[Icare dixit]

Whose insurance doesn't fully cover being admitted to hospital for being at risk of suicide or after an attempt or just for physical recovery/treatment after an attempt?

And how much (as a percentage) do you pay? Is there a cap on expenses?

Is that about the same for all insurances? What do you pay for your health care insurance (annually/monthly)?

What happens if you can't afford payments?

And please explain to me how this Medicaid and Medicare work. I have no idea.

Who do you think are most evil: for-profit health insurance companies, (investment) banks or (patent-exploiting) pharmaceutical companies?

Being admitted to the ER costs me $100.00. If I'm kept longer, I pay nothing out of pocket. I have no idea what I pay for insurance monthly. It's deducted from my Medicare automatically.

I have no opinion on who is more evil. It's probably a case by case thing and not something I can judge as a whole.

I'm glad to see you posting again. I've missed your posts recently.

My insurance has always covered my hospitaliztions for whatever reason. There is no cap on our insurance (that is not allowable under federal law anymore). I don't remebr exactly what our premiums are a month but they are within reason. I believe we are required to pay 10% of hospitalization up until we hit the deductible which is also fairly reasonable. We have a FSA to help cover out-of-pocket which pretty much takes care of our share most years. I don't see insurance companies as evil. They are a business and I know what their restrictions are so I am careful about choosing our insurance plan. Without insurance, we would not be able to receive the medical care we have, so I am grateful for having excellent health insurance. Crappy medical insurance is awful; know what you are purchasing. I don't know much about investment banks so I have no opinion. I think the government needs to do more so that patients aren't priced out of needed medications, but I also think good research is being done in pharmaceuticals -- it is definitely a two-edged sword.

[~Christina]

Most insurance companies never cover 100 % (well unless your in a Govermental position.) There is always going to be copays of some sort either by % or set fee per day if IP or regular hospital.

Patient balance widely based on there health insurance some companies pay more some much less.

Again there is no set insurance costs per month. Some people pay 100.00 per month some others pay 200.00

If you can't make your monthly insurance payments the coverage will be cancelled and you will have no coverage and be responsible for any and all medical services you have need of after cancel date.

Medicare is used when a person retires or becomes disabled ( if disability is awarded you have Medicaid the first 2 years, then it flips to Medicare.

Medicare pays 80% of approved charges, patients are responsible for the 20% balance for services, Blood work is paid at 100%.

Medicaid is by the state. Typically it covers all medical needs but many providers do not accept medicaid because the payments are so low. Also its often hard for a doctor to find medications that work because medicaid will not allow for the more costly ones.

Insurance companies are out to make money, As for Obama care making health care availabile for everyone? Sure if a person can afford the monthly premium and actually understands that they have a deductible they have to pay out before the insurance even starts to pay. Insurance is confusing for most everyone , Only reason I happen to know more than the average Joe is that I use to do medical billing.

My opinion Insurance and Big Pharma are just a way to manage population control .. But that is just my opinion.

[pirilin]

Mafia Mutual covers 100%. However, the affiliation fee could prove costly.

[Icare dixit]

Are the insurance companies free to decide what to cover and what not to cover, there being no minimum requirements, for all insurance plans they offer?

Despite "universal" health care, you could quite easily lose your insurance then? Or have an insurance plan which effectively covers next to nothing?

Are they allowed to discriminate (e.g. based on age)?

Does everyone who has a BP diagnosis qualify for Medicare?

Of course there are alternatives to for-profit health insurance companies. Many countries in Europe have a public/national insurance payed for by taxes, state revenue.

My insurance sucks ***. I will never go to IP because I can't afford it. And believe me, I wish I could give them the middle finger and swear at them for price gouging.

I don't know what I pay for my insurance, but from what I recall, it's a lot because I have a PPO plan.

Minimum copay is $750. Then it's 30% coinsurance per day after that, hence "price gouging"

[Coconutzo]

I have no idea.


Sent from my iPhone using Tapatalk

Originally Posted by Icare dixit

Are the insurance companies free to decide what to cover and what not to cover, there being no minimum requirements, for all insurance plans they offer?

Despite "universal" health care, you could quite easily lose your insurance then? Or have an insurance plan which effectively covers next to nothing?

Are they allowed to discriminate (e.g. based on age)?

Does everyone who has a BP diagnosis qualify for Medicare?

Of course there are alternatives to for-profit health insurance companies. Many countries in Europe have a public/national insurance payed for by taxes, state revenue.

We have group coverage through my husband's employer. I've only ever had group health coverage and it probably works differently than individual coverage. With group coverage, the plan is set for everyone in the group. That includes premiums, deductibles, what is covered, what is excluded, etc. The safety in that is they have to coverage everyone on the plan according to their preset rules -- they can't change the rules just for one person midstream. That also means you have to know what those rules are from the beginning (I think many people never read their plans in detail and then are surprised when they bump into exclusions that were already in the plan). With the new federal rules, insurance companies cannot exclude pre-existing conditions which was a huge improvement for us personally because my husband has a serious pre-existing condition that is expensive to treat. For many years we felt trapped in our jobs because we could not afford to risk losing insurance coverage if we changed jobs; that is no longer a factor.

[Icare dixit]

Apparently, the pharmaceutical companies struck a deal with the US government to legislate to make sure insurance companies can't opt to cover generics instead of originator/patent-protected meds.

The US is really too big to be democratic. Too few people wielding too much power afforded by too many rich special interest groups demanding too many compromises, liberties or outright undemocratic self-serving legislation.

Does a BP diagnosis mean you can be insured via Medicare?

Apart from pre-existing conditions, are insurance companies allowed to discriminate on non-medical grounds (e.g. level of education, age, profession)?

[Icare dixit]

And what do you, more or less, pay for your insurance?

[Nammu]

Medicare premiums $124
Except for me cause I live below poverty level the state kicks in and pays it. Plus I get extra help to cover the 20% that Medicare doesn't cover....but it's harder than hell to find doctors that accept both, so....wish I were rich enough to have regular Medicare because I could have more options in Doctors. But then I'd have much more to pay with copy's and it adds up fast.

Oh, that who's the most evil.......big businesses by any name. The terms monopoly and carpet bagged isn't used any more but should be.

[~Christina]

The only time a person will have Medicare is if they retire OR if they are receiving SSDI ....

SSI is Medicaid coverage.

[BeyondtheRainbow]

Bipolar doesn't necessarily mean you can get Medicare. If you qualify for disability (which is often difficult to get approved and often takes a couple of years) then about 2 years after your "date of disability" you get Medicare, assuming you have SSDI which means that you worked long enough to pay into the system long enough and in the right pattern of fiscal quarters.

Medicare has 3 parts. Part A is hospitalization only. It has a set deductible around $1200-$1300. It covers everything in the hospital after the deductible except doctors which are covered under Part B at 80%/20% copay. Part B covers out-patient, so dr.visits, labs, testing, ER, etc. It is 80% covered/20% patient responsibility so it adds up fast (blood work is free for some reason that I'm extremely thankful for). Part D is medication and it is very complicated. Most plans have a deductible I think of a few hundred dollars. After you meet that you have a set of co-pays up to a limit I don't remember. That limit puts you in the "donut hole" which means you don't have coverage until you meet another limit. AFter that limit you have co-pays again but usually they are much lower. I only went through that once and then found a plan that is quite low cost for me. I get my expensive meds free through programs sponsored by drug companies because the Part D co-pay is too high (name-brand APs are hundreds of dollars per month beforeth donut hole where they could be a thousand or more; I can't afford that).

For Med B I have a monthly payment around $100 I think and then Part D is about $30.I buy my own dental and vision coverage which aren't related to medicare at all but are necessary since a pair of glasses would wipe out more than my savings and my teeth require hundreds of dollars of work annually thanks to meds.

[bizi]

We have blue cross blue shield of louisiana group benefits thru the state, hubby is a professor at the university here.
WE pay a small monthly premium less than $200 (we were paying almost $500 a month)but have a large deductible.
$4,000. (max out of pocket is $10k then %80/20 after that)
So I pay the contracted rate for my meds out of pocket, not bad about $65 a month so much lower now that geodon has multiple generics. and I pay for my psych doctor $95 if I am stable and only requires a med check every 3 months.
WE also have a health savings account so things can be paid thru that account that is tax deferred which is great!
The low premiums are fantastic until some one gets sick.
then look out!
So far we have been fine.
bizi
18 years ago I was living in Arizona, took myself off meds and got manic/psychotic. Did not have any insurance at the time. $10,000 hospital bill that I paid on for10 years. at least still had a balance but they changed collection companies and I was getting harassed so I finally just paid the whole balance off.

[Icare dixit]

Even just $150–200 monthly is quite a lot compared to the UK and other European countries if you consider a pound is about equal to a euro and a dollar, considering wages and inflation and such, the purchasing power. From what I understand, the real costs are a lot higher.

In the UK it's about £100, given the share of state revenue for health care, including national insurance payments and a cap on med costs. Of course, those who earn less pay less due to progressive taxation. Not everything is fully covered (or at all), but much/all of the life-saving treatment is.

However, the public health care system is underfunded. Part of the reason is making the health care system less attractive due to (EU) migration.

In other countries it's not all that different. Some might be a bit more like the US. There tends to be (still) a belief that competition between insurance companies or health care providers, a liberalised market, makes things better. Underfunding is used to "proof" that point.

But that you don't have to pay the premium if you can't is good, at least.

[Nammu]

It's my perception ( could be very wrong here) that fueling the underfunding is the far right wings of government, just like here in USA they prefer not to fund what they see as entitlements. That's what I understood anyway.

[Icare dixit]

Originally Posted by Nammu

It's my perception ( could be very wrong here) that fueling the underfunding is the far right wings of government, just like here in USA they prefer not to fund what they see as entitlements. That's what I understood anyway.

Yes that's about it. But not just the far right. What the centre left tries to do, generally, is allowing for and promoting (by lots of legislation/rules) lots of bureaucracy.

Bureaucracy can be a real problem with large, public health care. But the same can happen with big insurance companies which can take more risk than smaller ones in investing their funds, creating monopolies that can afford lots of bureaucracy. State monopoly is still preferred to a market monopoly given how each insurance company and health-care provider needs to do the same things as others, having a cumulative growth of bureaucracy.

The thing is, there is a information asymmetry between provider and user/consumer/buyer. Your doctor knows more than you do. That's why competition/markets don't work well.

You could say insurance companies could help you be a better informed user, but they have to effectively do the work of doctors, meaning costs will increase dramatically. Labour costs are (always) high. Health care isn't an exception.

In the US, insurance companies can't only cover generic meds. Effectively, the ability to reduce overall costs has thereby been taken away.

In other words, it's just added bureaucracy. Lots of redundancy.

As there are no real good effects of competition possible, bad effects like advertising and deception are all that's left.

Of course profits can rise because it's nearly impossible to enter the market, since economies of scale are extreme: the more money you have, the more risk you can take and the more you will earn.

You also have little bargaining power, because you don't really choose treatment, you need it.

Only the very worst of capitalism remains.

[Icare dixit]

But underfunding results in waiting lists pretty much across the board, sadly. Including surgery, GP appointments and midwives, for example.

Of course it's different for emergencies, but it affects everything.

I personally don't think waiting lists themselves are a problem, but if they're too long, the overall costs are very high as conditions worsen.

My husband is retired from working a state job. We now have medical insurance for life and our kids are covered until age 26 I believe. My parents worked union jobs and we always had excellent insurance growing up. When my husband was injured at work a few years ago, we lost our insurance and were so terrified since we all have serious, ongoing health issues. We didn't know what we would do. I don't have any idea how, since our incomes were always so high, but when we needed it, we qualified for medical instantly and everything was covered 100%. My provider is called Kaiser Permanente. I was born in a Kaiser hospital and have had covered with them pretty much non stop for 41 years. They are not perfect, but we've never had to fear going broke due to medical bills. I pay $30.00 for doctors visits and less than $10.00 for prescription. If we need to go to into the hospital, it costs $100.00. I feel so badly for people with high medical costs. I have no idea what we would do. I've been VERY lucky. The one time we needed it, thanks to current legislation, we received excellent coverage. I don't know why I'm so lucky when so many are not. I don't deserve such luck but I'm grateful.

[Nammu]

Originally Posted by ElsaMars

My husband is retired from working a state job. We now have medical insurance for life and our kids are covered until age 26 I believe. My parents worked union jobs and we always had excellent insurance growing up. When my husband was injured at work a few years ago, we lost our insurance and were so terrified since we all have serious, ongoing health issues. We didn't know what we would do. I don't have any idea how, since our incomes were always so high, but when we needed it, we qualified for medical instantly and everything was covered 100%. My provider is called Kaiser Permanente. I was born in a Kaiser hospital and have had covered with them pretty much non stop for 41 years. They are not perfect, but we've never had to fear going broke due to medical bills. I pay $30.00 for doctors visits and less than $10.00 for prescription. If we need to go to into the hospital, it costs $100.00. I feel so badly for people with high medical costs. I have no idea what we would do. I've been VERY lucky. The one time we needed it, thanks to current legislation, we received excellent coverage. I don't know why I'm so lucky when so many are not. I don't deserve such luck but I'm grateful.

You do deserve it!