While comforting her daughter on the way to the nearby emergency room, Maria had a thought she didn't express. "Times are tough -- I'm so glad we've got health insurance." Ana's cut just above her forehead was still bleeding, and would probably need stitches. At the hospital, which was listed on her insurance plan, Maria was relieved when the doctors told her Ana's head injury was minor and that they'd fixed her cut so it would quickly heal. A week later, as she watched a recovered Ana happily resume active play with her friends outdoors, Maria opened the letter from her insurance company. And gasped. Thanks to her insurance, the ER visit would only cost her $50, as she'd expected. But, despite the insurance company's contribution, the bills didn't stop there. The total charges Maria faced paying for Ana's care in the ER topped three thousand dollars!
We've all heard about the heartbreaking cases where insurance companies have canceled coverage and refused to pay hospital bills for patients after they've received treatment. But, as in Maria's case, even when the insurance company forks out their required share, patients and their families could still be on the hook for big bucks. When she aimed for her "in-plan" emergency room, Maria didn't know that, while the ER itself was "in-plan," its doctors, hired on contract, were not. And, the CT scan they'd ordered to ensure that Ana didn't have bleeding on the brain, performed in a trailer adjacent to the hospital, had been done by a partner company of Radiology doctors, who -- you guessed it -- were also not participants in Maria's preferred provider insurance.
Because the ER and the X-ray doctors were "out of plan," Maria's insurance company would only pay 60% of their fees, not 80% as with "in plan" providers. To her dismay, Maria quickly discovered that, for out-of-plan providers, the insurance would pay 60% of the rates it had negotiated with in-plan doctors. Anything over that became Maria's responsibility. In-plan doctors might bill the insurance company $500, of which $400 would be paid by the insurance company and $100 by Maria. Out-of-plan doctors who had no deal with the insurance company could charge much more -- $1000, for example -- for the same service. The insurance company would then pay 60% of the $500 agreed upon for in-plan doctors -- not the $1000 demanded. The final insurance payout would be $300 and Maria would be left with a $700 bill. Had the ER warned Maria that their doctors' services might be out-of-plan so that she could opt to go to another facility? Not a chance.
As a doctor, I've seen many cases like Maria's, where patients think they're abiding by insurance company rules, only to find that their final bills are overwhelming. That's why it's critical for everyone who "has health insurance" to "read the fine print" and develop an "emergency preparedness plan" for healthcare that ensures you or your family won't be caught in a financial bind in case of illness or injury. Here are six steps to giving your insurance a "check-up":
That's exactly what Maria did. Fortunately, the out-of-plan doctors agreed to reduce her charges to her plan levels in her case, resulting in a much more manageable bill for Ana's ER visit. Maria hopes Ana won't need another ER visit in the future, but, with her own "healthcare emergency plan" now in place and up to date, Maria knows if illness or injury strikes, she'll be prepared to do the best for her family, medically and financially.
When I read consumer information for Americans about choosing a health care plan, it makes my head spin! And then, even if you think you have chosen well and you can afford it, they can do things like this article outlines! Or you have to get an advocate to fight for you if they refuse to cover something! AND we don't have to fill out complicated papers for every procedure we have.
My father had a heart attack after paying into Blue Cross for many years. They refused to cover much of his care and he ended up losing everything. Fortunately, my parents were able to move to Canada where we have alot of family. He had the best of care and was able to let go of the stress of worrying about medical bills in his later years.
Please don't let these morons bully you out of what is a right , not a privilege, in every other civilized country!
So when you say that complete medical coverage is a right, you're really saying that those who don't have money have the right to other people's money. Perhaps you can explain why this is so. why taking other's money is a right.
"Health care in Canada is funded and delivered through a publicly-funded health care system, with most services provided by private entities.[1]
Health care spending in Canada is projected to reach $160 billion, or 10.6% of GDP, in 2007. This is slightly above the average for OECD countries, and substantially below the 15.2% of GDP taken up by healthcare in the United States.[2]
In Canada, the various levels of government pay for about 71% of Canadians' health care costs, which is slightly below the OECD average. " Full article here:
http://en.wikipedia.org/wiki/Health_care_in_Canada
Romulus, you need to think things out logically. Stop listening to People who have agenda's that are not in the best interest of America.
And we don't have to worry that the health plan is going to decide you aren't eligible for a certain procedure either. Canadians (and the rest of the civilized world) don't understand these movie plots in American movies that revolve around a parent trying to get care for a sick child when they have no health insurance. This is insane! Why do you put up with this?? The US is the only country in the First World that has such an unfair system.
I just don't understand this insane "freedom" thing in relation to health care. We Canadians are free from worrying about medical bills like the one described above! We are free to choose our own doctors! We can have a baby at home with a registered midwife if we like and it's on the plan. Having a premature baby will not bankrupt you. And we are just as much a "democracy" as the States. So is France , the UK, Australia, etc. What is the matter with these people!!! I just don't get it! (see part 3)
But, please hear me-- we choose our own doctors and we have more choice than you do because we do not have to choose one who is connected to a certain plan! I live in a small community with 3 doctors who choose to work part time. I can go to all three, and I do, because each one has certain strengths. (However, I choose to have a healthy lifestyle, so I don't see them often.) The medical plan in BC also pays for some chiropractic, physiotherapist, massage, and naturopathic care, if you are low income. Your personal doctor can refer you to a specialist. Registered midwives are on the medical plan, too. (The provincial plans are all a little different.) (see Part 2)
A better comparison is to suppose that police coverage was all privatized and offered by different companies at different rates, and expect a 911 caller to first shop around for the best deal on protection from the carjacker knocking on their window.
Compare this with any other kind of insurance:
If the body of your car is injured, you don't have to worry whether the paint-spray operator is "in the plan" . Why should you have to worry about it when it's your own body that is injured?
They only pull this stuff because they can get away with it. They shouldn't be able to.
The same people that do air fares do health ins........Oh do plan on getting sick on tues or thurs ?Then its $$ much. Friday to Monday it's $$$$ ...etc