Coming USA - IV HealthCare

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All Indians that come here will have Health Insurance. What that means is your health care cost will be paid by an insurance company, atleast in part. More about this later. You might be wondering how expensive is it anyway? This a thumb rule you can use. In Dharwad, we pay Rs 50 ( to Rs 70) for consultation, in USA , it would be $50 ( or $70). How much does a X-ray cost in Dharwad, around Rs.150, USA its $150.  Basically numbers are almost same as in Dharwad, except you pay here in DOLLARS. That is expensive, thats why we have health insurance. If you have health insurance, you will probably pay $10 for consultation instead of $50.

When you come here, you should call your employer and get the Insurance ID card ( this will be size of credit card and you should carry it always with you, preferably in your wallet, along with drivers license and car insurance card). Most insurance companies want you to select a PCP ( Primary Care Provider). PCP is equivalent of "family doctor" in Dharwad. You should select a PCP as soon as possible and even see him once. So that he knows about your general health and he has record of you authorizing him to take care of your health. This is useful in emergencies. If you suddenly develop some urgent medical condition, if you don't have PCP ( and you have not seen him), they will refuse to prescribe over phone and will give you an appointment 3 or 4 days later. But if you have seen them once, you can call and sometimes they prescribe the medicine over phone, you just go to pharmacy and pick up the medicine. If its serious, they will even give you appointment, the same day. Basically, once you become their customer( patient) they WILL take care, otherwise they might delay the care. Bottomline, see your PCP ASAP.

No matter what happens you see PCP first.( ofcourse, if its emergency call 911, forget about PCP, health insurance etc) PCP will decide if you need to see a specialist or need to get admitted to hospital etc. e.g you fall down and injure your leg. You call (or see) your PCP immediately. He will see if the bone is broken etc will refer ( authorize) you to see a orthopedic specialist. Insurance company will pay ( usually in full less $10 -> copay). If its just minor injury, he will probably prescribe some pain killers and ointment ( like Iodex). If you decide to see the specialist directly, guess what, your insurance company may not pay in full. So its always better to see, consult or just call your PCP. He is responsible for your health and well being.

Health Insurance companies are for profit and they are not in business of charity. They want to make profit by providing health care in most efficient way and that means patients will have to follow some rules and take the health care from whatever doctors and hospitals the insurance company has deals( contracts) with. Some of the Insurance Lingo,
1. Copay - This is what you pay when you see the Doctor, Specialist. Its usually $10 ( Sometimes $20). Some lucky ones have $0. This will be printed on your Insurance card.
2. Pharmacy Copay - This is what you pay when you purchase medicine. Usually $5 or $10.
3.Hospital Copay - This is what you pay when you are admitted to hospitals. This amount depends on your insurance company. Sometimes its per day basis(e.g $100 per day) or % basis ( e.g 20% of costs) and to a maximum of $XYZ. e.g if yours is $100 per day and maximum is $1000. You will pay for first 10 days and after that you pay nothing. But unless its life threatening, nobody is kept in the hospital for that long. Even mothers, after delivering are discharged within 24 hrs!!!.
4. Emergency Copay - Its usually $50 to $100. If you have emergency, and go to emergency room. And you should call your PCP and/or insurance company about the incident. Assume you had emergency, called 911 and ambulance people took you to nearest hospital. That hospital asks you to get admitted. If you call your PCP/Insurance company, they may shift you to another hospital ( with whom they have a deal/cheaper).
Usually you have 24 to 72 hrs to inform the PCP and/or of the emergency.

If you follow these simple rules, you may probably spend something like $100 in whole year ( and actual insurance bill might be $5,000!!!) and you will certainly feel good about your health.

What if you need to see a doctor when you have gone on a trip? If you think you are going to need see doctor in another city/state, its better to call insurance company before the trip find out about the which doctor/hospital you may go to. ( e.g. You live in Texas and you want to go for skiing to Utah. As skiing is a dangerous sports, you may want to think ahead about what if "leg is broken"?). Normally you can go to any hospital and then file the claim with insurance company( If the hospital has contract with your insurance company, they will take care of filing the claim). Insurance company may pay somewhat reduced amount ( instead of $500 , they may pay $400 and you will have to cough up $100)

Another tricky thing is when you are changing jobs. Usually the health insurance starts after one month.(e.g. You leave Intel and join Microsoft on May 1. Your insurance will start from June 1). What if you fall sick during that time? COBRA will take care of that. When you leave Intel, Intel will offer to continue your health coverage, if you are ready to pay the full premium. This is called COBRA. If you have a kid or pregent wife or you think you might fall sick ( or need medical assistance), its better to take the COBRA and pay the premiums ( Should be around $200 per month per person). The premium you pay will be less as you will covered under employee group health coverage. If you decide to buy insurance on your own ( like car insurance), its will be much more expensive and very restrictive in benefits. So when changing jobs, keep this in mind.

If you are not very careful in knowing all the rules and procedures, you may get frustrated when you want to see the doctor and receptionist just refuses to give you an appointment. There are very few "walk - in" clinics in US. For these you don't need appointment. Its a good idea to look in yellow pages and find out where these are. The information will come handy, in case of urgent medical care (e.g. loose motion, urinary infection, dehydration, very high temperature, twisted ankle etc etc)

There is whole another story about vision and dental insurance. Vision is simple. You an see doctor ( for normal check up) once a year and get new pair of glasses every two years. Ofcourse, if your number changes etc, insurance will pay. Dental is usually covered by another insurance and it has another policy number etc. Dental is also fairly simple. Preventive care ( cleaning, cavity filling etc) are covered in full upto a maximum (of $1200) per year and other procedures like extraction, crowning etc are covered only 80% (i.e if doctor charges $500 for extracting wisdom tooth, insurance will pay $400 only and you will have to pay $100). If you go to SDM dental college, they will do it for FREE;-)

One thing that impresses me is the use of technology in medicine and its availability to all rich and poor. Every single clinic has X-Ray machine, ultra sound, lab for blood, urine .. testing, digital weighing machines, digital blood pressure, cat scan, MRI, reclynable beds,you can access every room in a wheel chair( no steps!) and are extremely clean and professional. Doctor wont touch a patient without gloves, you wont see a doctor without proper attire ( white/green gown). And Doctors usually explain the medical condition and explain why they are prescribing a particular drug. They will explain X-Rays and lab reports and its meaning in plain English. If you questions ( I am sure you will have) ask them, doctors will explain in detail. They wont rush you out.

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