The medical insurance

Health & FitnessMedicine

  • Author Andrew Andreeff
  • Published March 1, 2011
  • Word count 1,249

The system of payment of the help through individual insurance has made for the USA possible creation of the brilliant medicine which is carrying out huge number of the most difficult and expensive interventions.

The choice of optimum type of the medical insurance is a challenge, as the list of services given by the insurance companies and so rather various, all time extends.

The basic types of insurance of the health, however only three:

  • Basic Medical Hospital Insurance

  • Basic Medical Insurance

  • Major Medical Insurance.

Basic Medical Hospital Insurance defrays your hospital expenses, and more often the insurance company establishes limits on duration of stay in hospital and for a total sum for treatment. Laws of states, however, regulate conditions of insurance contracts: in New York, for example, any company by granting Basic Hospital Insurance is obliged to compensate you expenses not less than for 60 days of continuous stay in hospital and to pay for this period at least 80 % of your hospital accounts. If such services aren't given to you, such insurance can be called only Limited Benefits Health Insurance.

Basic Medical Insurance serves for the reimbursement, the doctors bound to services, surgeons and anesthesiologists, including visits to doctors in hospital. Payments under this insurance also are limited on time and on the sum. Under laws of the State of New York, Basic Medical Insurance should cover not less four fifth reasonable charges on visits to doctors.

Major Medical Insurance serves for a covering of additional expenses which arise in case of serious disease and fall outside the limits the basic hospital and medical insurance. Sometimes this insurance is offered separately, sometimes - together with the basic insurance. The size of indemnification paid to you depends on type of the insurance contract and from a company policy. Sometimes the contract assumes a covering of 100 % of your expenses, but is more often you should pay from the pocket and additional payments. Some insurance contracts assume payment of medical accounts only in the event that you have addressed for the help to the certain doctor or in the certain hospital which list has been in advance discussed in the contract (this rule usually doesn't extend on cases when you should address for urgent medical aid). Quite often the contract assumes full payment of medical accounts in case of treatment in in advance certain medical institution and partial payment of invoices in other cases.

It is necessary to mean also that the overwhelming majority of the insurance doesn't assume payment of your medical accounts caused by those diseases which have been diagnosed before signing of your insurance contract. On what the medical diagnosis but which have caused symptoms which should force to address the person for the corresponding help hasn't been made concern these diseases also. The medical expenses caused by such diseases, aren't paid by the insurance company or in general, or during certain time (usually two years).

Accident Insurance are the usually highly specialized insurance extending only on accidents discussed in the contract and on specific disabilities (for example, the insurance on a case of loss of an eye etc.). The price of such insurance rather isn't high that is bound to low probability of similar cases.

Hospital Indemnity Insurance covers the certain sum of your hospital accounts. Its difference from Basic Medical Hospital Insurance consists that not certain percent from your account, and the concrete sum is compensated to you. Such insurance is better for having not instead of, and in addition to Basic Medical Hospital Insurance.

Specified Disease Insurance extends on the expenses bound to treatment only of those diseases which are discussed in the contract (for example, a cancer). In New York such kind of the insurance is forbidden by the law as, according to the staff authorities, interests of patients are better observed in case of complex medical insurance.

Buying the medical insurance, it is necessary to mean that you have a possibility to get it at the private company, at the state (for example, you can buy insurance on Medicare if have no right to use this program free of charge) or from the noncommercial organizations among which the most known Blue Cross and Blue Shield.

The insurance given by public organizations, costs more cheaply, but it is completely not free, besides contains essential restrictions and covers usually no more than 80 % of medical expenses.

Don't try to save money by reduction of given services, it can cost much further to you.

The group insurance usually costs more cheaply, but in that case it is necessary to study especially attentively the contract to avoid unexpectedness. The matter is that if you conclude the group contract, say, in a work place, and among your employees there are inhabitants of other states the group contract can not fall under jurisdiction of your staff, and in it there can be no those points as which you considered self-evident (for example, 80 percentage covering of your expenses at the general medical insurance).

Always be interested, it is what is the time taken away to you on reflection after contract signing. Under laws of the State of New York the period during which you can terminate the contract, having returned all paid money, makes for medical insurances of 10 days.

Remember that any reference to the doctor demands the prior notification of the insurance company (and sometimes and an expert estimation). Without such notice your accounts won't be paid at the expense of the insurance unless you needed urgent medical aid. And, at last, last council - don't tighten searches of the medical insurance comprehensible to you.

As the patient you possess the certain legal rights which disturbance can form the basis for giving in court on the infringer of these rights.

The following concerns your basic medical rights:

  • The Right to prevention of a surgical intervention or procedures on which you haven't given the consent. Each doctor before to undertake similar actions, necessarily should receive the consent of the patient. Your consent can be given either in writing, or orally. The consent is considered void if you have been incorrectly informed on a situation or were unable understand, on what agree (if the patient the minor, the consent of parents) is required. Though you have the right to flat refusal of health services concerning yourselves and the children, in certain cases the law provides its compulsion (for example, in case of inoculations).

  • The Right of the patient to death in a case not curable illness and-or a coma is now one of the most debatable questions of jurisprudence and ethics. Laws of some states allow the termination life-support procedures in case of a recognition doctors of a condition of the patient who is in a clod, remediless and in the presence of the consent of its close relatives or trustees.

Laws of many states demand, that your doctor informed you on all possible complications bound to concrete medical procedure. However in case of rendering of an acute management the doctor is, of course, released from such obligations.

In some cases the attending physician has the right to hide from you the information on a state of your health and on menacing danger. However it should give this information to your close relatives. If you have made an explicit statement that don't wish to know the certain information, nobody in the right to inform you it.

Without your preliminary consent your doctor has no right to resolve somebody to be present on medical procedure.

One of main principles of medical insurance - high efficiency of medical aid. The insurance companies protect the clients from nonprofessional medical aid.

Article source:
This article has been viewed 580 times.

Rate article

Article comments

There are no posted comments.