I'm a non-US citizen and want these details to perform a situation.
Particularly:
1) Is medical health insurance compulsory for everybody?
2) What goes on if a person can't afford it?
3) When a surgical procedure must be done, does medical health insurance cover all of the bills? Does the individual have to pay anything extra?
4) Does the individual have say over what type of procedure he is able to take? Say if 2 remedies are for sale to his condition, can the individual pick the more costly treatment? And when so, could it be taught in insurance?
Thank you for reading through this. Your assist in responding to any area of the questions could be greatly appreciated!
Because of individuals who've responded to date.
I must further request:
Does any adverse health insurance contract condition that it'll only cover the "normal" rates for any procedure? For eg. if you will find 2 possible remedies for any disease, 1 which is much more costly but more efficient compared to other, will the individual simply be taught in LESS costly one?
Or perhaps is it a situation where the patient can choose the more costly one and "top-up" the main difference?
This can be a crucial question to my comprehending the situation. Thanks!
You've requested an extremely broad question. There's no simple answer.
In reality, medical health insurance works just a little in a different way in each condition.
To reply to your particular questions:
1) No, medical health insurance isn't compulsory for everybody. Should you're lucky, you'll be able to join an organization policy at the office. (Should you're really lucky, it's a great policy and also the employer pays the vast majority from it.) Some states have lately managed to get compulsory, but that's this type of recent change there's no obvious cut answer yet based on how that's likely to work.
2) What goes on if a person can't afford it's... they don't have it, usually. Until your earnings puts you below the "poverty level", by which situation you be eligible for a State medicaid programs. (In certain states you will find programs that typically provide help with covering children, though they're few in number for covering grown ups.)
3) Medical health insurance rarely covers all of the bills if you have a process done. Most plans cover 50-80% once you meet your deductible. The deductible amounts vary broadly (however the trend would be that the insurance deductibles are becoming greater and greater to maintain the rates lower.) Should you're really, REALLY lucky, you don't possess a deductible (that is only a choice on group plans), and you'll just pay 10% of covered charges. (Efforts are few in number. As with, you may have them should you're in Congress.)
4) Yes, the individual has some say over methods. However, when the patient decides to have an "experimental" procedure, a treadmill that isn't considered "medically necessary", then medical health insurance may won't cover any charges whatsoever.
Ultimately, associated with pension transfer things, the center class takes the brunt of those costs. It has become this type of problem which more than 50% of bankruptcy are consequently of medical bills (as well as individuals, a lot more than 75% had medical health insurance.)
** Edited to include:
It's not By pointing out money whenever a procedure is involved. If it's, the condition monitors complaints filed with respect to customers with "handled care" (ie. any kind of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point and services information organizations -- also called PPO, HMO, and POS) and might easily revoke a business's charter to conduct business within the condition should the organization be turning lower a lot of legitimate claims.
However, insurance providers are sticklers for following a "standard" for health care. This is exactly what causes it to be hard to answer your question. Simply because they shouldn't deny something that's considered standard for care within the given conditions (shouldn't and won't being two different things, obviously.) There might be a number of options that might be considered "standard." When the patient wants treatment that isn't yet considered "standard", they'd balk. Period.
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{ 3 comments… read them below or add one }
Health insurance doesnt work in the US. If you cant afford it (it is very expensive) you dont have it. We do have programs to provide insurance to those that cant afford it, but it is primarily for children. You can choose any treatment you want as long as you are going to pay for it. If you do have insurance the insurance company pretty much tells you what they will pay for, otherwise you are on your own. Insurance companies rule in the US, and if you dont like it…..too bad.
References :
You've asked a very broad question. There is no simple answer.
In truth, health insurance works a little differently in each state.
To answer your specific questions:
1) No, health insurance is not compulsory for everyone. If you're lucky, you are able to join a group policy at work. (If you're really lucky, it's a good policy and the employer pays at least half of it.) Some states have recently made it compulsory, but that's such a recent change that there's no clear cut answer yet for how that's going to work.
2) What happens if someone 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 for Medicaid. (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)
3) Health insurance rarely covers all the bills when you have a procedure done. Most plans cover 50-80% after you meet your deductible. The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.) If you're really, REALLY lucky, you don't have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges. (These plans are few and far between. As in, you might have them if you're in Congress.)
4) Yes, the patient has some say over procedures. However, if the patient opts for an "experimental" procedure, or one that isn't deemed "medically necessary", then health insurance may refuse to cover any charges at all.
In the end, as with most things, the middle class takes the brunt of these costs. This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)
** Edited to add:
It's not ALL about the money when a procedure is involved. If it is, the state keeps track of complaints filed on behalf of consumers with "managed care" (ie. any type of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point of Service organizations — also known as PPO, HMO, and POS) and may very well revoke a company's charter to do business in the state should the company be turning down too many legitimate claims.
However, insurance companies are sticklers for following the "standard" for medical care. This is what makes it difficult to answer your question. Because they should not deny anything that's considered standard for care in the given circumstances (should not and will not being two completely different things, of course.) And there may be several options that would be considered "standard." If the patient wants treatment that isn't yet considered "standard", they would balk. Period.
References :
http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1
And this just in (an article about Massachusetts, one of the few states that is mandating health insurance for residents):
http://news.yahoo.com/s/ap/20070304/ap_on_re_us/massachusetts_health_care
Wow. What a question. In the order asked.
1. No.
2. You do without.
3. Rarely do they cover all the bills. Most often, patients pay a pre-negotiated portion – either a set dollar amount of a copay or a percentage.
4. In a perfect world, only doctors and their patients would have say over what treatments are performed. But, since this is by far NOT a perfect world, the insurance companies have the say. The patient doesn't get to choose the more expensive treatment – and the ONLY way it would be covered was if the patient and their doctor(s) can prove beyond a shadow of a doubt that by the insurance shelling out more money up front (in the form of the treatment) they would, in fact, save money in the long run – by not having to pay for complications or repeat proecdures.
If the patient ops to "top up" the treatment, they better have deep pockets because they'll probably end up paying for most, if not all of it.
References :
I'm a medical biller