scott wrote:
>>>   Not if you live in Canada, Cuba, Finland, or basically any western
>>> country which is not the US. ;)
>>>
>>
>> But at times your options are limited because you don't pay for it.
> 
> You mean to say that you pay for your medical care directly?  If you 
> needed some complicated heart operation and the cost was $200k, you'd 
> have to pay that sum yourself?

Technically, you are responsible to pay for your own care.


   Or do you mean you pay an insurance
> company?

It depends on what kind of insurance you pay for.

Some insurance plans reimburse you directly (Traditional)
	I pay a $500 doctor bill myself.
	I submit the receipt to my insurance company.
	The insurance company comes up with a UCR of $300.
		UCR is Usual Customary Reasonable
		How they come up with this - who knows....
	The insurance covers only 80% of my bill.
	So I get sent a check for $240.
	I am out $260.
	The doctor gets $500

Some insurance plans contract directly with the doctor (PPO)
	I go see the doctor.
	The doctor submits the $500 bill directly to the insurance
	The insurance already negotiated with the doctor $300 UCR
	The insurance company tells the doctor that I have a $10 co-pay
		a portion I pay for each visit
	The insurance sends the doctor a check for $290.
	The doctor bills be for $10
	I pay the doctor $10
	Since the doctor has an agreement with the insurance company
		The doctor agrees to only accept the UCR
	I am out $10
	The doctor gets $300


If I have a PPO insurance plan like above, but see a doctor they do not 
contract with, it turns into something like the Traditional plan.  All 
based on the terms of the contract with the insurance company.

This very simplistic description of health insurance plans is from my 
own experience.


What's really sad is that doctors will inflate the initial charge (the 
$500) higher to be able to get a higher end payment from the insurance 
company.

   If you pay insurance, then I can't believe that the insurance
> company will let you choose how to treat your illness, otherwise 
> everyone would be getting the most expensive treatment possible for tiny 
> things and your premiums would be huge.

Insurance companies do have mechanisms that help keep costs under 
control.  They also raise rates based on usage as a whole.  In some 
places this is turning into a real crisis - I know where I work the 
premiums for insurance have gone up 30% in a single year.

Also, some places will not treat you unless you have a prescription from 
a doctor... ie, you might have a problem getting a baby ultrasound if a 
doctor does not call for it.  That's the choice for the place, and 
possibly a restriction for accepting insurance covered people.


   Or maybe you can, and that is
> why the US health system works so badly ;-)
> 

It has its problems, yes.  And some people leave the US to go to other 
countries to get different care.  Just as some people come to the US to 
get different care.


I know a specific example where a person with eye cancer came the the US 
to get treatment that would allow him to keep his eye.  His only option 
in Canada was to lose the eye.



The health system in the US is full of problems - insurance is just but 
one of them.

Other places have problems as well, they are just different.

;-)




Tom

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