Most Americans with health insurance can relate to this scenario: you get the bill from the doctor’s office or the imaging center, you open it and wham!  How did that one procedure end up costing so much? And how come you have to pay that much of it?  Despite having insurance, many of us have policies that require co-pays or co-insurance.  Yet most of us don’t know the difference.

A co-pay is a fixed amount that you pay each time you see a doctor while co-insurance is the percentage of the cost of doctor visits, hospitalizations (and prescription drugs) that you must pay under your insurance policy.  So, if you give birth via c-section and the bill comes out to $10,000, and your co-insurance is 80/20, you’re going to be paying $2,000 yourself, typically referred to as “out of pocket.”

Co-insurance

Co-insurance is common; according to the Kaiser Family Foundation, over half of all Americans with coverage through their employer have co-insurance.  Older Americans and women are more likely to have the highest “out of pocket” costs for care.   They frequently have more trips to the doctor and need more medical care, resulting in more co-payments and co-insurance payments.

This fall, heading into open enrollment, consumers can take steps to limit their financial risk.  Some plans offer a limit on the amount the patient can pay out of pocket.  Several online sites provide calculators to help you understand the real costs of choosing a particular policy, when you consider all the factors.

Come 2014, the new health care reform law will set some limits on the total amount consumers will pay out of pocket, but until then, it is important to continue to read the fine print.

photo credit: Anil Mohabir

Health insurance reform has helped making an "apples-to-apples" comparison between health plans much easier.

Anyone who has ever tried to buy health insurance as an individual knows it is just not as simple as purchasing other goods and services.  It is easy to compare a Delta flight to New York to a United flight to New York based on price, when both start and end at the same destination.  Both come with a seat, and these days — if you are lucky — probably a soft drink and maybe even some peanuts.

The trick in purchasing health coverage is that it is very difficult to make apples-to-apples comparisons between plans, especially just based on price.  The plan with a cheap monthly premium may actually have a much higher deductible—and end up being much more expensive in the long term.  Two plans may look very similar and be comparably priced; but one may cover maternity care, while the other does not. That can be tough, especially for the consumer who only learns this after she becomes pregnant.

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Is there a difference between choosing a primary care provider (family physician) and a specialist to treat you?

Primary care is struggling. Doctors in this field aren’t getting paid from organizations like Medicare and other government-funded entities. And even though many people who have HMO coverage are required to have a primary care physicians, the same HMOs skimp on payouts to the same physicians in their network. No doubt, as a result, patient care is suffering. We can complain and moan all day about underfunding for primary care, but that won’t address the real issue here: Where is that money supposed to come from?

With our economy in the state it is currently in, we can rest assured that additional funds are going to appear out of thin air (or out of other countries’ pockets) to help us solve our health care issues, but wouldn’t it be nice if everything else could stay well funded (though thinking so is laughable), while enough money went to primary care?

One can dream. The Wall Street Journal Health Blog took an informal survey from readers, asking where they thought that extra money for primary care should come from. The most popular answer was this: Lowering reimbursements for care and procedures provided by specialists. Is this a feasible solution? What would Congress do? Are we all just going to have to keep hoping the health care system in this country is going to magically remedy itself? (more…)

Health Reform was a big topic this year.  After all, President Barack Obama stood in front of congress more than once to encourage bipartisan support for the measures.  In the end, the country was deeply divided in their opinions about the bill’s veracity, but few can deny that Health Reform – as described in HR 3590 - will have far-reaching effects for millions of Americans (for better or worse).

This list of the 10 Most Costly Conditions was taken from our consumer guide to Health Reform in 2010.

Among the extensive coverage of health reform (Google shows an astounding 4,100,000 results for the phrase “health reform bill”) there is very little in the way of consumer guides.  MedHealthInsurance.com sought to remedy that shortfall by publishing a consumer guide to health reform in conjunction with the Insurance Research Organization.  We hope this guide will help you better understand your options under the new bill, its timeline, and how it will affect you – no matter which walk of life you hail from.

Doctors are regular people, just like the rest of us. They put their pants on one leg at a time, and they go through the same thought processes that we all do. They have good and bad days, and sometimes, they wish they could just open their mouths and let their patients know what they really think about health, lifestyle choices and your incessant whining. Reader’s Digest compiled a comprehensive, telling and hilarious list of quotes from the likes of general practitioners, surgeons, shrinks, pediatricians, and other specialists, and their honesty and bluntness is refreshing. You may see your patient self reflected in some of the following accounts, but don’t feel bad. Now you know what your doctor is probably thinking and you can use what follows as a tool to create a better doctor/patient relationship.

Doctors Say: Impatience is Our Virtue

Although a doctor is supposed to be endlessly patient, listening as we prattle on about our list of suspected ailments, what they are doing inside is mentally tapping their foot and rolling their eyes. Some secrets doctors around the country shared:

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President Obama made a lot of promises in his 2008 Presidential campaign, and many of them were around changes he wanted to see happen in America’s health care and insurance system. Unfortunately, many time politicians will talk the talk in order to get voters to punch their ticket a certain way on election day.

Walking the walk as far as campaign promises doesn’t always happen. Just look at the Bush administration…don’t even get me started. It is refreshing to hear Obama say that he is welcoming ideas on how to reform the health care proposal he created during his campaign, and I am all for a system in which many have a say in ideas to find a solution that works for everyone in the current state of the economy.

But the real question is, especially after hearing President Obama’s State of the Union address: What is the buzz around Obama’s statement of “come one, come all” for hearing opinions on health care, and will it work in creating a just and successful health care system for America?

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