Selecting and Contracting for Medical Insurance
In deciding to enter into a contract with an insurance company, or to accept an employer’s, insurance plan:
a. discuss all the above factors with the insurance company’s sale srepresenatative and any human resources office of an employer.
b. check out the kinds and quality of customer service of the insurance company and its drug distributor
c. check out the formulary of the drug distributor to see if it contains the brand of growth hormone or other drugs prescribed your endocrinologist; and, the delivery methods for receipt of those products, especially growth hormone, which, in general, must be kept between 36 and 46 degrees F. (2 to 8 degrees C.).
d. check out the reputation of the insurance company in the granting and denial of claims.
e. check out the relations of the employer and any human resources office with the insurance company in the handling of claims and appeals as wellas other issues.
f. check out all internet services available from the insurance carrier and drug distributor.
g. check out the civil liability and criminal sanctions taken against the insurance company and the drug distributor, with the State department, insurance commission or agency; the State department of health, the State department of licensing, the States attorney general’s office, and the State court.
UNDER NO CIRCUMSTANCES ACCEPT AN INSURANCE POLICY OR CHANGE INSURANCE COMPANIES based on the representation by the prospective insurance company of medical necessity or coverage of benefits, oral or written, of any employee, agent, or representative of the insurance company with respect to providing coverage for the diagnosis or coverage of any diseases, disorder, condition, or illness; and, any drugs, product, or services which appear to be covered or not covered.
Only the medical or pharmacy director, acting in within the scope of his/her duties and responsibilities and in accordance with company policy and procedure, are authorized to make such determinations and representations concerning medical insurance claims. Any such representation should be made in writing, on company letterhead, and state that the medical director is authorized to bind the insurance company; and, if possible, counter-signed by any other offical who normally approves the issuance of approval for coverage and medical necessitiy for the diagnoses or conditions set forth in an insurance claim.