Hospital Information: Questions to Ask Your Insurance Company

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

  1. What type of insurance plan do I have?
  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? 
  5. Is the percentage of my bill paid by the insurance company based on usual, customary, and reasonable (UCR) schedules or on the actual charges?
  6. Does my insurance plan offer any additional coverage through special networks for treating medical conditions such as cancer? 
  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?

Questions?

Patients with insurance questions should contact Memorial Sloan Kettering's Insurance Information line at 646-497-9176, Monday through Friday, 9 AM to 5 PM ET.