What Should I Know Before Choosing a Health Plan?
Coverage: What services does the plan cover? What are the deductibles? Does it cover home care, chiropractic services, mental health services, or anything else that is particularly important to you?
Choice: Is there a certain doctor you’d like to choose, either for routine care or specialty care? Do you have to choose a provider from among those specified? Do you have a primary care hospital? If you have different rules for “emergency care” and “urgent care” how do you define the difference between the two?
Convenience: Does your plan cover providers who are located near your home or office? What is the procedure if you choose a provider and then find that you do not like him/her?
Cost: You will pay all or part of the premium directly or through payroll deduction, plus a visit fee, or co-payment, whenever you get care. If your coverage is through your employer, your benefits manager can tell you what your portion of the premium will be. If you are in a Medicare managed care plan, there may be no premium.
Other
- Are the deductibles one time only, or yearly?
- Is the insurance provider financially stable?
- Is the plan accredited by NCQA? The National Committee for Quality Assurance is a non-profit watchdog organization created to assess, measure and report on care provided by the nation’s managed care groups. Since 1991, NCQA accreditation surveyors–mainly doctors–have evaluated a health plan’s organization, structure and quality improvement processes to see whether the plan was capable of delivering high quality care and continually improving the care it provided?
- How long has the company been in business?
- What is the average turn-around time on claims?
Put It All Together: Is the combination of cost, quality, coverage and access to your preferred providers or specialists acceptable?
Insurance Participation
Central Maine Healthcare (Bridgton Hospital, Central Maine Medical Center and Rumford Hospital) accepts most major insurance companies. Below is a list of insurance companies that we participate with. If you don’t see your specific plan or product below, please contact your insurance company customer service department to check that the facility you will be receiving care at is a participating provider. Each patient’s medical situation and insurance plan are different and you should ask your health insurance company to review your coverage and benefits at Central Maine Healthcare’s facilities. Insurance plans are agreements made between you and your insurer, and Central Maine Healthcare cannot ensure that an insurance company will pay for your care. It is your responsibility to understand what types of coverage your health insurance provides and to be sure that you meet all requirements stipulated by your specific plan. Your health insurance company will be able to inform you of your level of coverage and what, if any, copayments, coinsurances and deductibles will be your responsibility. Many insurance plans are now considered “tiered” plans, and have different levels of costs depending on where you go for care. It is important that you check with your own health insurance plan to see what level of coverage you will receive at a specific hospital. Even if you see your insurance plan listed, additional referrals or authorizations may be required. Some services may not be covered by your insurance coverage at every location. The level of coverage provided to you is determined by your insurance company. Also, many health insurance plans use other companies to cover certain services such as behavioral health (mental health). Please contact your insurance plan or employer for your specific questions.
CMH Contracted Insurance Plans
- Aetna
- Aetna Medicare Advantage
- Anthem
- Anthem Medicare Advantage
- CHAMPVA
- Cigna
- Community Health Options
- Harvard Pilgrim
- Humana Medicare Advantage
- MaineCare
- Martin’s Point Generations Advantage
- Martin’s Point USFHP
- Medicare
- Meritain Health
- Multiplan
- NH Medicaid
- Patient Advocates
- TRICARE
- UnitedHealthcare
- UnitedHealthcare Medicare Advantage
- VA Community Care Network (VACCN)
- Wellcare Medicare Advantage