It is hard to come up with one article that will suit everyone's needs. You have to figure in their location, age, pre-existing conditions, dependents, whether they want an HMO or a PPO and then the contracting Hospitals.
I am more concerned with referrals and can only afford an HMO. I do not want to have to go see a primary care Dr to get a referral approved to then see the Dermatologist just to get another refill RX for my cortisone cream.
The same with my asthma spray. So I have been searching through PCPs to see which ones have these kind of Drs within their clinic and whether they do referrals and what type of cost their drug coverages are, especially the co-pay and the cost for generic and name brand drugs.
Here in California it is important for me to have a Doctor whose first language is English, this way I can understand them and feel more comfortable.
With some insurance plans you need to make a payment for ambulance and emergency room services, so this is important to check and many have their own Drs and need to find a plan their Dr is affiliated with and then the Hospital as well.
Many steps to take to find a plan that is suitable for individuals and families.
When I had Blue Cross through the county I got my Elidel for no co pay and could get a refill every ten days. Now with my insurance plan through the Union I can only get a smaller tube every 45 days and have to pay five dollars.
The Dr they chose for me since this plan does that first and then you can change it, well the Dr is in an area I have never been to and will not be driving there anytime soon and they only contract with County hospitals and no way would I go to one of those in Los Angeles and spend hours waiting.
So I have been researching Blue Cross to pay for myself since my kids are covered as they are on SSI and their insurance is fine for their needs at the moment.
For females you need to decide what specialty you want your Primary Care Physician if you are choosing an HMO. I used to have an OB/GYN but that got stale when I stopped having kids years ago and their specialty is not really my lifestyle and my issues are with my skin and breathing, so to always sit and give urine tests to see if I am pregnant was bothersome to me.
Do you want a medical group or an IPA, does the facility have lab tests in the same building or elsewhere, is there a lab for Mammogramms and X rays on site?
Then when you narrow it down are they open to taking new patients?
An IPA is an independent provider so that would be going to their office that is not associated with other Drs and practices. A PMG is a primary medical group where there is more than one Dr and specialty Drs within the same building or practice.
Years ago when in New Jersey I chose a primary group for my prenatal care and then found out that you only see nurse midwife and I requested that for my delivery I wanted a MD and they did follow through with that and made an issue of it while I was going through contractions.
Also if you are in child bearing years it is important to find out through the group you choose whether the Hospital you will be using will be releasing you in 12 or 24 hours or longer and what the policy is for having the baby in the same room or going through several rooms. Another consideration is the circumcision and whether it is considered routine care and will be done and whether there is a separate charge and if you are not interested in this how to make sure it is noted in your chart. Also whether the Hospital has any speciality nurses or staff to assist with breastfeeding to the new Mom.
Here is an example of what I am searching whenever I have the chance to find a group that meets my needs through the HMO CaliforniaCare with Blue Cross:
https://www.geoaccess.com//wellpoint-bcc/po/Gateway.aspHope this is helpful. I have an article on Open Enrollment:
http://www.bellaonline.com/articles/art32696.asp
