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Point of Service Option for Insurance
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Point of Service Option for Insurance


The Tennessee Consumer Health Care Advocacy Act, which went into effect on January 1, 1999, l allows you an attractive option if you have “managed health insurance” through your place of employment*. Many “managed health insurance” plans reimburse for covered services only if you see someone on their approved lists of health care providers. Such plans do not reimburse for services provided by doctors who are out of the plans’’ networks.
Now, however, you have an opportunity to choose another option--one which will allow you to see a health care provider who is not on the insurance plan’’s list--and get reimbursed for it. “Health care provider” refers to physicians, as well as psychologists, pharmacies, and other specialties. If you do not choose this more flexible option at the annual renewal period for your health insurance, you may not have another chance until next year, at the next renewal period (usually in October).
This option, called a “point of service” option, allows you much more flexibility as you seek health care. It will allow you to continue to see your health care specialists even if you change jobs or if your employer changes insurance to one which does not have those specialists on its approved list. You can also see any medical specialist you choose, whereas with current managed care plans, many health maintenance organizations (HMO’’s) do not have medical specialists on their staffs, and many preferred provider organizations (PPO’’s) have a limited selection.
You, or your employer, will pay a slightly higher premium for this option, and your co-payment will be somewhat higher when you see out-of-network providers. However, you will maintain more choice and will not face the frustration of having your insurance company dictate which health care provider you will see.
Look for this option when you sign up for health insurance or when your renewal date approaches.
*Employers with 25 or less employees, and certain insurance plans provided by large self-insured employers are not required to offer this option.
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