[chassis]

Originally Posted by Joekerr

Is it true that the insurance companies and hospitals in some degree dictate the care that the patient will receive? For example, lets say you want to order a CT and a few other tests because you believe it will be in the best interests of the patient and will dictate the course of care. Does the CT and all other tests first have to be approved by the insurer /(hospital)? Can you be blocked from ordering something? It is something my wife has heard that makes her nervous as she feels like it is a different way of doing medicine down there.

Providers (physicians) prescribe “standard of care” which insurance companies are most likely to pay for and gives the patient some semblance of care.

Standard of care is an iterated/negotiated scenario between providers and insurers. The patient can accept the care prescribed and the level of cost covered, or the option exists to pay full retail out of one’s own pocket.

[UncleWede]

Originally Posted by Joekerr

This is precisely the crap I would worry about.

Not only will your wife need to know what particular medication will provide symptom/cause relief, but ALSO which particular insurance carrier I have, and what they have on their own formulary. Is the generic just as good? Should she fight for the brand name, and can she justify it's need?

Or hire you as her assistant to know these things. . . you seem pretty AR about stuff and could keep it all straight for her At least until you take of as ruler, your Lordship.

[dreamingat30fps]

Originally Posted by RickFLM4

Also, I don't know how the spending numbers are compiled - using actual spending or using ridiculous "list prices" before insurance "discounts" which no one really pays but healthcare entities like to use because they inflate numbers to their benefit. For example, insurance statements show how much money they "saved" me by comparing my out of pocket cost to this ridiculous pricing that I would be required to pay without insurance. That part of the system is nonsensical and designed to confuse consumers.

A lot of places also have self pay prices which are a lot lower than those list prices. I have also heard from family who has done it that you can negotiate those hospital bills if you don’t have coverage to get them significantly lowered.

Originally Posted by Joekerr

Actually, it is true to some degree. For example, my wife has people who have been waiting for 2 years to get some elective services done and she just can't get them in because she has to prioritize cancer and other more urgent things. Whereas in the States, if they are willing to pay, I bet these people wouldn't wait very long at all?

That said, what I've heard about the states, and would like grocerylist and Germanauto to chime in on to see if there is any truth to this:

Is it true that the insurance companies and hospitals in some degree dictate the care that the patient will receive? For example, lets say you want to order a CT and a few other tests because you believe it will be in the best interests of the patient and will dictate the course of care. Does the CT and all other tests first have to be approved by the insurer /(hospital)? Can you be blocked from ordering something? It is something my wife has heard that makes her nervous as she feels like it is a different way of doing medicine down there.

Luckily I have never been hospitalized, but day to day stuff I have always gotten whatever tests, scans my doctor has requested. It also probably depends on your tier of insurance plan as some may fully cover an MRI for example and some may have a deductible or co-pay for something like that. If I recall I typically have paid around $150 for MRI and such scans in the past. No issues actually getting them. You pretty much get right in once your doctor prescribes it.

The only time I encountered any bureaucracy was when I got my sleep apnea test. The insurance requested I do an at home test first (cheaper than doing the in lab test) which honestly I was happy with as I would rather do that. I believe there may be some expensive medications that they may also require you to try the cheaper alternative first before approving the expensive stuff. That being said it depends on your plan and you can always pay directly for whatever you want and not deal with any of it.

[chassis]

The level of expenditure has no excuse to me. I have first hand experience inside the “system” and I know how it works. The U.S. system broken and the reason is not the patient.

[Alfisti]

That's what loses me, your expenditure is off the charts high even compared to countries with primarily public systems. This is despite a huge influence from private providers and insurers which should EASE the public spending.

You've somehow got the worse of both worlds.

[chassis]

Originally Posted by Alfisti

That's what loses me, your expenditure is off the charts high even compared to countries with primarily public systems. This is despite a huge influence from private providers and insurers which should EASE the public spending.

You've somehow got the worse of both worlds.

Yes, this is precisely the point.

[damnitBobby]

Texas is alright if you have a family. I've spent half of my life here, and the first half I lived in Queens, NY. Texas is pretty flat and boring unless you get to the hillsides near Austin. Even then it's nothing special to be honest. Nothing like the mountains you will find elsewhere. The politics are red until you get to a major city. If you are looking for good schooling then the suburbs will be a good fit for you. Also the cost of living is relatively low compared elsewhere.

The summers are brutally hot and humid, but good the rest of the seasons. Sometimes I miss the real winters of NY and sometimes I enjoy the liberating feel of wearing a t shirt and shorts on pretty much most days in Texas.

If you bleed red and are xenophobic, go out to the rural small towns and you'll find people with TRUMP WON flags on the back of their pickup trucks. You'll fit in great over there.