snj_2000

We've just moved to North OC with our 2 young children, we had to take the youngest to the doctor today and were a bit confused at how it all works. Can anyone give me a simple explanation of things to know, things to ask, etc?

We have an international policy with Aviva and have all the documentation but we realised we don't really know much about how things actually work! They told us today they would bill the insurance and bill us for anything outstanding - is this standard practise?

Pulaski

Yes.

Generally speaking you have to pay a per-visit fixed fee, known as a "copay", commonly $20-$30, then the rest is compared to your "deductible", which is (usually) the annual amount you have to pay before the insurance company pays anything. So if your first medical expense of the year is to have minor outpatient surgery that costs $1525, your copay is $25, and your deductible is $1,000 the you would pay $25 up front, the doctor would bill the insurance company for $1,500, but they would deduct $1,000 and only pay the doctor $500. The doctor would then send you a bill for the balance of $1,000.

Why do you have an "international policy" with Aviva? It's not "travel insurance" is it?

You will almost certainly be better off with a regular local policy. You can also set aside pre-tax money in a "healthcare spending account", or under certain circumstances in a more advantageous "healthcare saving account", but that's a whole other story.

snj_2000

no it isn't travel insurance, it's an expat insurance because when it was set up we didn't have a social security no or anything so it was the only option given to the company as far as i know. It was recommended to us by other forum users which is why we picked it.
We will ask in the bank about the healthcare account, thank you. My husband is going to ring up tomorrow so I will tell him to ask about the deductible.

Pulaski

You can't just open a health related account at a bank, it has to be done through your payroll as far as I know. I am not sure how it would work if you're self employed.

penguinsix

We have a Wiki on Health Insurance that might answer some basic questions.

Health Insurance : British Expat Wiki

snj_2000

he isn't self employed so I will get him to look into it with his work, thank you

SanDiegogirl

Why have you not been given information about your company's health insurance scheme prior to you moving to the US?

Health insurance is probably the next thing most people find out about next to what their salary is going to be.

The majority of health insurance policies have monthly premiums, deductibles, in and out of network costs, co-pays etc. Without a decent policy you could find yourself hundreds of dollars out of pocket.

Sally Redux

Is this some sort of interim policy until you get healthcare through your company?

MarylandNed

Maybe thousands of dollars out of pocket.

Bob

You don't need a SSN to get a insurance policy.

Might need one to get on a government exchange, I don't know, but not for a work/private policy.

S Folinsky

Unfortnuately, the Idiot's Guide to healthcare is both out of print and is outdated:

snj_2000

maybe I haven't been clear. We have a good policy which was recommended to us by expats, we just didn't really understand exactly how it worked. Th company have paid for it so we aren't going to end up out of pocket or paying monthly premiums. We knew about sticking within the network which is what we did yesterday when we registered our son so he could see a doctor. It isn't a dodgy policy, we just didn't get the terminology and how to go about paying etc. The policy is the international solutions policy with aviva, we have all the info, it is just very confusing when you haven't lived in the US before hand to get the terminology and how it all works. I understand it now having read the guide posted above

MsElui

we came over on an expat deal in 2007. Its a VERY BIG company and they did this a lot - but even so - the local HR people on the ground have little idea how bizarre/baffling the US healthcare and insurance systems are to a brit. The deductions came out of my husbands salary, and that was it - we didnt get much choice or advice on what to do next. Some mistakes i learnt the hard way (like making sure my doc was in network but neglecting to check the lab he used for bloodwork was too), and others i picked up by reading stuff on here.

Even now - 7 years later i don't feel at all confident about healthcare insurance issues.

GeoffM

Mmm but it sounded like you were on a temporary inbound immigrant/visitor - or worse, a travel insurance - policy which typically have extremely limited cover and high copayments. People new to the US typically need temporary cover until their employer's insurance kicks in which could be 30 days after starting employment - it's not a long term solution. Hence the concern posted by others.

snj_2000

it isn't a temporary policy or a travel policy, but now i am worrying that it isn't going to be good enough :-(
my husband did a load of research and settled on this one, his company is a new company being set up as a US subsidiary of a UK company so this is unchartered water for them/us. it was paid for in one go afaik and was to cover him, me and our 2 little ones and it was expensive! We've definitely got the list of in network doctors and dentists to go to and I am certain it isn't travel or temporary but he is calling today for further info on the deductible amount and the copay. I am having a bit of a wobble about it after reading all this!