Three Questions the American Medical Association Wants Patients to Consider before Choosing a Health Plan

AMA and More than 115 Organizations Call for Increased Transparency for Health Insurers to Protect Patients

CHICAGO - Nov. 18, 2014 - As Open Enrollment for 2015 Exchange Plans gets underway, patients are being bombarded with messages from health insurance companies vying for their attention. The American Medical Association (AMA) urges patients to thoroughly review all aspects of the plans they are choosing in order to prevent interruptions in care and higher out-of-pocket costs.

Whether it’s a new plan or a renewal of an existing plan, there are many factors patients should take into account including deductibles, co-pays and drug costs. Patients should also consider which physicians and facilities are covered under their health insurance plan and the cost for receiving treatment out-of-network so that they make informed health care decisions. Additionally, patients should make sure to ask their physicians whether they are participating in plans they are considering.

“We want to make sure Americans choose a plan that is right for them and their families in terms of cost and coverage,” said AMA President Robert Wah, MD. “It is very important that patients look beyond the big print, color-coded plan designations and price of insurance plans and check the small print details before making their selection. Patients deserve to know what coverage they’re buying when they choose a health insurance plan, including the physicians they will have access to. This will ensure they are selecting a health plan that has the value they need.”

AMA asks patients to consider the following:

1)   Are your family’s doctors in the plan?  If not, what will you have to pay out-of-pocket for office visits or other services your doctor prescribes?  Is the plan’s directory of participating physicians up-to-date and accurate?  Are there physicians on the list who are still accepting new patients?

2)   What does the plan cover?  What percentage of your health care costs will you have to cover? If so, how much and can you afford it? How much will you have to pay out of pocket for the medicines your family needs? Will you be able to use hospitals, labs and other facilities that are convenient to where you live or work? Does the plan provide access to a sufficient number of specialists that you need? 

3)   Does your primary care physician have to receive permission from the insurance company to refer you to a specialist?  Does that rule include specialists you see regularly for a chronic condition? Does the insurer use penalties or incentives to induce physicians in the plan to limit referrals in any way?

Yesterday, the AMA joined with the Children’s Hospital Association and more than 115 organizations representing hospitals, physicians, and other health care providers serving children and adults in sending a letter to the National Association of Insurance Commissioners (NAIC) calling for network adequacy for patients, greater regulatory oversight in the hands of commissioners and increased transparency for health insurers.

The AMA is dedicated to ensuring patients have access to the care they need and is addressing insurance network adequacy through a new policy passed at its Interim meeting on November 10. The policy supports strengthening the monitoring and enforcement of network adequacy at the federal and state levels and also offers additional financial protection for patients who need to seek care out-of-network.

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Media Contact:
Randi Kahn
AMA Media & Editorial
(202) 789-7442

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