Question about US medical insurance

[BubbySoup]

I was talking about this with a friend tonight, and my Google skills must be weak because I couldn't find a clear answer to this.

If an American gives birth to a disabled child who is going to need care for the rest of its life,

a) Who pays for the bills at the time of birth? Obviously as it wouldn't be classed as a normal pregnancy, is this covered by the mother's medical insurance?

b) Once the child is home, how would the parents go about getting medical insurance for the child? My understanding of US medical insurance companies is that they are like any other insurance company, ie pay for as little as possible. How on earth could you get insurance for someone who is going to need constant payouts for the rest of their life?

I no very little about how US medical care works, so I may be missing something very obvious.

 

[arknor]

It likely depends on the insurance or maybe they are covered by the parent's to a certain age.

I believe I read 20,000 Americans die every year from insurance companies wriggling out of paying medical bills

I cant be bothered to google enough to find out if I remember that correctly but I found this

http://news.harvard.edu/gazette/sto...s-annually-linked-to-lack-of-health-coverage/
The study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking into account education, income, and many other factors, including smoking, drinking, and obesity. It estimated that lack of health insurance causes 44,789 excess deaths annually.

pretty shocking

 

[arknor]

I was wondering how the medical system works in america.

if you get rushed into hospital say for a gun shot, do they treat you then bill you if you dont have insurance?

films have tended to portray the opposite although being films it might be an exaggeration of the facts.

 

[MissChief]

I believe in some areas ambulances were privately owned and wouldn't (or would be forbidden from) stopping at RTA's etc in case of malpractice suits etc.

With regard to Us Healthcare, the whole private medical insurance is a absolute racket from start to finish. All the Senators and Congressmen trying to get Obamacare repealed or defunded and getting huge campaign contributions from private medical insurance companies. Giving cheap, affordable Healthcare to those who can't afford it privately isn't a bad thing, but to listen to some of them it's akin to communism or socialism.

 

[arknor]

I believe in some areas ambulances were privately owned and wouldn't (or would be forbidden from) stopping at RTA's etc in case of malpractice suits etc.

With regard to Us Healthcare, the whole private medical insurance is a absolute racket from start to finish. All the Senators and Congressmen trying to get Obamacare repealed or defunded and getting huge campaign contributions from private medical insurance companies. Giving cheap, affordable Healthcare to those who can't afford it privately isn't a bad thing, but to listen to some of them it's akin to communism or socialism.

weren't they all complaining ombamacare is a monopoly lol?

 

[On Holiday]

I was wondering how the medical system works in america.

if you get rushed into hospital say for a gun shot, do they treat you then bill you if you dont have insurance?

From what some US friends have told me, yes.

 

[thedoc46]

You cant be denied medical attention, its the hospitals responsibility is to make you stable before releasing you.

So even without insurance you get taken care of.

They'll bill you afterwards, and you can bet that it'll be astronomical. Like 10k a night in hospital.

If you have insurance, you'll have to pay probably 20% up to a fixed amount example 5k a yr out of pocket.

If you don't have insurance, you'll get billed afterwards, by various groups that have treated you.. Example the ER doctor, the xray, bloodtests etc...

Problem is no hospital ER's make any money, cos those who have no insurance / or money go to the ER knowing they'll get treated, then afterwards say they can't pay. They can't take what you haven't got. With 20millon illegals, and the huge number of people living paycheck to paycheck here, without insurance, its a bit of a mess. The middle class get billed ridiculous amounts to cover the non-insured. Remember all hospitals are privately owned and profit making corporations.

The problem is if you have no insurance but have money, then they'll come after you. Which is why the biggest percentage of bankruptcy in the US is due to medical bills.

Healthcare quality is like a million times better than it is in the UK, however !!! you're screwed if you do not have insurance, or a pre-existing condition that'll not allow you to have insurance.

Insurance is also expensive. I'm very lucky in that my company covers my family and i, and i pay less than what i was paying in National Insurance.. So for me ATM its a win win. However I have also been at the other end... I even had to speak on the phone to the British Embassy, who told me to best do a runner back to England, after my wife was 2 months pregnant, when we arrived here back in 2004, and subsequently, unable to get insurance since being pregnant is considered a pre-existing condition. Anyway baby came early, like 3months early, and the bills came rolling in. My kid, cos he was born an american and spent 3months in the NICU, was covered, by medicaid (a millon dollar baby, as we like to call him) lol My wife, well she wasn't covered and for the six days in hospital, we got billed 60k. To which i paid about $30k. the rest the wrote off.

But that 30k was money well spent as far as i was concerned, cos the healthcare my son rec'd for those three months was the absolute best he could have rec'd anywhere in the entire world. Actually, i think its fair to say, there was NOWHERE else in the entire world where he would have rec'd better healthcare.

There are winners and losers.

 

[Zefan]

Some of the statistics I've read about "uninsured people are 40% more likely to die"... does that take in to account the fact that people who have insurance are almost certainly going to be better off, and therefore not involved in anywhere near as much reckless activity, crime, drugs, dangerous driving, and will be more sensible with regards to how they treat their bodies? Maybe it's just the cynic in me, but I don't think those stats are all they first appear.

:Edit:

ATM its a win win. However I have also been at the other end...

Oh my. That was too much for my childish mind

 

[thedoc46]

I would like to see them totally do away with pre-existing conditions, which i think is part of the healthcare reform. If you have a pre-existing condition, the way round the problem, is work for a corporation who provides group coverage.. Then you're ok, its the small biz owner who struggles, cos if he let his insurance lapse, he'll never get insurance again.. They can't deny / or drop you once you're insured. But can deny taking you on.. Except if you go with a group coverage, which then they're not allowed to ask, if you have preexisting conditions.

Sound like running though a minefield? well you've got that right.

 

[arknor]

Some of the statistics I've read about "uninsured people are 40% more likely to die"... does that take in to account the fact that people who have insurance are almost certainly going to be better off, and therefore not involved in anywhere near as much reckless activity, crime, drugs, dangerous driving, and will be more sensible with regards to how they treat their bodies? Maybe it's just the cynic in me, but I don't think those stats are all they first appear.

it tells you in the link I posted 2nd post in the thread which is where you likely read about the 40% higher risk of death for non insured people

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking into account education, income, and many other factors, including smoking, drinking, and obesity. It estimated that lack of health insurance causes 44,789 excess deaths annually.

 

[momentimori]

Healthcare quality is like a million times better than it is in the UK, however !!! you're screwed if you do not have insurance, or a pre-existing condition that'll not allow you to have insurance.

Yet the richest people, who can afford good healthcare and generally have good lifestyles, in America have a shorter life expectancy at 65 than the poorest in the UK.

American healthcare gives you choice but that comes at the price of efficiency. How expensive is it if you have the choice of, say, 10 cardiologists or oncologists whereas all you need is one?

The Americans should just fund healthcare through taxation as it avoids excessive duplication and cuts out useless administration like medical advertising, debt collection etc in addition to removing the profit motive and providing vast economies of scale to drive down the cost of drugs.

 

[Scuzi]

Healthcare quality is like a million times better than it is in the UK

Amen to that. One of the things my wife hates about the UK is the godawful health care. Even with private medical insurance it really is years behind the US if you have decent insurance. None of this GP rubbish, for example, if your baby is sick you go straight to a Pediatrician who knows what they are talking about, rather than going to a clueless GP who gives you a whole 7 minutes of their time only to refer you on to someone who knows what they are doing with an appointment 6 weeks down the line.

With regard to the OP's original question, we have close friends who were in that unfortunate situation. Their son was born with severe disabilities and required round the clock medical care. The father had to keep switching jobs because they would hit the medical insurance $10 million limit in the space of a couple of years. Every time he got a new job he would get a new policy and another $10 million of cover.

 

[arknor]

One of the things my wife hates about the UK is the godawful health care. Even with private medical insurance it really is years behind the US if you have decent insurance. None of this GP rubbish, for example, if your baby is sick you go straight to a Pediatrician who knows what they are talking about, rather than going to a clueless GP who gives you a whole 7 minutes of their time only to refer you on to someone who knows what they are doing with an appointment 6 weeks down the line.

true GP's are like secretaries for the real people just there to weed out the hypochondriacs from the sane people or something...

 

[momentimori]

Amen to that. One of the things my wife hates about the UK is the godawful health care. Even with private medical insurance it really is years behind the US if you have decent insurance. None of this GP rubbish, for example, if your baby is sick you go straight to a Pediatrician

Extremely inefficient. It is rare that you would actually need to see a paediatrician or other specialists. The GP is a far better one stop shop for the vast majority of medical circumstances.

If you need a specialist urgently you see one extremely quickly with an emergency appointment; I saw a specialist at my local hospital within 45 mins of being referred by my GP when I needed it.

 

[garak112]

Amen to that. One of the things my wife hates about the UK is the godawful health care. Even with private medical insurance it really is years behind the US if you have decent insurance. None of this GP rubbish, for example, if your baby is sick you go straight to a Pediatrician who knows what they are talking about, rather than going to a clueless GP who gives you a whole 7 minutes of their time only to refer you on to someone who knows what they are doing with an appointment 6 weeks down the line.

Except that 9 times out of 10 you dont actually need a paediatrician and you are just wasting their time...

 

[Dolph]

I believe in some areas ambulances were privately owned and wouldn't (or would be forbidden from) stopping at RTA's etc in case of malpractice suits etc.

With regard to Us Healthcare, the whole private medical insurance is a absolute racket from start to finish. All the Senators and Congressmen trying to get Obamacare repealed or defunded and getting huge campaign contributions from private medical insurance companies. Giving cheap, affordable Healthcare to those who can't afford it privately isn't a bad thing, but to listen to some of them it's akin to communism or socialism.

If you think Obamacare achieves the above, you need to do more research...

Obamacare only forces the private medical companies to take everyone on, and prevents them charging a higher premium to people more likely to claim, and combines it with a requirement for the people to by insurance or suffer several thousand dollars in tax penalties. There is no cap on costs, nor is there really much subsidy for the poor who aren't eligible for medicare or mediaid.

This is the reason why premiums are skyrocketing for those who already had insurance, and not really helping the poor who aren't destitute.

 

[pitchfork]

You cant be denied medical attention, its the hospitals responsibility is to make you stable before releasing you.

Which is fine, except it would imply you have let your condition reach the point where you are ill enough to require stabilisation.

So even without insurance you get taken care of.

Patched up until stable enough to turf out you mean.

They'll bill you afterwards, and you can bet that it'll be astronomical. Like 10k a night in hospital.

Which

If you have insurance, you'll have to pay probably 20% up to a fixed amount example 5k a yr out of pocket.

Which is astronomical, and additionally, most lower income folk have excesses up to 60%

If you don't have insurance, you'll get billed afterwards, by various groups that have treated you.. Example the ER doctor, the xray, bloodtests etc...

Problem is no hospital ER's make any money, cos those who have no insurance / or money go to the ER knowing they'll get treated, then afterwards say they can't pay. They can't take what you haven't got. With 20millon illegals, and the huge number of people living paycheck to paycheck here, without insurance, its a bit of a mess. The middle class get billed ridiculous amounts to cover the non-insured. Remember all hospitals are privately owned and profit making corporations.

ER isn't the only dept in a hospital, there are dozens of other departments which make huge profits to support the money leakers.

The problem is if you have no insurance but have money, then they'll come after you. Which is why the biggest percentage of bankruptcy in the US is due to medical bills.

How we live in a world where it is ok to bankrupt a family because someone got sick is unreal.

Healthcare quality is like a million times better than it is in the UK, however !!! you're screwed if you do not have insurance, or a pre-existing condition that'll not allow you to have insurance.

You're also screwed if you can't afford insurance, which many people can't. Not to mention people who are priced out of insurance as they get old, then are unable to work, they die before they can get near the medicare or whatever the old age pensioners fund is called.

Quality might be better, but it's still overpriced.

Insurance is also expensive. I'm very lucky in that my company covers my family and i, and i pay less than what i was paying in National Insurance.. So for me ATM its a win win. However I have also been at the other end... I even had to speak on the phone to the British Embassy, who told me to best do a runner back to England, after my wife was 2 months pregnant, when we arrived here back in 2004, and subsequently, unable to get insurance since being pregnant is considered a pre-existing condition. Anyway baby came early, like 3months early, and the bills came rolling in. My kid, cos he was born an american and spent 3months in the NICU, was covered, by medicaid (a millon dollar baby, as we like to call him) lol My wife, well she wasn't covered and for the six days in hospital, we got billed 60k. To which i paid about $30k. the rest the wrote off.

$30k is more than most people earn in a year, it's extortion. Insurance for you might work out cheap as a young man, over your life course it would be cheaper to pay into a centralised fund via taxation, instead of paying for ridiculous bonuses to the CEO's of the hospital and massive markups on every treatment option going.

But that 30k was money well spent as far as i was concerned, cos the healthcare my son rec'd for those three months was the absolute best he could have rec'd anywhere in the entire world. Actually, i think its fair to say, there was NOWHERE else in the entire world where he would have rec'd better healthcare.

No one is denying the healthcare in the states is quite good, but it's also ridiculous in the developed world people are sent away to die because they don't have money.

There are winners and losers.

Winners: Upper middle class families, Upper class people
Losers: Everyone else

 

[Uther]

My wife just spent 14 days in a central London hospital having a heart valve replaced. Big op carried out by a top surgeon, two days in ICU, followed by 2 days in HDU, then back on the ward. The care was fantastic. Thank god for the NHS, for all its faults.
I would hate to have the American health system here. No idea how much that operation and after care would have cost over there, but it would probably have resulted in bankruptcy!