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Old 01-31-2011, 09:44 AM
 
Location: Brisbane, Australia
309 posts, read 738,028 times
Reputation: 242

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Another "I know nothing, I'm moving to DFW from the UK" type questions - sorry! I will sign up for one of the medical insurance plans that my employer offers but the whole medical insurance thing seems to be so complicated over there compared to what I am used to here.

I have read and researched about the differences between the different types of offerings in terms of EPO, PPO, HSP etc as well as learning about the terms of deductibles and co-payments but am not a whole lot wiser

So to go back to basics, without taking any benefits from a medical plan into account, please can someone enlighten me as to approx. how much a "standard" visit to the Doctor's office costs, say to renew a prescription or to have an annual asthma check up is? Currently I only go to the Dr about once a year for an annual review of the asthma medication I take and then my medication is on a repeat prescription for another year. My husband has visited the Dr twice this year about a bad neck/shoulder pain and she prescribed him some medication. I understand that these sort of visits to the Dr (non emergency) would be paid for until the level of the deductible has been reached but without knowing how much such a visit costs it is hard to work out whether to go for a higher deductible/cheaper monthly payment or lower deductible/higher monthly payment plan would suit us!

I see that there are various websites (mainly Canadian) that offer precription medication on sale over the internet. If you know what medication you should be taking (and assuming it works fine and doesn't need adjusting) can I just buy it over the net without having seen a Dr first?

Thanks in anticipation of your knowledgable input!
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Old 01-31-2011, 11:25 AM
 
Location: Mostly in my head
19,864 posts, read 60,015,703 times
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Cost depends on what type of doctor seen: specialist or general practioner. If you have any chronic conditions that might get worse in a different climate (asthma, arthritis), get a lower deductible.
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Old 01-31-2011, 12:23 PM
 
Location: Fort Worth, north TX
427 posts, read 898,382 times
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For a basic office visit, (without insurance), you're looking at approximately $100 at least. If they include tests etc., you're looking upwards from $200+

Since living in the US (from Australia - another country with socialized medicine), I've always chosen the HMO option, so that I didn't have to worry about the deductible - I pay $20 out of pocket for a doctor's visit, and between $10 a $30 for a prescription drug and that's it. Because we so rarely go to the doctor, we would never hit our deductible if we were in a PPO.

I'm not in the medical profession, but as far as I am aware, you cannot legally get prescriptions (even online) without seeing a doctor first.
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Old 01-31-2011, 12:34 PM
 
Location: Keller, TX
295 posts, read 876,842 times
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HMOs are becoming harder to even choose if your health plan is provided through work. Chances are, you'll end up in a high deductible plan where you pay your expenses with an HSA account. In general, family doctors will charge you $100, pediatricians a bit more (about $120 with Cooks Childrens) and specialists even more $200+. Medicine is also something to think about. Depending on your plan, there are expensive medicines. I bought an antibiotic last week for $116 with plan (without plan I think it was $178). So keep that in mind.
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Old 01-31-2011, 12:35 PM
 
Location: Fort Worth, TX
1,379 posts, read 6,047,721 times
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Generally...(or how it works for us) is that your health insurance is offered through your employer (in both your and my case - its hubby's). You have a choice usually from a few different types of plans.

For us, we had PPO or HMO. My husband pays a portion and his employer pays a portion. Children are dependents and will add to the cost of the plan. We have had both plans.

PPO usually you don't have a copayment, the monthly fee out of hubby's check is less, but if you have to go to the hospital and have to have surgery, then you pay a percentage of the bill from the hospital up to a specific amount yearly. Ours was up to 3500.00. I didn't "pay" anything at the time of being seen for yearly appointments, kids well checks etc. I didn't have to pay a copayment when the kids were sick, but they had a yearly deductible of 300.00. The appointments were about 120.00 per appointment and I got an invoice in the mail from the provider to pay.

An HMO is a network of doctors. Essentially you have a family doctor and they refer you out to their "in network" doctors and hospitals. You can use Out of Network doctors or specialists, but you will have to pay more and that is usually a percentage or you are notified of those costs during enrollment.

Our HMO was more than the PPO, but it could be potentially less (in the long run) if you use it alot with specific illnesses. (asthma, allergies come to mind). The fee is taken out of your hubby's check and then you pay a copayment (from 15-35) an appointment.

You will get an outlay of each particular cost (Ambulance, ER, Xrays, etc) during enrollment.

Prescriptions are filled through pharmacies either through grocery store pharmacies, corner pharmacies (Walgreen's and CVS) are the popular ones here. They are also covered through insurance.

When you figure out an area, come on back here and let us know and we all can give you some names of some of the doctors we have seen.
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Old 01-31-2011, 12:53 PM
 
Location: Mostly in my head
19,864 posts, read 60,015,703 times
Reputation: 19250
That's one bad thing about HMOs. You need a referral from your Primary Care Physician to see any specialists. And you can only see doctors in their "network." I have never liked that type of plan, personally. I want to see the best available, whether s/he is in the network or not.
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Old 01-31-2011, 01:25 PM
 
Location: Brisbane, Australia
309 posts, read 738,028 times
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Wow - confusing! Please can I recap how I think it works....

I sign up for a medical plan thru my employer (Guingirl, it is my job that is bringing us to USA my hubby gets to be house husband for a while!) deciding between a higher monthly cost and lower deductible or vice versa. Whatever the deductible is I have to pay for general office visits to the GP up to limit of the deductible, i.e. if the deductible is $1,000 annual then I pay for say 10 GP visits (assuming a $100 per visit cost for the sake of this calculation)? After that the cost of any further standard GP visits are paid for by the plan plus a co-payment by myself? In the event of an emergency / hospitalisation etc then once the remaining deductible is paid by me, the rest of the cost is paid for by the plan?

I'm not sure that my employer is offering an HMO scheme, I think it is a choice between an EPO, PPO and HSP (as jcamber suggests this can be linked to an HSA). What I need to try and understand is how to balance keeping the monthly cost down (as initially, and for an unknown period of time depending on work permit approval and hubby being able to find a job, my salary is our sole income) and taking a view that generally neither of us have to date been sickly people - yes I know that is an unknown in the future. If I chose to find my own medical plan e.g. An HMO type offering, is it likely to be any less expensive than choosing a plan thru my company schemes? This whole thing seems to be a complete gamble, mind you I suppose you can say the same thing for any insurance, always seems expensive when you don't need it but a godsend on that one occasion when you do!

Thank you for your patience whilst I try and understand the pros, cons, implications and the gamble between cover and expense!
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Old 01-31-2011, 01:35 PM
 
Location: Ohio
15,719 posts, read 14,860,993 times
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Quote:
Originally Posted by Tigerlily64 View Post

I see that there are various websites (mainly Canadian) that offer precription medication on sale over the internet. If you know what medication you should be taking (and assuming it works fine and doesn't need adjusting) can I just buy it over the net without having seen a Dr first?

Thanks in anticipation of your knowledgable input!
You still need a Drs. prescription to obtain drugs from Canada.......you just have to mail them the script. I am not sure if you can fax the script or not.

Several of my friends save a lot of money getting their scripts from Canada. They called the toll free number for the pharmacy, the pharmacy sent them a packet of info, then they mail in their scripts.

I recently found out Canada also has generic meds that are not available in the U.S. too.

If you do not have good presciption drug coverage, Canada is the way to go.
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Old 01-31-2011, 01:41 PM
 
Location: Brisbane, Australia
309 posts, read 738,028 times
Reputation: 242
Quote:
Originally Posted by Annie53 View Post
You still need a Drs. prescription to obtain drugs from Canada.......you just have to mail them the script. I am not sure if you can fax the script or not.

Several of my friends save a lot of money getting their scripts from Canada. They called the toll free number for the pharmacy, the pharmacy sent them a packet of info, then they mail in their scripts.

I recently found out Canada also has generic meds that are not available in the U.S. too.

If you do not have good presciption drug coverage, Canada is the way to go.
Yes I saw that they do a generic alternative to the asthma med that I am prescribed here in the UK. It has exactly the same active ingredients in the same formula but is just "unbranded" and therefore considerably cheaper. Worth consideration I think as I woul have a prescription, not trying to obtain drugs illegally!
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Old 01-31-2011, 04:00 PM
 
32,537 posts, read 51,063,879 times
Reputation: 18419
once you see what your company offers consider what you are most likely to need
if you and your husband are healthy with no chronic illness/condition like severe allergies/asthma, diabetes, high blood pressure, IBS, and you normally DON'T get ill
and you don't have children now and don't plan to
you might want to take the plan that costs the least and mainly covers major medical costs the best--like accident/injury or illness like appendicitis

this is something you should be discussing with your human resource person at your company and your co-workers
they are likely to have first hand experience of how well/poorly the plans work in the real world...
while your human resource person is presenting the plan in the best light--the co workers know the real deal...

adding children to the plan usually sees your costs and your employer's double
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