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More Washington Health Insurance Shopping Tips

Shopping for health insurance

Tips: checking out an insurance company

Before you buy health coverage, find out about the company selling the plan. Here are key factors to consider:

Customer service. Find out how the company services its members. Does the company have a toll-free customer service number? Do they answer it without a long wait?

Complaint history. Does the company have a high number of consumer complaints? Check with our Insurance Consumer Hotline at 1-800-562-6900.

Licensing status. Make sure the insurance company is licensed to do business in Washington state. Call our Insurance Consumer Hotline to check a company's status at 1-800-562-6900 or visit our Web site at www.insurance.wa.gov.

Financial stability. Financial stability helps ensure a company can pay its claims. In addition, Washington state law establishes requirements that each company must follow. The Office of the Insurance Commissioner (OIC) continually monitors insurers to make sure they are financially stable. Independent organizations also rate the financial stability of insurance companies. Check your public library's reference desk for published ratings.

Questions to ask:

What does the plan pay for and what does it exclude? Look for preventive care, immunizations, well-baby care, substance abuse, organ transplants, durable medical equipment, alternative or chiropractic care.
Does the plan have mental health benefits?
Will the plan pay for long-term physical therapy?
How much do I have to pay when I receive health care services, or how much is the copayment or deductible? How often do I have to pay the copayment or deductible (per year, per occurrence)?
Are there limits on how much I must pay for health care services I receive (out-of-pocket maximums)? Are there maximums per year, per occurrence?
Are there limits on the number of times I may receive a service (lifetime maximums, daily or annual benefit caps)?
Does the company have a high number of consumer complaints?
What happens when I call the company's consumer complaint number? How long does it take to reach a real person?
Will the plan pay for prescriptions? If so, what is the maximum benefit?
Are my prescriptions on the formulary (list of approved drugs)?
Is my favorite doctor or other health care professional part of the company's network?
Can I choose my Primary Care Provider (PCP)? If I don't like him or her, what options will I have?
How will I get access to specialists?
What does the company consider as urgent and emergency care?
What treatments does the company consider "experimental" and as a result do not cover?
How does the company coordinate benefits with other plans?
What options do I have if I disagree with the treatment plan?

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