Insurance Basics: Home

Shared Decision Making and Preference-Sensitive Conditions

To get the best care, it helps if you and your doctor make decisions together. The process is called "shared decision making." This article suggests ways to talk to your doctor about three common health problems where there may be no clear, "right" option. They are uterine fibroids, type 2 diabetes and low-risk prostate cancer. These are examples of preference-sensitive conditions.

Shared Decision Making and Preference-Sensitive Conditions
Provider Networks

Your plan may contract with doctors, dentists and other healthcare practitioners; hospitals; labs; radiology facilities; pharmacies and other types of providers. These are the providers in your “network”.

Provider Networks
Experimental Treatments and Clinical Trials

Most health plans don´t cover treatments they regard as “experimental”. Sometimes, they may deny a claim for such a treatment.

Types of Out-of-Network Reimbursement

Most health plans have a “network”, a group of doctors, hospitals and other healthcare providers who agree to take your insurer´s rate.

Limited Health Plans: AHPs and STLD Plans

New rules have expanded access to two types of limited health insurance plans. They are association health plans (AHPs) and short-term, limited duration (STLD) health plans. Because they don’t have to follow the Affordable Care Act, these plans can cost less than regular health plans. But, they have limitations you should know.

Getting Covered for Alternative Medicine

Acupuncture, chiropractic care and massage therapy have one thing in common: They may not be covered by insurance. That’s because they may be looked at as alternative treatments, not part of conventional medical care.

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IN AND OUT OF NETWORK

When Out-of-Network Care Can Be Covered in Network
PLAN COSTS

Flexible Spending Plans
YOUR RIGHTS

Appealing a Reimbursement Decision
KNOW BEFORE YOU GO

Choosing Your Healthcare Provider In-Network and Out-of-Network Care