Coverage for GI specialists in New York

What is the best health insurance plan for someone living in New York City, who has Irritable Bowel Syndrome and acid reflux?  I want to be able to see gastroenterologists when I need to have specialized procedures or tests done.  My main concern is that when a doctor recommends me to someone else there’s a decent chance that my insurance covers them.

Sour Tummy in NYC

Dear Sour Tummy,

Overall, you might be better off with a PPO (Preferred Provider Organization), rather than an HMO (Health Maintenance Organization).  A PPO would give you greater flexibility to see out-of-network doctors.  Some HMOs do cover out-of-network doctors, but some do not.  If you go with an HMO, carefully check their out-of-network benefit. 

Since you know where you will be living and what condition you will be treating, you can do some in-depth research about the plans’ networks.  In New York, Empire Blue Cross and Blue Shield has the largest share of the individual health insurance market.  Blues plans typically have the widest, most inclusive provider network.  So you might want to give their plans special consideration.

You could also ask your current doctor whom he/she uses for GI referrals.  Then you could check these specialists to see whether they are in-network for the plan you want.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.