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Health insurance shopping tips 

& & by Pia K. Hansen & & & &

Define your needs and make sure you understand the way the benefits are listed in the insurance plan. Some plans cover a certain number of physical therapy sessions -- 10 per year, for instance -- but you'll have to pay for the rest of the sessions on your own.

Don't just compare rates, make sure you compare the benefits as well. Prices vary wildly, so it's important to know exactly what you are getting extra if you spring for a more expensive plan. Sometimes all you get is a different choice of doctors. If you already have a primary care physician and would like to continue to work with him or her, make sure your new insurance is accepted at that doctor's office.

Remember that Washington state sponsors a public health plan, Basic Health, for people who make too much money to qualify for public assistance, but too little to be able to afford individual coverage. If you have a doctor already and would like to use Basic Health, call the office and make sure your doctor is still accepting state subsidized clients.

Ask specifically what your copayment will be and also whether there are limits to how many times you may receive a service (lifetime limits or annual limits). You may also want to check what happens when you call the insurance company, how long does it take to reach a real person, for instance?

Find out what your copayment for medications will be, and if you already take medication, find out if your specific brand is on the insurer's preferred drug list or if you have to pay more to continue with the same drug.

If a claim is denied, the reason for denial should be clearly stated in the accompanying letter and explained in relation to your benefits. If you disagree, check your membership booklet to find out about the insurer's appeal procedures. Before you write the insurance commissioner's office, call the hot line. The commissioner's office will investigate your complaint and keep you advised of what's happening. If the insurer has erred, the office will work on your side until the claim has been cleared.

If you have children or plan to have children, make sure the pregnancy and neonatal coverage the plan provides is what you are looking for. Check to see which hospitals are available through the plan as well.

Before you buy a policy, be sure you understand how to file a claim, where to send it and how you will collect your reimbursement. If you chose a Health Maintenance Organization (HMO), remember to always contact your primary care physician for a referral, except for women's health issues, such as gynecological care, and emergency care.

If you already have a health insurance plan but would like to change to a different one or upgrade the one you have, making these corrections may be restricted to certain time periods every year. Check with the insurance company and the organization through which you get the insurance (church, employer or other sponsor) before you do anything, or you may risk dropping your coverage before you can obtain a new plan.

& & & lt;i & -- Source: The Washington Insurance Commissioner's

Health Insurance Consumer Action Kit & lt;/i & & lt;/center &

& & & lt;i & The general insurance consumer hot line for Washington is (800) 562-6900. The Statewide Health Insurance Benefit Advisors (SHIBA) help line is (800) 397-4422. The Washington State Health Insurance Pool, for Washington residents who have been turned down for individual coverage, is (800) 877-5187. Basic Health can be reached at (800) 826-2444. Visit the Washington State Insurance Commissioner's Web site at The complete health insurance consumer action kit can be downloaded from here.8 & lt;/i & & lt;/center &

& & & lt;i & Health insurance consumers in Idaho can contact the Idaho Department of Insurance in Boise at (208) 334-4250 or visit the department's Web site at & lt;/i & & lt;/center &

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