Question : How does health insurance work in the US?
I am a non-US citizen and need this information to do a case. Specifically:1) Is health insurance compulsory for everyone? 2) What happens if someone cannot afford it?3) In the event that a medical procedure needs to be done, does health insurance cover all the bills? Does the patient need to pay anything extra? 4) Does the patient have any say over what kind of procedure he can take? Say if 2 treatments are available for his condition, can the patient choose the more expensive treatment? And if so, is it covered by the insurance? Thanks for reading this. Your help in answering any part of the questions would be greatly appreciated!Thanks to those who have responded so far. I would like to further ask:Does a health insurance contract state that it will only cover the "normal" rates for a procedure? For eg. if there are 2 possible treatments for a disease, 1 of which is more expensive but more effective than the other, will the patient only be covered by the LESS expensive one? Or is it a case in which the patient can opt for the more expensive one and "top-up" the difference? This is a crucial question to my understanding the case. Thanks!
- asked by synchronised
All Answers:
Answer #1
Health insurance doesnt work in the US. If youcant afford it (it is very expensive) you donthave it. We do have programs to provide insuranceto those that cant afford it, but it is primarilyfor children. You can choose any treatment youwant as long as you are going to pay for it. Ifyou do have insurance the insurance company prettymuch tells you what they will pay for, otherwiseyou are on your own. Insurance companies rule inthe US, and if you dont like it.....too bad.
- answered by Pinky Lee
Answer #2
You've asked a very broad question. There is nosimple answer.In truth, health insurance works alittle differently in each state.To answer yourspecific questions:1) No, health insurance is notcompulsory for everyone. If you're lucky, you areable to join a group policy at work. (If you'rereally lucky, it's a good policy and the employerpays at least half of it.) Some states haverecently made it compulsory, but that's such arecent change that there's no clear cut answer yetfor how that's going to work. 2) What happens ifsomeone can't afford it is... they don't get it,usually. Except if your income puts you below the"poverty level", in which case you qualify forMedicaid. (In some states there are programs thattypically provide assistance with insuringchildren, though they are few and far between forcovering adults.)3) Health insurance rarely coversall the bills when you have a procedure done. Most plans cover 50-80% after you meet yourdeductible. The deductible amounts vary widely(but the trend is that the deductibles are gettinghigher and higher to keep the premiums down.) Ifyou're really, REALLY lucky, you don't have adeductible (which is only an option on groupplans), and you may only have to pay 10% ofcovered charges. (These plans are few and farbetween. As in, you might have them if you're inCongress.)4) Yes, the patient has some say overprocedures. However, if the patient opts for an"experimental" procedure, or one that isn't deemed"medically necessary", then health insurance mayrefuse to cover any charges at all.In the end, aswith most things, the middle class takes the bruntof these costs. This has become such a problemthat more than 50% of all bankruptcies are as aresult of medical bills (and of those, more than75% had health insurance.)** Edited to add:It'snot ALL about the money when a procedure isinvolved. If it is, the state keeps track ofcomplaints filed on behalf of consumers with"managed care" (ie. any type of networkarrangement including Preferred ProviderOrganizations, Health Maintenance Organizations,and Point of Service organizations -- also knownas PPO, HMO, and POS) and may very well revoke acompany's charter to do business in the stateshould the company be turning down too manylegitimate claims.However, insurance companies aresticklers for following the "standard" for medicalcare. This is what makes it difficult to answeryour question. Because they should not denyanything that's considered standard for care inthe given circumstances (should not and will notbeing two completely different things, of course.) And there may be several options that would beconsidered "standard." If the patient wantstreatment that isn't yet considered "standard",they would balk. Period.
- answered by ISOintelligentlife
Answer #3
Wow. What a question. In the order asked.1. No.2.You do without.3. Rarely do they cover all thebills. Most often, patients pay a pre-negotiatedportion - either a set dollar amount of a copay ora percentage.4. In a perfect world, only doctorsand their patients would have say over whattreatments are performed. But, since this is byfar NOT a perfect world, the insurance companieshave the say. The patient doesn't get to choosethe more expensive treatment - and the ONLY way itwould be covered was if the patient and theirdoctor(s) can prove beyond a shadow of a doubtthat by the insurance shelling out more money upfront (in the form of the treatment) they would,in fact, save money in the long run - by nothaving to pay for complications or repeatproecdures.If the patient ops to "top up" thetreatment, they better have deep pockets becausethey'll probably end up paying for most, if notall of it.
- answered by zippythejessi
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