Health Insurance, What’s Up with That?

Health Insurance: What’s Up with That?

Although every country tries to find the best way to provide health care for its citizens, it seems there is no one system that is perfect for everyone. In the United States, health insurance is a huge issue. How can we be sure everyone has access to excellent health care? How can we help people pay for doctors and expensive treatments? What will a family do if someone becomes seriously ill and needs hospitalization? Medical care in the United States can be very expensive, and no one wants people to suffer because they can’t pay.

Most large companies and some small businesses offer health insurance benefits to their employees. This means that they participate in a health insurance plan and cover some of the costs. Other costs for the plan will be deducted from the employee’s paycheck. This is usually the best option for employees, but there are many plans and many rules, so it’s important to get all the information from the human resources department at your job or from your employer. A very important thing to remember is that, if you have health insurance through your job, you usually must use a doctor in the insurance network. Many insurance companies have arrangements with certain doctors to charge only a certain amount for care. In most cases, your insurance will only pay for doctors in the network. If you choose a doctor who is not in the plan, you will have to pay most of the costs for service yourself.

Many health insurance plans say that you must choose a primary care physician. This is the doctor that you will see first whenever you have a problem. If the doctor feels that you need more specialized care, the health insurer may require a referral to the specialist. This isn’t as complicated as it sounds. Most doctors are very knowledgeable about insurance rules. Doctors often have a staff member whose only job is to deal with the insurance companies.

Once you see the doctor, it’s possible that she may prescribe a medication for your condition. She will write the name of the medicine and the dose on a special form. Take the prescription to the drugstore. The pharmacist will ask for your insurance card and fill the prescription. He may substitute a generic drug unless your physician specifically requests a name brand. If you have prescription coverage in your health plan, you’ll only need to pay a co-pay. The insurance will pay the rest of the cost. Insurance plans are complicated, but it’s worth taking time to figure them out!

LIA: Hi. My name is Lia. I called a little while ago. My neighbor recommended that I come in to see Dr. Patelli.

RECEPTIONIST: Yes, of course. First, I’ll need you to fill out this form with your health history. It’s for your chart. While you’re doing that, I’ll make a copy of your insurance information.

LIA: Oh, no! I didn’t bring any information with me! What do you need? Do I need to call my job?

RECEPTIONIST: No, it’s okay. You don’t have to call them now. But didn’t you get an insurance card with your group number?

LIA: Oh! I think I have a little card that has my name and a bunch of numbers on it. Is that what you mean?

RECEPTIONIST: Exactly! That’s all the information I need. We’ll process all the insurance claims for you if we have those numbers.

LIA: Whew! I think worrying about this insurance was making me sicker than my illness! Will it take a long time for me to see the doctor?

RECEPTIONIST: Well, we know patients sometimes have to wait a long time for lots of doctors. Dr. Patelli tries to be respectful of her patients. She won’t make you wait unless there’s an emergency and she has to squeeze someone in. The nurse will take you in and take your vital signs, and then Dr. Patelli will come in to examine you. After she makes her diagnosis, she’ll write a prescription if you need one. But she will always leave time for you to ask questions. She wants you to understand exactly why she thinks a certain medicine will help.

LIA: I think I like this doctor already!