Giving More Provider Choices: Private Health Care Insurance

Although a managed health care plan is more common for people who are currently employed, since their employers, professional organizations or unions provide the choices in health care plans, there are some individuals who opt for private health care insurance since, although it costs more typically, it also usually offers more choices in plans and providers than managed health care plans, especially for home health care insurance. Private health care insurance, otherwise known as non-network or indemnity insurance, means that there is not a network of providers that have joined together to offer services under that particular plan. This usually means that the rates for these plans are higher, but the person insured has more options as to what provider he wants to go to for a particular service.

Private health care insurance also means that the person insured usually has more of a responsibility for filing the claims with the insurance company, which means he has to know more about what is covered by his insurance and what is not so that he can press the issue if the claim is denied. There is also usually a clause that requires the individual to list who his primary care provider is, through whom he must usually get authorization to have specialized services and tests run, showing that they are indeed necessary and eligible for coverage under the private health care insurance plan. The normal coverage in these types of plans is eighty percent of the claim is covered and twenty percent is paid out of pocket by the individual. Often there is an out-of-pocket maximum for the year so that when the individual reaches that maximum, the private health care insurance company pays one hundred percent of the claim.

Questions to Ask

When searching for a private health care insurance plan, there are certain questions that the individual must be aware of in order to choose the best plan for him. He must read all the fine print and find out what the premiums are, and what those premiums cover, what benefits are given for that premium. He must also find out what he must do to file a claim and what prior approval is needed for specialized services. In addition, he should find out what amount of access he has to doctors, hospitals and other providers such as chiropractors. He should also know what to do if the claim happens during after hours or if it is an emergency situation.