What does "underinsured" mean in the US?

[Brandon716]

Geez,

For $2,100 I hope they at least framed the X-ray.

The original cost was nearly $2600 but it wasn't an x-ray, it was the entire setup. Imaging was only part of what I had done.

But great news, this week I got a letter after filing a complaint with the state insurance agency. They are paying up and now my bill is only $343 (which is, according to my original plan, the right amount I have to pay with deductibles and co-insurance).

Only took 6 months and several collections notices and getting the state insurance board involved... Quite pathetic, eh?

And to think that most people don't have the tenacity I had to file so many appeals and follow this through.

 

[kEiThZ]

Your story is what really floors me when I see those ridiculous ads suggesting that a government bureaucrat will get between a patient and their doctor. I wish they put more stories like yours on TV.

 

[salvius]

Your story is what really floors me when I see those ridiculous ads suggesting that a government bureaucrat will get between a patient and their doctor.

Apparently the private sector bureaucrat who has to attempt to deny the maximum amount of coverage possible to boost the company's profits is somehow preferable.

 

[Brandon716]

Americans have been brainwashed so long they don't know whats reality or not when talking about this issue. Its just the way it is... Fear based system and anytime government is involved people on the right play the socialism card.

Luckily its not working as much these days. The Public Option in the Health Exchange that Congress has been debated is almost ready to pass, regardless that $1.5 million is being spent daily to defeat it.

 

[kEiThZ]

What I don't get is that even if you are a conservative, should you not support a public option based on the need to bring down health care costs? I am by no means a hard left type of person, but I still consider a single payer health care system absolutely essential for the country's economic competitiveness. A healthy population makes for a healthy workforce.

 

[Maggie]

What I don't get is that even if you are a conservative, should you not support a public option based on the need to bring down health care costs? I am by no means a hard left type of person, but I still consider a single payer health care system absolutely essential for the country's economic competitiveness. A healthy population makes for a healthy workforce.

That sound you just heard was my jaw dropping to the floor. Who are you and what have you done with the real keithz ?

 

[afransen]

I don't think Keith's position is all that surprising.

 

[kEiThZ]

That sound you just heard was my jaw dropping to the floor. Who are you and what have you done with the real keithz ?

I have never questioned the value of a single payer system so my position is hardly a new revelation. I maybe a bit more market oriented on some issues, but by no means I am ideologically committed to using free markets to solve all the world's problems. Sometimes, only the government can have sufficient economy of size and the expertise to effectively deliver a service. Health care is a perfect example. Do I want government workers picking up trash? Probably not.

 

[Brandon716]

There was a mass murder here in suburban Pittsburgh earlier this week, nearly 15 people shot and 4 dead because of a lone gunman who went crazy. Not sure if it has made Canadian headlines, but it made national news here for several days.

Now this...

http://kdka.com/video/?id=61091@kdka.dayport.com

 

[kEiThZ]

^ It made the news here. But this part about paying the bills didn't. That's terrible.

I thought they can sue the perp or his estate in the US for medical costs. Would that work here?

 

[Blues]

Here are some other tax structures from various states. As you can tell, New York certainly doesn't have higher taxes than most states. And quite frankly these differences are mostly insignificant, except for the few states that don't levy state income taxes.

As you can tell, most states have an average tax rate similar to one another; however, Tennessee (where I grew up) levies no state level wage income tax.

However, Tennessee also has a 10% sales tax which is rather high for the US and considerably higher property taxes. Texas is another state that levies no state level income tax, so you see the higher net pay using that example. But again, Texas has a higher than average sales tax and considerably higher property taxes.

A $200,000 property in some Dallas suburbs may have as much as $6,000 in yearly property tax, for example. The Dallas-area suburb of Southlake, Texas has a median property tax rate per year of over $7,000, and median incomes are $48k per year. This is far and above what most Canadians pay, and its the price they pay for not having a state levied income tax.

...that $200 more per monthly paycheck doesn't seem like much of a savings by contrast.

And one thing is consistent no matter where you live: the same dedicated Medicare health tax that we pay yet receive no universal health benefits. A tax that cannot be used in general funds and must be used for medical care, yet we don't have a universal program.

It sucks you had to go through that (going through it myself). Just to note, I don't think the stat for Southlake, TX is correct. Southlake is a very wealthy place.

 

[Blues]

It's a huge problem with medicine that the general public equates better technology with better medicine. Technology is great, but only if used properly, otherwise it's pretty much pointless. Interestingly enough a lot of research that occurs in Canada is more centered on the long-term usage of known drugs, or even of medical processes. One such example is the amazing research put out by the University of Ottawa which creates clinical decision rules like the 'Ottawa ankle rule' which determines when best to use x-rays for sprained ankles. The point of such research is to REDUCE the need for technology and invasive procedures by finding the optimal use of technology.

This contrasts with the oft quoted American statistics of 'the top 5 American research centers put out more research than any other country in the world', which unfortunately heavily skews towards new technology, but not necessarily better healthcare.



Surprizingly there are about as many family doctors in the USA as there are in Canada. Considering there's 10x the amount of people in the USA this is HUGE. The big problem is that people feel in general that they know more about healthcare than doctors. The internet is the worst culprit in this, in that people truly believe that they can direct their own healthcare better than a professional who went to 10 years of school with very high standards and whose job every day is to provide healthcare.

While I don't argue that a lot of times doctors may miss things or may downplay a symptom, the fact that the US medical system is so much more 'consumer driven' is a cost contributor. People who know nothing but demand and receive unnecessary MRIs or full body scans. People who pay $2000 for an annual physical when really they aren't even in any risk group that would justify all these tests. People who demand orthopedic surgeries for problems which could be more easily or even better treated conservatively and end up getting what they want because they pay.

Even if people didn't end up getting these services, by going directly to specialists or by shopping around to multiple specialists, they end up costing the entire system (whether medicaid or the private insurance system) a ton of money.

All this adds up, and if the American system required family doctors to refer first, a lot of this would be mitigated because family doctors are uniquely situated to address a lot of these issues. A lot of times people come in demanding something, and really all they need is reassurance, but hey if they were paying you a ton of money for a relatively benign but useless test (i.e. MRI) you may do it for them.

Spot on. A lot of doctors are retiring due to all of these factors. The problem with Medicare/Medicaid is that once you factor in the costs (overhead, staff, treatment, ect.), doctors either break even or lose money on this. This has to countered by charging higher fees to those with insurance.

As you noted, Americans (I am one) demand the best. We want to extend our lives by 6 months (even in a frail state) that will cost an insane amount of money on the dime of others. We'll also sue doctors if they do something or don't.

We also need to take better care of ourselves. Personal responsibility is gone (and the downfall of our country). Another problem is we get charged higher drug prices due to lack of price control (we basically pay for the rest the world). That's a sticky issue.

Just curious, how does Canada handle foreigners (not counting legal residents) in regards to treatment? I hate the idea of having a job tied to your insurance. I think in a way, and Canada-style system allows for risks.

 

[Northern Light]

How we deal with 'foreigners' etc.

From the Ministry of Health website (Ontario)

On April 1, 2009, changes were made to the OHIP eligibility rules under Regulation 552 of the Health Insurance Act. As a result of these changes, you may be eligible for the Ontario Health Insurance Plan (OHIP) if you are included under one of the following categories :

* you are a Canadian citizen, permanent resident or landed immigrant, or are registered as an Indian under the Indian Act;
* you have submitted an application for permanent residence in Canada, and Citizenship and Immigration Canada has confirmed that you meet the eligibility requirements to apply for permanent residence in Canada (please note: applicants for permanent residence are no longer required to provide confirmation of having satisfied the Immigration medical as a condition for OHIP coverage);
* you have applied for a grant of citizenship under section 5.1 of the Citizenship Act (Canada), and Citizenship and Immigration Canada has confirmed that you meet the eligibility requirements to apply for citizenship (i.e., children adopted internationally by Canadian citizens);
* you are a “protected person†- i.e. a Convention Refugee or a person in need of protection;
* you are a foreign worker who holds a work permit valid for at least six months that allows you to work in Canada, and you also have a formal agreement in place to work full-time for an employer situated in Ontario which sets out the employer’s name, your occupation, and states that you will be working for no less than six consecutive months;
* you are a foreign clergy member who will be ministering to a religious congregation in Ontario for at least six months;
* you hold a Temporary Resident Permit with case type 80 (for adoption only), 86, 87, 88, 89, 90, 91, 92, 93, 94 or 95;
* you are the spouse, same sex partner, or dependent child (under 22 years old or 22 years and over if dependent due to a mental or physical disability) of an OHIP-eligible foreign worker or an OHIP-eligible foreign clergy member;
* you hold a valid work permit under the federal Live-in Caregiver Program;
* you hold a valid work permit under the federal Seasonal Agricultural Worker Program;

AND

* you make your primary place of residence in Ontario; and generally speaking,
* you are in Ontario for at least 153 days of the first 183 days immediately following the date you establish residence in Ontario (you cannot be absent for more than 30 days during the first 6 months of residence); and
* you are in Ontario for at least 153 days in any 12-month period.

Tourists, transients or visitors are not eligible for OHIP coverage.

Your eligibility for Ontario health insurance coverage is based solely on :

* you having one of the above OHIP-eligible citizenship or immigration statuses, and
* you making your primary place of residence in Ontario, and
* meeting the physical presence requirements.

As a tourist, you would be expected to have your own insurance.

That said, the system here would never decline to provide emergency care.

But if you have no coverage of any kind, expect to get the bill.

(residents of other provinces are covered under a reciprocal arrangement)

 

[Blues]

As a tourist, you would be expected to have your own insurance.

That said, the system here would never decline to provide emergency care.

But if you have no coverage of any kind, expect to get the bill.

(residents of other provinces are covered under a reciprocal arrangement)

How do you collect on the bill?

 

[Northern Light]

Bills

I'm not privy to any unique details on this subject.

But as I recollect, policy is that if you were admitted to hospital they would, normally have your ID and they would verify that, and typically try to get you to pay at discharge.

Failing that, Canada and the U.S. courts respect each other on the subject of money owed, typically, and I imagine if all else failed, a law suit would be filed, if bill payment failed, and collections agencies failed, etc.

That assumes the bill in question is worth suing over.

Its not an issue that often.

Remember that if you come from most other developed countries in the world, you are already covered by some public or private combo of insurance in the country where you live. You have no incentive to come all the way to Canada to bilk the system.

Also you wouldn't get non-emergency care here w/o proper coverage, and even then probably not. So you won't get elective surgery here or the like.

What you get here is treatment for a heart attack, or pre-mature labour or nasty fall etc.