The NYTimes recently did a nice job of boiling down the data from the Labor Department spelling out what types of services and procedures are generally covered by Health Insurance and which ones aren’t. This is an interesting chart in that it may shed some light on your plan and how yours stacks up against what other Americans get (of those that actually have Health Insurance), as well as telling us about priorities in the Health Care system.
First off, to be considered “covered”, it just meant that some portion was covered, not necessarily that the health plan paid it in full. In all, I was a bit surprised to see the LACK of coverage for certain services I would have assumed to be 100% (of some degree of coverage per nomenclature above).
- Maternity Care – I’m not sure exactly what this entails as it may be more involved than it seems, but by the categorization, I’m surprised only 2/3 of women receive what I’d assume is standard maternity care – ultrasounds, blood tests, etc. So, 1/3 of Americans with Health Insurance pay for Maternity Car out of pocket completely? Seems strange.
- Ambulance Services – This one is arguable. Occasionally, an ambulance call goes out when a patient could have just driven themselves, their kid or whoever, to the ER themselves. Some towns fine people for ambulance calls. Others argue though that penalties like this will dissuade people from calling when they really needed to, resulting in a tragedy. Tough call.
- Ob-Gyn Exams and Services – Again, surprised this is down at 60%. Why?
- Transplants – This was another surprise. Transplants are pretty rare, and last time I checked, people aren’t having organs transplanted for their own leisure. It’s usually so they can survive. I have to imagine paying out of pocket is probably a six figure expense as well. So, surprised to see this one so low.
- Dialysis – I would have thought this would be at or close to 100%. Without dialysis, many patients are either impaired or will die quickly. Strange that this was such a low percentage of coverage.
- Sterilization – This one was a surprise as well. Coming in at the bottom of the list was sterilization. I wonder if there’s some “religious” or political component to this. For instance, many Catholic hospitals still won’t tie tubes following delivery even if the mother (and/or husband) request it in advance. And we know how the political right feels about sterilization and abortions (different, but, well, similar goals). Let’s face it, it’s expensive to pay for maternal and infant care, which often are covered by insurance. So, why would a plan forgo a preventative measure only to incur higher costs down the road? It’s kind of like not paying for vaccines or routine office visits when they are shown to prevent higher costs (and mortality) down the road. We also know there’s an inverse correlation with income and fertility rate throughout the world, US included. So, (often times), the families that can least afford another child are more often the ones having another. This is what the data shows, so please don’t jump on me for making some sort of ethical/political statement; just telling it like it is. Financially speaking, it wouldn’t make sense NOT to pay for sterilization, right?
Based on what’s NOT covered, many people need to come up with constant side job ideas just to keep funding the annual increases in their premiums – it’s nuts!
How’s Your Plan Stack Up?
Are You Surprised By These Data?