What I learned about medicine in the United States when I got insurance

Insurance in the United States is required for all. Photo

There are many myths about American insurance. I remember, the three of us were walking in the southern Ukrainian city and were hotly discussing what we had never encountered in general. It is clear that everyone knows that it is expensive (especially dentistry), everyone has different impressions about quality, but everyone agrees that there should be a great service, because it is the United States and there is no other way.

Now I have medical insurance (United Healthcare | PPO - a Preferred Provider Organization) and therefore I will share some facts on this topic.

Attention: All prices quoted are related to my insurance, you can choose another one, possibly more profitable.

Medical insurance is obligatory for everyone (if there is no insurance, you must pay a fine). There are budget options from $ 20 per month, but many prefer to get off fine.

There are hospitals where you can get advice from a doctor or medical service without insurance, but the bill can be a pretty penny, to put it mildly. For women there is Planned Parenthoodwhere it is free or almost free you can go for an examination, get a prescription for contraceptives or a referral for childbirth / abortion

The main difference between insurance is that some allow you to choose a doctor and go to him directly, while others allow you to go to your therapist and take directions from him to the rest of the doctors. The first kind, in theory, is better because you lose less time in queues and do not depend on the choice of another person.

You must pay tax for insurance (at the end of the year, an invoice will be sent to the post office and, in any case, insurance must be declared). The tax is about 8% of the total amount you pay.

The employer often helps by paying 50 – 90% insurance. Good employers cover it not only for the employee, but also for the wife / husband and children of the employee. It often happens that an employee is covered with 90% and his spouse / wife is covered with 50% or less, but it happens that everyone is covered with 90%.

You can “share” your insurance with your roommate, it is not necessary to be officially married. Moreover, often no one checks who and by whom, so you can enter in the column Dependent virtually any person with any visa status.

There are many different insurance options (for students there are good budget options). Those that are more expensive (cost about $ 600 per month, but of which you personally pay, say, $ 60), allow you to choose any doctor. Then you pay a fixed amount for the visit: $ 20 (visits are different - from consultations to procedures, so prices vary greatly, but this does not concern you, this is all covered by insurance).

Many doctors have records for a couple of months ahead. You call in August, and the nearest free “window” is already at the end of October. But it happens that you can make an appointment right on the same day. For an urgent visit you will have to pay $ 75. “Fast” will cost $ 150.

From the booklet: deliveries in the USA cost $ 7 540, but if there is good insurance, you only have to pay $ 500 (this is if there are no anomalies). In connection with the new reform, childbirth in the USA is now free, but I would first clarify this point, given my own visa / visa status. I know for sure that if you are not yet a resident (a person with a green card) and not a citizen, then you should not “go for a walk” with taxpayers' money.

On any insurance there is a maximum amount that you can pay from your pocket (I have it $ 2 500 per year). Everything else 100% is covered by insurance (whatever happens).

If, all of a sudden, you lose your job, not for any reason, but for some other reason, the state “maintains” your health insurance for another 18 months. The same applies to the insurance of the person recorded in the column. Dependent. In this case, it means that you do not lose it automatically and can pull at your own expense.

Registry girls who book you up for a doctor and solve all sorts of minor issues will call you Honey and Love, saying it is so sweet that it seems to be sincere. Photo

Everyone has a “own” pharmacy by default (which accepts your insurance and is within walking distance from home). All recipes are sent to the address of this pharmacy. There is also a home delivery service - OPTUMRx (they send medicines in batches and remind you when the prescription is over; if the medicine is to be stored in the cold, they are delivered in disposable cold storage chambers with “cold fillers”).

Many drugs cover insurance for free, some with a small surcharge (my insurance covers almost all the drugs I may ever need).

On a special website, you can order a variety of different goods by spending virtual money that lies on your insurance account. For example, buy orthopedic insoles, creams and oils for tanning, care products, vitamins, etc.

Ophthalmological insurance - a separate song. You need to pay extra for it (from $ 5 per month if the employer again covers 90%) and there is accumulated a separate amount that can be spent on lenses, liquid for storing lenses, glasses, including luxury sunglasses from Prada and other well-known companies.

Dental insurance usually costs the same as usual (we still have $ 60 from the nose). It covers annual examinations and tooth brushing. Dental treatment is really very expensive (cleaning the canal costs $ 1 200 – 2 000, filling ~ $ 255, any simple work ~ $ 170), so it is much more profitable to travel to another country for this. Bleaching is considered a cosmetic procedure and insurance is not covered (whitening plates can be found at any pharmacy, a huge selection of toothpastes and other means). I decided not to take insurance, since there are no problems with my teeth.

Considered that if you come “from the street” for cleaning (walk in), it will be cheaper. I found a good price for cleaning on Groupon at a luxury dentist nearby and paid only $31. This price included x-rays of the oral cavity, photographs of teeth, an examination by a doctor and, in fact, cleaning. At the end of the day goodie bagin which she found 2 probe toothpastes, a toothbrush, mouthwash and a box of dental floss - in general, a complete care kit that is especially convenient to take with you on trips.

The sum insured is usually necessary to spend as much as possible by the end of the year, so everyone strenuously makes an appointment with the doctors for the new year.

By insurance, you can get a decent course of massage, acupuncture and other medical procedures. Each visit is paid the same way: $ 20 from your pocket.

The insurance company has a website and a mobile application. With the choice of a doctor and the order of medicines can be handled once or twice or three. There is an automatic additional order of medicines when they come to an end, as well as reminders of when the prescription issued a year ago will turn into a pumpkin.

There is still broker about doctors in the States (though they say that the administration deletes negative feedback, so that you can’t believe in 100%).

If in Ukraine, doctors mostly consult and write prescriptions, as well as referrals for tests, in the USA, a specially trained nurse will take a blood test at the first appointment, etc. That is, in most cases you get the full service for the same $ 20 ( the results can then be viewed electronically), but to hear the doctor’s comment and get a prescription for medicines, you need to sign up for follow-up visit (this is still $ 20).

You can donate blood once for 6 tests: COMP METAB PANEL W / EGFR, RPR W / TITER + CONF RFX, Hepatitis Panel, Pap Lb, Ct-Ng, rfx HPV all, CBC W / DIFF & PLT, Test HIV. By the way, about a blood test - of course, it depends on what this or that test is done for, but often it will be done at any time of the day (none there in the morning and on an empty stomach).

When writing to the doctor, they ask you about your ethnicity, race, and for some reason religion. The first time it is embarrassing, but then you boldly say: Eastern European, white, not religious.

By name it is often difficult to guess the doctor’s nationality (if suddenly someone is important). I recommend to watch the list of languages ​​that the doctor owns. I once signed up for a doctor, focusing only on rating and geolocation, and came to a black Muslim woman. While waiting for the reception, I read something about Allah (there was a printout under the glass) and wanted to escape. As a result, the doctor turned out to be a good professional and a pleasant person, so to hell with prejudice.

Let's say you are assigned to 3 hours of the day. The meeting is likely to be held at 3: 30. Almost all physicians have a waiting time ranging from 15 to 45 minutes.

In good medical centers there are fresh magazines, tea, coffee and expensive leather sofas (in institutions there is water and a TV with a health channel). If the toothache does not bother you, you can take a laptop with you and have time to send a couple of letters.

You will be charged $ 20 from you for a non-appearance at the appointed time to an ordinary doctor, and $ 100 for a non-appearance to the dentist.

If you are a new patient, you will be given first to fill out a card with basic information about health and all sorts of formalities. It's nice that the question is “Do you feel safe at home? It's cool that they also ask about the diseases of their close relatives (cancer and other serious things).

Doctors openly ask about smoking, alcohol and recreational drugs, specifying how often and what exactly you use.

For the time being, I had only two doctors and with each I had an easy relaxed conversation on 7 minutes, which immediately disposes to a trust relationship.

The main difference between insurance is that some allow you to choose a doctor and go to him directly, while others allow you to go to your therapist and take directions from him to the rest of the doctors. Photo

The girls from the registry, who write you to the doctor and solve all sorts of minor issues, will call you Honey и Lovesaying it is so sweet that it will seem like it is sincere.

At first, it is striking that for each procedure (x-ray, for example) you are given an individually wrapped “vest” and slippers, i.e. you should never feel uncomfortable or uncomfortable anywhere.

Before meeting with some doctors, the nurse will weigh you, measure growth, and measure pressure. Data is entered into your medical card.

There is a concept wellness-An examination is about general health indicators and this is something that everyone is recommended to do at least once a year. The price of the question is the same $ 20.

Cats and dogs in the United States can fly on airplanes with the owner for free in the cabin, if there is a certificate from the doctor that the pet provides emotional support. And, by the way, with such a certificate, you can move into apartments, where living with animals is initially prohibited (you simply have no right to refuse this).

In California, doctors recommend smoking marijuana in many diagnoses (from back pain to depression) - I know this for sure from my airbnb- host. Herbs are sold according to recipes, of course.

Many doctors practice the treatment by “breaking in” the temperature until it reaches a critical peak (they say, the body is fighting, do not interfere with it). That is, drinking pharmacytron overnight and going to work the next morning is not a very good option from the point of view of an American doctor. You can go to work, but leave the pharmacitron here!

In the subway, I often see social advertising about the fact that the employer is obliged to provide paid sick leave: 5 days per year at the same rate or at least $ 9 per hour (here information about this).

In the US, there are drugs that prevent HIV infection. And now there are a lot of cases that women with HIV can give birth to healthy children (with a negative HIV test).

For immigration documents you need to check the blood for many diseases, as well as to identify which vaccinations were made, and make the necessary. It is often written on the Internet that this does not cover insurance. In my case, the insurance covered everything, but I had to go to the doctor three times, which means I paid $ 60 in total. As a result, the doctor issues a sealed envelope, which must be sent to the immigration service.

The only procedure for which no money is taken at all (from what I know on 100%) is fluorography.

Blog published by permission Kate lopez

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