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A.G. Schneiderman offers tips to help consumers compare health care plans in advance of state marketplace open enrollment

by jmaloni


Mon, Nov 10th 2014 12:55 pm

Purchasing health insurance coverage starts Nov. 15; review details of current plan and directory of participating providers; double-check your doctor is "in-network" for the plan you select

Attorney General Eric T. Schneiderman has issued a brochure offering tips to New Yorkers buying health insurance coverage for 2015. The pamphlet, titled "Shopping For Health Insurance Coverage," is being released in advance of the New York State of Health Marketplace's open enrollment period, which begins Nov. 15. The marketplace is the only official health insurance exchange for New York established under the Affordable Care Act (often referred to as "Obamacare").

In anticipation of the upcoming open enrollment period, Schneiderman, in particular, encourages consumers to confirm their key health care providers participate in a plan before enrolling - or that they are still participating in a plan before re-enrolling. 

"Take the time during the upcoming open enrollment period to evaluate available plans. I am urging you to do this even if you are happy with your current health plan, because your plan, and other plans, may have changed," Schneiderman said. "I also strongly urge New York consumers not to rely solely on provider lists offered by insurance companies. Call the insurance company you are considering, as well as your providers, to confirm that they are in the plan's network. Do this before you sign up. It's a quick and easy way to protect your family's health and your wallet."

The attorney general's brochure offers important information for all New Yorkers shopping for health insurance, whether they are considering purchasing health coverage for the first time, re-enrolling in an existing plan, or switching into a new health plan. The New York State of Health Marketplace first offered New Yorkers access to affordable health insurance coverage this year, and approximately 960,000 New Yorkers enrolled.

Open enrollment through New York State of Health begins Nov. 15. New Yorkers seeking coverage effective Jan. 1, 2015, must enroll by Dec. 15. Once open enrollment begins, one can review all available health insurance plans, as well as determine what premium tax credits, or subsidies, one may be eligible for to reduce the cost of monthly premiums.

Take this opportunity to review all available plans. Prior to enrolling, take some time to: (1) identify health needs for the upcoming year; (2) consider a budget; and (3) based on identified health needs and budget priorities, compare the available plans to evaluate how they satisfy those needs.

The attorney general's office encourages all New Yorkers shopping for health insurance to take the following steps when evaluating health care providers:

1) Check and confirm your provider's participation status with the insurance company

•As a first step, check the list of participating providers made available by the health plan you're considering.

  • Health plans typically make lists of their participating providers available on their websites, sometimes through a search tool. 
  • You can also search through the New York State of Health website if you are planning to enroll through the marketplace.

•Next, if your providers are listed as participating, call the insurance company directly and ask a representative to confirm that your providers are participating in particular plans. 

•Keep in mind health insurance companies often offer several different health plans, and the different plans may have different participating provider networks. Make sure you're searching and asking about the right plans.

2) Check with your providers

•Even if the insurance company confirms the provider's participation in the plan, call your providers so they can confirm as well. Do not just rely on information posted on the provider's website, as it may not be current. 

3) Document all searches and conversations

•Document all online searches and calls, even if both the plan and provider confirm participation in the plan. 

•If you have conducted an online search of a provider directory, print or save the results of that search.

•If you speak with a health plan representative or provider, make sure to write down when you called, with whom you spoke, the providers discussed, and what you were told about each provider's participation status.

•If a provider turns out to be incorrectly listed as participating, but you have taken these steps, you will be in a better position to obtain reimbursement for out-of-pocket expenses incurred as a result of the inaccurate listing and/or temporarily continue treatment with that provider.

If you encounter inaccurate provider listings once you are enrolled in a plan and cannot access needed care from that provider, contact the health care bureau helpline for assistance: 1-800-428-9071.

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