Specialty Area: Managed Care

Questions That Should Be Asked:

1. Where can I get a background on the doctors in the plan - both primary doctors and specialists?
2. What hospitals are approved?
3. Is vision and dental care included?
4. What are the limits on prescription costs?
5. Do you limit the medications that my doctor can use?
6. What standards are used in covering emergency room care?
7. Can my obstetrician be my primary care physician?
8. If the plan is point of service, how do you determine the reasonable and customary 80% reimbursement?
9. Are all pediatric specialists included?
10. Is there pediatric emergency room coverage?
11. What travel coverage is available in the plan other than emergency?
12. Who decides if it is an emergency?
13. Is the plan rated by certifying agencies?
14. Does the physician gain by limiting testing, referral to specialist, or the use of certain medications?