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# Ten Questions for Your Managed Care Plan

How does the health plan handle preexisting conditions? Inquire if you and your family are immediately covered for illnesses that you may have recently had. There may or may not be a waiting period. People with chronic illnesses or disabilities should find out who the specialists are and how their illnesses will be handled by the plan.

What is the managed care plan’s policy on very expensive treatments such as organ transplants? They’ll probably tell you that it’s covered if it’s appropriate. And, of course, they will decide what’s appropriate at that time. Most plans won’t pay for treatments deemed to be “experimental�? This one may be difficult to get a definitive answer for; a doctor you trust might be able to give you some insight into how the plan will handle those circumstances.

What does the plan pay for mental illness and substance abuse? All health plans have sliced coverage in these areas, but mental health professionals have stated that HMOs have gotten especially tight. Patients with serious problems may only be given a handful of covered visits to a psychologist or psychiatrist. For a drug or alcohol problem, coverage may be pared down to as little as a week in a treatment program.

After a representative has answered all of these questions for you, make sure that they can provide the answers that they’ve given to you in writing. Remember, it’s only binding if it’s in black and white.

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