T HE PG ing a health plan is whether pre-exist- ing conditions are excluded. Many HMOs will not cover care for pre-exist- ing conditions at any time, while others require a waiting period of up to three months before paying for care for a pre-existing condition. Here are some other important questions to explore prior to signing up for any health plan: What is the pre- mium each month? Are there co-pays? What is the deductible? What exclu- sions are there that might affect you or your family? Are preventive services covered? What do you have to do to see a specialist? If you have a chronic condition, will your plan cover it? What is the lifetime expenditure cap? How and when can you change doc- tors? What is the appeals process? If you want to check on the quality of your health plan, you can contact your state health or insurance depart- ment to find out if they have reports on medical loss ratios, disenrollment figures, complaints, financial stability and doctor turnover. Additionally, many HMOs conduct satisfaction sur- veys of their members which they pub- lish in a "report card." Ask if you can obtain a copy before joining a plan. You may also want to find out if your HMO is accredited by the National Committee for Quality Assurance or the Joint Commission on the Accreditation of Healthcare Organizations. These organizations review HMOs based on a set of prede- termined standards and grant accredita- tion accordingly. Although you hope and expect to receive a certain standard of care from your HMO and your primary care physician, there is no guarantee that you won't encounter a problem some- time down the road, either in service or coverage. Fortunately, there are steps you can take to try to remedy the situa- tion. The first step is to talk with a service representative. If that fails, you can file a formal complaint with the member services department or grievance office of your HMO. If your complaint is denied, you may be able to file an appeal, which will be reviewed by a higher-level committee. If you are still not satisfied with the outcome, you can contact your state insurance depart- ment. As with any bureaucracy, it's impor- tant to keep accurate written records when dealing with a managed-care organization, noting when you first made a complaint, the date and to whom you spoke. ❑ The Premier *ntai *tirement Community WisAos ow residosits, friends and famiey Happy liatiti4a4 24111 Civic Center Drive • Southfield, MI 48034 (248) 352-0208 Assistance for your tooed one at home Get Results... Advertise in our Entertainment Section! Call The Sales Department (248) 354-7123 Ext. 209 DETROIT .1111WISII =WS •TN A Century of Caring Visiting Nurse Association Support Services can help you or your loved one maintain an independent lifestyle at home. /RN Assessment & Supervision 2 tour to 24 hour care - 7 days a week •Personal care •Medication reminders •Light housekeeping •Shopping & transportation •Nursing care •Sitting service •Wake-up phone calls Caregivers are &life insured aad beaded. Call (248) 967-5800 VISITING NURSE ASSOCIATION ■ SUPPORT SERVICES An affiliate of VNA of Southeast Michigan Joist Commission on Accrodatt‘on of Hsattlxvir Orpnivitions • Let us help you be the best you can be with 1 on 1 training at our club. A patient friendly program designed just for you to help you reach your realistic fitness goals. Change your life by changing your lifestyle. Muscle therapy and nutritional consulting available. Call us today for a FREE consultation. • Children's Fitness Programs • Nutritional Counseling • Muscle/Massage Therapy personal Training C l u b• Free Consultation 4119 Orchard Lake Rd. (at Pontiac Tr.), West Bloomfield (248) 855-0345 12/26 1997 131