Simple health insurance questions

[nychila]

I live in Canada, so I'm not completely familiar with the US health system. I looked into reading materials, and I still have 2 very simple questions on health insurance in the US.

Who are the medically-uninsured? Would that be those who are not covered by private insurance, Medicare, or Medicaid? So any American who does not carry health insurance from his/her employer, is not over age of 65, disabled, nor living in poverty, which would typically be the American working adult who is low-income?

If an American citizen who is not covered by private insurance, Medicare, or Medicaid has a car crash and is rushed to the hospital, after he recovers, does he/she have to pay the entire medical bill? Since medical bills sometimes run beyond $10,000, especially for emergency rooms and ICUs, how would the low-income American be able to afford that, even in monthly payments?

Thank you for your help. I'm really starting to enjoy the Canadian health care system now, which I have always taken for granted...

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[notbobtrustme]

I live in Canada, so I'm not completely familiar with the US health system. I looked into reading materials, and I still have 2 very simple questions on health insurance in the US.

Who are the medically-uninsured? Would that be those who are not covered by private insurance, Medicare, or Medicaid? So any American who does not carry health insurance from his/her employer, is not over age of 65, disabled, nor living in poverty, which would typically be the American working adult who is low-income?

If an American citizen who is not covered by private insurance, Medicare, or Medicaid has a car crash and is rushed to the hospital, after he recovers, does he/she have to pay the entire medical bill? Since medical bills sometimes run beyond $10,000, especially for emergency rooms and ICUs, how would the low-income American be able to afford that, even in monthly payments?

Thank you for your help. I'm really starting to enjoy the Canadian health care system now, which I have always taken for granted...

You pretty much nailed it with the medically uninsured.

In your second example, they would have to pay the bill if they don't have insurance. The hospital pretty much knows it won't collect in this case but still tries to collect. What usually happens is that the patient renegotiates with the hospital to pay something like 10% of the bill or declares bankruptcy.

 

[LizzyM]

The uninsured are those who choose not to buy health insurance, often because it is "too expensive", or who are unable to buy insurance because no insurance company will offer them a policy at any price due to a pre-existing condition. They can be working poor, self-employed, employed in a setting where health insurance is not offered as an employee benefit, or affluent but unemployed.

If someone in this situation has a medical emergency, they will get care and they will get a bill. The hospital may attempt to collect the whole bill or negotiate it down and write off a portion as bad debt (uncollectable) or charity care.

Keep in mind, too, if the injury is the result of a car crash, then an auto insurance policy may cover the medical bill.

 

[nychila]

You pretty much nailed it with the medically uninsured.

In your second example, they would have to pay the bill if they don't have insurance. The hospital pretty much knows it won't collect in this case but still tries to collect. What usually happens is that the patient renegotiates with the hospital to pay something like 10% of the bill or declares bankruptcy.

For my second question, wouldn't many hospitals and clinics lose money over saving the lives of the medically-uninsured? Do hospitals and clinics do anything to reduce this financial loss issue?

Also, if someone gets hit by a car on the street and requires immediate medical care, do hospitals ALWAYS treat the patient right away, knowing that there's a chance the patient might not be able to pay his/her medical bills, or do hospitals wait for family members to guarantee that either the patient or the family will pay the bill?

 

[LizzyM]

For my second question, wouldn't many hospitals and clinics lose money over saving the lives of the medically-uninsured? Do hospitals and clinics do anything to reduce this financial loss issue?

Also, if someone gets hit by a car on the street and requires immediate medical care, do hospitals ALWAYS treat the patient right away, knowing that there's a chance the patient might not be able to pay his/her medical bills, or do hospitals wait for family members to guarantee that either the patient or the family will pay the bill?

Federal law requires patients in active labor and those in need of emergency services be assessed and stabilized without regard to ability to pay.

In non-emergency situations, when you call for an appointment, the first question will almost always be what insurance you have. You can't even get in the door if you don't have coverage and in some cases, if the doctor doesn't accept patients with x or y insurance, then you can't get in even though you are technically "insured".

 

[Bangersandmash]

For my second question, wouldn't many hospitals and clinics lose money over saving the lives of the medically-uninsured? Do hospitals and clinics do anything to reduce this financial loss issue?

Also, if someone gets hit by a car on the street and requires immediate medical care, do hospitals ALWAYS treat the patient right away, knowing that there's a chance the patient might not be able to pay his/her medical bills, or do hospitals wait for family members to guarantee that either the patient or the family will pay the bill?

Losses incurred by treating the uninsured are usually subsidized by local/state/federal governments (as in the government has funds to pay for it). It can be a huge burden on the system and is one reason why people push for insurance for all.

Hospitals treat emergency patients until they are stabilized. Once they are not in an eminent risk of dying, hospitals don't have to continue to treat. For example, they must stop a brain bleed in the person hit by a car, but they wouldn't necessarily have to do an entire knee replacement so they could walk again.

 

[TheMightySmiter]

For my second question, wouldn't many hospitals and clinics lose money over saving the lives of the medically-uninsured? Do hospitals and clinics do anything to reduce this financial loss issue?

Hospitals try to reduce this burden in a number of ways. They may get money from the government, enact charitable foundations to help provide financial assistance to patients, or distribute some of the cost to insured patients by raising the price of care. The important takeaway, IMO, is that someone still has to pay for the care of the uninsured and having uninsured patients ultimately puts a burden on the whole system. Since hospitals are legally obligated to provide care in emergency and labor situations, the only real remaining options are to either make health care affordable for uninsured people (doubtful) or to somehow get everyone health insurance coverage. The Affordable Care Act is attempting the latter.

 

[GomerPyle]

Just know that it is probably the worst healthcare system in the world.

France and Canada offer healthcare to every single person (which is obviously expensive), yet they still spend HALF of what the U.S. spends on healthcare! The problem is for-profit organizations that are more focused on making money than saving peoples lives. Their administrative costs are super high, and their main priority is to avoid paying medical bills by choosing what treatments they will pay (and they obviously will choose the ones that are least expensive and try their best to avoid the pricey operations). Land of the free ladies and gentlemen....where companies are allowed to do whatever they want.