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# Ten Questions for Your Managed Care Plan

Before enrolling in a new managed care health plan, you need to be sure that you鈥檙e comfortable with the services that it will provide. Sometimes your employer will pick a plan for you, in which case you should be aware of its rules. Sometimes you can choose a plan yourself, but not without answers to some pointed questions which you should pose. Here are ten questions (and some appropriate answers) to help you choose the right plan.

Which doctors can I choose? A managed care network can鈥檛 be any better than the doctors and other service providers that it uses. Check to see if you recognize any of the providers鈥?names on the network list. You鈥檙e generally allowed to pick whichever primary-care doctor that you want, and to change to another if you鈥檙e not satisfied. Keep in mind, however, that a long list of doctors does not necessarily equate to a better healthcare network. Plans with high-quality reputations are often those with a central clinic and a closely-knit group of salaried doctors working together for their patients鈥?best treatment course.

Will the doctor treat me by phone? Will the doctor make you come in and wait for every minor illness, or can it be done over the phone for your convenience?

Does my primary doctor see patients from several care plans? If not, you may have to switch doctors if you change jobs. Different employers offer different plans. A change of jobs may require everyone in your family to start new medical relationships from scratch.

How easy, or difficult, is it to see a specialist? Generally, you must see your primary-care provider first so that he or she can assess the problem. If the doctor feels that a specialist is needed, a referral will then be given. Some doctors, however, will refer you over the phone, which is a substantial time-saver. A few HMOs will even let you see a specialist in the network without prior permission.

To what extent does the managed care plan control the drugs that my doctor can prescribe? HMOs and other managed care providers have formularies, which are lists of drugs its doctors are allowed to prescribe. Some lists are broad; others are quite limited. If you鈥檙e on a maintenance drug, for example, ask if it鈥檚 on their list. If it鈥檚 not, you need to know what the health plan is going to do about it.

Which hospitals are on the network list and do I have a choice of which I can use? Plans will usually list the best hospitals in the area, although they won鈥檛 necessarily let you go there all the time. The best hospitals may be reserved for the most serious illnesses, and you may find yourself in a less-costly place.

How convenient are the hospitals, doctors, and other service providers? You probably won鈥檛 want to go all the way across town when there are perfectly good services nearby.

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