gov
www.ama-assn.org
www.nejm.org
www.mayohealth.org
www.intelihealth.com
and www.ihealthcoalition.org
You can also get information from the U.S. Department of Health and Human Services (page 109) or your state health department. |
|
|
|
|
|
Home
