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Patient Advocate Foundation
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Part III: The Provisions


The purpose of this part, Understanding the Provisions of Your Plan, is to assist members of health insurance plans, particularly HMOs and PPOs, who have been diagnosed with cancer. This Part profiles common questions to ask the insurance company in order to specifically define your coverage or benefits. The type of plan you have can affect who directs your medical plan of care (the physician), where that care can be delivered (the facility providing services), the length of time certain services can be administered (precertification/predetermination), and any additional cost of treatment to you (co-insurance).

Managed care, by definition, is a comprehensive method of managing and coordinating medical care you receive. The goal of case management is to coordinate and facilitate access to medical care, while adhering to the guidelines and provisions of your health benefit plan. A wise course of action is to be proactive by finding out what your policy covers and how to access medical care services.