Steps For Care

In the United States of America we have to have insurance to pay for our health care.  Or we pay out of pocket.  There is an interesting thing that happens when you don't have insurance, some providers (doctor offices) charge less.  Some don't.   If there is any federal or state assistance with healthcare, I have noticed a level of discrimination since the assisted insurance does not typically pay for the full bill.  And they use this as excuse to charge astronomical rates.  Most providers are charging around $500 for a visit.  $500 an hour is a pretty sweet deal.   But it depends of what kind of visit.  If you say a well check, that might be a $300 visit as opposed to a physical check which can jump to that $500 charge.

If a patient has insurance they must follow the steps to get the care they need unless they wait and go to the emergency room at a hospital.  And the insurance company can easily say, "Oh you went to the wrong hospital, we don't cover that one.  You will need to pay the bill yourself."  A tragedy many don't realize until after the mistake of using the "wrong" hospital for emergency care.

When the patient goes to their chosen primary doctor who typically works out of clinic they can determine the next step.  If there is imaging needed the doctor typically sends the patient to another location to get imaging.  If they need a specialist, that specialist could be 20 miles away.  Either way, it must start with the primary who might charge a minuscule co-pay for around $10, maybe $20.

The specialist office may take a bigger cut.  Co-pay of $45.  It all depends on the insurance.  Did I mention the deductible?  This all comes out of the patients pocket until the deductible is reached, which can be around $1000 or more.  This system is not necessarily the way all insurance companies run things since employers usually pitch in for their employees care and may have variations of different deductibles and co-pays for their insurance plans which may be modified to accommodate the employers who are allowing their employees to have a plan or choose a plan.

It is a cumbersome process.  A long cry from when doctors would pay house visits to the sick.