Questions to Ask Your Insurance Company

Use the following questions as a guide when you talk to your insurance company about your coverage options.

1. What type of insurance plan do I have?
   (Your insurance company might tell you that you have one of the following plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Point of Service (POS), and indemnity insurance plans.)

2. Is Memorial Sloan-Kettering in my network? If so, here are some follow-up questions to ask:
   • Does my insurance plan cover physician costs, as well as inpatient and outpatient hospital services?
   • What, if any, are my co-payments?

3. Memorial Sloan-Kettering is not in my network, but my plan has out-of-network benefits.
   • If I choose to go out-of-network, what do I have to pay?
   • What is the amount of my deductible?

4. If I go out-of-network, what percentage of my bill will be paid by the insurance company? (Examples: 80 percent paid by insurance/20 percent paid by patient, 70/30, 50/50, etc.)

5. Is this percentage based on usual, customary, and reasonable (UCR) schedules or on the actual charges?

6. Does my plan participate in any other preferred provider organization (PPO) networks that provide additional coverage? (Note: Check your insurance card as one of the following networks may be listed: Multiplan, Magna Care, Beech Street, Integrated Health Plans, Cancer Resource Services, and United Resource Network.)
7. Does my policy have an out-of-pocket maximum?

8. If my out-of-pocket expenses reach a certain amount, will the insurance carrier ever reimburse at 100 percent?

9. If so, does this mean that my claims will then be paid in full, or will I still be responsible for the difference between Memorial Sloan-Kettering's charges and usual, customary, and reasonable (UCR) rates?

10. Before I see a doctor at Memorial Sloan-Kettering, do I need a referral from my primary care physician, or will I need authorization from my insurance carrier?

11. Will I be covered for any testing, pathology, or radiology charges that may be incurred as part of my initial consultation with a Memorial Sloan-Kettering doctor?

Note: Be sure to make note of the name of the person that gave you the answers to these questions and the date that you spoke to him or her.