Private Health Insurance
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One type of plan is a standard indemnity policy, which gives people freedom to visit a health care provider of their choice and pay out of pocket for their treatment. The insurance plan reimburses members for some portion of the cost. The other common plan is a managed care plan. Under this plan, medically necessary care is provided in the most cost effective -- or least expensive -- way available. Plan members must visit health care providers chosen by the managed care plan. Generally, a co-payment is charged to the patient, but sometimes all care received from providers within the plan is covered.
Grievances
All health insurance companies have internal grievance and complaints procedures. If you have a complaint, follow the company's procedures. All states have a state health insurance commissioner. Contact that office of the state government to see what external grievance and complaint procedures may exist in your state.
Other Web Sites:
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Foundation for Health Coverage Education
This resource provides public and private health insurance eligibility information in order to help people, including those who are uninsured, access health insurance coverage. In addition to information contained on their website, they offer a 24-hour helpline.
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Health Care Plans
The U.S. Agency for Healthcare Research and Quality provides information on health care plans for consumers
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Mental Health Parity and Addictions Act
Overview of the 2008 law providing "parity" of insurance coverage for mental health and substance abuse services (from SAMHSA - Substance Abuse and Mental Health Services Administration)
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State Insurance Commissioners
Contact your State Insurance Department to see if they have a state health insurance counseling program that can address your concerns, including information on companies providing insurance in your state and public insurance programs.
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Kaiser Family Foundation
"A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan, 2005 Update." This publication helps consumers understand their rights and how to pursue complaints they may have with their private insurer.
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National Health Law Program
The National Health Law Program is a national public interest law firm that seeks to improve health care for America's working and unemployed poor, minorities, the elderly and people with disabilities.
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Patient Assistance Programs
The Pharmaceutical Research and Manufacturers of America (PhRMA) offers an online directory of patient assistance programs run by over 40 of its member companies. PhRMA is the trade association for pharmaceutical and biotechnology companies.
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