Question about US medical insurance

[Scougar]

Even if you have insurance, much like car insurance you can have an excess which is easily equal to your monthly payment (i.e. you pay $400 to 800 a month and your excess might also be that much if you need treatment... ouch!).

For all the constant ****ging off and the attempts by the government to make the NHS look bad, we are incredibly fortunate to have it. My wife doesn't particularly like it as she's American and used to private medical, but I'm sure she can appreciate the fact that it doesn't cost thousands in this country for simple care, or that the birth of our daughter didn't cost $20,000. We have put the majority of our money into moving country and her effectively being a single mother whilst working has proved extremely difficult, and I can tell you that without paying for decent cover you get screwed, there are no two ways about it. Also, as I mentioned before as well... the $80K that my brother in law had as a bill for three days in hospital! eek.

 

[Xordium]

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?

Ok the hospital covers the care costs irrespective of whether you are uninsured or insured. All policies for the parents must add on the newborn child irrespective of their health and cover the cost to the policy limit - the onus on the parents was to do this within 30 days. You would need to have a look at the "Health Insurance Portability and Accountability Act" if you wanted to know further details. This however can have exclusions eg plastic surgery. Let me give an example:

A baby is born with a hole in the heart and a cleft lip - the insurance would pay for the hole in the heart operation when that was required (not a pre-existing condition naturally so covered, life threatening therefore covered, etc) but may well not pay for the cleft lip repair (not a pre-existing condition - so covered but classes as plastic surgery and therefore not covered as part of an exclusion clause). However, there would be a good chance a clinic would do the operation anyway.

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?

Well it would depend on the needs of the child and the specific problem. A lot of work is done by 'free' institutions especially the various children's hospitals. However, as I am sure you are guessing sometimes the figures don't add up and care will be more palliative than curative.


One interesting side effect of this and one not commonly really recognised by people who haven't got a clue about what constitutes quality in healthcare and sing the praises of American excellence is that the poor actually often get a better deal. Let's look at our earlier example:

a) Fully insured couple: The baby is born at the local hospital immediately added to the policy. The hospital can get all the money back so therefore an adult surgeon performs the heart repair along with the cleft lip repair.

b) Non insured couple: The baby is born at the local hospital and immediately the hospital recognises the cost implications of the treatment they ethically need to do but can't get the money back for. The local hospital transfer to the regional children's centre. Now an pediatric heart surgeon and a pediatric cranio-facial surgeon perform the relevant ops 'pro bono'.

Which kid do you think had the better surgery, nursing care and consequently the better long term outcomes.

Hope that answers your questions. As aside American care is poor really by all reasonable standards. The doctors there are often very weak - they are almost junior in mentality. They think nothing of throwing a systematic barrage of expensive tests to determine something that a UK trained doctor could narrow down to one or two with a degree of finesse and talent. Think of it like the US military - yes they get results but by spending a ton and just chucking everything at a problem - however this rarely does not mean better results. Most peoples perception of a good healthcare experience is how the environment looks etc as they have no way of judging that actual quality of care. Where do you think the Middle East royalty send their ill kids too? London. Where do you think Europe sends the kids they can't treat? London. Where do you think famous US actors send their kids to? London. Where do you think rich Russians send their kids to? London. Where do you think rich Indians send their kids to? London. Kind of says it all really.

 

[Windle]

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

You're dead wrong there, one of my friends moved to the states and his wife is a nurse who had previously worked for the NHS and now works in a US hospital. She says the healthcare standard in the US is at least 20yrs behind where the NHS is now.

This is backed up by numerous studies as well, such as:

"In a 2010 report by the nonprofit Commonwealth Fund, the United States, despite spending twice as much on healthcare, came in dead last compared with six peers - Britain, Canada, Germany, Netherlands, Australia and New Zealand."


"Despite already spending more per head than any other nation on Earth, the United States suffers 'mediocre' health care according to newly published research.

Worryingly for the current administration, the study published in the Journal of the American Medical Association, doesn't even take into account the projected trillion dollar expenditure of Obamacare, which will be rolled out this decade.

Compiled from 1990 to 2010, the damning report reveals that with investment that already dwarfs other developed nations, the U.S. fell from 18 to 27 in rankings among wealthy nations in terms of early infant mortality."

"'Despite a level of health expenditures that would have seemed unthinkable a generation ago, the health of the U.S. population has improved only gradually and has fallen behind the pace of progress in many other wealthy nations,' Dr. Harvey Fineberg of the Institute of Medicine in Washington, D.C"

 

[Scuzi]

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

The beauty of having a choice. If it is a simple problem you can choose to go straight to the family doctor. If you know the problem requires specialist attention, you go stright to the specialist. Waiting list of about 2 hours instead of months.

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.

It is only inefficient if there are a shortage of specialists and in my experience there is far from a shortage in the US. For example, when my wife was pregnant, we were dealt with exclusively by a very experienced Obstetrician from the beginning. With his years of experience, he pointed out some anomalies very early on at a point where intervention was successful. Under midwife led care which we get here in the UK, the problem would have gone unnoticed and any intervention would likely have been unsuccessful.

The NHS is great if you have a life threatening problem but in my experience of US medical care, many problems were never allowed to get to that stage due to early intervention and care directed by specialists.

 

[pitchfork]

The beauty of having a choice. If it is a simple problem you can choose to go straight to the family doctor. If you know the problem requires specialist attention, you go stright to the specialist. Waiting list of about 2 hours instead of months.

In the UK you can elect to go private to avoid waiting lists, however if you're in desperate need of it then you are prioritised on the list anyway.

More to the point, no one has to go private, it's a choice for those who can afford it.

It is only inefficient if there are a shortage of specialists and in my experience there is far from a shortage in the US. For example, when my wife was pregnant, we were dealt with exclusively by a very experienced Obstetrician from the beginning. With his years of experience, he pointed out some anomalies very early on at a point where intervention was successful. Under midwife led care which we get here in the UK, the problem would have gone unnoticed and any intervention would likely have been unsuccessful.

Unlikely, you really underestimate how well they train people in this country and the policy under which they operate. Any doubts and you'd have gotten a second opinion.

How can you really say it's better when you've never experienced the staff over here performing the same procedure?

The NHS is great if you have a life threatening problem but in my experience of US medical care, many problems were never allowed to get to that stage due to early intervention and care directed by specialists.

The NHS is great because anyone who is worried about the a small thing won't hesitate to go and see a doctor. It's how we catch so much.

In the US? People won't see their doctors over small worries because they quite frankly can't afford to a lot of the time. They will then develop and cost huge sums of money.

It's one of the reasons healthcare is so lucrative in the states.

 

[Xordium]

If you know the problem requires specialist attention, you go stright to the specialist.

If you are qualified enough to know that decision then why go to a doctor? You are such an expert you could sort it out yourself. Care to explain how you know?

 

[Mark A]

In the US? People won't see their doctors over small worries because they quite frankly can't afford to a lot of the time. They will then develop and cost huge sums of money.

It's one of the reasons healthcare is so lucrative in the states.

Very true. I see it all the time on websites with a lot of US members, like 4 chan for example. People asking for advice from random people on 4chan as they cant afford to go to a doctor . This is better than what we have? I don't think so.

There was also a video on ******** of a guy removing a cyst as he couldn't afford to pay thousands to get it removed in a hospital.

 

[BubbySoup]

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.

That's a truly awful situation to have to been in on top of having to care for a child for life

Oh, and thanks Xordium for that very informative answer

 

[pitchfork]

There was also a video on ******** of a guy removing a cyst as he couldn't afford to pay thousands to get it removed in a hospital.

I saw this, the healthcare system in America is just shambles.

It's like I was reading about these family planning centres, which masquerade as abortion clinics, but then when the woman comes in for an abortion, a decision not taken lightly, they bombard them with religious guilt and all sort of nasty things.

These centers of christian fundamentalist mind****ery are state funded.

Real abortion clinics are not.

EDIT: Link to the wiki article, theres lots about these atrocities online http://en.wikipedia.org/wiki/Crisis_pregnancy_center

 

[Allnamestaken]

Ive heard stories from family in america of people being left on the street after being picked up by ambulance to essentially die.

 

[garak112]

The beauty of having a choice. If it is a simple problem you can choose to go straight to the family doctor. If you know the problem requires specialist attention, you go stright to the specialist. Waiting list of about 2 hours instead of months.

How do you deal with the problem that the vast majority of people are not qualified to make that call and given the choice will always choose to see the specialist?

 

[thedoc46]

Ive heard stories from family in america of people being left on the street after being picked up by ambulance to essentially die.

Stories.... You've got that right. They're not going to dump on the side of the street because you have no insurance.

They'll treat you. What you'll struggle with is follow up appointments, but for emergency care you'll get seen too. Not financially assessed and if not financially viable, dropped off at the nearest street corner.

My family has rec'd non insured care and it's the same as insured care. Though they are more keen to keep you in the hospital once they know they'll get paid.

 

[D.P.]

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.

A) mothers medical insurance pays
B) the expecting mother must alert the is raunch company during pregnancy and sign up for a family or mother +child insurance policy to initiate automatically from the birth date. Hence a disabled baby will be covered from before birth and the insurance pays. The only thing I am not sure on is if you change insurance providers then this would be a pre-existing condition and finding coverage might be expensive.

 

[D.P.]

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?

In emergencies the payment is always treated without question of insurance. If the patient has no insurance they are billed. If you are rich then you are screwd because you will have to pay all that money. If you are poor then basically you can't, so you either declare bankruptcy and 7 years later you are fine from a credit perspective, or more commonly you arrange a payment schedule with the hospital where you pay small amounts monthly based on what you can afford. Typically after some period of honest work to repay the debt the hospital may simply wipe the debt, e.g. After 5 years of paying $50 a month they say you have paid enough and as a good will gesture will stop requesting payment.

 

[arknor]

Stories.... You've got that right. They're not going to dump on the side of the street because you have no insurance.

They'll treat you. What you'll struggle with is follow up appointments, but for emergency care you'll get seen too. Not financially assessed and if not financially viable, dropped off at the nearest street corner.

My family has rec'd non insured care and it's the same as insured care. Though they are more keen to keep you in the hospital once they know they'll get paid.

I bet they do the absolute minimum compared to someone with insurance though

 

[D.P.]

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!

Most likely you would have insurance, so your actual cost would be anywhere from 0 cents to like £1600.

Any white collar job will offer free or cheap health insurance.

 

[D.P.]

I bet they do the absolute minimum compared to someone with insurance though

Nope, they will give the same level of care. They basically follow recipes or instructions to care for people. They might also be sued if they give inadequate medical care.
Your opinion of American hospitals is far from the truth though, sure some might be strictly concerned with profit and costs of the ER but most operate on a Robin Hood mantra- get excessive money from the unsinsured rich and the well insured to help support the uninsured and underinsured. The profits comes from other departments.

 

[arknor]

Most likely you would have insurance, so your actual cost would be anywhere from 0 cents to like £1600.

Any white collar job will offer free or cheap health insurance.

What happens with insurance when you retire in the US? do you get any as part of your pension or something?

 

[Xordium]

Any white collar job will offer free or cheap health insurance.

Yep, but there will be still be limits on what they will and won't do, for how long, exclusion of certain things, exclusion of pre-existing problems, etc.

I bet they do the absolute minimum compared to someone with insurance though

I covered this in relation to the OP - if anything it is the opposite.

 

[D.P.]

How do you deal with the problem that the vast majority of people are not qualified to make that call and given the choice will always choose to see the specialist?

Better safe than sorry. A pediatrician will have assistant nurses that do initial assessments and prepare documents, tests, questions etc. The doctor will come in when ready to conduct their assessment which can be very efficient sic e all prep work is done. If the ailment is minor the nurses will take over again, if more serious the pediatrician carries on.

This way the specialist makes the call and you are done within like an hour of first phoning in, rather than some inept family GP that you wait hours to see before getting a misdiagnosis, retuning a week later, then getting transferred to the specialist you should have gone to immediately but have to be put on a 5 week waiting list.