Laura Nathanson, MD
Laura Nathanson, MD
Check your own Medical RecordsKeep safe in under-staffed HospitalsOutwit Insurance Companies
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Outwit Insurance Companies

Q. My insurance company says I can choose my Primary Care Provider myself. I know my excellent PCP will make sure I don't get stiffed by my Plan. What is there to outwit?

Your PCP can be both excellent and utterly powerless. That's because your doctor is embedded in a network that includes only a small number of the specialists, services, and options that your Plan says it covers.

On many plans, your doctor may not even refer you to one of the in-Network hospitals, specialists, services, or options unless your case meets certain requirements of severity or complication.

Q. How do I find out who and what is included in that network, and what restrictions there are?

Most people find out only after they need a specialist, service, or other option and get refused. Sometimes, but not always, it is possible to figure this out ahead of time from the Plan's information brochures. Rarely, someone in the Plan's administration will give you a direct answer.

The main thing to remember is that the promises made by your Plan can be overridden and voided by the Network.

Q. And you say that you can teach me to outwit them?

I can show you how to increase your chances of getting the specific care and attention you and your family are most likely to need.

 

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Laura Nathanson, MD
author of What You Don't Know Can Kill You

Copyright 2007 Laura Nathanson, MD
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