Health Care 101

Navigating the Healthcare system in the United States can be very confusing to an International student as the U.S healthcare system in privatized.  What this means is:

• U.S. Government does not manage the healthcare system.

• Healthcare is not managed by a single organization.

• Physicians, Hospitals, and other Healthcare Providers bill the patient for services rendered.
  These costs can be very high and are the responsibility of the patient.

  
  

Most international students come from countries that have a socialized healthcare system, in the United State an individual selects where they receive their medical care depending on the reason for the visit.  The cost for these services can vary from a couple of hundred dollars to thousands of dollars. The cost will also vary depending on the type of provider selected:

• On-Campus Student Health Center

• Minute Clinic

• Physician’s office – who do you go to?

  • Primary Care Provider

  • OB-GYN

  • Internal Medicine

  • Orthopedic

• Urgent Care Center

• Hospital Emergency Room

Medical Insurance is the key to help offset the cost and reduce the financial burden of a medical emergency.  

• Does your College/University offer a medical insurance policy?

• If your College/University does not have a mandated school plan, ask if they have a list of insurance plans /companies that offer medical insurance for international students.

It is important that you understand the medical insurance options provided to you.  As you select the medical insurance plan that best meets your needs ask these questions: 

What is the Deductible, Copays, Coinsurance?

Most insurance policies do not pay 100 percent of the medical cost that are covered under the policy.  Your share of the cost is the deductible, the co-payment, and/or the coinsurance.  It is important that you understand what you are required to pay as it can vary between medical insurance plans

• Deductible is the amount you pay before the insurance pays anything. For example, you may have a deductible of $200 per year. This means that you must pay $200 in covered medical costs before the insurance pays any part of the cost. Some policies have an annual deductible (you pay only once each year) and others have a deductible that is paid for each separate illness.

• Copay can be an amount that is your responsibility for certain types of service – for example a $30 Copay can be charged per Physician’s visit or $250 for an Emergency Room Visit.

• Coinsurance is the percentage that is your responsibility – some medical plans pay 80% of the covered charge and you pay 20% others may pay 70% and you pay 30%.

• Out of Pocket Maximum: If you have a very large medical expense your deductible and coinsurance can add up very quickly. For example, if you need major surgery, your total cost could be $100,000 or even more. If you have a 20 percent coinsurance you might still have to pay more than $20,000 yourself. In such a case the insurance pays 80 percent of your covered expenses, but 20 percent of a large bill is more than most people can afford. Some insurance policies protect individuals from these high cost through an out-of-pocket maximum, which limits the total amount an individual needs to pay out of pocket. Check with your insurance company to understand how your coverage works.

• Per Occurrence & Lifetime Maximums: Many international student insurance policies specify a limit in the amount they will pay for any single individual’s medical bills. Some policies limit the amount of coverage for any one illness or injury per policy year, other policies give a specific dollar amount per policy year for all medical conditions, and others may offer unlimited coverage. It is important to understand the limits of your insurance plan. 

• Can I go to any provider? Insurance companies can keep costs low by giving incentives to patients who seek treatment from the company’s preferred list of providers. These providers are fully licensed and offer the same type and quality of care as other providers. The reason they cost less is that they have agreed to provide care at special contracted rates. This benefits you and the insurance company. Very often, insurance companies reduce or waive deductibles and co-payments for treatment received from preferred providers. In some cases, treatment outside the preferred provider network is not covered at all. Make sure you understand the requirements and incentives for the PPO (Preferred Provider Organization) before you seek treatment from a provider outside the network.

• Covered Expenses: The medical expenses that will be paid under the policy are called covered expenses or covered conditions. When the insurance company calculates what they will pay, they consider only the expenses that are covered. For example, if a bill is submitted for $1000, the insurance company first identifies which costs are covered under the policy. For example, they may determine that the “covered” expenses total $700. They will reduce the $700 by the amount of your deductible, copay, coinsurance and then pay the rest. You would then be responsible for your deductible, copays, coinsurance percentage and the additional $300 of expenses that are not covered under the policy.

• Exclusions: At least as important as what an insurance policy covers is what it does not cover, the exclusions. These are typically listed as a separate category in the policy description. Read the exclusion section carefully. No matter what is described in the other parts of the policy, the company will deny claims for anything listed as an exclusion.

• Some other questions to ask.

  • Does it Cover Pre-Existing Conditions?

  • Does it cover Prescriptions?

  • Does it cover Routine Health Care?

  • Do I need to Pre-Authorize procedures – some insurance plans require test and procedures to be pre=approved and will not pay or pay at a reduced rate if pre-authorization is not obtained.

Once you purchase coverage make sure you have the following:

What are my Insurance coverage dates?

                Effective Date: ______________________   Termination Date: ___________________ 

Coverage is normally bought for a specific time period and it is your responsibility to renew the coverage prior to the termination date if you did not purchase for your full time of study in the United States.                                                   

How do I obtain an identification card?  When you go to a medical provider you must present your ID card so it is very important that you get your ID card and carry it with you at all times.

How to I file a claim:  Your insurance ID card should have information on how to contact the claims office.

Where to call for questions on your coverage and on medical claims:  Your insurance ID card will have a number to call if you have questions about your insurance coverage.  That is the best place to seek answers if you do not understand any part of the policy, or if you need to know whether a particular service is provided.                    

 IMPORTANT TO REMEMBER:  It is the written policy and not any verbal information that will control decisions about payment for claims.