Compelling discussions going on here.
In the US, a person can see any doctor that will set an appointment, the only question is Who Pays?
That varies. The patient, the Govt, or an insurance company (IF the patient has been paying the premiums, or the premiums are being paid on their behalf; insurance expires and requires monthly payments [usually] else terminated prematurely by the company). Even if there is no expectation of payment, Someone or Something is usually assigned to a charged medical event as Responsible Party for the bill. For the unconscious unidentified, this kind of thing can be sorted out later and probably immediately entered as patient responsible.
It is not to be expected that every cost is covered by the insurer, the patient pays premiums and other amounts towards their annual deductible, after which insurance picks up more of the cost, but usually not all of the cost. There is a max out of pocket for the patient, after which there should be no more costs for that year, for services reasonably covered by that insurance. This max has nothing to do with items outside of the coverage.
A person can be covered by more than one insurance or program, each would have their own deductibles and limits. Medicare is kind of a prepaid benefit as money is extracted from worker paychecks over decades. I know little about it (I am far from 65 yet) but many retirees buy supplemental insurance, too, so one could assume it is basic on the entitled services part. Supplemental policies are like other insurance as far as being offered by numerous outside companies. Medicaid is complicated but covers children, disabled, aged, poor... and is administered by states with monies from fed govt. VA (military) may pay all or most all for retired. Dental and vision are usually special insurance no matter what program. Often prescription policies may be needed.
True self pay is an entirely different thing. That is a person with no insurance, or, their insurance is not accepted by that doctor. There are often discounts for this, also, but a person should declare it Self Pay when they set appointment so the office knows you plan to pay it vs total write off. Most people can pay at least a little bit. One may need to pay in full at time of service, but payment plans are also common. Even with insurance, payment plans are common. I don't think people ask about these things, though.
Note that a person is not limited to only seeing doctors in their network. This is a common misunderstanding. A person may choose to limit themselves to choosing from that list, but in my experience, it is wise to call around. Many doctors will submit claims to any insurer, but they do not have to accept any insurance they don't want to. In the mass of insurance companies and doctors, there are bound to be some hard-to-work-with entities so both sides maintain choice in the matter, not having to do business with anyone they don't want to do business with. If they accept you as a patient, this at least means that they will accept your money, no middleman.
Even with some employer-administered obscure policy (my employer owns the health insurance company), I am finding great coverage well outside that list. The few that will not accept my insurance work with me on reasonable payments as True Self Pay. Even those payments should be reported to insurance company because there is a category for Out Of Network spending, which does have coverage for the employee, odd though it may seem. I am sick this year, I long ago met my in network out of pocket and have met out of network deductible. I am into the co-insurance part, where the insurance covers 80% and I pay 20% until meeting out of pocket max. I may meet out of pocket max in and out of network. It is an expensive year, for sure, but when one has a big illness, that's what happens. If I can get back to work in 2019, I can repair the financial damage. I am luckier than many.
I have numerous payment plans in force in order to pay as little as possible monthly to conserve financial resources. Hospitals, especially, will work with a patient. It can be wise to seek the range of treatments within a hospital system, they have bundled it together for me in many cases so I make one vs multiple payments. I have spread my care around 3 hospital systems and many "unaffiliated vendors". I required a treatment device considered out of network so that deductible was met quickly, even though I am paying little towards it monthly. I pay my acupuncturist out of pocket ($85 each) and submit claims to insurance company myself. True Self Pay is not a terrible way to go. I have done so with chiropractor, paid $45, when I had no insurance.
A network is essentially a list of pre-approved providers that your insurance company probably already has a relationship with. They are at least easy to do business with, will play ball with claims process, etc. Nobody has ever had to give up a doctor unless they desired to, and it could indeed be more expensive to continue with your old doc when your insurance doesn't have them in network, but that is not automatically the case. That is not the same thing as losing your doctor. I have lost doctors that retired or moved. But I have also had doctors establish a relationship with my insurance company where they had not previously been "in network". I would urge people to call those doctors they think they are losing and ask what they would be paying without insurance there. For me, it can be worth it to pay a little more to keep continuity but usually it hasn't been any big money issue.
The problem is that this stuff is massively complicated and myths and mistruths abound. If we could solve some of the complexity, we could solve some of the excessive costs. Now that I have a pre-existing condition, true self pay is either the best way to go, in case I never have a recurrence, or fast track to death or bankruptcy if I get sick again. If I don't return to work, paying for insurance could send me to BK faster than not having it. Wild stuff. And each person or family has their own unique situation and therefore reasons for managing their health care arrangements how they do.
maybe I'll retire to Canada just to have it simpler to be sick!
In the US, a person can see any doctor that will set an appointment, the only question is Who Pays?
That varies. The patient, the Govt, or an insurance company (IF the patient has been paying the premiums, or the premiums are being paid on their behalf; insurance expires and requires monthly payments [usually] else terminated prematurely by the company). Even if there is no expectation of payment, Someone or Something is usually assigned to a charged medical event as Responsible Party for the bill. For the unconscious unidentified, this kind of thing can be sorted out later and probably immediately entered as patient responsible.
It is not to be expected that every cost is covered by the insurer, the patient pays premiums and other amounts towards their annual deductible, after which insurance picks up more of the cost, but usually not all of the cost. There is a max out of pocket for the patient, after which there should be no more costs for that year, for services reasonably covered by that insurance. This max has nothing to do with items outside of the coverage.
A person can be covered by more than one insurance or program, each would have their own deductibles and limits. Medicare is kind of a prepaid benefit as money is extracted from worker paychecks over decades. I know little about it (I am far from 65 yet) but many retirees buy supplemental insurance, too, so one could assume it is basic on the entitled services part. Supplemental policies are like other insurance as far as being offered by numerous outside companies. Medicaid is complicated but covers children, disabled, aged, poor... and is administered by states with monies from fed govt. VA (military) may pay all or most all for retired. Dental and vision are usually special insurance no matter what program. Often prescription policies may be needed.
True self pay is an entirely different thing. That is a person with no insurance, or, their insurance is not accepted by that doctor. There are often discounts for this, also, but a person should declare it Self Pay when they set appointment so the office knows you plan to pay it vs total write off. Most people can pay at least a little bit. One may need to pay in full at time of service, but payment plans are also common. Even with insurance, payment plans are common. I don't think people ask about these things, though.
Note that a person is not limited to only seeing doctors in their network. This is a common misunderstanding. A person may choose to limit themselves to choosing from that list, but in my experience, it is wise to call around. Many doctors will submit claims to any insurer, but they do not have to accept any insurance they don't want to. In the mass of insurance companies and doctors, there are bound to be some hard-to-work-with entities so both sides maintain choice in the matter, not having to do business with anyone they don't want to do business with. If they accept you as a patient, this at least means that they will accept your money, no middleman.
Even with some employer-administered obscure policy (my employer owns the health insurance company), I am finding great coverage well outside that list. The few that will not accept my insurance work with me on reasonable payments as True Self Pay. Even those payments should be reported to insurance company because there is a category for Out Of Network spending, which does have coverage for the employee, odd though it may seem. I am sick this year, I long ago met my in network out of pocket and have met out of network deductible. I am into the co-insurance part, where the insurance covers 80% and I pay 20% until meeting out of pocket max. I may meet out of pocket max in and out of network. It is an expensive year, for sure, but when one has a big illness, that's what happens. If I can get back to work in 2019, I can repair the financial damage. I am luckier than many.
I have numerous payment plans in force in order to pay as little as possible monthly to conserve financial resources. Hospitals, especially, will work with a patient. It can be wise to seek the range of treatments within a hospital system, they have bundled it together for me in many cases so I make one vs multiple payments. I have spread my care around 3 hospital systems and many "unaffiliated vendors". I required a treatment device considered out of network so that deductible was met quickly, even though I am paying little towards it monthly. I pay my acupuncturist out of pocket ($85 each) and submit claims to insurance company myself. True Self Pay is not a terrible way to go. I have done so with chiropractor, paid $45, when I had no insurance.
A network is essentially a list of pre-approved providers that your insurance company probably already has a relationship with. They are at least easy to do business with, will play ball with claims process, etc. Nobody has ever had to give up a doctor unless they desired to, and it could indeed be more expensive to continue with your old doc when your insurance doesn't have them in network, but that is not automatically the case. That is not the same thing as losing your doctor. I have lost doctors that retired or moved. But I have also had doctors establish a relationship with my insurance company where they had not previously been "in network". I would urge people to call those doctors they think they are losing and ask what they would be paying without insurance there. For me, it can be worth it to pay a little more to keep continuity but usually it hasn't been any big money issue.
The problem is that this stuff is massively complicated and myths and mistruths abound. If we could solve some of the complexity, we could solve some of the excessive costs. Now that I have a pre-existing condition, true self pay is either the best way to go, in case I never have a recurrence, or fast track to death or bankruptcy if I get sick again. If I don't return to work, paying for insurance could send me to BK faster than not having it. Wild stuff. And each person or family has their own unique situation and therefore reasons for managing their health care arrangements how they do.
maybe I'll retire to Canada just to have it simpler to be sick!
