My occupational therapist has suggested I get health insurance, so that I can go to a private hospital and get my trauma junk sorted out. The problem is, I've... never actually had insurance before? I'm Australian, so the basic stuff has always been covered for me. Do any of you have advice on what to do/not do when getting insurance for the first time? I'm supposed to come up with questions for her to ask the insurance companies, but I'm not sure where to start. Thanks for any advice you can give!
1) what services do you cover 2) what hoops does the insured have to jump through to be approved for behavioral health services 3) what's prescription copay 4) what's specialist copay 5) what's hospital copay 6) how are claims submitted, does the insured submit them or does the provider submit them 7) what's emergency copay 8) is [hospital] in network for this provider that's off the top of my head i know there's others and if you have any more questions you can post them here (meanwhile i thought this was a screaming thread about how piss-poor the american marketplace insurance is this year. don't move to america. promise me)
(don't worry i will not move to america, with all my health junk it is a Scary Place) And thank you! Behavioural health services... is just a fancy word for mental health services, right? (I've never run into that term but that's what google tells me.) Also, this came up in a brochure I was reading about one of the things: what do they mean when they say $x amount is payable in a calendar year? Is that just like... 'we'll help up to this amount of money, and then you're on your own'? And what's the difference between hospital excess and hospital co-payment, in the context of going inpatient?
1) yes, it's the fancy thing that insurance companies call mental health, it also includes substance abuse treatment (thus "behavioral") 2) i think so, but don't quote me on this 3) i have no idea, i have literally never gone to a hospital for inpatient anything and have no experience, even indirectly, of hospital claims
Ahaha, hospital claims are fucking wild, let me tell you. I have paid not once, not twice, but three different times for a single emergency mental health visit back in October, all totalling a couple hundred each. I was billed for services, evaluation by a professional, and use of facilities, all separately. But that because I was uninsured at the time. Moral of the story, though: hospitals will try to wring every last penny out of you. But! I might have an answer about "x amount is payable" although I'm American, so your mileage may vary on the accuracy for Australia. If I'm right, though, "x amount is payable" actually refers to the max amount you are obligated to pay out of pocket, after which insurance covers everything (but I believe your premiums go up for the next calendar year as a result). I may be wrong though, because you didn't give a whole lot of context and it may have said something like "insurance only pays x amount". I don't know what "hospital excess" refers to, but hospital copay is where you pay a portion of the amount owed, usually (I believe) a fixed amount (my copay, for example, is $20 for doctor appointments and $30 for hospital visits and specialists), and the insurance covers the rest of it. Inpatient services usually bill you for every day you are there as a single "visit", like a doctors appointment. When I did in patient services, my therapy appointments with the psychiatrist were billed separately than my actual inpatient day bills, if that makes sense.
Sorry for not replying to this earlier, I've been kinda wiped, but thank you! That was all really helpful. The 'x amount is payable' stuff was like... they'd say '$x is payable per person' with regards to hospital excess/hospital co-payment, usually followed by '$y is the maximum you will pay in a calendar year for a single and single parent policy'. I'm still not 100% clear on what that refers to but I guess it's just the amount of excess/co-payment you spend.
