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Topic: Question: US Medical Insurance-How does it work? (Read 392 times) |
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Turts
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Question: US Medical Insurance-How does it work?
« on: Apr 2nd, 2004, 6:58am » |
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I have heard many instances of people being without meds because medical insurance wont cover the cost ( Just read Carl D post "About to lose my Cool"
Maybe we can get some sort of exchange happening here. You guys send gorgeous 22yr old brunettes to Oz and I can send meds. hehe Its great to dream!!!
Here, I go to the dr. If he Bulk Bills, my medicare covers the cost of the consultation. I tell him the symptoms of CH explain some details etc. He writes me a prescription of Imitrex Nasal Spray: Two sprays (in one pack) costs me approx $24. ($18 US).
I go to a chemist he fills the script. I use the two sprays. ( can usually get a script for 6 nasal sprays at a time, presriptions filled over $60 are compensated) I repeat steps above.
However the level of cover that I have purchased does not cover O2 hire and refills. The difference in cost of cover is greater than the expected cost of O2 Hire and usuage
Im never out of meds,unless i am lazy!!!??? I cont understand.
Please explain.
Turts
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'I'm very brave generally,' he went on in a low voice: 'only today I happen to have a headache.' (Lewis Carroll)
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t_h_b
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Re: Question: US Medical Insurance-How does it wor
« Reply #1 on: Apr 2nd, 2004, 7:17am » |
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In the US insurance is provided at little or no cost for the elderly and disabled (Medicare), for the extremely poor (Medicaid), and for the very poor (Family Health Plus and Child Health Plus or similar programs). The rich can pay for medical care or purchase private insurance. Many (but not nearly all) working people get subsidized insurance through their employers. A lot of working people have no insurance, especially those in low-wage jobs or those who work for small employers. Often those with insurance have fairly large premiums and deductibles as well as co-payments for services. People without insurance are entitled only to emergency treatment for life-threatening conditions and even then only to stabilize them. Fortunately, many hospitals give "charity" care.
More and more, insurance is moving towards "managed care" where visits to specialists, expensive tests like MRIs, surgery, and medications are controlled and/or limited. There are limits of coverage especially for expensive or experimental medications and it takes a great deal of effort to get these limits waived.
In my situation I pay about $35 a month for my insurance. (Very cheap, but my employer pays the rest, probably around $300-400 a month.) It costs me $10 to see a physician. There are limits on psychotherapy, physical therapy, drug rehab, etc. Surgery is free but must be pre-approved. It costs $50 to go to the emergency department unless you're admitted.
Generic medications have a $10 co-pay, brand names have a $15 co-pay. All medications are not "formulary". Sometimes my physician might have to choose from one or two specific drugs out of a class of drugs, for instance, the statin drugs for high cholesterol or the triptans for headaches. My insurance company, after receiving letters from my neurologist and a mini-novel from me, now pays for oxygen at no cost and allows me up to 12 vials of Imitrex a month. (My prescription is only for 10 but that is sufficient for me at this time. Their normal limit is 4 vials a month.) They throw in the syringes for free. If I want more I can buy it with a prescription but drugs are VERY expensive here compared to the rest of the world.
The US spends several times what any other country in the world spends per person on health care yet we are no healthier than than anyone else in the "developed" nations. The cost of health care increases at a rate many times that of the general level of inflation.
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No, it's not a headache--it's a Stage Ten Primary Chronic Periodic Idiopathic Trigeminovascular Cephalalgic Crisis.
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Charlie
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Re: Question: US Medical Insurance-How does it wor
« Reply #2 on: Apr 2nd, 2004, 7:39am » |
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I think that pretty much covers it.
I'm not employed but I pretend to be for insurance reasons. I pay a little to our Chamber Of Commerce so I can be on the plan they have. It used to be a great deal but not anymore. I have to pay close to $200 a month. My epilepsy medication would be very expensive without it. Soon I will have to go on disability and then everything will be covered as far as standard stuff goes. Our hospitals like to charge the the state as much as possible...and they usually do and it helps to drive up costs for everyone.
The best insurance in the US? Members of Congress who have total coverage for everything at no cost whatsoever. Only in America. The State of Maine with about two million people is going to be the first to adopt universal coverage for anyone who feels they need it. In New York State there are similar programs for poor children but it's something you have to sign up for I believe.
If you are clever and persistant you can probably arrange for some help but it's not automatic.
Charlie
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Opus
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Re: Question: US Medical Insurance-How does it wor
« Reply #3 on: Apr 2nd, 2004, 7:58am » |
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It doesn't work, the system is broke becouse none of the losers that we get to vote for will work on the real problem which is malpractice insurance for the docs, and hospitals. Everyone is so sue crazy here that even vets have to carry it. So now average peaple cannot afford healthcare for their family or their pets all becouse of lawyers who get the vast majority of the money that is won in court.
Opus/Paul
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floridian
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Re: Question: US Medical Insurance-How does it wor
« Reply #4 on: Apr 2nd, 2004, 8:49am » |
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Quote:| the real problem which is malpractice insurance for the docs, and hospitals. |
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Disagree with you there, Opus. There are many problems (including insurance costs) but the biggest problem is based on greed and the ability to charge consumers outrageous rates because the consumer has little choice. This is true of the pharmaceutical companies, doctors, medical equipment supply companies, insurance companies, etc.
I was referred to a nutritionist a few months ago after my triglycerides tested high. Looked at the paperwork on my way to the checkout counter - $150 for a half hour talk on portion size, basic food groups, etc. I did learn a few useful strategies, but how in the hell can they charge $300 an hour for that?? Even if that person had a masters degree in nutrition, is she worth $600,000 a year (2000 hours x $300 /hour)?? Maybe the insurance company pays less for this type of visit - say a meager $100. That knocks their real billing rate down to $400,000 per year, but probably gives them a write-off for tax purposes.
On medical malpractice insurance: the goal of the industry has traditionally been to balance the rates they charge doctors to modestly exceed the payouts from lawsuits. Profits are made by holding the money and investing it elsewhere. A drop in the stockmarket and low interest rates put the malpractice insurers into a red ink; these are the real causes of the medical insurance crisis.
Here's a study that shows that insurance losses have been steady and are not the cause of the insurance crisis.
http://www.insurance-reform.org/StableLosses.pdf
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fubar
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Re: Question: US Medical Insurance-How does it wor
« Reply #5 on: Apr 2nd, 2004, 10:45am » |
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Hmmmmm How does it work...
Well, I pay and pay and pay. My doctors submit claims. The Insurance company denies them. I pay more. Repeat as necessary.
To be accurate, I pay $369/mo which is the 'my share' after my employer pays some of it. For prescription, I have to pay a co-pay of $10, $20, or $30 depending on how expensive the medication is and where it is on the insurance company's formulary. Imitrex is $20 per box (2 stat dose). There are many medications that are simply not covered at all. For doctor visits, I pay a $15 co-pay. They refuse to pay for ER visits for a headache since ER is for real emergencies. The refuse to pay the doctor's rates a lot, which leaves me with the remainder to pay myself.
Dental is a whole nuther story.
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Opus
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Re: Question: US Medical Insurance-How does it wor
« Reply #6 on: Apr 2nd, 2004, 4:58pm » |
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Floridian,
I didn't explain why drugs are so high priced here in the USA. The drug companies admit that they charge higher prices here because they can, and that they need the money for research. The cost of drugs varies depending on the country, even though it is the same drug. These are the people who would not make a drug that would treat a rare disease if there wasn't enough demand for it. If a good drug treatment or cure were found for CH we may have to face the fact that no one will make it.
The PDF you gave shows the average premium for Drs. to be about $10,000. Here in NYS the average is around $50,000 with some Drs. paying $150,000. Maybe that's why a 20 min appointment is $200 now. HERE Is the first link I found, there are probably many more.
Opus/Paul
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Lizzie2
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Re: Question: US Medical Insurance-How does it wor
« Reply #7 on: Apr 2nd, 2004, 5:13pm » |
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Malpractice insurance is out of control in Pennsylvania. Many doctors are leaving to go to states where the premiums are much cheaper. I feel that doctors charge so much because the insurance company pays them such a small percentage. Therefore, doctors keep increasing the price so they can get their pay from the insurance company. Afterall, they are human with human needs and many are running a business straight out of their own funding.
The unfortunate part in all of that is that people without insurance can get screwed big time! Insurance companies can agree to pay a small percentage, and in many cases, the hospitals and doctors accept what the insurance will pay, and leave it at that. However, people without insurance cannot say, "Well, I'm only gonna give you this small percentage of what you charged because that's what I feel your services are worth." uhhhhhhh Doesn't really seem too fair to me!
My orthopedic surgeon has said that in some cases, the insurance will only pay $5,000 for major surgery on multiple joints. He said it's hardly worth getting up in the morning with all of the added costs.
I do sympathize with doctors, but also patients as well. The cap on malpractice suits prevents people who are sue happy from bankrupting doctors, but there are some cases where I feel people should be able to sue to the max for things that happen to them. For instance, the girl who was transplanted a heart of the wrong blood type which drastically reduced her chances of ever surviving another surgery. Or the woman who got a total mastectomy based on false breast cancer results. In my mind, that's just not right.
20-somethings generally have a difficult time with insurance, too. Many of our parents have insurance coverage that covers us, but in a lot of cases, that coverage ends upon college graduation or age 23...whichever comes first. Well, I'm 23, but I'm still in college. And Penn State student insurance does not cover services outside of State College, and you have to get a referral through University Health Services. Basically, I'd be screwed because there is NOBODY here who specializes in headaches....and only like 2 neurologists, and I've heard they both suck!
So my parents have cobra'd me onto their plan, which they can do for a max of 1 year after my 23rd birthday. They pay $350 a month so that I can then pay rediculously high copays for meds and doctors visits. Nature of the beast, I guess! And my insurance still refuses to pay for many of the things I need. They never paid for botox. They have refused coverage of DHE and toradol, and my most recent battle is that they will not pay for any more than 9 tabs of Amerge/month.
In May, I will hopefully be switching over to Jefferson's student insurance because it will hopefully at the very least cover services at Jefferson! I have to check into it, and hopefully they will have a continuation of coverage law so that they can't reject me since I'm actively covered right now.
Insurance = one big pain in the head!
Lizzie 
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Giovanni
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Re: Question: US Medical Insurance-How does it wor
« Reply #8 on: Apr 2nd, 2004, 5:36pm » |
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IMHO the medical system in this country is all but totally broken. How many millions of people are totally uninsured? Last year my total insurance health cost and co-pays was almost $9,000.00. And I belong to a group!!!
The pharmacy companies spend billions of dollars per year on TV advertising and we in the U.S. pay the highest price for any drug........go figure. The congress is bought off by the pharmacy cartels and the insurance companies. The malpractice attorneys are having a field day. The doctor's malpractice insurance premiums are astronomical.
Employers are reluctant to hire new people because of these costs....and now outsourcing to other countries.
This never ends and at this point I don't know if it can be ever fixed.
John
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Charlie
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Re: Question: US Medical Insurance-How does it wor
« Reply #9 on: Apr 2nd, 2004, 5:38pm » |
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Quote:| the real problem which is malpractice insurance for the docs, and hospitals. |
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Nope. Malpractice suits barely register. The kind of huge claims that make news are very rare. It makes for great TV and fodder for creepy legislators who get pressure to sceam about it. Limiting lawsuits like this and others protects no one but big corporate contributors. I'b be very safe betting that should some kind of silly limitation be passed, not a penny in savings would benefit consumers. It's the way 21st century busines works so far.
You don't think drug companies have anything to do with this?.....Nah.....
Charlie
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Lizzie2
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Re: Question: US Medical Insurance-How does it wor
« Reply #10 on: Apr 2nd, 2004, 5:42pm » |
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Charlie, I do think, however, that malpractice insurance premiums need to be smaller. It is literally forcing many doctors out of practice. Many trauma centers in PA, including the infamous Hahnemann Hospital, have had to close their doors due to the rediculously high cost of malpractice insurance. I just think that malpractice insurance premiums really hurt both practitioners and consumers due to the bad side effects from it!
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t_h_b
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Re: Question: US Medical Insurance-How does it wor
« Reply #11 on: Apr 2nd, 2004, 5:47pm » |
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on Apr 2nd, 2004, 8:49am, floridian wrote:the biggest problem is based on greed and the ability to charge consumers outrageous rates because the consumer has little choice. This is true of the pharmaceutical companies, doctors, medical equipment supply companies, insurance companies, etc.
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There are many contributing factors and greed is certainly one of them. I just dealt with a surgeon who wanted over $30,000 to do a 10 to 14 hour surgery. I had another one a couple of weeks ago who wanted $35,000 for a 6 to 8 hour surgery.
One of my co-workers just told me that new BSN RN graduates are getting $75,000 a year fresh out of school at a hospital in Queens on a med-surg floor. That seems like a lot to someone like me, but in contrast with what some of the surgeons want.....
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No, it's not a headache--it's a Stage Ten Primary Chronic Periodic Idiopathic Trigeminovascular Cephalalgic Crisis.
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FZfan
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Re: Question: US Medical Insurance-How does it wor
« Reply #12 on: Apr 2nd, 2004, 5:50pm » |
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opus and floridian, you are both right. Combine what you are both saying, throw in a little corporate greed, fold in some political ineptitude and, viola, we have our wonderful health care "system".
Flame me till I cook, but I still think health care should be one of the basic rights for EVERY citizen in this country. Or the world for that matter.
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Lizzie2
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Re: Question: US Medical Insurance-How does it wor
« Reply #13 on: Apr 2nd, 2004, 6:04pm » |
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on Apr 2nd, 2004, 5:47pm, t_h_b wrote:
One of my co-workers just told me that new BSN RN graduates are getting $75,000 a year fresh out of school at a hospital in Queens on a med-surg floor. That seems like a lot to someone like me, but in contrast with what some of the surgeons want.....
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For real??? Woohoo! I'm gonna be a BSN RN fresh out of school in 1 year from May!! Well, the way my education works though, if I get my scholarship, I have to work for Jefferson for 2 years, and during that time I will be working for my MSN/CRNP/CNS. The advisor I spoke to at Jefferson said that after I have all those degrees, I will be done school in less time and be making more money than the docs! About time the nurses of the world got compensated for all the crap they have to put up with!
Oh and FZ, I'm all for health care for one and all. People might not like this, but I do believe that government regulation of insurance companies so that they are not out of control would be a nice first step...
Lizzie
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Charlie
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Re: Question: US Medical Insurance-How does it wor
« Reply #14 on: Apr 2nd, 2004, 6:13pm » |
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Quote:| Charlie, I do think, however, that malpractice insurance premiums need to be smaller. |
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I almost got into this but I think there is a fear factor here. Doctors and health care types are so terrified of malpractice that they are willing to get screwed over and over by our delightful insurance companies....like the one that talked my mother into accepting $50 for the cost of her refrigerator that caught fire....makes me tingle all over.
Anyway there is something really shitty about sick people suffering further because of what I believe is more perceived fear than actual experience. Sure MDs need it but it's way out of wack. Something is really rotten Denmark and my bet it's our paying for overseas golf resort memberships by insurance executives and the like.
Call me a socialist but when it comes to this, it's accurate.
Charlie
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t_h_b
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Re: Question: US Medical Insurance-How does it wor
« Reply #15 on: Apr 2nd, 2004, 6:56pm » |
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on Apr 2nd, 2004, 6:04pm, Lizzie2 wrote:
For real??? Woohoo! I'm gonna be a BSN RN fresh out of school in 1 year from May!! Well, the way my education works though, if I get my scholarship, I have to work for Jefferson for 2 years, and during that time I will be working for my MSN/CRNP/CNS. The advisor I spoke to at Jefferson said that after I have all those degrees, I will be done school in less time and be making more money than the docs! About time the nurses of the world got compensated for all the crap they have to put up with! |
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It's all supply & demand. The average nurse is fairly old, few are entering the workforce. I know they're hurting for nurses when the travel company I worked for TEN YEARS ago has called me and left a message on my telephone. The shortage is on, good for nurses' pay, bad for nurses' work load, very bad for patient morbidity & mortality.
Have you considered being a Nurse Anesthetist?
Don't let them kid you that you'll be making more than the MDs. Maybe a couple of physiatrists and family practice docs on salary, but I know of several surgeons who get salaries of $2,500,000.00 and more PLUS what they bill. Go to guidestar.org and check out some of the hospitals in Philadelphia and see what they're getting.
Quote:| Oh and FZ, I'm all for health care for one and all. People might not like this, but I do believe that government regulation of insurance companies so that they are not out of control would be a nice first step... |
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Insurance is one of the most heavily regulated industries around, believe it or not.
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| « Last Edit: Apr 2nd, 2004, 7:00pm by t_h_b » |
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No, it's not a headache--it's a Stage Ten Primary Chronic Periodic Idiopathic Trigeminovascular Cephalalgic Crisis.
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Lizzie2
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Re: Question: US Medical Insurance-How does it wor
« Reply #16 on: Apr 2nd, 2004, 7:09pm » |
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My dad was recently talking to his podiatrist about my choice of professions, and the doc asked the same thing about considering to be a nurse anesthetist. My response to my dad was, "I want to work with people when they're conscious." Although some days I'm not sure why!!! My dad said that I'd make good money that way, but I am not doing it for the money. If I never make it out of apartment living, but I'm happy with my job...well then I guess that'll be good enough for me. At this point, I'm very dedicated to going into headache clinical care, education, and research. We'll see if that stays the same after some more schooling and experience! I do know that Jeff ER nurses make about $50/hour. Or if it isn't Jeff, then it's one of the other hospitals I worked at! Never actually sat down to multiply it all out....
I have checked the job listings at Jefferson a lot, and many of them have nice sign on bonuses for nurses right out of school.
My own worry is that the scholarship could assign me to any one of Jefferson's hospitals. I'd like to be at TJUH or Jefferson Hospital for the Neurosciences, but I could end up at Germantown, even! eeeeeeek I'm not sure I would like that a lot. Although James says that their hospital is really not technically in Germantown, it just has that zipcode. My grandma grew up in Germantown....wayyyyyyyyyyyy back when it was a whole lot different than it is today!!
Lizz
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t_h_b
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Re: Question: US Medical Insurance-How does it wor
« Reply #17 on: Apr 2nd, 2004, 7:17pm » |
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Generally you can double the hourly rate to get the approximate annual salary in a hurry.
$50.00/hr x 40 hrs/wk = 2,000 x 52 weeks = $104,000/yr
or 50 x 2 = 100,000
Of course, nurses don't usually get paid for forty hours.
I used to work three twelve-hour shifts, have a day off, work three twelve-hour shifts, then have a week off. That was sweet. They don't do stuff like that much any more.
I did just look at nursingspectrum.com, saw one hospital offering 76,500 and another offering a $10,000 sign-on bonus.
Lizzie, listen to your teachers and do a year on a med-surg floor when you get out. If you start out in a specialty area it's like learning to drive on an automatic--it's very hard to drive a stick shift.
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No, it's not a headache--it's a Stage Ten Primary Chronic Periodic Idiopathic Trigeminovascular Cephalalgic Crisis.
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Lizzie2
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Re: Question: US Medical Insurance-How does it wor
« Reply #18 on: Apr 2nd, 2004, 7:26pm » |
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Yeah I agree with you there! I might actually get my CRNP/CNS in acute care because some nurses have told me that once you have acute care, you can do anything. You aren't limited to working in ER, ICU, or CCU, but you do have that option. I have no idea what I'd wind up doing for my 2 years of floor experience. Jefferson has one floor strictly for headaches and other neurology when not full of HA patients.
The great part, if I get a job at Jefferson, is that I have stayed on med/surg, neuro floor, cardiac floor and cardiac ICU, and oncology floor. I have lots of nurse friends!! hehe
Lizz
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ClusterChuck
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Re: Question: US Medical Insurance-How does it wor
« Reply #19 on: Apr 2nd, 2004, 7:45pm » |
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Quote:| Question: US Medical Insurance-How does it work? |
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Simple, answer: Does not work worth a shit!
Chuck
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