Private Health Care Insurance Choices

Managed health care plans through employers, unions or other professional organizations are by far the most popular plans out there. There are some people who choose private health care insurance, paying more but reaping the benefits of having more choices in providers and plans, especially when it comes to home health care coverage.

Private health care insurance, also known as indemnity or non-network insurance, is not a part of a provider network that you find under a managed care plan. Usually, this means that the premiums for these plans are more costly, but the insured individual has more choices when it comes to choosing what doctor he or she wants to visit for differing types of care.

When you have private health care insurance, you also are usually taking on more responsibility when it comes to filing claims with your insurance company, which means you have to be more educated about what your policy covers and what it doesn’t in case your claim is denied.

You may also find a clause that requires you to disclose the name of your primary care provider, or PCP. Your PCP is the individual who can give you authorization to have specialized tests run and approve specific services, demonstrating to your insurance company that such services are actually required and covered under your private health care insurance plan. Typically the coverage in one of these of plans is 80%, meaning that the remaining 20% must be paid by the person covered.

Quite often, however, there is an annual out-of-pocket maximum that puts a cap on how much you can spend on specialized services every year. Once you reach this point, your private health care insurance plan covers 100% of your claim.

Things to Consider

When you are looking into a private health care insurance plan, there are specific things that you must consider if you want to find the very best plan for you and your family. First, go over the premiums and find out what they specifically cover by reading all the fine print. Second, find out what you have to do to file a claim and what kind of prior approval you need for specialized tests and services.

Third, find out what kind of access you have to doctors, hospitals and specialized providers such as dermatologists. And finally, find out what you need to do if your claim is an emergency or occurs after normal working hours.