US Medical System

[AFQuaid 18]

Hey Folks,

Moving from being under the NHS to the US way of managing health is going to be tricky to get to grips with the change and what's different and what isn't.

Here's a bit of background before I dive into my questions.

I have been under 5 specialists which grew in numbers over the years. But thankfully I have been discharged from everyone of them because of the move to Adult Services. Now I just see ONE consultant every 6 months (unless something happens) and GP once a month or so for minor issues. I am on 6+ medications that I need a constant supply of.

Now here's my questions. When/If I'm approved how do I actually go about arranging to go under a doctor in Andys area? I know really stupid question but the NHS has normally just refered me on throughout my life, I logically assume I'm going to arrange this myself. There is a consultant in the US (Andys consultant) who has said he is willing to take me on. But how do I actually arrange that? He has not said it in writing or anything but has said it to Andy. Also how do you go about getting yourself a GP? I assume similar way to getting a specialist. I would need ot arrange these things prior to my moving or else I am making a huge health risk. I can order 3 month supply of all my medications from the NHS before I go but here's another thing, how do you actually get your prescriptions moved so you can obtain them in the US? I *think* (again bit confused by how the US health system works) I'm going to have to get like long term health insurance, till I get my greencard or become a citizen maybe? Can anyone recommend any good companies that may take *complex cases.* And one last thing, how do you go about getting medical records shipped to the new consultant/GP from the UK to US?

I would just like an overview of how you go about these things. Perhaps somebody who has moved from the UK-US can tell me how they went about some of these things?

Fiona

[luvaLimey 0]

It would depend on the insurance company's policies.

Some HMOs require you to choose a Primary Care Physician. This could be just a Physician who does General Practice and then refers you to specialists, or it could be this specialist, as long as he/she is in the HMO's network of physicians.

Some insurance plans don't require you to choose a PCP right up front, but allow you to go to any doctor in their network, and then you would just pay extra to visit any doctor outside your network.

For your prescriptions, they wont be valid here in the US unless a US Physician prescribes them to you. So you it may be a good idea to bring over an extra supply of them until you've seen your new physician, let him/her know what you're taking, and also bring over a copy of your medical files (ask your GP for them before you come) so they have all your records. They can then prescribe your medications here, and you would be able to get those prescriptions filled here.

[Kathryn41 3,205]

I have an ongoing medical condition that requires regular maintenance check ups as well as prescriptions. When I moved, I arranged with both my primary care physician and my endocrinologist to have physical copies of my medical files to give to my new health care providers in the US. I also obtained copies of all prescriptions to give to my new doctors in order to obtain US valid prescriptions. If you have any type of health coverage right now, obtain from them a statement of coverage. Your partner's insurer may require proof of prior insurance for a pre-existing condition before they will cover it here. If you are totally covered trough the government obtain a copy of the government policy or procedure that provides you with health coverage.

When you get here, obtain your Social Security Number right away - that is, apply 2 weeks after your arrival - since your new health care provider will request that as well. Generally, it is a matter of finding a primary health care provider who is acceptable to the type of insurance you have in the US - the insurance company often maintains a list of doctors who accept their insurance - then calling the doctor's office to make an appointment as a new patient. Some insurance companies will require you to have a referral to a specialist and others don't. Some doctors will make the appointment with the specialist for you - and others may just hand you the phone number and you have to make the appointment yourself. It varies.

You may have to wait until after you are married as well before you can be added to your spouses' health coverage so do be prepared to bring several months worth of prescription medication with you - along with a letter from your physician authorizing you to carry that amount of medication with you into the US. I had to wait 3 months to get a first appointment with the specialist just because his scheduled was booked. You may also have a several months wait for a complete physical due to the doctor's booked schedule as well - it was a three month wait for that as well, although I can generally get a regular appointment within a day.

Good luck.

Edited July 4, 2006 by Kathryn41

[flipside 0]

You need to seriously research your medical options before you get here, especially for the first 6-9 months after you arrive.

There is no real "public" health system here, and as a non-citizen, you will have practically zero options for non-emergency health issues. Considering your preexisting conditions, I can't imagine a health plan costing you less then $1500-$2000 a month, if they will even take you on at all. This is a very serious issue for you, and you really need to look at all your options before you consider the move here.

The US has the most expensive health care in the world so please weigh all your options very carefully.

[Lou Lou 1]

Getting a GP or a consultant is not the hard part of all of this. Paying for it will be. Marrying a US citizen does not give you any more rights to healthcare unless they are adequately insured to cover you. Becoming a citizen takes 3+ years from marriage, and being a citizen does not automatically give you free healthcare.

In most states, the government provides no health benefits except in cases of extreme poverty. You will have to buy health insurance for yourself, or get married immediately to be added to your spouse's insurance. There is no way you should risk coming to the US with no insurance. As Flipside has explained, it's not gonna be cheap, and most insurance companies will either refuse to cover for the pre-existing condition or sting you with extremely high premiums each month. With 6+ medications I can't begin to imagine how much those prescription charges each month would be, which is why the insurance company would be worried.

To get a PCP (GP), just call them up and ask to be signed on to their books. With regard to the specialist, you then speak to your new PCP and ask to be referred to them. To get your records from the NHS, call your GP and specialist, explain the situation and ask them to copy all of your records. I know there is sometimes a charge for this.

Good luck

[UKJen 0]

Fiona,

Do you/does your husband have medical insurance? That's your first step. You say that Andy's consultant will take you on, but you need to check your cover. By law doctors cannot turn you away from treatment (in theory) but you must have insurance or you will need to pay.

The US system works like the UK private system. Some people have cover, and some do not. Those who do, may have the bulk paid by their employer and they may pay an amount towards that. Others do not have this provided as a benefit so they must either go without, or pay private premiums themselves.

A US private doctor charges about what a UK private charges: in my experience $85+ per visit, plus medications, etc. Some insurance policies cover meds, some do not. It all depends.

As mentioned, Medicaid covers the very poor. Medicare helps the over 65s, but that is all that is provided in the way of a managed government system.

We are moving from the UK to US and plan to take a break before we start working (I am transferring back with my company). We will obtain private insurance to cover ourselves in case of an emergency. For us this is $2-300 a month for basic cover. Notice I said basic--we are (touch wood) rarely ill and if we are then I don't mind paying $85 for a doctor visit as it's a one-off. We want to be protected in case we have an emergency. Our insurance will exclude all pre-existing conditions for at least 6 months, if not longer (depends on the policy). Pre-exisiting is anything that we have sought treatment for/have medication to take as a result of...you get the idea.

We have had issues in obtaining cover for the green card holder. You will want to check this on your husbands policy--he can ask his benefit or HR office for the paperwork. Some policies require a waiting period. I got good info on diveintoamerica, a site for Americans moving from the UK back to the US with partners/spouses.

As the others said, be very very careful about this. It is possible to find good cover but it is very costly to go with out, or to cover pre-existing conditions (in some cases).

Good luck!

[AFQuaid 18]

Thanks everyone for your informative replies. I'm starting to build an understanding now We're "on the ball" now looking over how we're going to deal with this and have been looking into health insurance companies.

First we looked at the BlueCross CA which looks great with the individule plans though I did get a tad confused about what copay and deducutions meant. They cover every area and are by our budget. $200 is the max a month we can afford to go towards this unless Andy took out a loan. BUT the site doesn't say if it excludes pre-existing medical conditions. I like the part of choosing your own specialist thats great and the drug coverage (main concern) can near be 100% helped with. So I tried to email the BlueCross but for some reason the page just went to that "try to refresh" #######. Does anybody have an email address for enquires for them? It also doesn't say the age requirement for applying.

Secondly I tried looking at a company called Kaiser (sp?) which Andy mentioned but that went out the window as there minimum age requirement is 19.

I've heard the BlueCross getting mentioned a while back by somebody so I did a search of VJ but couldn't find the thread. Does anybody know anything about them or have any experiances?

Also I have a really dumb question When you exceed the amount of the coverage say by being admitted to hospital do they inform you? Or do you get a rude awakening and maybe a doctor ends up telling you can't get anymore treatment cos your coverage won't cover it. How does that work? Or do you get told what amounts you pay towards this and that i.e 10% for prescription drug, in advance to going ahead with anything medical?

And in answer to your question Jen, yes Andrew but we're unsure whether I'll be able to "hop on."

Am I right in thinking I cannot obtain health insurance in the US until I get a SSN?

Edited July 5, 2006 by AFQuaid

[samir_shannon 0]

ALL I HAVE TO SAY ABOUT HTE MEDICAL SYSTEM HERE IS YOU BETTER HAVE INSURANCE OR ALOT OF MONEY

[Anastassia 0]

Fiona,

your husband's insurance is one thing, and the employer's insurances mostly accept pre-existing conditions. You can also have this in mind when you are looking for your own job, I have my own insurance and they accept sick people too.

Good Luck,

Ana

[Lou Lou 1]

It's a bit worrying that you only have $200 a month to fund health insurance. Does this include funding for your copays and deductables?

Of course state to state varies somewhat but I know of someone here in VT who has no pre-existing health concerns, and was quoted a price of $270 a month for a plan that would cost $11,000 a year for deductables and co-payments through Blue Cross.

As you may have discovered there is a LOT of reading to do about this.

With regard to your latter question: In general you're responsible for all the initial payments up to a certain amount (your deductable), and after that you pay a portion which is the co-payment, until another level is reached, after which the insurance company pays the 100%.

Most healthcare plans don't include dental care, or at least very minimum, so include that in your budgeting too. Dental bills can be horrendous!

With regard to going back for NHS care. Once you have spent six months+ out of the UK you won't be entitled to any more care unless you go back to live there. I'm sure there are plenty that slip through the system, but on the whole it is frowned upon, and the NHS are becoming pretty savvy in dealing with it.

[UKJen 0]

Hi Fiona,

We found some places that would cover me with a copy of my visa, and others wanted a US drivers license and SSN#--it all depends on the policy. You'll need to check this and the waiting period carefully.

As Anastassia mentioned: the employment plans are better in dealing with these types of things. Do try your husband's policy as a starting point.

Will you work in the US? If yes, and if it comes with insurance than you can compare your policy to Andy's, and you can take out your own policy only if needed (as we are, to bridge the gap until we are working).

In general, you pay the monthly premium and you pay your medical charges up to the deductible. So, you need to make sure that you could safely pay that deductible amount if needed. After that it is generally a coinsurance, whereby you pay 20% of the cost and the insurance pays 80% (this varies). This would be up to the Maximum Out of Pocket amount, which is also in the fine print. This is the Max that you will have to pay. There is also a Lifetime limit on what the insurance company will pay towards your care, but this is usually quite high.

In addition to all of this, some policies allow doctor visit with a co-payment of say $25. That means if you go to the doc you pay $25 and you do not need to reach your deductible first. Other polcies require you to meet your deductible first.

It's the same with medications: some have a deductible for this.

If you look in the fine print you will see info on pre-exisiting. Blue Cross varies by state, but in my state it has a 12 month wait. At the time of application they ask for all the doctors/illnesses you have had in the past few years and they will make the exclusions then.

The monthly premium is driven by the deductible amount (higher deductible = lower payment) and the type of plan.

To answer you query: yes, it can sometimes be 'by surprise' that you'll get a bill in the post for medical treatment that you thought was covered. Some companies are sure to notify you, but you'll want to double and triple check everything yourself.

I don't mean to scare you, but medical bills are the leading cause of bankruptcy in the US-hence the imporance of all of this. We have done heaps of research on this as it's such a confusing topic!

The big questions that we asked ourselves were:

1) How much can we safely afford to cover deductibles? $1000, $10,000?

2) How much do we want to pay per month, knowing that we might not reach a deductible or need care?

3) What are the co-payment terms? Paying 20% of a doc visit is easy...but 20% of heart surgery or cancer is catastrophic!

4) What is the Max Out of Pocket we can afford. Can we afford $5000? $10000 in case of emergency? Do we go higher assuming and hoping we will be healthy?

There is a good online quote generator called ehealthinsurance.com. Have a look at it. When you find a plan you are interested in read the Exclusions section, and then go to the companies website and read the brochure. I emailed my local Blue Cross office a few times for info--have a look on their website again and see what you can find (each state is different).

Good luck,

Jen.

[Tim and Bethanie 1]

Fiona, have you thought about contacting the MDA? Present them with your situation, and perhaps they can point you in the right direction. After all you can receive benefits from a non profit organization, this does not fall under means tested benefits. I am quite sure you are not the only immigrant who has faced these issues, and it is well worth checking into every means possible.

B

[Kathryn41 3,205]

When I first arrived, my husband was covered by Blue Cross. I was added to his plan. My first claim for treatment was denied due to the pre-existing condition clause. I contacted them and they stated that if I did not have proof that I had been covered under a health plan immediately before enrolling in Blue Cross I was subject to a 12 month exclusion for the pre-existing condition. As I had been covered by my previous employment, I contacted the health care provider and received a Statement of Coverage from them verifying the start and end dates of my health coverage. I presented that to Blue Cross and they allowed my claims for the pre-existing condition. When we left Blue Cross for another company later that year (the employer changed), Blue Cross provided us with a Statement of Coverage which I had to submit to our new insurer in order to avoid the 'pre-existing condition' clause again. I am from Canada where we have public coverage for basic medical costs, so provided them with both the Ontario Health Insurance Plan statement as well as my former employer's coverage statement which included prescriptions, etc. Even still, it gets expensive with deductibles and co-pays: $20 a doctor visit; $40 a specialist visit, plus percentages of all tests and $30 copays on prescriptions. We are supposed to have 'good' health coverage, but I can tell you, nothing in the US is good after you are used to the Canadian public health care system. US health care is profit based and they - the health care providers and the insurance company - will get their profit.

Edited July 5, 2006 by Kathryn41

[UKJen 0]

Kathryn,

That's a very helpful suggestion about the statement of cover. We were not going to bother in bringing our UK medical records to the US, as it didn't seem worth the hassle (fee paying, form filling request).

We both use the public health system and don't have private care. My husband requested a copy of one of his prescriptions from his NHS consultant and they refused to give it--said they will give it out only if an insurance company requests it. I'll ask him to call the consultant again and push for something...as coverage for this pre-existing would be excellent.

Was the Statement of Cover something simple like a letter outlining the coverage you had and the dates, or did it also include your full medical record?

Just curious as to how specific I need to be.

Thanks again for mentioning this. We are thinking of going with blue cross so might come across this same issue--and it's good to be prepared.

Jen

[Kathryn41 3,205]

Was the Statement of Cover something simple like a letter outlining the coverage you had and the dates, or did it also include your full medical record?

Just curious as to how specific I need to be.

Thanks again for mentioning this. We are thinking of going with blue cross so might come across this same issue--and it's good to be prepared.

Jen

Hi Jen,

The Statements of Coverage were very straightforward - both were written on business letterhead, and basically stated that I, with my full name and date of birth, was covered by them for insurance that included all medical expenses including prescriptions inclusive from enrollment date to end date, then signed and dated by the benefits administrator. I also included the information I had from OHIP, which is the Provincial Health Insurance that covers all Ontario residents showing the coverage it provides and included a photocopy of my health benefits card. I asked both my primary care physician and my endocrinologist for photocopies of relevent medical documents and they both provided me with copies of what they felt were the important documents and said that my new provider could contact them if there was something else they might need.

One of the really good things here in the States that I like is that you as the patient get copies of all medical test reports and can even keep your own xray or MRI films if you wish. THe attitude is that since you paid for them, you own them. I would definitely bring as complete a medical file as you can, make a copy to keep for yourself, and then hand the other over to your new GP here.