I see terms like co-pay etc. We have private insurance here but this something we pay for and it usually doesn't reimburse much for T. eg if you are privately insured T will charge $200+ for a session and you only get back $40 from the insurnce company with a limit of 5 sessions then no more. If you don't have insurance you can usually negotiate an acceptable fee (sometimes)

[roads]

I'm in the United States, and my company is self-insured through Aetna. When I see my therapist, I pay $40 co-pay directly to him that day, and he bills my insurance later for the rest.

[trdleblue]

This might be difficult, even for us living in the U.S. Answers right now will very. I have had great insurance, where I would only pay $20 per session for a t, with no limit for the year. (Too bad I didn't start therapy when I had this insurance.) The insurance that I may be getting soon through my job will cost me $85 every two weeks. If my T took this insurance (he / they don't) I would pay $35 per session. There will be some people that have a cap as to how much they can spend on mental health, some people who aren't covered for therapy, and some people who are in a great situation. There is a lot of new regulation that will take place beginning next year, but as of now I don't see how it will improve my situation. This probably doesn't answer your question, but I think that is fitting when discussing U.S. health insurance. Being confused is the norm.

[healed84]

I have a hard time understanding health insurance.... All I know that for my T visits I get an unlimited amount of sessions. T charges $110 a session, I only pay a $25 co-pay and then T's office bills my insurance company for the rest of the allowable charges. That is about as much as I understand.

[trdleblue]

Originally Posted by Roadie

I'm in the United States, and my company is self-insured through Aetna. When I see my therapist, I pay $40 co-pay directly to him that day, and he bills my insurance later for the rest.

Aetna is what I can get through work, but since I am a server / bartender (making $2.13 hour on my paycheck) I would have to send a check every two weeks for $85.00. My T also doesn't take Aetna. I had Kaiser before.

[TheWell]

I pay $20 for each session, my insurance pays the rest. There is no limit to how many sessions I have a year as long as my therapist deems it medically nescessary.

I go to individual therapy every other week and group therapy every week. I've been in individual therapy for four years and group therapy for over a year.

I also have a psychiatrist. I see him monthly or every other month. Same deal, I pay $20 my insurance pays the rest.

[BlessedRhiannon]

My first thought when seeing your subject line was "probably not!!" The US insurance system is an interesting animal, and it's about to get even more interesting with upcoming legislation.

Here's kinda the basics, though. Medical insurance is handled either by administration companies that manage the payment of doctors, and determine what benefits you will qualify for and what acceptable rates to pay the doctors are, or it's handled by government funded agencies. Typically, if you are employed, you company will sign up with an insurance administration company to provide health insurance for all employees. The employer will pay all or part of the insurance premiums (cost to the ins. company for providing the insurance). If you're self-employed, you'll typically purchase private insurance, which is handled pretty much the same as if you work for someone else, except that you have to pay the whole premium. If you're not employed, retired, or have other special circumstances, you can qualify for a government funded program.

Once you've got insurance, medical providers are divided in to "in-network" and "out of network." In network means that the provider has signed up to provide medical care to people insured via that particular ins. admin company. In network care is usually covered at either 100% of the cost by the insurance company, or the patient is required to pay a small cost, called a co-pay. Co-pays are usually around $20 or some percentage of the full fee. Out of network providers can provide you with care, and you can submit a claim to the insurance company. If the ins. company decides to cover the costs, they will usually only cover a portion of it, and you're responsible for the rest.

Some insurance plans also have what's called a deductible. In that case, the insurance coverage doesn't full kick in until you've met the deductible. So, you might have a $1000 deductible. You have to pay a portion of your care up to that $1000, and then anything over that, the ins. company covers. They often also have yearly and lifetime out of pocket costs, and if you exceed those, the company covers everything else.

For some types of medical services, the insurance company will set a "reasonable and customary" rate for the service, and if your medical provider charges more than that, you are responsible for the difference. Say - a dentist charges you $200 for a filling, but the insurance company says the fee they will cover is $150. You are left paying the remaining $50 to the dentist, in addition to any co-pays.

Oh! And, medical providers also have the option of not signing up with any insurance agency and not accepting insurance. In that case, you are responsible for the full cost of any treatment they provide. (both my T and pdoc are this way, but they're so awesome that I don't mind the cost).

Hope that helps!!! There are tons of different plans that offer different types of coverage, but that's the basics.

[ECHOES]

Most U.S. health insurance is provided as an employment benefit, by our employers. We may or may not pay a portion of the cost (premium); that is a decision each employer makes. If we do pay all or part of the premium, it is deducted from our paycheck.
We also have privately obtained health insurance that is paid in full by the insured person.

Coverage varies by policy. Some benefits are generous and some are limited. Recent laws have been passed to try to ensure that mental health benefits are provided and are reimbursed at the same rate as medical health benefits.

Depending on the type of policy, benefits may be a percentage of the amount the insurance company determines is the maximum billable (allowed) amount, paid only after a large annual deductible has been satisfied (up to $2,000.00). With this type of policy, a person pays all costs until the deductible is reached; the person may never receive benefits during the year because the large deductible isn't reached. When the deductible is reached, then the person would pay a percentage of the allowed amount - for example 20%.
Or, with another type of insurance policy, the benefits may be payable at maximum allowed amount, minus a specific dollar amount that is the patient's responsibility ($20 or $30 co-pay, for example. The co-pay can be any amount).

An insurance policy is merely a legal contract between the parties involved: the insurance company, the employer or purchaser, and often the providers (who are contracted to perform care at a specific price), so there can be a wide range of types of policies and of the benefits the policies provide.

So, when you change jobs here, you usually change insurance policies also. You may end up with a better policy with good benefits, a wide range of providers (doctors, hospitals, pharmacies, etc) that you can use and at a low cost ... or you may end up with a policy that is more restrictive in the kind of benefits provided, a higher cost, fewer providers to choose from, requirements for obtaining approval before seeking certain types of care (including mental health).

I hope this helps!

Is nothing in your country simple? (besides politicians I suppose thats universal)

[sunrise]

Originally Posted by Bipolarartist

Is nothing in your country simple? (besides politicians I suppose thats universal)

LOL. It is not simple because it is a patchwork of insurance companies and options. This is because it is not a single government system. It is a free market solution typical of a capitalist economy, with many insurance companies competing to lure customers and maximize profits. Every insurance company and plan is a bit different, and there are oodles of each here.

[Crescent Moon]

Originally Posted by Bipolarartist

Is nothing in your country simple? (besides politicians I suppose thats universal)

I know we have a problem with availability of medical care to the uninsured, but I fear socialist-type medical care. The biggest reason the US has the best and most advanced health care treatment in the world is because it is within a capitalistic model. If I were going to be a physician and spend all those years in school and training, you'd better believe I'd want to be the BEST physician in my specialty. I'd be working hard and competing with others in my field to be the best and brightest... to come up with new and better techniques and devices. Here, the really good doctors are rewarded financially, and they compete with each other to be the best so they have a steady stream of patients.

When healthcare is delivered through a government and doctors are paid a salary... then what is the incentive? Here, if a doctor does shoddy work, word spreads and he looses business. But if the government pays doctors a salary and assigns them patients, then there is just no incentive to be the best.

[Eliza Jane]

One of the things that really upsets me about the US system...People have referenced how insurance is usually obtained through your employer. If you don't have an employer (or a spouse that does) you have to buy private insurance that is usually more expensive and doesn't usually cover as much. That is, IF they will sell it to you.

Before I got married, I was self-employed, so I was supposed to buy one of those private plans. However, because of my psych diagnosis and meds, no company would accept me for medical insurance at all! Even though I was young and healthy otherwise, I was too "high risk" to insure. This is not small issue. If you wind up in the hospital w/o insurance the cost could be crushing. My friend had a baby at the hospital w/o insurance. Everything went well and it was a textbook delivery. It cost them $20,000.

They are working on reforms to address this. After a mandatory period w/o insurance (during which I was lucky enough not to need much medical care) I was able to buy a state subsidized insurance for us high risk folks. Unfortunately, that program was just cancelled due to running out of funds. Supposedly, the new health care reform that takes effect in 2014 will prevent denial for pre-existing conditions. However, the health insurance companies are always one step ahead of the game and they have a lot of power. And many politicians and citizens don't want the reform to occur.

Sorry so long. It is something that really bothers me. I believe everyone should have access to health care.

Best,
EJ

[ECHOES]

When healthcare is delivered through a government and doctors are paid a salary... then what is the incentive? Here, if a doctor does shoddy work, word spreads and he looses business. But if the government pays doctors a salary and assigns them patients, then there is just no incentive to be the best.

This model has been used by insurance companies already, in managed care plans. The provider who joins "the network" gets paid so much per month for each enrollee they have as a patient.

I live where we have many visitors from Canada and the UK. When I meet someone from there, I ask how they feel about their universal health care. I've not heard one negative word.

Our health care system, in this economy, will not be able to be sustained. The high quality is going to fall because there is less money for R&D and there are fewer persons seeking medical care due to the cost. So an adjustment is going to happen anyway, over time. I think the most sensible and most inclusive, caring answer is universal healthcare with the option to buy private insurance.

Originally Posted by Bipolarartist
Is nothing in your country simple? (besides politicians I suppose thats universal)

LOL!! No, nothing is simple when so much money is at stake. The insurance industry probably has the most lobbyists, protecting their fortune. Where else can you issue relatively useless contracts, call it "healthcare", charge a fortune, create it so it is too costly to use and therefore few benefits have to be paid, and just sit back and watch the bank account grow. It is so obscene and inhumane.