Choosing a Specialist
The following is an excerpt from Asthma & Allergy Advocate, a quarterly newsletter from the American Academy of Allergy, Asthma, & Immunology.
Can you see the specialist of your choice?
Survey shows that in choosing a health plan, patients put access to medical specialists as their most important criterion. When selecting a health plan, make sure you have the right to see a specialist if necessary, especially for appropriate treatment of your asthma or allergies. Seeing a specialist trained & experienced in treating your specific medical condition often results in early diagnosis & treatment. Many financial experts have found that prompt consultation with a specialist generally reduces health care costs. It is important to get answers from your prospective health plan in writing about specialist coverage & referral procedures before you join. Some important questions to ask include:
- Who determines whether you see a specialist?
- If a primary care “gatekeeper” must approve your visit to a specialist, is the decision based upon your health or financial considerations such as capitation or a quota system?
- Can you appeal a decision against your seeing a specialist, and how quickly can another decision be made?
- Is the appeal review board independent of the health plan?
- If you want to see a specialist not with the plan how much of the cost does your health plan cover?
It’s up to you to shop wisely & choose a health plan that best suits your needs as a patient with allergies & asthma. Your decision requires that you take an active role in managing your health. If you’d like further information to guide you, call the Patient Access to Specialty Care Coalition at 800-766-1100.
