"You have to have a baby to get Medicaid"

[Tama]

This is what I was told last year. I bring it up now because I am facing needing expensive oral surgery and there is ONE doctor who actually takes medicaid for it!

So officially I can't get health insurance. Al's work would charge him $180 (triple what he pays now) PER PAY PERIOD to put me on.

What the hell is this? I don't have a kid because I'm not in good health or in a good place mentally to deal with being pregnant if I did want one.

Why am I being penalized for being responsible?

[Aragarthiel]

In my state, you have to be under 18, disabled, or pregnant. I get a special kind that provides me with womanly exams and birth control and things, but that's it. So I know how you feel. I need my wisdom teeth pulled, and I have an assortment of issues that should probably be checked out by a doctor, but we're still trying to pay off my E.R. bill from when I had a kidney stone.

[Kheldarson]

Might recheck with your state. The new insurance laws have changed things.

[NecCat]

I saw your post about your dental work, and there is something I don't understand. What does 'doesn't take my insurance' mean. I've read and heard it said in other places as well. The way every medical insurance I've had works is that there are pharmacies, optometrists, dentists and whoever that will take my insurance card, run it, and only charge the balance if there is one, while there are others who will charge me, give me a receipt and I send it to my insurance company who write me a check and mail it to me. Most of those won't even make me pay upfront, just send me the bill, which I can submit to insurance and they will send a check directly to the medical professional, so I only have to pay a balance between what's covered and what's not if there is one. Come to think of it, that's how the car insurance works too.

So do you (and others) mean that you would have to pay and wait for the insurance company to write you a check, and you can't afford a payment upfront, or do you actually mean you are not insured if you go to certain health care providers? And how would the providers get to make that decision? Or does it mean that your insurance only covers you with approved providers, and you have to check (with the provider?) if they are on the approved list.

Sorry if it seems like a really stupid question, I've just never understood the concept.

[Aragarthiel]

you are not insured if you go to certain health care providers?

Exactly. The health care system is so screwed up in America (I'm assuming you're not American), it would be hard to describe it perfectly. The best I can come up with is that the doctor charges $400 for a service, Insurance Company A pays the full amount, Insurance Company B pays $350 and says that's the full amount, and Insurance Company C pays $100 and says that's the full amount. The doctor can choose not to accept Insurance Companies B or C if he doesn't want to. So if you go to that doctor, you're paying for everything with your own money.

[NecCat]

But if the doctors bill is $400, and the insurance you have covers you to $350 for that service, would the insurance company not pay the doctor $350 and you would pay the doctor $50. Or you have to pay the doctor $400, then the insurance company pays you $350 once you submit the receipt?

I still don't understand, doesn't accept that insurance. What does the doctor care who pays what portion of a bill if he gets checks for the total amount?

And no, not American.

[Tama]

My understanding of it. I have this insurance with a certain well known insurance company.

Now, suppose I want a doctor that does not accept this insurance. Some oral surgeons do not take dental insurance, I've been told. I would not be insured if I went "out of network" as it were, to dentists/etc who do not accept my company of insurance. I'll need to look in the little insurance booklet Al got when he got this dental insurance to check up on it though.

I'm not sure why the providers get to make that decision, but

[Aragarthiel]

But if the doctors bill is $400, and the insurance you have covers you to $350 for that service, would the insurance company not pay the doctor $350 and you would pay the doctor $50. Or you have to pay the doctor $400, then the insurance company pays you $350 once you submit the receipt?

That's where it gets cloudy. The doctor says the procedure is worth $400 even though it is actually worth, say, $250, because he knows that the insurance companies will argue with him and end up paying less than he says. So if he was charging $250 instead of $400, the insurance companies would all say, "I'm only paying $200/$150/$100," and the doctor loses money.

Not many Americans understand exactly how the whole thing works, even doctors know too little about it, so that's really the best I can do.

[Tama]

That is exactly why medicaid acceptance is rare for dental stuff. Medicaid has some stingy mofos.

[HYHYBT]

The insurance company decides not only what *they* will pay, but what beyond that, if anything at all, you can charge the patient.

(Also, depending on your insurance company and what you're prescribed, your "copay" at the pharmacy may be higher than what you'd pay for the same medicine outright if you didn't have insurance, because they can get away with that.)

[NecCat]

Okay I think I somewhat understand. Sorry for the derailment. Back to your regularly scheduled rant about children and medical insurance.

[wolfie]

The insurance company decides not only what *they* will pay, but what beyond that, if anything at all, you can charge the patient.

(Also, depending on your insurance company and what you're prescribed, your "copay" at the pharmacy may be higher than what you'd pay for the same medicine outright if you didn't have insurance, because they can get away with that.)

First part sounds like the reason some doctors don't accept some insurance - the insurance company is telling them that they aren't allowed to make enough off a procedure for it to be worthwhile, so they tell the insurance company to go to hell.

With the second part, if your "copay" going through insurance would be higher than the cash price for people without insurance, why can't the pharmacist ring you through as if you didn't have insurance, saving you money?

[Kaylyn]

I, too, dislike the whole notion that, apparently in my state, you aren't entitled to any healthcare assistance if you don't have a kid. So my health and life isn't as important as someone else's, merely because they've fathered/mothered a child? I guess it's because the state wants to make sure they can continue to provide for the children, but if I had my way I'd extend the coverage to any needy person. Being there for my family is just as important to me, whether that family is just me, or my husband and two cats. But then again I support fully socialized medicine and not this feeble attempt at it with ACA, so... /shrug

[Andara Bledin]

The issue is that kids, by nature of not having full rights and privileges, are given special consideration. This must, by necessity, include those children's caregivers.

Not saying that it's a particularly good system or metric, but that's the reasoning behind why it works out that way.

[BlaqueKatt]

but if I had my way I'd extend the coverage to any needy person. <snip> But then again I support fully socialized medicine and not this feeble attempt at it with ACA, so... /shrug

Well part of the ACA was to expand state medical assistance with federal money, however almost all, if not all republican governors rejected the money simply because of their hatred for the president. Yes they hurt their constituents out of nothing but pure spite.