In a recent entry, I encouraged you to think about how your overall access to health care might be subtly affected by a health insurance company's policies and restrictions. 

The following are some questions that you might want to investigate before deciding on your health insurance plan for next year. Note that some of the answers to these questions may be difficult to find, so that you may need to seek opinions from your doctors and from other consumers who have dealt with the insurance plan(s) you are considering.

• Does the drug plan change its formulary often? The pharmacy-benefit provider for an insurance plan is always trying to negotiate the best prices for any of the drugs it pays for. This means that a provider may change its formulary (the list of medications available to you within that plan) whenever they find a comparable drug at a lower price. What that can mean is that the insurance provider might request that you switch from one drug to a comparable one — and later back again! But every time a medication is changed, you, the patient, may need additional lab tests and/or doctor visits to make sure that the underlying problem is still well controlled. You may have a very hard time getting a clear answer about this subject from an insurance provider. Your doctor might have an opinion about which companies tend to do this more often than others.
  
• Does the plan require new prior authorizations each year? Insurance plans may require that your physician fill out a form justifying a particular medication or diagnostic test. Sometimes, the company will request the same form every year, even though nothing has changed. These extra forms may seem like no big deal to you, but remember that every minute your doctor spends on such administrative tasks is a minute not available for seeing patients. As a result, many physician practices now charge patients a fee to complete these forms, in order to recoup those extra expenses. This is another area where your doctor might be able to advise you.
  
• Will your physician need to ask permission for you to see a specialist? A good primary care physician can manage a broad variety of problems and, when necessary, will judiciously refer you to a specialist. But some insurance plans turn your physician into a gatekeeper, requiring the insurance company's permission (and another form) every time you need to see a specialist. Your insurance plan may also restrict your care to particular specialists with whom the company has established a contract. If agreeing to these restrictions doesn't worry you, then these types of health plans can save you some money.
  
• Will you have adequate access to non-physician health providers? Frequently, the best treatment for a problem isn't medicine or surgery, but education, therapy, or lifestyle/behavioral changes. Nutritional counseling, diabetes education, and physical therapy are good examples. Mental health coverage is another thing most people don't think twice about when choosing a health insurance plan, unless they have a significant illness like major depression or schizophrenia. But be aware that if your mental health coverage is very limited, you will have to pay out of pocket to see a counselor for such common complaints as anxiety, on-the-job stress, or mild mood disturbances. In fact, mental health coverage has become so inadequate in recent years that increasing numbers of these practitioners no longer participate in any health plans at all.
  
• Does the plan stipulate a single laboratory or radiology service? Some insurance plans limit their coverage to a single lab or radiology provider who has agreed to accept a lower price from them. In my experience, however, the labs that have an exclusive contract like this with an insurance company tend to be the ones who most often lose patient samples, fail to provide timely results, and are not able to offer me electronic access to test results.
  
• Does the plan hinder your physician's ability to practice medicine? The medical care we physicians provide has also become a business. To keep their practices open, doctors must be able to pay their own bills. Insurance companies whose policies create too many barriers or who don't reimburse doctors adequately are the ones most likely to be dropped by those physicians who are able to be selective.

When choosing your insurance plan, try to look beyond the stated costs. Your doctor's office may have to impose fees to deal with lots of extra forms, prior authorizations, and administrative burdens, all of which can reduce the time your physician has available to see you.

The bottom line: Consider asking your doctor which insurance plans he or she feels do the best job of getting out of the doctor's way and allowing him or her to efficiently help you maintain your health.