by MochaVamp » Thu Sep 20, 2007 9:26 pm
Chronic,
The US system is a complete mess so I think you made a fairly good guess. It is not the doctors who are a mess, but the insurance companies and the pharmaceutical companies that really run the show. I used to have to explain coverage to non-US citizens coming here and the look on their faces was one of complete shock. I'll give the simple overview. I have lived in both the US and Europe.
The key difference between the US system and pretty much the rest of the world, is the US is completely private. So, in most countries you have a public system that ensures coverage for all citizens, but if they wish to pick up private coverage they can. In the US, nobody has automatic coverage. No automatic right to health care!
So, not being covered is a huge financial risk. One short stay in the hospital can place someone in debt for years. Cost is the second hardest thing for newcomers to grasp. For example, about five years ago, I had an accident that injured my knee. I had what was considered excellent coverage (from my job -- how most adults get coverage), so I received great care at a good price. I paid $10 to see specialist (referred from a mandatory visit from my regular doctor $10 again). The specialist ran an x-ray and an mri (done by radiology techs). The cost billed to my insurance for the specialist's visit -- over $5000. My deductibles (what you pay out of pocket) $20 - $10 for each drs visit. Minor injury, I required no hospitalization.
If you have poor coverage, less treatments are covered, and your deductibles are higher. If you have no coverage, well it gets very dicey. Like I said, huge debts can build up. So, if you were taken to a hospital and they are totally private and if it is a large city you can be sent ASAP, to a county hospital. A smaller town like Sunnydale probably has one hospital that would admit anyone. It is not hard to rack up $30,000 + in debt for a short stay. You would be placed on a payment plan.
One of the first things that happens when you are admitted to a hospital, is that you have to produce an insurance card. That often determines what procedures will be run. Anything the dr runs that is not covered, yet is deemed necessary you pay out of pocket. Now, one dirty little secret is that since everything is procedure based, your type of coverage does change your care. If you have great insurance, lots of tests, surgeries, and pills. Poor or no insurance, extremely minimal treatment. Your not going to bleed to death, but you might have benefited from more work. On the flip side, great coverage can lead to over treatment.
So, in Chronic's story, Tara is covered by her father's insurance. Quite possible if he had medium to good insurance. Coverage for dependents varies from age 18-25 birthday, from most insurance companies. Some insurance covers the dependents for free others require the insurance holder to pay extra for each dependent.
If she was a dependent, her treatment would show up on his statement. They love to show you how much you saved by having insurance. Most likely he would receive a statement showing where and what hospital the work was done at. Now, he is not entitled to her medical records, that is private but you would see every little thing the hospital charged for (they list everything from bandages on up). Plus, often the insurance will only cover part of the cost, i.e. the ambulance ride cost $600 but the insurance company decided that ambulances should only cost $500, so that is what they pay to the hospital.
Good idea, because would Tara even think of it, when you are in ER you tend to hand over the card and get the paperwork going ASAP. It is a good possibility, being young and in good heath she might not know that the info listed on the statement would be so complete. She would probably know about coverage because of her mother's illness, but would she have ever seen a statement? If she did know, I'm not sure there is much she could do, even if she paid the deductibles -- the billing is pretty automatic. . One other problem, all insurance has a cap, both per individual and per plan. That is why they are so keen on listing what is done. You go over the cap you lose coverage. So her father as the main insurance provider does need to know how much was spent.
Some universities offer cheap student plans, but their coverage is minimal.
I think this is a realistic and innovative way to have him track her down.
