Getting Help | Health Care Insurance

15 Million Americans will have have surgery this year - are you ready?

Are you facing surgery? You are not alone. Every year, more than 15 million Americans have surgery.

Most operations are not emergencies and are considered elective surgery. This means that you have time to learn about your operation to be sure it is the best treatment for you. You also have time to work with your surgeon to make the surgery as safe as possible. Be active in your health care to have quality care.

Your regular doctor is your primary care doctor. He or she may be the doctor who suggests that you have surgery and may refer you to a surgeon. You may also want to find another surgeon to get a second opinion, to confirm if surgery is the right treatment for you. You might want to ask friends or co-workers for the names of surgeons they have used.

Make sure you ask some questions of your primary care doctor and surgeon before you have surgery. There are good reasons for asking these questions as the answers will help you make the best decisions.

Your doctors should welcome questions. If you do not understand the answers, ask the doctor to explain them clearly. Bring a friend or relative along to help you talk with the doctor. Research shows that patients who are well informed about their treatment are more satisfied with their results.

Things have changed a lot since the 1970s, when most people in the United States who had health insurance had indemnity insurance. Indemnity insurance is often called fee-for-service or traditional health insurance. This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service provided to the patient—that is, you or a family member covered under the policy.

With fee-for-service insurance, you go to the doctor of your choice, and you submit a claim to the insurance company for reimbursement. Often, your doctor or hospital will submit the claim for you. You will only be reimbursed for “covered” medical expenses; that is, the covered services listed in your plan’s benefits summary.

When a service is covered under your policy, you can expect to be reimbursed for some—but generally not all—of the cost. How much you will receive depends on your policy’s coinsurance and deductibles. You will be responsible for the portion of the bill not reimbursed by the insurance company. Go to the section on Indemnity Insurance for more information on coinsurance and deductibles.

Today, many Americans who have health insurance are enrolled in a managed care plan, such as a health maintenance organization (HMO) or a preferred provider organization (PPO). For more information on HMOs and PPOs, go to the section on managed care.

When we talk about health insurance, we usually mean the kind of insurance that pays medical bills, hospital bills, and typically, prescription drug costs. This type of coverage includes Medicare and Medicaid, two government programs that provide health insurance coverage for certain populations, such as seniors, people with disabilities, and individuals and families with low income. But there are other types of coverage as well, including disability insurance, long-term care insurance, and other coverage that can offer additional financial protection for you and your family. Information on these types of plans is provided later in this guide.

Source: http://www.ahrq.gov/