Monday, September 25, 2017

Waiting For A Single Payer System

Single-payer health care would be great if it can:
1)  Reduce health insurance and medical costs.  (According to Bernie, it will) and
2)  Avoid the very long waits for getting healthcare (as is the case for the UK and Canada).
I don't know how Bernie's proposal addresses point #2.  But it's a real problem in other countries.  An opinion piece on CNN Why Single Payer Health Is A Terrible Option discusses some of the challenges that other countries face with a single payer system. 

 For example, in Canada's single-payer system:
  • The 2016 median wait for neurosurgery after already seeing the doctor was a shocking 46.9 weeks -- about 10 months.
  • The 2016 median wait for a referral from a general practitioner appointment to the specialist appointment was 9.4 weeks
In England:  "...over 362,000 patients waited longer than 18 weeks for hospital treatment in March 2017, an increase of almost 64,000 on the previous year; and 95,252 have been waiting more than six months for treatment -- all after already waiting for and receiving initial diagnosis and referral." 

When my wife's neurosurgeon decided it was time for surgery, it took only 5 days to get the surgery done.  Three of those days were doing pre-op tests.  Two of those days were a weekend.  I would have gone nuts if we had to wait months to get the surgery. 

A single payer health system may be the eventual way to go. Provided, of course, that we can learn  from the challenges that similar systems have had in other countries and not fall into the same traps.

Friday, September 15, 2017

You Down With O.O.P?

About this time of year, kids are going back to school and summer vacation photos are being looked at nostalgically.  Autumn is also a good time to take a look at your OOP benefits on your medical insurance policy.

"OOP" stands for "out of pocket".  (Don't confuse this with the hit song by Naughty By Nature:  "I'm Down with O.P.P.").  It is a very important benefit of health insurance policies that can really help insured that have high amounts of medical bills.  That's because insurance policies put a limit on the total OOP expenses an insured has to spend in a calendar year.  After that limit (or cap) is met, then the insurance company will pay 100% of medical services.

Those with a modest amount of medical issues are likely still seeing if their annual deductible has been met.  But those with a greater need for medical care are looking at their OOP about now.  If you have met your OOP limit, then essentially all of your medical care for the rest of the year is free.

But there's a catch.  (Isn't there always?)  When you go to a doctor's office or a facility, they will check your insurance coverage and ask for your applicable co-pay.  DON'T PAY IT!  The typical office staff will not be able to see if your OOP maximum is met.  They only see what the co-pay is and how much the insurance coverage will pay.

It's up to YOU to know when your OOP cap is met.  It's up to YOU to inform the front office that you are covered 100%.  It's up to YOU to say "No" to the requested co-pay.

You should know that if you do pay the co-pay (even when it is not necessary), you will almost certainly get this money back at some time after the bill has been processed by the insurance company.  But why overpay and wait for a refund?  It's your money.  Keep it in your pocket.

So, are you down with your O.O.P.?  Check and find out.