Actor Mike Wiley ’04 (MFA) was himself uninsured when he was cast in a commercial to portray an uninsured man alarmed by the presence of a
bee — and the prospect of the medical costs a bee sting would mean — causing him to spit punch all over a woman at a party.
and just to have access to care if it’s needed
for an emergency,” Kriss noted. “The
biggest concern is not getting preventive
care and then having a health issue become
bigger because you don’t know about it.
For example, if you have high blood pressure or high cholesterol or diabetes and
you don’t get professional care, it can get
worse. And reproductive health care is
important for women in this age group.”
Pam Silberman ’ 81 (JD), who received
her doctorate in public health at UNC in
1997, echoes Kriss and adds: “If you get
health insurance when it’s first offered to
you or when you’re healthy, the price is
generally lower, and you won’t be subject
to pre-existing condition coverage exclusions.” Silberman is president and CEO of
the N.C. Institute of Medicine and associate director for policy analysis at UNC’s
Cecil G. Sheps Center for Health Services
Research. If you wait until you’re sick to
get group insurance through an employer,
she notes, you won’t be excluded from all
coverage, but you may be excluded from
coverage for pre-existing conditions for
up to a year. If you’re already sick and you
buy an individual policy, you’ll get locked
into a higher-cost tier.
Continued on following page
Selecting a Health Plan
Pam Silberman ’ 81 (JD), president and
CEO of the independent, nonprofit N.C.
Institute of Medicine, has written a consumer’s guide to selecting a health plan.
She suggests including these ques-
tions when researching a plan:
■ What type of health plan is it — a
health maintenance organization,
preferred provider organization,
point-of-service plan or a fee-for-service plan? Different plans give
different levels of flexibility and
control over the providers you can
see and the types of services you
receive.
■ Which primary care providers and
specialists are in the health plan’s
network of providers? Where do they
practice?
■ Do you need to choose a primary care
provider to coordinate your care, or can
you obtain care from any provider in
the network?
■ Can you seek care from a non-network
provider?
■ If your provider is not a member of the
plan, can you continue to get care from
your provider for a certain period?
■ Can you select a specialist to serve as
your primary care provider?
■ How will the health plan treat your
health condition?
■ Does the plan contract with medical
and surgical specialists who can treat
your health condition?
■ How much choice do you have in
choosing a specialist?
■ Are there restrictions on the use of specialists?
■ What is the approximate waiting time
for an appointment with a specialist?
■ Does the plan permit you to obtain a
second opinion? Can you use an out-of-network physician for the second opinion?
Silberman also suggests:
■ Before you select a plan, ask for an
“evidence of coverage” document or
policy contract, which contains
detailed information about covered
benefits and exclusions.
■ If you have a medical condition,
contact others with that condition for
advice about which plan to choose.
■ Review all written materials and
keep all written correspondence
from your plan.
The NCIOM guide is available at
www.nciom.org/hmoconguide. The N.C.
Department of Insurance also offers a managed care plan handbook and an HMO performance report. Call (800) 622-7777 or
(800) 546-5664.
