Use the following questions as a guide when you talk to your insurance company about your coverage options. Be sure to make note of the name of the person that gave you the answers to these questions and the date that you spoke to him or her.

• What type of insurance plan do I have?
• Is Memorial Sloan Kettering in my network? If so, here are some follow-up questions to ask:
  • What is my benefit coverage for different types of services?
    • Physician costs
    • Inpatient hospital services
    • Outpatient hospital services
  • MSK bills services as an “Outpatient Hospital” rather than a “Doctor’s Office.” Many insurance carriers have different benefits for “Outpatient Hospital” services, so be sure to ask about your coverage.
• What, if any, are my co-payments?
• What rights and protections do I have against any surprise medical bills?
• Do I have pharmacy coverage?
  • If yes:
    • Is there a separate pharmacy card?
    • If there is no separate pharmacy card, ask for the following information:
      • Pharmacy plan ID number
      • Prescription BIN number
      • Prescription PCN number
      • Prescription group name and number
      • Phone number to contact the pharmacy insurance provider
    • Does this plan have any specific restrictions?
    • Am I locked into a specialty pharmacy? If so, what is the name and contact information for that specialty pharmacy?
    • Is mail order required?
  • If no:
    • What are my other options for prescription coverage?
• Memorial Sloan Kettering is not in my network, but my plan has out-of-network benefits. If I choose to go out-of-network, what do I have to pay? What is the amount of my deductible?
• If I go out-of-network, what percentage of my bill will be paid by the insurance company?
• Is the percentage of my bill paid by the insurance company based on usual, customary, and reasonable (UCR) schedules or on the actual charges?
• Does my insurance plan offer any additional coverage through special networks for treating medical conditions such as cancer?
• Does my policy have an out-of-pocket maximum?
• If my out-of-pocket expenses reach a certain amount, will the insurance carrier ever reimburse at 100 percent?
• If so, does this mean that my claims will then be paid in full, or will I still be responsible for the difference between Memorial Sloan Kettering’s charges and usual, customary, and reasonable (UCR) rates?
• Before I see a doctor at Memorial Sloan Kettering, do I need a referral from my primary care physician, or will I need authorization from my insurance carrier?
• Will I be covered for any testing, pathology, or radiology charges that may be incurred as part of my initial consultation with a Memorial Sloan Kettering doctor?