Lambert Ron
Feb 14, 2022
Things I don’t get about American health insurance bills
Things I don’t get about American health insurance bills
This is something I saw on twitter that I thought would be helpful!!
1. Deductible
This is just money you pay. For a deductible of. 200, the patient pays up to. 200 at the beginning of a treatment, after which insurance rates apply. In the case of dental treatment, general treatment during the insurance cycle is also considered as one treatment.
For example if you get the treatment A, and the deductible is 200, and the insurance burden rate is 20 percent, if the cost is $500, you have to pay deductible 200+300*0.2=260.
I don’t get the reason deductibles exist.
2. Different terms for same meaning: for example Co-pay/co-insurance
Co-pay is what I pay and coinsurance is what the insurance company pays
3. PPO/HMO insurances
PPO applies insurance to whichever hospital I go to (no matter the level of the facility) on individual treatments. HMO (from what I understood) you meet up with the General Practitioner first then go to a higher hospital to get insurance. People prefer PPO and the cost is higher.
I think HMO is a program that the insurance companies created to delay the time that they give us money. (that’s how they make profit. Most systems that I don’t understand comes down to this reason)
The justification for this is the ‘general practitioner’ system. But to be honest, does it make sense to go to a general practitioner first when you get a rash on your skin then going to the dermatologist? You can’t go to the optometrist when you get eye problems. None of the GPs I’ve met (except for the dentists) have made clear and correct diagnosis for me. This is just another way they delay giving us money.
4. Pre-approval system
For unconventional or expensive treatments you need to get approval from the insurance company and your primary care physician. They are saying that they will only approve it when the company and the primary care physician deems that you need it. This is another way they delay giving us money (related film: Flawless)
I’ve had 10+ back and forth calls to get my medicine (just imagine the hassle this would be for a large scale surgery because it took so much time for one medication). There are quite a lot of treatments that need this procedure (not really sure though).
5. The annual list of medications they cover (this changes every year)
One time a whole set of diabetes medication just disappeared from the list (the diabetic patient has to get approved first or get another insurance). The list is too long so it also wastes paper.. It is a tool to avoid responsible behavior.. Most other countries on the list don't change much.. So the elderly have to struggle to find their medication on the list.
6. In-network/Out-of-network
The conditions for your insurance differ depending on whether it is in-network (your doctor joined the insurance) or out-of-network. It also differs on whether it’s an emergency or not. Some insurances, when it is not in-network, there is no out-of-pocket (the max amount the patient pays yearly, $2000-$3000 on average) or the premium rate is 0.
So it’s a must to search the in-network before going to the hospital and also call to make sure. This is why they go to a hospital that is 2 hours away instead of 30 minutes despite emergency situations (get rid of the thought that everyone can ride the ambulance, it is frustrating when it is not covered).
7. The fine you pay if you don’t have health insurance (GC holders & citizens only)
If you want people to have health insurance, other countries would make cheap insurance, but the US only fines you. (but this is cheaper than the insurance so many young people choose this route)
8. The medical fee varies too much depending on the region/hospital.
The worst case was when they charged the stuffed bear they brought to calm the patient down (they didn’t even give it, they took it back).
Lastly, one general hospital said that the inpatient ward is an orthopedic ward, so for other serious digestive-related diseases, they should be transferred back to the ward for treatment.
Closing comment: If the State undergoes medical reform, it would extend its average lifespan for 2 years. (it is 5 years shorter than Korea right now). I just saw the news that covid took 1.8 years off of the average lifespan of Americans.. It went back to 2003 level.
(check out the original tweet here https://twitter.com/hyeok__kim/status/1490742340624916481?s=21)
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Slammz DApr 4, 2022
You wouldn’t pay the full $500 deductible upfront in the first example if the total cost of the medical procedure is less than $500. in that instance, you would pay $200 and then still have another $300 to pay out of poket during subsequent appointments before the insurance would start paying 20 percent of the cost. my plan with blue cross blue shield has a $1000 deductible so that’s how I know …it’s basically a way for the insurance co to make money, total rip-off if you ask me
