December 25, 2009, Newsletter Issue #211: Managed Care Plans

Tip of the Week

Managed care health insurance coverage are those plans that aim to control costs by negotiating agreed upon fees, with a network of medical service providers called participating providers. As a means of maintaining cost control, the insurer requires a high degree of service coordination on the part of both the service providers and the health care consumer--in other words, you! You will need to designate a primary care physician from among the insurers approved provider network. All your medical needs must be coordinated through that provider.

For example, if you need to see an ear, nose, and throat (ENT) specialist, your primary care provider will need to submit a referral to the specialist and your insurance company. If you go to the ENT doctor without first receiving the referral, your insurance company will most likely deny your claim and you will have to pay for the treatment.

If you expect to receive the bulk of your health care in your own community and you would not mind some loss of flexibility and the extra coordination required, a managed care health insurance plan can save you a considerable amount on your insurance premiums. Most managed care plans make exceptions for emergency care provided outside of the network when you are traveling.

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