insurance

[physicslover]

can someone explain to be specifically what the insurance problems optometrists face?

Not trying to ask a dumb question here, just trying to get the specifics. I am Canadian, if that makes it any better. We are covered here for standard eye exams until age 19 in Ontario and then usually corporate insurance can cover glasses, or exams.

So, is there problem in the States that many ppl come in w/o insurance? Or insurance that does not cover eye exams? Or particular tests..?

How does this get resolved?

I'm trying to understand the situation. Everyone always says that this is the major hassles with the field, so I would like to gain a better understanding of the situation.

Anyone who can offer a clear answer is appreciated

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[nc2tarheels]

each individual pays for their own insurance. Most insurance plans do not cover eye exams. There are some programs that the government pays for that do cover eye exams (medicaid etc), however, there's not that much of a reimbursement on them. Not sure what exactly you want to know, but there's the general idea.

 

[KHE]

each individual pays for their own insurance. Most insurance plans do not cover eye exams. There are some programs that the government pays for that do cover eye exams (medicaid etc), however, there's not that much of a reimbursement on them. Not sure what exactly you want to know, but there's the general idea.

That's not even close to true.

The number of people making for their own health insurance themselves is vanishingly small.

About half of people get their insurnace through some sort of government program, the two big ones being medicare and medicaid. Then there are the other programs such as the VA or IHS that are also basically provided by the government. If you could government workers, it's way over half.

Almost all working people obtain their health insurance through their employers with the employer picking up a substantial percentage of the bill. That's slowly as more and more employers are shifting costs of health insurance onto employees but overall, workers pay for much less than half of the overall cost of their insurance plans.

So the notion that each individual pays for their own insurance is not correct.

 

[nc2tarheels]

That's not even close to true.

The number of people making for their own health insurance themselves is vanishingly small.

About half of people get their insurnace through some sort of government program, the two big ones being medicare and medicaid. Then there are the other programs such as the VA or IHS that are also basically provided by the government. If you could government workers, it's way over half.

Almost all working people obtain their health insurance through their employers with the employer picking up a substantial percentage of the bill. That's slowly as more and more employers are shifting costs of health insurance onto employees but overall, workers pay for much less than half of the overall cost of their insurance plans.

So the notion that each individual pays for their own insurance is not correct.

That's what I meant by people pay for their insurance. It comes out of your pocket in some way, shape, or form.

 

[physicslover]

can someone explain hmo's

 

[Mata]

can someone explain hmo's

All I know about it is that you can't choose the doctors already assigned for you.

 

[KHE]

All I know about it is that you can't choose the doctors already assigned for you.

That's also not true.

In an HMO setting, you are required to see someone who is on panel list of providers. No doctor is assigned to you but you are limited to that HMO list of doctors.

You have no out of network benefits. In other words, if you elect to see a doctor who is NOT on that list, you would be responsible for paying the doctor's full fee.

In contrast with a PPO, you have a list of providers who you can see where the services are covered in full but if you elect to see someone who is NOT on the PPO panel, your insurance would still pick up some pre-determined amount of money and you would be responsible for the rest.

It's a lot more complicated than that and there's dozens of permutations of this which is why this is such a screwed up industry but in a nutshell, that's the basic difference between HMO and PPO.