Questions about medical insurance and covid in the US.

I'm hoping to avoid to much argument and get some actual answers from this, I'm not looking to rattle any cages in any way.

As I come from the UK and we have a nationalised healthcare system I don't really understand how the US system works but I'm interested in how the insurance companies are acting regarding the pandemic.

If you get covid 19 is that covered in your policy and they pay for treatment?

If you have a "vaccine" and become ill will they pay for treatment?

If you are eligible for a "vaccine", don't have one and get Ill from covid would they pay or claim it's your fault for not having a "vaccine" that would have prevented it?

I'm assuming policies differ greatly so I'm asking for individual circumstances or general info/hearsay.

Not sure totally but these are great questions

However, knowing my experiences with My father's(RIP) treatments for pancreatic cancer unless it was written in the policy every new "treatment" was delayed waiting for health insurance approval. Ergo unless you have platinum insurance be ready the fight and argue.

Dad had decent insurance we thought, LOL we were down fighting them on how long they would cover his paternal nutrition, you know the only way he gets sustenance till he gets better

If health insurance is like any other insurance I imagine it's full of so many loopholes it's barely usable?



a reply to: putnam6

a reply to: nonspecific

this fella said he wasn't going to have to pay most of his bill because he has medicare and medicare advantage through a insurance company. and they said they'll wave most of the out of pocket cost.

Flor says he may not ultimately need to pay for much of his treatment. He’s insured by Medicare and Medicare Advantage through Kaiser Permanente. The health care company has announced that it will waive most out-of-pocket costs for COVID-19 patients through 2020.
A Seattle Man Received a $1.1 Million Bill for His COVID-19 Treatment

and here is one that said the insurance company only paid 10% of a 1,1225,000 dollar bill. not sure if the rest will be coverd.

"Over one million dollars for one person. Insurance paid $100,000 of it –10%. Mind you, they may accept insurance and clear this balance, but even so these numbers are insane," the user said, adding that their deceased family member had both Medicare and private insurance.
Family of Man Who Died of Coronavirus Hit With $1 Million Hospital Bill

a reply to: putnam6

LOL, being at the mercy of Medicare can be a real experience.
Could you tell if it was the Medicare that was the problem, or his supplemental coverage?



As to the OP, I cannot say about and covid protocols, but it has always been the policy with Blue Cross to cover even pre-exisitng conditions.

Can I ask for a bit of a back story on what Medicare actually is please?


a reply to: DontTreadOnMe

a reply to: DontTreadOnMe

Medicare Part A (the free part) is crap, it is for people over 65 who paid into Social Security.
"Medicare Part A is health insurance offered by the federal government to United States citizens and legal immigrants who have permanently resided in the U.S. without a break for at least five years. You’re eligible if you’re 65 and older or under age 65 with certain disabilities. You may also qualify at any age if you have end-stage renal disease or amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease). Together with Medicare Part B, it makes up what is known as Original Medicare, the federally administered health-care program. Medicare Part A helps pay for the cost of inpatient hospital care, while Part B covers outpatient medical services." Part A is free, Part B (supplemental) each person over 65 pays for. Part A also generally pays Docs and hospitals less than it costs to treat the patients, so there are places and really excellent Doctors who won't take Medicare patients.

It is the supplementals that make the difference.

I know, I'm on it.

Got a great supplemental, which I PAY for each month, no family plan, my husband pays for himself and I pay for myself. (together we pay about $300 a month to get outpatient care, good medication coverage (average $5-$10 per med), tests, etc.)

With my supplemental I pay next to nothing. I had major surgery and hospitalization in 2020 and ended up paying less than a few hundred dollars out of pocket, and had a fantastic doctor and hospital experience.

Without the supplemental, I would pay for nearly everything except 80% of actual hospitalization costs.

People under 65 don't realize that Medicare is not free unless you only want coverage for hospitalization and nothing else.

Hope this helps.

originally posted by: DontTreadOnMe
a reply to: putnam6

LOL, being at the mercy of Medicare can be a real experience.
Could you tell if it was the Medicare that was the problem, or his supplemental coverage?

 

As to the OP, I cannot say about and covid protocols, but it has always been the policy with Blue Cross to cover even pre-exisitng conditions.

Pretty sure it was Medicare.LOL there was no discussion with his other insurance company lol

originally posted by: nonspecific
I'm hoping to avoid to much argument and get some actual answers from this, I'm not looking to rattle any cages in any way.

As I come from the UK and we have a nationalised healthcare system I don't really understand how the US system works but I'm interested in how the insurance companies are acting regarding the pandemic.

If you get covid 19 is that covered in your policy and they pay for treatment?

If you have a "vaccine" and become ill will they pay for treatment?

If you are eligible for a "vaccine", don't have one and get Ill from covid would they pay or claim it's your fault for not having a "vaccine" that would have prevented it?

I'm assuming policies differ greatly so I'm asking for individual circumstances or general info/hearsay.

I guess it depends.

55% of Americans are covered through insurance from their work, 20% is covered by medicaid (Goverment provided health coverage for the poor) 20% is covered by medicare (Goverment provided health coverage for the old) so that leaves about 5% (15 million or so) with no coverage for one reason or another, many are young people not really working as example that do not fall into the two categories for Goverment support.

So yes insurance pays, and many companies like mine also pay people if they are sick with COVID, need isolation, time off to get vaccinated, sick from the vaccination... so they don't need to use sick leave or PTO (paid time off that can be a mix of sick leave or vacation time). We also have State level medical leave for longer off time from work, up to 16 weeks, where the state pays you 55% of your base pay. No taxes or anything else is taken out so it come close to one's pay that hits their checking account.

Lastly medical needs by law can not be turned away and so people will use the ER, it's the illegal alien's doctor office..

a reply to: nonspecific

Well I am under Tricare in the US due to my husband been a retired military that is sponsored government medical care, plus my husband have blue shield due to his job.

I never had any problems, now or before, covid and I had several surgeries all paid in full.

So for me is all good soo far and nothing have changed.

originally posted by: nonspecific
If health insurance is like any other insurance I imagine it's full of so many loopholes it's barely usable?

I just had shoulder surgery with 2 MRIs and two doctor visits prior, I'm in rehab for 6 weeks or so with follow on doctor vistis...so far I paid zero, so insurance isn't bad...lol My surgery was 18,000 by itself.

The most frustrating part though, is there is no straightforward bill. Everyone bills and pays different amounts to where you really have no clue to what is what in cost.

a reply to: Xtrozero

That's up to the hospital that did your surgery, they should send you a brake down of the cost, I always get one after my surgeries, but the one from the anesthesia is no included, that comes by itself. The cost is incredible, I am glad I do not have to pay for it.

originally posted by: marg6043
a reply to: nonspecific

Well I am under Tricare in the US due to my husband been a retired military that is sponsored government medical care, plus my husband have blue shield due to his job.

I never had any problems, now or before, covid and I had several surgeries all paid in full.

So for me is all good soo far and nothing have changed.

I'm the same... I get free Blue Cross/Blue Shield through work, family is Tricare at 670 or so per year. Never had issues with either. I can go anywhere and see anyone at anytime, family needs their primary provider to approve first, but it is 100% approval.

So what if you had a reaction to a covid jab? Would that be covered?




a reply to: Xtrozero

originally posted by: marg6043

That's up to the hospital that did your surgery, they should send you a brake down of the cost, I always get one after my surgeries, but the one from the anesthesia is no included, that comes by itself. The cost is incredible, I am glad I do not have to pay for it.

I got that, but then I got a bill for 1650.00, and the numbers my insurance companies have are different in what they pay. One says they payed XYZ but the amount is nowhere near the surgery billing, another company says they deny XYZ due to not being primany, but paid others...

I finally call up the surgery billing department and they said ignore the bill as they are working with the insurance companies. So I'm thinking why did I get the bill in the first place? Nothing is straightforward.

a reply to: Xtrozero

That is the best care soo far, no bad, at least the government is doing something good for their retirees military, but since they are now using the online pharmacy I am no happy with that, it took me a while to set that up.

I kept getting my medications send to the local pharmacy and tricare kept sending me warnings.

a reply to: nonspecific


That is a good question, I guess it will be treated as any other medical problems, I am sure big pharma and government have it all fix.

So even with all the talk of side effects and complications and it being only under emergency approval they would still likely pay out?

That surprises me as it sounds like there's a whole bunch of reasons they could choose from to exclude vaccine related illness.



a reply to: marg6043

originally posted by: nonspecific
So what if you had a reaction to a covid jab? Would that be covered?

It would be treated as any other illness. We actually tell people NOT to come to work if sick in anyway, and the company still pays for their time, insurance would pay for their medical cost. With COVID we have special charge codes for people to use if they are sick with covid, in isolation etc.

If a person is sick from a vaccine we would use the code, but the interesting part is with a couple of thousand people getting the vaccine in my company no one has used the CC for being sick from the vaccine. They have charged 1 or 2 hours to get the vaccine on company time, but no one has used it for days as example to being sick, but have used it for COVID and forced isolation.

I'm surprised by this but also glad.

I really had visions of people getting screwed over with the insurance companies using the emergency approval as a get out clause or something.

Maybe they are not as bad as I thought.



a reply to: marg6043