Tuesday, June 08, 2010

Frequently Asked Questions About Health Care Reform

If you are hopelessly confused about the intricacies of health care reform, you are not alone. After all, it was written to be understood by lawyers and medical professionals, not by Real People. But as a public service, I have done a great deal of research and have compiled an initial set of answers to frequently-asked questions (FAQ's, for those of you who live on the net) about health care reform...

What does HMO stand for?

This is actually a variation of the phrase, "Hey, Moe!" Its roots go back to a concept pioneered by Doctor Moe Howard, who discovered that a patient could be made to forget about the pain in his foot if he was poked hard enough in the eyes. Modern practice replaces the physical finger poke with hi-tech equivalents such as voice mail and referral slips, but the result remains the same.

Do all diagnostic procedures require pre-certification?

No. Only those you need.

I just joined a new HMO. How difficult will it be to choose the doctor I want?

Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors who were participating in the plan at the time the information was gathered. These doctors basically fall into two categories: those who are no longer accepting new patients, and those who will see you but are no longer part of the plan. But don't worry - the remaining doctor who is still in the plan and accepting new patients has an office just a half day's drive away!

What are pre-existing conditions?

This term refers to conditions which require treatment, but which are not covered by your insurance. This is a phrase used by the grammatically challenged when they want to talk about existing conditions. Unfortunately, we appear to be pre-stuck with it.

Can I get coverage for my pre-existing conditions?

Certainly, as long as they don't require any treatment.

What happens if I want to try alternative forms of medicine?

You'll need to find alternative forms of payment.

My pharmacy plan only covers generic drugs, but I need the name brand. I tried the generic medication, but it gave me a stomach ache. What should I do?

Poke yourself in the eye.

I have an 80/20 plan with a $200 deductible and a $2,000 yearly cap. My insurer reimbursed the doctor for my out-patient surgery, but I'd already paid my bill. What should I do?

You have two choices. Your doctor can sign the reimbursement check over to you, or you can ask him to invest the money for you in one of those great offers that only doctors and dentists hear about, like windmill farms or frog hatcheries.

What should I do if I get sick while traveling?

Try sitting in a different part of the bus.

No, I mean what if I'm away from home and I get sick?

You really shouldn't do that. You'll have a hard time seeing your primary care physician. It's best to wait until you return, and then get sick.

I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a heart transplant right in his office?

Hard to say, but considering that all you're risking is the $25 co-payment, there's no harm giving him a shot at it.

What accounts for the largest portion of health care costs?

Analysts disagree, but generally agree on two factors: doctors trying to recoup their investment losses, and lawyers looking for a Big Score.

Will health care be any different in the next century?

No, but if you call right now, you might get an appointment by then.

I hope this helps remove some of the mystery surrounding health care reform. If you would like to read the text of the bill, you can do it here. Of course, before you do that you should ensure that your insurance covers eye damage from reading 1990 pages of dense legalese.

But it probably won't. Good luck.

Have a good day. Stay healthy. More thoughts tomorrow.



Phfrankie Bondo said...

...enjoyable reading, sir...

Bandit said...

I'm afraid that some of this is kind of true only the answers are given in the polititian vernacular.

Leslie David said...

On getting sick away from home, you know I ended up in the hospital in Spain last fall and needless to say I did not call first for authorization. When I got back I called my insurance company and told them what had happened and that if they didn't cover it they'd have to treat me for the nervous breakdown I'd have. All kidding aside, they really were good, they took the information I gave them over the phone and I later faxed them copies of the documents, and they paid 80%, even converting the Euros to dollars for me and commented on how good the price was for the care I'd received in Spain.

Mike said...

This new plan sounds better than what I have now.