I hope this is the correct sub, if not, please direct me somewhere.
Let me preface this – I do not live in USA.
I’m an interpreter from Poland, currently during training. Since we’re going to help Poles living in USA with, for example, health insurance, we’re being taught how it works.
But in theory it’s all nice and dandy, while in reality it seems horrible. I can’t find the middle ground and how it’s applied to real life situations. Trainer denied explanations, claiming interpreters are not allowed to have opinions (or at least express them), but I think this knowledge would allow me to better understand the context of the situation.
If there are deductibles and then copay and then out of pocket maximum (that apparently nobody ever reaches anyway), then why people have such high med bills even though they’re insured? If out of pocket maximum is for people with serious medical issues ending up with hospitalisation, why insurance companies suggest setting up gofunmes? If insurance or M4A work, then why people can’t afford their insulin, or don’t go to therapy? Why do I see people complaining about “insurance don’t cover my basic meds and I have to pay full price” if there are these… PPOs? I think that’s what they’re called. Insurance should direct them to where they can get a price at least partially covered by the insurance.
I don’t understand, but since I don’t live over there, I probably miss something that is obvious to people who do.
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People get into trouble largely by not calling their insurance before a procedure. It is always the patients responsibility to verify coverage, even if the provider assures the patient that their insurance will cover something.
A provider might be out of network, the treatment might not be covered but a comparable treatment would have been. Each plan is different and if you check with your insurance you avoid lots of issues.
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