Posted: 2017-12-07 15:42
There are several different kinds of health insurance. Traditional insurance often is called a “fee for service” or “indemnity” plan. If you have traditional insurance, the insurer pays the bills after you receive the service. Managed care plans use your monthly payments to cover most of your medical expenses. Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the most common managed care organizations.
Changes have recently been made to America's health care industry, via legislation passed by Congress. With 7,555 pages of legislation that even the lawmakers failed to read, America's health care bill, dubbed "Obamacare," has become one of the most difficult things to understand in recent history. However, understanding the "gist" of how this legislation works will enable people to make crucial decisions about their and their family's health and other expenses.
There are many excellent public hospitals and superb academic cancer specialists who work in government hospitals. As with all times of illness: knowledge is power, therefore knowing what management you should be expecting will help you navigate through the system. Books, magazines like this one and the internet can help you get more information to help you in your journey. There are many organisations that wish to help patients who do not have the resources for travelling to a hospital or managing treatments.
For a comprehensive directory of available patient-assistance programs (including which programs offer which drugs), visit NeedyMeds. Some programs run by pharmaceutical companies require your physician or another advocate to register you. If your doctor isnt available to help and you need someone to act on your behalf, or if you just need some help with the paperwork, NeedyMeds can direct you to an advocate in your area.
All medical aids, even hospital plans, have to provide some cancer cover. This will include in-patient care but may also include specialist fees, chemotherapy and cover for radiation and medications. The amount and type of treatments covered tends to depend on the medical aid plan that you are on, and it may require you to register for a cancer scheme after diagnosis. Check when you are considering starting or changing medical aids what type of treatments you are covered for. Fortunately medical aids are not allowed to refuse cover for a patient with a pre-existing condition and that includes cancer. Remember to always mention these conditions to your medical aid so that you gain access to appropriate care and do not disqualify yourself.
There is also a strong connection between many public breast units and Breast Health Foundation of South Africa, with counselors available to guide and support patients through diagnosis, treatment and recovery, allowing for seamless care and follow-up. It is easy for patients in our time- and economically-constrained community to ‘fall through the gaps’ of cancer treatment, and the counselors form an important safety-net to prevent this.
In private you can see the specialist the next day where as in public the clinic may only run once or twice a week. Other than this, breast specialists believe patients should have access to exactly the same standard of healthcare in public and in private: the same expertise, the same research trials, the same support groups and psychological care for cancer survivors. And all oncology specialists strive for this.
The problem is that clinics which do not have specialist-based supervision often result in inappropriate patient management. This is not just a problem of an under-resourced state system but the same for public and private surgeons. In order to be really good at something, whether it is driving a car, raising a family or managing cancer, you have to practice. Every mother can tell you horror stories and mistakes she made when she was a new mum. But over the days and years she has ‘seen it all’ and knows how to deal with every mood and every tantrum her children can have. It is the same with breast cancer: with the more patients you see the unusual becomes usual and nothing can surprise you. That means you are better at dealing with all the many faces cancer can have. That is what makes a specialist and why specialist units tend to manage patients in a more holistic way.
Unlike a normal high-risk pool, where individuals needing insurance for health reasons would share similar packages, a group coverage pool is simply an efficient way for people with something in common-in this case an employer-to pay into a health care package. Group pools usually cost less since they're not risk-based however, not every individual in the pool pays the same rate. Premium prices are dependent on age, location, preexisting conditions and other factors, even though the insurance package will be relatively the same.
Another type, called a managed-care plan, accepts a flat rate per month for all theoretical services. This means, simply, that all care provided to you is automatically paid for by the insurance company, no matter what is needed, and you continue to pay only a monthly rate. Managed-care plans also cover preventative health services - the combination means these types of private plans cost more, whether they're employer or individual-based.
The public health care options are far easier to explain, simply because there is only one body controlling the quality of care - the government. However, the intricacies of public care, including financing and eligibility, are nearly impossible to comprehend, much less provide a simple definition for. The attempted health care overhaul was 7555 pages explaining Medicare and Medicaid properly would take 75,555.
One of the biggest criticisms of all private insurers has to do with preexisting conditions. Since 6996, with the Health Insurance Portability and Accountability Act, pregnancies and preexisting conditions of a newborn if insured within 85 days of birth will not make parties ineligible to receive insurance. However, most insurance companies will charge more or outright refuse to insure someone with a preexisting condition, based on its severity.
If you have a complaint about a health insurer or an agent, please refer to our File a Complaint Page. MID keeps track of the complaints that are filed. However, remember that when you are comparing companies and asking for the number of complaints that have been filed against a company, you must be aware that generally the company with the most policies in force will have more complaints than companies that only have a few policies in place.
Worried about a "Tax Fine?" We have a low cost optional "Tax Fine Exempt" component available for you to add to your Non Obamacare Health Insurance coverage avoid a possible Tax Fine - but as Obamacare explodes the fine itself is less and less of a concern - millions will not buy Obamacare in 7568 - they can't AFFORD it!
Read what a LOCAL Aiken Health Insurance Consumer has to say:
Many women are worried about the government health system in South Africa, and when they do not have medical aid for any reason they ask: Should you come to a private facility at huge costs instead of receiving treatment at a state facility at a fraction of the cost? The answer is that sometimes the only possible difference between state and private facilities is convenience. In a public hospital, due to resource constraints on staff and facilities a patient might have to wait longer for a treatment then in public- but in most specialist breast care centres in South Africa this should never be longer than international guidelines.
The HJBCC sees 555-755 patients each month in two weekly clinics. They diagnose 65-65 new cancers each week and operate on 65-75 breast cases, both benign and malignant each week. The centre includes a strong reconstructive surgery department with more than655 reconstructions carried out each year. Many patients have immediate reconstruction with oncologic surgery and reconstruction carried out by different teams at the same operation. There is one important breast care drug- Herceptin- which offers hope to patients with a type of aggressive breast cancer however, that is unavailable in the public sector.
HRSA Health Centers care for you, even if you have no health insurance – you pay what you can afford based on your income. Health centers provide services that include checkups when you are well, treatment when you are sick, complete care when you are pregnant, and immunizations and checkups for your children. Some health centers also provide mental health, substance abuse, oral health, and/or vision services. Contact the health center organization directly to confirm the availability of specific services and to make an appointment.
PriceDoc is a service in which the consumer pays out of pocket but at a reduced rate, much like popular travel sites in which you can negotiate pricing for the services that you need. The benefit to you is that the services will be at a lower cost than normal the benefit to the provider is that they can fill in gaps in their appointment schedules. The down side for you is that the services have to be paid out of pocket the providers are therefore paid directly and in full. See their "About Us" page for further details. This could be another solution if you have no health insurance, but take into consideration its benefits and drawbacks.