Not being familiar with all the facets of medical insurance in the US, I contacted a representative of a health insurance company to see if he could help me with some questions.

MEDICAL INSURANCE EXPLAINED

Q.Thankyou for agreeing to answer my questions.
A. Not at all, medical insurance is simple.

Q.What does HMO stand for?

A. This is actually a version of the phrase, "HEY MOE". Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget the pain in his foot if he was poked hard enough in the eye.

Q. If I just joined an HMO how difficult would it be to choose the doctor I want?

A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. The doctors basically fall into two categories: those who are no longer accepting new patients and those who will see you but are no longer part of the plan.
But don't worry, the remaining doctor who is still in the plan and accepting new patients has an office just a half-day's drive away and a diploma from a third world country.

Q. Do all diagnostic procedures require pre-certification?
A. No. Only those you need.

Q.Can I get coverage for my pre-existing conditions?
A. Certainly, as long as they dont require any treatment.

Q.What happens if I want to try alternative forms of medication?
A. You'll need alternative forms of payment.

Q.My pharmacy plan only covers generic drugs but I need the name brand. I tried the generic medicine but it gave me stomach ache. What should I do?
A. Poke yourself in the eye.

Q.What if I'm away from home and I get sick?
A. You really shouldn't do that.

Q.I think I need to see a specialist, but my doctor insists he can handle the problem. Can a GP really perform a heart transplant right in his/her office?
A. Hard to say, but considering that all your risking is the $20 co-payment there's no harm in giving it a shot.

Q.I note in your publicity material that you say you always on the lookout to give your customers more. Can you explain?

A. Certainly. We are aways looking out to have more fine print policy conditions, more exclusions and more claim disputes. As I say we always like to give our customers more.

Q. Thankyou for answering my questions.
A. Not at all. As I said, medical insurance is simple.........

I missed this one. It's very funny.

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When health care was put into the hands of third party payers, costs went up shortly after. HMO's were a product of the 70's and that is when health care became ridiculously expensive. In the 80's my first born cost $3,000 in delivery room and doctor charges. The second child a year later cost $4000 Two years late our daughter cost $8,000.
Over a 200% increase in the same services over four years.

I had an MRI done the other day. Since I have insurance, I did not even ask how much it was. The insurer, BC/BS had a negotiated rate that was much less than the charged amount, but if I would have been paying for it directly, I could have gone to a even cheaper place.

The not so funny part of it, is that a cash patient would be charged the full amount of the MRI procedure. Maybe they would have taken less, but only if you asked and made prior arrangements. Most people do not even think to do this.

Medicare and Medicaid would have paid hardly anything for the procedure so my insurance and especially the cash patients would be making up the difference.

All of the processing of the insurance claims and other red tape will cost the practice about 10 to 15% of the cost of the procedure, depending what it is.

That is how insurance distorts the market place for health care in a nutshell. If everyone had just major medical insurance, you would see rates drop quickly. Routine procedures would be market place driven, and not filing insurance claims would automatically save at least 10%.

Dan

It's outrages. I wonder how much it costs now in US.

I would hate to know how much it is now. Granted that the eighties were inflationary to begin with, but that was over twenty years ago. Does anyone know what it costs now to have a baby in a hospital.

I just remembered that my daughter did end up staying longer in the Hospital because of Jaundice.

Wow, I am really old.

Dan