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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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Choose
the health care plan that works best for you
Dec. 3, 2004
Q:
My
husband is retired from the Navy and is now a government
civilian employee. We did not sign up for the civilian
health plan. We have Tricare Prime. Recently I saw a
doctor who did not accept Tricare Prime so I chose to
pay out of pocket. This was fine with me as it would
have taken two to three weeks to see a specialist through
the military system versus getting a same day appointment
with this doctor.
While
in this office I spoke with a nurse who had previously
been an active duty military nurse. She asked me why
we chose to go with Tricare Prime instead of Tricare
Standard. She discouraged staying with Tricare Prime.
She felt it was not cost effective compared to the Standard
policy. Since the Prime policy is basically an HMO,
we don't have the option of choosing an area healthcare
provider. We have to exhaust the military sources first
which can be time consuming.
What
would be your recommendations? We are both in good health.
The only medication either of us takes is cholesterol
medicine for my husband. I assume our yearly deductible
for the Standard policy would be less than what we are
currently paying in premium costs for Prime. How would
it affect our access to area hospitals? Everyone seems
to have a differing view.
A:
I
do not know the specifics of any of the health insurance
policies. Each policy has to be individually evaluated
to fit the patient's needs. You are on the right track.
Identifying your needs and matching them to a health
insurance plan is the first step.
Look
at your healthcare needs over the past year or so. Are
there changes or has your healthcare needs remained
fairly stable? What types of healthcare services did
you require? How often did you see a doctor or a specialist?
Medication in your case is minimal so prescription benefits
may not be a deciding factor. Is it important to you
to have a wider range of choices in selecting your healthcare
providers? What are the out-of-network benefits if any?
You will have to talk to the insurance representatives
to determine if the local military affiliated hospitals
accept a particular health insurance plan. Also verify
coverage with the hospitals themselves. And, as always,
document these phone calls.
Now
you can compare monthly premiums, deductibles, and co-pays.
Make a chart so you can just glance at the costs and
the benefits. This will help you determine the best
policy match for you. Keep in mind that your evaluation
will be based on your current and past medical history.
You will be making an educated guess as to what your
future healthcare needs will be. Only you can ultimately
decide what kind of protection you will be comfortable
with.
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