What to look when choosing a health insurance?

When the insurance tells you that you are allowed to see doctors outside the network

This is not really true. In many cases, the provider will accept whatever your insurance pay. But if this is not the case, you may be totally responsible for the bill.

Your Primary Care Provider affiliation

HMO require that you choose a primary care provider. This doctor or institution is responsible for your referrals and your primary care. They will direct you to the right doctors within the network. They will keep your records, etc. If you want your doctor to take care of you or look over you when need to be in the hospital. You must only visit the affiliated hospital. If you need to go to the emergency, you should let the nurse know which is your primary Doctor.

When you choose your doctor, make sure you also like the affiliated hospital.

GHI is the worst Health insurance I ever had.

The way they seem to work, is that they try all the ways before they pay. And if at the end, they pay something, they pay so little that does not affect your bill by much. Usually it's way less than half.

This is my personal experience with GHI.

Last year, we moved to NJ and my husband was going to commute to NY. Well we wanted an insurance and since he is the only money maker, we decided to pick an insurance accepted in NJ. GHI was the perfect choice at the moment.

After we were here with the new insurance. We found out that there are very few if any within our area. I recognize that this is a small town, but we decided to get all the service from the hospital. Usually hospitals accept all kind of insurances. Lucky us, this is a wonderful hospital. Then I found out that the OBG is independent. They had separate bills and they are not part of the GHI network. Therefore we assume all obligations and the insurance will reimburse some deductibles. I needed some sonograms. Well, I also found out after I received all the bills, that the department was not part of the network. I did asked the hospital before the exam if the insurance would cover and they told me that I had no bills with the hospital.

Well I got the exam, them after a bill over $2,956.00, I found out that the insurance will not cover.They would pay only $443.53. It seems that the hospital does not tells me that some parts are not networking with my insurance.

I recognize that the billing system in the hospital is not too helpful. But the insurance never gave me a list of providers within my area. They said they serve all areas in NJ. I don't see anything fairly close within 15 miles from home except the pediatrician for my children. Customer service gave me two providers. When I called them up, they were not longer working there.

If the problem was only that they don't have enough providers and that I don't know what they pay and what they not.

Any individual procedure seems to be different. They haven't even paid for anesthesia. I was taken to emergency and right after to surgery and the bill for anesthesia for $805 is coming to me now from a collection agency. I called GHI twice regarding to this specific bill and they told me that they do cover anesthesia, but the fact is that they haven't paid.

They did not pay the emergency doctor who did the surgery because he was not part of the network.

I wonder if I do have to ask the ambulance when I call 911 if every single procedure will be cover by GHI. I should ask for no anesthesia. I should wait for the next day or ask to be translated to another hospital where a network provider is available in order to make it affordable for me.

If this doctor would not quickly stop the blood from coming out when he did, I would be death by now.

I do feel that I am not cover or maybe I should say that my family and I are "a little bit covered" by GHI.