Keep an eye out for money off coupons for your Cancer medication. No, really.

I've already had my little winge about what is and is not covered by insurance in the US of A. Well, I thought it would actually be a bit useful to share some of the stuff I've learnt to overcome the medical minefield. 

I can't help you with choosing a health insurance provider. That was decided by the old man's employer, although we were given a choice of coverage within that. Turns out I'm making the same choices about my own healthcare as I am about the cats - I have to decide if I am prepared to pay $x per month for basic emergency healthcare and coverage of prescriptions, or, if I think I'm going to get cancer, I need to pay $x extra a month to cover any potential tests I might need to diagnose stuff. And if I want cover for having kids and whatnot? Thats an extra bundle of coverage that costs an extra $x per month. But what if I get some hideous thing and I don't know about it til its too late? Simple - pay an extra $x a month to have a free annual checkup with allsorts of tests. I have read ALOT of fine print. The main things to look out for:

1. If you want coverage for something specific (a particular congenital disorder, a specific medication) check that it will be covered and to what extent before you sign up. You can talk to a rep on the phone from the chosen insurance company. 
2. If its something pre-existing you will have to work quite hard to determine what will and wilt be covered. Lot of insurance companies simply won't cover pre-existing issues, meaning that if you went to the doctor with a stomach ache yesterday, signed up for insurance today, and in 2 months it was discovered to be a tumor then that won't be covered, nor will any of the tests or medication. 
3. There is also a period of time during which you can't claim. It depends on the company, but it could be a couple of weeks up to a month.
4. You will have to pay for all your doctor visits. This is called co-pay - its the wad of cash you'll shell out when you go to the doctor, or pickup a prescription. It can be as low as $0, but it will vary depending on the pharmacy you go to and what your insurance coverage is. Heck, it may also depend on what drugs you're getting.
5. You can decide what your voluntary excess should be - they call that your 'deductible'.
6. Prescriptions are often written Rx. I have no idea why they decided to go all latin up in this bitch.
7. Not all the prescriptions you get from your GP will be covered by your insurance. Apparently one cannot get acne after the age of 31, so my insurance company did not cover my prescribed medication. Nice. You can fight them on it, and, in fact, you are encouraged to, because if they don't know there is a problem then they won't change it. 

   

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8. YOU will have to check if a particular drug or test or therapy is covered by your insurance company - you can do that by calling them up. Alternatively they should have a list of covered things online.
9. If your prescription involves some extra mixing of specific amounts of drugs you may need to find a Compounding Pharmacist. These chaps seem to be talked about in hushed tones, and exist only on certain mythical plains. 
10. If a prescription isn't covered by your insurance:
1. Shop around - find out how much your medication costs at various pharmacies. Also, note that the price can change daily, so if you find somewhere good it probably won't be that price next time you go there.
2. Once its in the system at one pharmacy you can't get it back. Yup - I took it to one pharmacy, they told me they didn't have any in stock and that it would be $90, because my insurance didn't cover it. Wow. I said, no thanks, can I have my script back and they said that once its in the system they can't give it back to me. FFS.
3. BUT if you find a better pharmacy they can call up the first pharmacy and have it transferred electronically. This took a couple of hours to be sorted, so you might want to come back later.
4. Get a coupon for your prescription medication. Actually, this isn't even something that most of my local chums know about. I was certainly able to download an Rx app and get my prescription medication (that wasn't covered by my insurance) half price. I just had to show the coupon to the pharmacist. Astounding. 
5. Pharmacists can refuse to give you your medication. Yup. There have been a few cases recently where they have refused to give women drugs to help with miscarriages because the same drugs are used in abortions, and the pharmacist did not believe that the doctor in each case had made an ethical decision. Yep, free ethics lesson with every pack of tampons from your friendly local pharmacist.
11. And on a less serious note:
1. If you need to get high, medical marijuana is a thing in certain states and you can go to an actual pharmacy and get a weed prescription. There are lists of things that you can get weed for in certain states.
2. Paracetamol is called acetaminophen.
3. If you are looking for soluble aspirin you won't find it. The closest they have is 'buffered' aspirin which doesn't have the coating on it for swallowing, so when you put it in water it slowly and reluctantly falls apart, rather than actively offering itself up to imbibement. 

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Emergency care can be pretty scary too. In the UK you go to A&E, or, get an emergency appointment at your local out of hours surgery. Here I had to call the insurance company and speak to a nurse who advised me on which hospitals nearby were covered by my insurance. I do pay extra each month to be able to claim SOME money back at hospitals that aren't in my 'network', but if we go to a hospital that is in the 'network' then we get back 90% -100% of the costs, rather than 50%-80%, so its worth knowing in advance.

The hospital was fine - same as the UK, except the wait time was a lot shorter, and you have to get your credit card out before you are allowed to leave. You don't pay all the money up front (like we will have to do with our cat insurance), but you do have to pay the co-pay fee for an emergency visit, and you are later sent a final bill by the hospital with the full cost of the treatment, minus the amount that your insurance company will pay. That just leaves you with your deductible, (which we call the excess in the UK), which was about $300 last time. I have no idea whether we would have to pay more if we took an ambulance, and whether we should just call 911 or whether there is a special private number to call? Who knows. I wonder how many people have actually died trying to work this shit out, find their healthcare provider's list of approved hospitals and balance their finances, all with a plank of wood through their abdomen?

Once you get your head round all this it starts to become routine, although I still don't think any system where an individual has to decide between getting their giant stomach tumor removed or paying the rent is acceptable. And don't even get me started on the influence of the drug companies. BUT, this appears to be one of the few situations here where you DO get better service because you are paying through the arse for it. Unless you're already sick. Or old. Then you're fucked.

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