Socialised health care really is better.
August 21, 2008 8:26 AM Subscribe
I've been recruited by a large firm in the US, who are going to relocate me to their offices in Washington. How do I deal with your weird health-care system?
My new employers are a large, reputable company, who are handling all the visa/relocation hassle. According to all sources they have excellent health care benefits. My concern is that I have been recently begun treatment for depression (medication and therapy). How do I maintain this treatment when I move to the States? Do I need a referral from my doctor at home, or from a GP, or can I just find a new psychiatrist/therapist in the phone book?
I know that for specific questions I should just be asking my employer, but I don't know if there is anything I shouldn't bring up to them: most of my understanding of the US health care system comes from AskMe, and it seems strangely adversarial, especially regarding mental health. Also, I am really weirded out by the idea of involving my job in any of my health care decisions. I'm used to socialised medicine - how does this 'employer health care' actually work? Do I actually go through my employer somehow for health care/do they end up knowing that I'm seeing a psychiatrist?
Any other hints about things I may not have considered are welcome.
My new employers are a large, reputable company, who are handling all the visa/relocation hassle. According to all sources they have excellent health care benefits. My concern is that I have been recently begun treatment for depression (medication and therapy). How do I maintain this treatment when I move to the States? Do I need a referral from my doctor at home, or from a GP, or can I just find a new psychiatrist/therapist in the phone book?
I know that for specific questions I should just be asking my employer, but I don't know if there is anything I shouldn't bring up to them: most of my understanding of the US health care system comes from AskMe, and it seems strangely adversarial, especially regarding mental health. Also, I am really weirded out by the idea of involving my job in any of my health care decisions. I'm used to socialised medicine - how does this 'employer health care' actually work? Do I actually go through my employer somehow for health care/do they end up knowing that I'm seeing a psychiatrist?
Any other hints about things I may not have considered are welcome.
It's employer-paid health-care, not employer-run.
Basically, your employer contracts out to some other company to handle your health care. There are various types of health insurance provider plan - PPOs, HMOs, etc - with different rules, but in no case does your employer have to know that you're seeing a psychiatrist. (There's actually a set of laws to make sure of that). In an HMO, you generally need to get a GP's referral; in other systems you need to find someone in your provider's network, and in others you can pick from the network or pick whoever you want and pay out-of-pocket if there's a difference between your provider's standard payment rates and your doctor's charges.
Basically, you need to find out how your plan works before you can find a doctor - you might just start asking HR about the process for seeing "A specialist" - this won't give away anything about the details of your treatment and not only is 'How the heck does this work?' a common question for them to field, it'll be extra-reasonable coming from some Socialist Foreigner Type.
And yes, it will be horribly complicated; that complication is, er, complicated by the fact that we can't all just learn one set of rules and regulations and stick with it; we're all relearning things all the time as we move between employers and insurance companies and plans.
posted by Tomorrowful at 8:43 AM on August 21, 2008
Basically, your employer contracts out to some other company to handle your health care. There are various types of health insurance provider plan - PPOs, HMOs, etc - with different rules, but in no case does your employer have to know that you're seeing a psychiatrist. (There's actually a set of laws to make sure of that). In an HMO, you generally need to get a GP's referral; in other systems you need to find someone in your provider's network, and in others you can pick from the network or pick whoever you want and pay out-of-pocket if there's a difference between your provider's standard payment rates and your doctor's charges.
Basically, you need to find out how your plan works before you can find a doctor - you might just start asking HR about the process for seeing "A specialist" - this won't give away anything about the details of your treatment and not only is 'How the heck does this work?' a common question for them to field, it'll be extra-reasonable coming from some Socialist Foreigner Type.
And yes, it will be horribly complicated; that complication is, er, complicated by the fact that we can't all just learn one set of rules and regulations and stick with it; we're all relearning things all the time as we move between employers and insurance companies and plans.
posted by Tomorrowful at 8:43 AM on August 21, 2008
How do I maintain this treatment when I move to the States?
Depends on the plan. It is also likely that you will have a few to choose between. Choose well.
Do I need a referral from my doctor at home, or from a GP, or can I just find a new psychiatrist/therapist in the phone book?
Depends on the plan. Strongly. Generally, plans called "PPO" or "preferred provider organization" are less restrictive than plans called "HMO" or "health maintenance organization."
Either way, you won't be able to choose any from the phone book. You'll have to choose a PCP from a "network." Most health insurance companies have webpages where you enter your address and your specific plan, and they say "Here are the 250 in-network PCPs closest to you." For a PPO, these pages will also tell you "Here are the 250 closest in-network psychiatrists" and "Here are the 250 closest in-network gynecologists" and "Here are the 250 closest in-network oncological radiologists." In practice this isn't NEARLY as limiting as it sounds.
For whatever it's worth, if you're a lady-type person with lady parts, you might want to know that some women in the US use their gynecologist as a primary-care physician, and some gynecologists are happy to operate that way.
The US-side HR has brochures that explain this, and can answer questions for you. I can understand feeling a bit squeamish about asking "So, I have depression..."* I would think that asking a series of questions like this:
"The brochure says this, but I'm foreign and don't understand your health system. Can you explain this to me?"
About different topics will neatly figleaf which things you just don't understand and which you need to know about because you have them. You should have a bunch of questions of this type anyway. And you should not be shy about asking them -- even if you're a single dude with no interest in kids, you might still have questions about obstetrical care.
Do I actually go through my employer somehow for health care/do they end up knowing that I'm seeing a psychiatrist?
It depends on the plan, strictly speaking. But the way it almost always works is that your employer writes checks to an insurance company, and their involvement ends there. Your doctors know what treatment you've received. Your insurance company knows. Your employer would not normally know, and privacy regulations under a law called HIPAA protect you from disclosure.
posted by ROU_Xenophobe at 8:49 AM on August 21, 2008
Depends on the plan. It is also likely that you will have a few to choose between. Choose well.
Do I need a referral from my doctor at home, or from a GP, or can I just find a new psychiatrist/therapist in the phone book?
Depends on the plan. Strongly. Generally, plans called "PPO" or "preferred provider organization" are less restrictive than plans called "HMO" or "health maintenance organization."
Either way, you won't be able to choose any from the phone book. You'll have to choose a PCP from a "network." Most health insurance companies have webpages where you enter your address and your specific plan, and they say "Here are the 250 in-network PCPs closest to you." For a PPO, these pages will also tell you "Here are the 250 closest in-network psychiatrists" and "Here are the 250 closest in-network gynecologists" and "Here are the 250 closest in-network oncological radiologists." In practice this isn't NEARLY as limiting as it sounds.
For whatever it's worth, if you're a lady-type person with lady parts, you might want to know that some women in the US use their gynecologist as a primary-care physician, and some gynecologists are happy to operate that way.
The US-side HR has brochures that explain this, and can answer questions for you. I can understand feeling a bit squeamish about asking "So, I have depression..."* I would think that asking a series of questions like this:
"The brochure says this, but I'm foreign and don't understand your health system. Can you explain this to me?"
About different topics will neatly figleaf which things you just don't understand and which you need to know about because you have them. You should have a bunch of questions of this type anyway. And you should not be shy about asking them -- even if you're a single dude with no interest in kids, you might still have questions about obstetrical care.
Do I actually go through my employer somehow for health care/do they end up knowing that I'm seeing a psychiatrist?
It depends on the plan, strictly speaking. But the way it almost always works is that your employer writes checks to an insurance company, and their involvement ends there. Your doctors know what treatment you've received. Your insurance company knows. Your employer would not normally know, and privacy regulations under a law called HIPAA protect you from disclosure.
posted by ROU_Xenophobe at 8:49 AM on August 21, 2008
Basically there are doctors that are available on your plan or in your network. You can usually go to these doctors and pay what is known as a co-pay. It is normally like 15-25 dollars. Your insurance company picks up the rest. I know this is fairly basic but I am not an expert by any means. As for finding a good doctor in your area, you are on your own :>)
posted by Mastercheddaar at 9:09 AM on August 21, 2008
posted by Mastercheddaar at 9:09 AM on August 21, 2008
You're going to want to look very closely at the brochure you're going to get from HR about your health care plan, because not all plans in the US cover mental health and even those that do often limit it severely. Sometimes, for example, they will say that you get 6 visits in a calendar year and that's it. Once you get your PCP, you can ask them to recommend a therapist or, if you're on antidepressants, tell them what you're taking and they can make sure to renew the prescription for you.
You will have to fill out a couple of health care enrollment forms on your first day at work. They will ask you questions about your general health and whether you've seen a doctor at all in the last seven years and if so, when and what for? I am now going to give you the controversial and possibly illegal or immoral advice not to admit to your depression. Actually, I suggest that you don't admit to ever seeing a doctor before in your entire life for anything more serious than a sinus infection or that could ever crop up again. If you had an appendectomy or something like that five years ago, something very clear cut, sure, admit it. But, and this is based on sad personal experience, if you admit to having had depression and seeking treatment for it in the last year, they are very likely to refuse to cover you for it for a year. Happened to me two years ago: they excluded me from all mental health coverage for a whole year because I admitted to having depression and anxiety issues. YMMV, but my feeling is that you're better off just quietly not admitting stuff than dealing with the possible consequences should they refuse to cover you and this goes for any chronic health issues that you may have.
There isn't any real connection between the doctors and the health insurance companies. Your doctor will never see the form that you filled out at work for the insurance company and frankly, he or she won't care anyway. You can tell him/her about any and all health care issues you have without any fear that it will go back to the health insurance company. If you do have chronic health issues, tell them that you didn't mention them to insurance and they'll write it down as a new problem when they go to bill the insurance company on your behalf. They know why you didn't admit it on the forms and they're fine with it.
posted by mygothlaundry at 9:18 AM on August 21, 2008
You will have to fill out a couple of health care enrollment forms on your first day at work. They will ask you questions about your general health and whether you've seen a doctor at all in the last seven years and if so, when and what for? I am now going to give you the controversial and possibly illegal or immoral advice not to admit to your depression. Actually, I suggest that you don't admit to ever seeing a doctor before in your entire life for anything more serious than a sinus infection or that could ever crop up again. If you had an appendectomy or something like that five years ago, something very clear cut, sure, admit it. But, and this is based on sad personal experience, if you admit to having had depression and seeking treatment for it in the last year, they are very likely to refuse to cover you for it for a year. Happened to me two years ago: they excluded me from all mental health coverage for a whole year because I admitted to having depression and anxiety issues. YMMV, but my feeling is that you're better off just quietly not admitting stuff than dealing with the possible consequences should they refuse to cover you and this goes for any chronic health issues that you may have.
There isn't any real connection between the doctors and the health insurance companies. Your doctor will never see the form that you filled out at work for the insurance company and frankly, he or she won't care anyway. You can tell him/her about any and all health care issues you have without any fear that it will go back to the health insurance company. If you do have chronic health issues, tell them that you didn't mention them to insurance and they'll write it down as a new problem when they go to bill the insurance company on your behalf. They know why you didn't admit it on the forms and they're fine with it.
posted by mygothlaundry at 9:18 AM on August 21, 2008
mygothlaundry's comments about enrollment forms are not universal. I've never had to fill out that kind of paperwork, and usually large companies' coverage is not dependent on whether or not you have preexisting conditions.
posted by Tomorrowful at 9:22 AM on August 21, 2008
posted by Tomorrowful at 9:22 AM on August 21, 2008
The human resources department of your company will give you literature on the choices of health plans, if you have choices, or the one you may use, if there's only one. That literature will outline a summary of benefits, deductibles, co-pays, provider networks, lifetime maximums, and the like. It can be pretty complex to understand what you will and won't have to pay toward your own health care; don't be afraid to ask lots and lots of questions. Also, some plans have separate provisions and separately delineated benefits for behavioral health needs, and some don't. Some companies also contract with an EAP, a so-called employee assistance program, which can offer free phone referrals to therapists or counselors who deal with depression, addiction, gambling, domestic abuse, etc, and the employer isn't involved at all.
I've always found that a company's HR department can answer basic questions, but the provider itself (e.g., Blue Cross/Blue Shield) is best equipped to answer specific questions about how you do things like find a new therapist. Providers usually also have web sites that let you compare their different plans before you're signed up.
Good luck! And welcome to the US.
posted by ImproviseOrDie at 9:23 AM on August 21, 2008
I've always found that a company's HR department can answer basic questions, but the provider itself (e.g., Blue Cross/Blue Shield) is best equipped to answer specific questions about how you do things like find a new therapist. Providers usually also have web sites that let you compare their different plans before you're signed up.
Good luck! And welcome to the US.
posted by ImproviseOrDie at 9:23 AM on August 21, 2008
All of the above, great info...and my two cents added here...Basically you are responsible for your healthcare, and the employer pays a lot of the cost as part of your compensation package, but has absolutely no knowledge of your healthcare issues. They will be strictly confidential between your provider and you. If you walk into a primary care physician with your current prescriptions or the bottles they came in, the doc will write new ones to be covered under the new employer's plan. You may prefer to have a Psychiatrist prescribe for your condition, if your depression has been difficult to treat/manage. But often a General Practitioner, or Internist can just continue to prescribe the treatment that's been working for you. And if it HAS been working well, don't let them talk you into trying a new treatment, or going off the medication "to see how it goes". At least for me those have been famous last words. Insist on continuing on what has worked for you. And remember, again, that the only persons you deal with or disclose anything to about your health, mental or otherwise, are medical professionals who cannot legally disclose any of it to anyone else including your employer.
As for therapy, it IS difficult to find a good therapist, as I think is the case anywhere, since if a person stays in school long enough and doesn't flunk out, they end up being able to hang up a shingle and call themselves a therapist...or if they're lucky, and take MORE classes, a bona fide shrink. Some are estimable, some execrable. Your prescribing doc may be able to refer you to someone they have found to be good...although it also may be someone they met recently at a cocktail party...But, I think that is an international, and not just a U.S. phenomenon.
However, you will find on many medical plans that the number of therapy visits per year are limited...to 20, perhaps...also, you likely will have to pay 1/2 of the costs of therapy (doctor visits, however are generally covered completely, except in some plans, where there is a "co-payment", of $10-$25, generally, per visit)). If you use therapists within the "plan" that your employer offers, the overall costs for therapy are generally lower. If you go outside the plan, they often pay, but at a lower level...however, if you find someone whom you work well with outside the plan, you may choose to pay at the higher level. It is, admittedly, a crapshoot at the beginning, finding the right providers for your specific needs. My family and I, all of whom have many health issues, mental and otherwise, are in the process of acquiring new providers on a new plan in a new city right now, too. We just found the largest clinic, near the largest hospital, that has many providers in all disciplines, and are starting there. Best of luck. I'd make a doctor's appt. as soon as you are "on the plan", and you should be able to transition pretty seamlessly...albeit perhaps not effortlessly, to the new system. (feel free to email me...I've been at this for many years!)
Best!
posted by mumstheword at 9:35 AM on August 21, 2008
As for therapy, it IS difficult to find a good therapist, as I think is the case anywhere, since if a person stays in school long enough and doesn't flunk out, they end up being able to hang up a shingle and call themselves a therapist...or if they're lucky, and take MORE classes, a bona fide shrink. Some are estimable, some execrable. Your prescribing doc may be able to refer you to someone they have found to be good...although it also may be someone they met recently at a cocktail party...But, I think that is an international, and not just a U.S. phenomenon.
However, you will find on many medical plans that the number of therapy visits per year are limited...to 20, perhaps...also, you likely will have to pay 1/2 of the costs of therapy (doctor visits, however are generally covered completely, except in some plans, where there is a "co-payment", of $10-$25, generally, per visit)). If you use therapists within the "plan" that your employer offers, the overall costs for therapy are generally lower. If you go outside the plan, they often pay, but at a lower level...however, if you find someone whom you work well with outside the plan, you may choose to pay at the higher level. It is, admittedly, a crapshoot at the beginning, finding the right providers for your specific needs. My family and I, all of whom have many health issues, mental and otherwise, are in the process of acquiring new providers on a new plan in a new city right now, too. We just found the largest clinic, near the largest hospital, that has many providers in all disciplines, and are starting there. Best of luck. I'd make a doctor's appt. as soon as you are "on the plan", and you should be able to transition pretty seamlessly...albeit perhaps not effortlessly, to the new system. (feel free to email me...I've been at this for many years!)
Best!
posted by mumstheword at 9:35 AM on August 21, 2008
I don't know about negotiating for certain benefits, but if you sign up with the default plan from your employer, the moment your paperwork goes through, and assuming you have mental health coverage from a PPO, you can do the following:
1. Look up the health insurance company's doctor database and find a psychiatrist/psychologist near you. These are the doctors you can see without having to manually file claims forms and generally this is the path of least resistance. Finding your actual insurance provider might take a little work, since your employer might sign up with an insurance carrier which bundles different insurance providers for dental/medical/mental health/vision, etc. This is what mine's like (PPO). Be really good with notetaking on the search, what each company does, who to contact, phone numbers, etc. Other plans might be all-inclusive (HMO), but I don't know what kind of insurance experience that is like.
2. Make an appointment with the mental health doctor you found. Talk to make sure they're a good fit with your needs or repeat step #1. Go to your appointment, get diagnosed or have the doctor transfer your records, etc. Once you have a diagnosis, your doctor needs to send the insurance provider a Request for Authorization and a treatment plan. Don't worry about payment at this point -- you can't file claims for the treatment anyway until your doctor has the Authorization Number. Medical treatments don't require a plan, just a doctor who's in the provider's database (to bypass the hassle of claims paperwork, less coverage, etc.)
3. Your provider will give the doctor an Authorization number and approve some sort of preliminary or long-term treatment plan, assuming they don't dispute your doctor's finding or applicable coverage. Now your doctor's staff can file claims with the provider and get money directly. At this point, you'll learn how much your co-pay is for each visit (you will pay a portion of the bill, mine is like 10%, between $20-$30). The treatment plan will show you how many therapy visit's you're entitled to. Your doctor will have to resend new treatment plans for approval to continue treatment. I got an 8-session weekly plan and then a monthly plan, for instance. Nag the insurance provider for the authorization number and treatment plan and make sure your doctor has this information. Communication between my doctor and my provider fell apart (old contact info, etc.) so I had to act as intermediary. Claims take forever to go through, so follow up with the provider and doctor if you get billed for the treatment somehow.
4. If you get a prescription, you'll present your insurance card to the pharmacist and have to pay a certain percentage of the bill (might be more money, drug coverage is sketchy and often horrible. Talk with your doctor about affordable alternatives if this comes up.).
5. Throw a party! You have treatment and are among the relatively few people getting adequate and affordable health care!
As far as I know, only the insurance carrier (not the provider) interfaces with your employer, so they might not have any details anyway, even if they share patient data -- which seems unlikely. I've taught myself not to worry about it. Your priority is to be well, not to worry about who knows what.
posted by cowbellemoo at 9:38 AM on August 21, 2008
1. Look up the health insurance company's doctor database and find a psychiatrist/psychologist near you. These are the doctors you can see without having to manually file claims forms and generally this is the path of least resistance. Finding your actual insurance provider might take a little work, since your employer might sign up with an insurance carrier which bundles different insurance providers for dental/medical/mental health/vision, etc. This is what mine's like (PPO). Be really good with notetaking on the search, what each company does, who to contact, phone numbers, etc. Other plans might be all-inclusive (HMO), but I don't know what kind of insurance experience that is like.
2. Make an appointment with the mental health doctor you found. Talk to make sure they're a good fit with your needs or repeat step #1. Go to your appointment, get diagnosed or have the doctor transfer your records, etc. Once you have a diagnosis, your doctor needs to send the insurance provider a Request for Authorization and a treatment plan. Don't worry about payment at this point -- you can't file claims for the treatment anyway until your doctor has the Authorization Number. Medical treatments don't require a plan, just a doctor who's in the provider's database (to bypass the hassle of claims paperwork, less coverage, etc.)
3. Your provider will give the doctor an Authorization number and approve some sort of preliminary or long-term treatment plan, assuming they don't dispute your doctor's finding or applicable coverage. Now your doctor's staff can file claims with the provider and get money directly. At this point, you'll learn how much your co-pay is for each visit (you will pay a portion of the bill, mine is like 10%, between $20-$30). The treatment plan will show you how many therapy visit's you're entitled to. Your doctor will have to resend new treatment plans for approval to continue treatment. I got an 8-session weekly plan and then a monthly plan, for instance. Nag the insurance provider for the authorization number and treatment plan and make sure your doctor has this information. Communication between my doctor and my provider fell apart (old contact info, etc.) so I had to act as intermediary. Claims take forever to go through, so follow up with the provider and doctor if you get billed for the treatment somehow.
4. If you get a prescription, you'll present your insurance card to the pharmacist and have to pay a certain percentage of the bill (might be more money, drug coverage is sketchy and often horrible. Talk with your doctor about affordable alternatives if this comes up.).
5. Throw a party! You have treatment and are among the relatively few people getting adequate and affordable health care!
As far as I know, only the insurance carrier (not the provider) interfaces with your employer, so they might not have any details anyway, even if they share patient data -- which seems unlikely. I've taught myself not to worry about it. Your priority is to be well, not to worry about who knows what.
posted by cowbellemoo at 9:38 AM on August 21, 2008
if your plan does cover mental health-care, your mental health care provider will have to answer to and report to the health insurance company your employer uses—and will have to justify your need for mental health care. this may or may not have repercussions in terms of certain disclosures. please make sure you investigate what all is involved because mental health care coverage and how mental health care is viewed in this country is still not where it should be.
my company's health plan does cover mental health care but i will not be using it to cover my therapy, as it's been my therapist's experience that the health care providers ask for a little too much information than she is comfortable with providing. but the discount she's been giving me for my sessions comes close to what i'd be paying with my health care plan anyway, and my anti-depressants are covered in the company's prescription plan (altho one can get most common generic anti-depressants for $5 at their wal-mart—evil, yes, but sometimes necessary depending on your financial situation). with the current state of things, although i have no problems revealing that i am in therapy, i would rather my mental healthcare be kept off the official radar.
posted by violetk at 9:44 AM on August 21, 2008
my company's health plan does cover mental health care but i will not be using it to cover my therapy, as it's been my therapist's experience that the health care providers ask for a little too much information than she is comfortable with providing. but the discount she's been giving me for my sessions comes close to what i'd be paying with my health care plan anyway, and my anti-depressants are covered in the company's prescription plan (altho one can get most common generic anti-depressants for $5 at their wal-mart—evil, yes, but sometimes necessary depending on your financial situation). with the current state of things, although i have no problems revealing that i am in therapy, i would rather my mental healthcare be kept off the official radar.
posted by violetk at 9:44 AM on August 21, 2008
I'm pretty sure most big group health plans (the kind offered by large reputable companies) don't have pre-existing condition clauses. With most plans in the US, psychiatric medications are covered like any other medication (usually you pay a co-payment or a percentage of the cost). Mental health counseling is usually capped at a certain dollar value or number of annual visits, unless there is a state law that states otherwise.
If you plan to go once a week to therapy, and the insurance caps at a certain number of visits, you can create a health savings account that will let you pay for your therapy with pre-tax dollars.
I would not lie on any initial paperwork (although most big group health plans will not ask much other than name, address, etc., since they're not doing underwriting like an individual plan).
posted by ClaudiaCenter at 9:46 AM on August 21, 2008
If you plan to go once a week to therapy, and the insurance caps at a certain number of visits, you can create a health savings account that will let you pay for your therapy with pre-tax dollars.
I would not lie on any initial paperwork (although most big group health plans will not ask much other than name, address, etc., since they're not doing underwriting like an individual plan).
posted by ClaudiaCenter at 9:46 AM on August 21, 2008
One thing that I want to emphasize is find out the details. There are a lot of things that are common, but not universal. For example, copayments are a topic you'll have seen discussed above, but I used to have an employer who decided to shell out for a plan with no copay at all. Same goes for paying half of therapy costs... It all depends and things can be better or worse than average.
posted by Tomorrowful at 9:51 AM on August 21, 2008
posted by Tomorrowful at 9:51 AM on August 21, 2008
I know you posted anonymously, but it might help to know where you're moving from in order to get a baseline for comparison. Maybe if you email an admin?
posted by polexa at 9:54 AM on August 21, 2008
posted by polexa at 9:54 AM on August 21, 2008
Oh, and in case it isn't clear: You'll get a packet of info from your insurance carrier/HMO/etc. in the mail or from your HR department once your hiring paperwork is finished. You won't have to communicate anything health-related through your employer, just your insurance carrier/HMO/PPO. They work for you, not your employer.
(But your employer pays them and can fire them for another plan. Or can drop health benefits alltogether.).
posted by cowbellemoo at 10:00 AM on August 21, 2008
(But your employer pays them and can fire them for another plan. Or can drop health benefits alltogether.).
posted by cowbellemoo at 10:00 AM on August 21, 2008
Just to add a bit to the very good advice everyone has given above:
--If it's a big company, there will almost surely not be pre-existing conditions exclusions. You probably won't be asked to fill out a medical history on your first day of the job (and if you are, it's totally legit to ask what the info is being used for). But I'm guessing this won't happen.
--If it's a big company, you'll almost surely be given a choice of different types of insurance at different price points. It's not usually a faux-pas to ask other people you become friendly with at your new job what the "best" or "most common" insurance to sign up for is (I field this question from newly hired coworkers all the time, and I'm always happy to tell them my impression of the different options). If you're asked to choose, you'll get something called the Explanation of Benefits (EOB) from each company, which goes over in excruciating detail exactly what benefits are covered. Check for mental health benefits--this may decide for you which insurance you want. It would not be surprising if the most expensive plan was the only one that provided mental health benefits.
--Speaking of cost: it's not really as expensive as it first seems. The premiums are taken out of your paycheck pre-tax, meaning you avoid both payroll taxes (~7%) and income tax (somewhere between 25% and 35%, depending on total income) on that money--so if the per-paycheck premium is for example $100, your take-home pay would only decrease by about $60 or $70. Take this into account when making your decision, as the more expensive option is not as expensive as it looks at first.
--Big companies usually also offer "flexible spending accounts," which is another way to save money on health care. (Sometimes these are also called "cafeteria plans" or "125 plans.") You agree to have a certain amount withheld from each paycheck pretax (like $10 or $25 or $100), then after you spend it on anything medical-related you can get reimbursed. It's a bit of a pain to do the paperwork, but it means that if for some reason you can't get mental health benefits through your insurance, you could just pay for a psychiatrist or psychologist out of pocket and get reimbursed from your flex spending account. Again, this in effect cuts out somewhere from a third to nearly half the cost by avoiding taxes. Plus, many health care providers in the U.S. are willing (or open, at least) to negotiating lower prices for cash-paying patients, further cutting down on cost.
posted by iminurmefi at 10:09 AM on August 21, 2008
--If it's a big company, there will almost surely not be pre-existing conditions exclusions. You probably won't be asked to fill out a medical history on your first day of the job (and if you are, it's totally legit to ask what the info is being used for). But I'm guessing this won't happen.
--If it's a big company, you'll almost surely be given a choice of different types of insurance at different price points. It's not usually a faux-pas to ask other people you become friendly with at your new job what the "best" or "most common" insurance to sign up for is (I field this question from newly hired coworkers all the time, and I'm always happy to tell them my impression of the different options). If you're asked to choose, you'll get something called the Explanation of Benefits (EOB) from each company, which goes over in excruciating detail exactly what benefits are covered. Check for mental health benefits--this may decide for you which insurance you want. It would not be surprising if the most expensive plan was the only one that provided mental health benefits.
--Speaking of cost: it's not really as expensive as it first seems. The premiums are taken out of your paycheck pre-tax, meaning you avoid both payroll taxes (~7%) and income tax (somewhere between 25% and 35%, depending on total income) on that money--so if the per-paycheck premium is for example $100, your take-home pay would only decrease by about $60 or $70. Take this into account when making your decision, as the more expensive option is not as expensive as it looks at first.
--Big companies usually also offer "flexible spending accounts," which is another way to save money on health care. (Sometimes these are also called "cafeteria plans" or "125 plans.") You agree to have a certain amount withheld from each paycheck pretax (like $10 or $25 or $100), then after you spend it on anything medical-related you can get reimbursed. It's a bit of a pain to do the paperwork, but it means that if for some reason you can't get mental health benefits through your insurance, you could just pay for a psychiatrist or psychologist out of pocket and get reimbursed from your flex spending account. Again, this in effect cuts out somewhere from a third to nearly half the cost by avoiding taxes. Plus, many health care providers in the U.S. are willing (or open, at least) to negotiating lower prices for cash-paying patients, further cutting down on cost.
posted by iminurmefi at 10:09 AM on August 21, 2008
Find out if there are pre-existing conditions exclusions; do not assume that there won't be since it is a big company. These exclusions are waived under HIPAA if you have had "creditable coverage" for the previous period of time without a break of more than 62 days. If you were covered under a U.S. health plan, you will get a certificate of creditable coverage. But you were overseas, and while a public health plan maintained by a foreign country counts as creditable coverage, you might not be able to get a neat certificate of this.
So find out, in writing, before you leave, what sort of proof you need to bring of your prior coverage, if any.
posted by grouse at 10:26 AM on August 21, 2008
So find out, in writing, before you leave, what sort of proof you need to bring of your prior coverage, if any.
posted by grouse at 10:26 AM on August 21, 2008
this may or may not have repercussions in terms of certain disclosures.
I'd be really, really surprised if the psychiatrist or the insurance company told the employer, or anyone else.
posted by ROU_Xenophobe at 10:45 AM on August 21, 2008
I'd be really, really surprised if the psychiatrist or the insurance company told the employer, or anyone else.
posted by ROU_Xenophobe at 10:45 AM on August 21, 2008
If you are concerned about your employer discovering your pre-existing conditions, there are privacy laws in the States governing this: HIPAA. You are now asked by every doctor you visit to fill out a HIPPA form which clearly states who they can share your health information with. Here's a pdf file which explains the law: http://www.hhs.gov/ocr/privacysummary.pdf.
posted by Taken Outtacontext at 11:06 AM on August 21, 2008
posted by Taken Outtacontext at 11:06 AM on August 21, 2008
It is extremely unlikely that you will receive full coverage/reimbursement from your health plan for mental health expenses. In addition, virtually all health plans that will pay for therapy (in whole or in part) will limit the number of visits you get per year (typically around 20, but it may be less) before they stop paying for it outright.
Good luck navigating this. It's going to suck, and cost you a lot of money, no matter how "good" anyone tells you the benefits are.
posted by Citrus at 11:14 AM on August 21, 2008
Good luck navigating this. It's going to suck, and cost you a lot of money, no matter how "good" anyone tells you the benefits are.
posted by Citrus at 11:14 AM on August 21, 2008
this may or may not have repercussions in terms of certain disclosures.
I'd be really, really surprised if the psychiatrist or the insurance company told the employer, or anyone else.
i'm not talking about the content of one's sessions. but insurance companies have requirements for what they will cover in terms of mental health. years ago when i was having my therapy sessions covered by another insurance company, my therapist essentially had to tell them that i was clinically depressed (which i was) in order to get coverage through the insurance company. a diagnosis that was less than clinical depression was not covered. i was in school at the time so therefore i wasn't worried about an employer but if you are employed, that is something that should be considered in terms of having your therapy covered under insurance.
posted by violetk at 12:09 PM on August 21, 2008 [1 favorite]
I'd be really, really surprised if the psychiatrist or the insurance company told the employer, or anyone else.
i'm not talking about the content of one's sessions. but insurance companies have requirements for what they will cover in terms of mental health. years ago when i was having my therapy sessions covered by another insurance company, my therapist essentially had to tell them that i was clinically depressed (which i was) in order to get coverage through the insurance company. a diagnosis that was less than clinical depression was not covered. i was in school at the time so therefore i wasn't worried about an employer but if you are employed, that is something that should be considered in terms of having your therapy covered under insurance.
posted by violetk at 12:09 PM on August 21, 2008 [1 favorite]
Depending upon where you are and who your doctor is, you may want to get a hard copy of your records to take with you. Their office staff may do this for free in a day, or they may charge you as much as they can and make you wait 2 weeks. (My doctor's office-staff did this. When I complained to him he said he was unable to speed up the process but quickly wrote a letter saying "KP has had these 2 conditions from [date], takes this drug daily and this other one as needed."
You don't know yet how much of your prescription medication will be covered. Maybe all, maybe none for the first 6 months. Tell your current GP that you are relocating to the US and you're unsure what your health-care-plan will cover and that it might be a long time before you get processed and into their system. They may be happy to over-prescribe whatever you're taking so that you land with a 2 month supply of whatever you take.
Many doctors in the US will help you get around the high cost of your pills by prescribing twice the dosage and letting you cut your pills in half. So if you should be taking 10mg of diazepam each night and 30 of those pills are $200 but 30 pills of 20mg of diazepam are $300, your doctor will prescribe you the 20mg pills. You use a $3 pill-chopper to chop them in half each night, and save $50 per month. (This assumes that whatever you're taking comes in a pill twice as strong as you need and it can be cut in half.)
If you live somewhere that allows co-codamol to be sold over the counter (without a prescription), be aware it's prescription-only in the US. If that's your painkiller of choice, or you like to keep some on hand just in case, take it with you. I believe technically you can't bring it in with you without a prescription, and in theory you could get in a heap of trouble trying. But the US isn't Dubai and even if your bags were searched and they did notice you had prescription-only-painkillers, I doubt they'd do anything more than confiscate them. By the way, paracetamol is known as acetaminophen.
posted by K.P. at 12:27 PM on August 21, 2008
You don't know yet how much of your prescription medication will be covered. Maybe all, maybe none for the first 6 months. Tell your current GP that you are relocating to the US and you're unsure what your health-care-plan will cover and that it might be a long time before you get processed and into their system. They may be happy to over-prescribe whatever you're taking so that you land with a 2 month supply of whatever you take.
Many doctors in the US will help you get around the high cost of your pills by prescribing twice the dosage and letting you cut your pills in half. So if you should be taking 10mg of diazepam each night and 30 of those pills are $200 but 30 pills of 20mg of diazepam are $300, your doctor will prescribe you the 20mg pills. You use a $3 pill-chopper to chop them in half each night, and save $50 per month. (This assumes that whatever you're taking comes in a pill twice as strong as you need and it can be cut in half.)
If you live somewhere that allows co-codamol to be sold over the counter (without a prescription), be aware it's prescription-only in the US. If that's your painkiller of choice, or you like to keep some on hand just in case, take it with you. I believe technically you can't bring it in with you without a prescription, and in theory you could get in a heap of trouble trying. But the US isn't Dubai and even if your bags were searched and they did notice you had prescription-only-painkillers, I doubt they'd do anything more than confiscate them. By the way, paracetamol is known as acetaminophen.
posted by K.P. at 12:27 PM on August 21, 2008
Yeah but violetk, the insurance provider is not going to go the poster's employer and report that "Employee X is clinically depressed, fyi". The insurance company knows what kind of treatment is being received, because they're sent the bill.
posted by MadamM at 12:46 PM on August 21, 2008
posted by MadamM at 12:46 PM on August 21, 2008
madamM, all of this goes on record. so there is a record of the patient going in for mental health treatment, and if the insurance company has a requirement for what that constitutes in order to be covered, than it is a matter of record what the patient may be in treatment for. some people would rather that not be a matter of record.
posted by violetk at 1:16 PM on August 21, 2008
posted by violetk at 1:16 PM on August 21, 2008
violetk, if you want to be really paranoid about it, that's your business, but anonymous should know that you are being needlessly paranoid.
What anonymous needs to know is that neither the physician nor the insurance company is going to tell anonymous's employer what anonymous is being treated for.
i was in school at the time so therefore i wasn't worried about an employer but if you are employed, that is something that should be considered in terms of having your therapy covered under insurance.
No. This is something that you should not worry about in the slightest. HIPAA is big, bad juju.
If the insurance company told your employer, you could sue the crap out of them, *AND* the government could sue them civilly, *AND* the people who actually told your employer would face criminal charges including lengthy prison terms.
posted by ROU_Xenophobe at 2:28 PM on August 21, 2008
What anonymous needs to know is that neither the physician nor the insurance company is going to tell anonymous's employer what anonymous is being treated for.
i was in school at the time so therefore i wasn't worried about an employer but if you are employed, that is something that should be considered in terms of having your therapy covered under insurance.
No. This is something that you should not worry about in the slightest. HIPAA is big, bad juju.
If the insurance company told your employer, you could sue the crap out of them, *AND* the government could sue them civilly, *AND* the people who actually told your employer would face criminal charges including lengthy prison terms.
posted by ROU_Xenophobe at 2:28 PM on August 21, 2008
uh, this isn't about me being paranoid—i'm pretty open about the fact that i am seeing a therapist. however, given that i pay only a little more now out of pocket to my therapist than i would if i was covered, i would prefer it not to be a matter of record that i am in fact seeing a therapist.
and read what i said carefully. i DID NOT say that the insurance company would go running to TELL YOUR EMPLOYER; i said that it would be a matter of accessible record. should your employer, or anyone, else decide to look into it, they could determine that you are being treated for mental health issues which, at the least, met your health insurance's requirement for coverage.
sheesh.
posted by violetk at 5:36 PM on August 21, 2008
and read what i said carefully. i DID NOT say that the insurance company would go running to TELL YOUR EMPLOYER; i said that it would be a matter of accessible record. should your employer, or anyone, else decide to look into it, they could determine that you are being treated for mental health issues which, at the least, met your health insurance's requirement for coverage.
sheesh.
posted by violetk at 5:36 PM on August 21, 2008
should your employer, or anyone, else decide to look into it, they could determine that you are being treated for mental health issues which, at the least, met your health insurance's requirement for coverage
No. This is just false.
Should your employer or anyone else decide to look into it, the physician would tell them "Are you high? I'd get sued into oblivion and face prison time if I told you anything about the care of any patient I might or might not have." and the insurance company would tell them the same thing.
posted by ROU_Xenophobe at 8:14 PM on August 21, 2008
No. This is just false.
Should your employer or anyone else decide to look into it, the physician would tell them "Are you high? I'd get sued into oblivion and face prison time if I told you anything about the care of any patient I might or might not have." and the insurance company would tell them the same thing.
posted by ROU_Xenophobe at 8:14 PM on August 21, 2008
You know how there's a gazillion federal/state laws governing how companies are supposed to act, and half of them are poorly enforced and the other half are just ignored?
HIPAA is not like that. It is hardcore highly-feared ninja magic and everyone I know in health/sciences treats it like an angry demon. Your insurance company will not be telling your employer about your treatment, and due to it being a big company with a group plan, there's no incidental evidence or anything like that.
posted by Tomorrowful at 10:19 PM on August 21, 2008
HIPAA is not like that. It is hardcore highly-feared ninja magic and everyone I know in health/sciences treats it like an angry demon. Your insurance company will not be telling your employer about your treatment, and due to it being a big company with a group plan, there's no incidental evidence or anything like that.
posted by Tomorrowful at 10:19 PM on August 21, 2008
HIPAA is like the third rail of healthcare. People just will not screw with it. Let me put it this way: we paramedics don't even discuss our patients behind closed doors when we're in the ready room filling out paperwork. And I mean, we don't discuss our patients, not even to the extent of what kind of call it was. For us, a HIPAA violation is an immediate loss of license, and a giant fine for our employer. And we're just paramedics.
What this means for you is that it is astronomically unlikely that your doctors (and/or their staff) will share any of your information with anyone not directly involved with your treatment without your written authorization. The penalties for violation are extremely severe for not only the doctor but the doctor's employer and the receiver of the information: HIPAA doesn't really discriminate about who it hammers.
Basically, what it comes down to is that under HIPAA, a healthcare practitioner can share relevant information with other healthcare practitioners directly involved in the patient's care. Note the "relevant" part: that means, if I'm a paramedic, I can tell the ER doctors your medications, your prior relevant history (as much of it as I know) and your allergies. I cannot, for instance, talk to them about your insurance or lack thereof, your ethnicity, your religious beliefs, and so forth: it's not relevant.
posted by scrump at 10:26 AM on August 22, 2008
What this means for you is that it is astronomically unlikely that your doctors (and/or their staff) will share any of your information with anyone not directly involved with your treatment without your written authorization. The penalties for violation are extremely severe for not only the doctor but the doctor's employer and the receiver of the information: HIPAA doesn't really discriminate about who it hammers.
Basically, what it comes down to is that under HIPAA, a healthcare practitioner can share relevant information with other healthcare practitioners directly involved in the patient's care. Note the "relevant" part: that means, if I'm a paramedic, I can tell the ER doctors your medications, your prior relevant history (as much of it as I know) and your allergies. I cannot, for instance, talk to them about your insurance or lack thereof, your ethnicity, your religious beliefs, and so forth: it's not relevant.
posted by scrump at 10:26 AM on August 22, 2008
and read what i said carefully. i DID NOT say that the insurance company would go running to TELL YOUR EMPLOYER; i said that it would be a matter of accessible record. should your employer, or anyone, else decide to look into it, they could determine that you are being treated for mental health issues which, at the least, met your health insurance's requirement for coverage.What you are saying is false under HIPAA. Healthcare records are not publically accessible without the aid of the courts: that's the whole point of HIPAA.
Of course, if the OP decides to permit record disclosure, that's a whole different ballgame, but as of the current day, every single provider in the US has new patients fill out a HIPAA disclosure form that clearly enumerates who may and may not be given the patient's information, and under what circumstances.
posted by scrump at 10:31 AM on August 22, 2008
everyone seems determined to misunderstand me. I AM NOT SAYING ANYTHING ABOUT YOUR DOCTOR SHARING ANY INFORMATION WITH ANYONE. i am well aware if HIPAA. i am saying that it is possible, based on knowing which doctor you are seeing, to determine their specialty (psychology, psychotherapy…) and that you are covered under such and such healthcare which requires such and such diagnosis to make a conjecture that you are at least meeting said requirement to be covered for mental health. furthermore, i am also positing that SOME people would just prefer that anything related to their mental health be really kept on the way down low because there is still some stigma attached to mental health illnesses in this country.
posted by violetk at 4:10 PM on August 22, 2008
posted by violetk at 4:10 PM on August 22, 2008
my other point about getting your healthcare covered by your insurance—which got all lost when everyone decided that i appear to believe that your doctor is going to tell the world about your medical history—is that again, because there are sometimes restrictions that the insurance company places on what will and will not be covered (based on diagnosis), you may be covered if, say, your doctor diagnoses you as clinically depressed but not, say, couples counseling.
posted by violetk at 4:15 PM on August 22, 2008
posted by violetk at 4:15 PM on August 22, 2008
everyone seems determined to misunderstand me. I AM NOT SAYING ANYTHING ABOUT YOUR DOCTOR SHARING ANY INFORMATION WITH ANYONE
Then your series of comments is entirely devoid of information.
i am saying that it is possible, based on knowing which doctor you are seeing, to determine their specialty (psychology, psychotherapy…) and that you are covered under such and such healthcare which requires such and such diagnosis to make a conjecture that you are at least meeting said requirement to be covered for mental health.
I suppose it might be, but "based on knowing which doctor you are seeing" is a bit silly. How is your employer or some interested individual supposed to learn this?
posted by ROU_Xenophobe at 4:39 PM on August 22, 2008
Then your series of comments is entirely devoid of information.
i am saying that it is possible, based on knowing which doctor you are seeing, to determine their specialty (psychology, psychotherapy…) and that you are covered under such and such healthcare which requires such and such diagnosis to make a conjecture that you are at least meeting said requirement to be covered for mental health.
I suppose it might be, but "based on knowing which doctor you are seeing" is a bit silly. How is your employer or some interested individual supposed to learn this?
posted by ROU_Xenophobe at 4:39 PM on August 22, 2008
This thread is closed to new comments.
posted by sulaine at 8:40 AM on August 21, 2008