CHOOSING A HEALTH PLAN

If you're looking for a world of caring, a world of expertise, a world of choices, then you'll want a health plan that gives you access to the world of healing that is Frankfort Regional Medical Center.  For a referral to a physician with privileges at Frankfort Regional Medical Center, visit our Find a Doctor section or call our referral specialists, Consult-A-Nurse at (877) FRMC-MD1 (877-376-2631) or (502) 226-1655.

To help find a health plan right for you, ask yourself these questions:

What type of plan do I want?
In Kentucky, managed care plans have all but replaced traditional fee-for-service insurance. Most employers have turned to managed care plans, which include health maintenance organizations (HMO), preferred provider organizations (PPO) and point of service (POS) systems. Most managed care plans require you to choose a primary care physician who will provide most of your care; if you receive care from other providers, your share of the cost will vary according to the plan. Generally, HMOs have the lowest co-payments, but place the greatest restrictions on who can provide your care. PPO and POS plans allow you more choice in providers, but at a greater cost.

Who will provide my care?
Before you choose your plan, choose your physician. After all, your plan won't diagnose or treat you - your doctor will.

If you already have a personal physician, ask which plans he or she accepts. If you need a physician, think about what you want from your doctor. You may prefer a younger or older doctor, or one who speaks your native language. If you have a specific health concern such as allergies, diabetes or sports injuries, look for a primary care physician specially trained in that area. Find out whether family members on your plan can each choose a different doctor.

Make sure the plan you select includes a comprehensive physician referral service to help you find a doctor who is right for you. If your health plan includes Frankfort Regional Medical Center, you can easily learn about a doctor's education, background, experience and interests by calling our physician referral service Consult-A-Nurse at (877) FRMC-MD1 (877-376-2631) or (502) 226-1655.

What if I need a specialist?
Most managed care plans require a referral from your primary doctor before you can receive care from a specialist, such as a dermatologist or allergist. The same may be true for laboratory tests, physical therapy and other services. Find out what your plan requires and what happens if you choose to receive care without a referral. Talk with your physician and other plan members about their experiences with referrals.

Where will I receive care?
You may prefer to see a physician near your home or work. Should you need hospital care, make sure your physician can and will admit you to the hospital of your choice. Some physicians affiliated with Frankfort Regional Medical Center, for instance, have admitting privileges at other hospitals at nearby counties.

Who pays for my prescriptions?
Check whether your medications are covered and at what cost to you. Most plans cover generic prescriptions with a small co-payment. If you want a brand name, or there is no generic equivalent, your co-payment may be higher.

What other services can I receive?
Look for a plan that reinforces your efforts to stay healthy through preventive screenings, education and support groups. You may only see your doctor once a year, but you might attend a low-fat cooking class or stress management seminar every month, for example.

Planning to have a baby?
Consider prenatal and maternity care. Ask about special programs for women, seniors and people with chronic conditions like asthma, diabetes or Parkinson's disease. Also, consider whether you want access to health care advice over the telephone via a nurse triage service.
 
Increasingly, health plans are starting to cover complementary services such as chiropractic, acupuncture and massage if you go to a therapist in their network. If you use these therapies, look for a plan that includes them.
 
The "right" health plan depends on you and your family. Make sure you choose a plan that offers excellent quality, compassionate care plus the programs and services you and your family need to achieve the best possible health.