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	<title>Comments on: Texas Health Insurance: a Step Ahead of the Future</title>
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	<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future</link>
	<description>Health Insurance information</description>
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		<title>By: Emily K</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-143</link>
		<dc:creator>Emily K</dc:creator>
		<pubDate>Mon, 14 Sep 2009 19:47:58 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-143</guid>
		<description>When you get health insurance, there is what is called a premium.  This is the amount you pay on a scheduled basis.  For instance, if you get insurance through your employer, you would pay your part of the premium each payday.

If you pay your premiums on time, you get to keep your insurance.  Now, when you use your insurance, there is what is called a deductible.  This is an amount of money you must spend before the insurance starts paying anything.  A typical deductible might be $250/year for the policy holder and $500/year for the family.  So, if your dad had the policy and went to get a prescription, if it was his first prescription of the year and it cost $100, he would pay $100.  Every time he used stuff under the plan, he would pay everything until he hit the $250 deductible, then the insurance would kick in.  (the same goes for the family coverage, until the $500 was met by everybody in total - not separately - you would pay 100%).

Now, once the deductible is met, the insurance starts picking up some of the costs...usually the costs are based on what doctor or provider you use.  If you use someone who is called &quot;in network&quot; the insurance company pays more of the bill.  They do this because they have negotiated lower costs with that provider.  For example, let&#039;s say you need to have some tests done and your family has met all your deductibles.  Let&#039;s also say the tests normally cost $200.  If you go to an in network provider, the insurance would cover 80%.  If you go out of network, the insurance might only cover 70%.  Now the nice thing is, by going in network, you get the discounted price, let&#039;s say $160.  So, if you go in network, you would pay $32 for the tests and the insurance would pay $128 (totaling $160).  If you went out of network, you would pay the 30% of $200 or $60 and the insurance company would pay $140.  So, by staying in-network, both you and your insurance company save money.

Also, there is something called an out-of-pocket maximum.  This just means that if someone in your family gets real sick or injured, the most you can pay for that year is the out-of-pocket max...say $5,000.  Once you hit that, everything after that is covered 100% by your insurance and you don&#039;t pay anything.

Last, there is a co-pay - what this means is that if you go to the doctor for a routine visit, it is usually covered without worrying about the deductible and you pay just the co-pay.  usually this is $15 or $20 on say a $100 office visit and the insurance company pays the rest (based on a negotiated amount).

And that&#039;s the short version of how insurance works.</description>
		<content:encoded><![CDATA[<p>When you get health insurance, there is what is called a premium.  This is the amount you pay on a scheduled basis.  For instance, if you get insurance through your employer, you would pay your part of the premium each payday.</p>
<p>If you pay your premiums on time, you get to keep your insurance.  Now, when you use your insurance, there is what is called a deductible.  This is an amount of money you must spend before the insurance starts paying anything.  A typical deductible might be $250/year for the policy holder and $500/year for the family.  So, if your dad had the policy and went to get a prescription, if it was his first prescription of the year and it cost $100, he would pay $100.  Every time he used stuff under the plan, he would pay everything until he hit the $250 deductible, then the insurance would kick in.  (the same goes for the family coverage, until the $500 was met by everybody in total &#8211; not separately &#8211; you would pay 100%).</p>
<p>Now, once the deductible is met, the insurance starts picking up some of the costs&#8230;usually the costs are based on what doctor or provider you use.  If you use someone who is called &quot;in network&quot; the insurance company pays more of the bill.  They do this because they have negotiated lower costs with that provider.  For example, let&#039;s say you need to have some tests done and your family has met all your deductibles.  Let&#039;s also say the tests normally cost $200.  If you go to an in network provider, the insurance would cover 80%.  If you go out of network, the insurance might only cover 70%.  Now the nice thing is, by going in network, you get the discounted price, let&#039;s say $160.  So, if you go in network, you would pay $32 for the tests and the insurance would pay $128 (totaling $160).  If you went out of network, you would pay the 30% of $200 or $60 and the insurance company would pay $140.  So, by staying in-network, both you and your insurance company save money.</p>
<p>Also, there is something called an out-of-pocket maximum.  This just means that if someone in your family gets real sick or injured, the most you can pay for that year is the out-of-pocket max&#8230;say $5,000.  Once you hit that, everything after that is covered 100% by your insurance and you don&#039;t pay anything.</p>
<p>Last, there is a co-pay &#8211; what this means is that if you go to the doctor for a routine visit, it is usually covered without worrying about the deductible and you pay just the co-pay.  usually this is $15 or $20 on say a $100 office visit and the insurance company pays the rest (based on a negotiated amount).</p>
<p>And that&#039;s the short version of how insurance works.</p>
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		<title>By: exenrontexas</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-136</link>
		<dc:creator>exenrontexas</dc:creator>
		<pubDate>Mon, 14 Sep 2009 04:57:02 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-136</guid>
		<description>It was the first and best president, George Washington, in his farewell address who warned America of people who have more loyalty to ONE PERSON or ONE PARTY than to the PEOPLE of America and the Constitution.  He was against poilitical parties.  I have been a Republican for forty years mostly because of Eisenhower and because in the areas that I have lived in the Republican nominees ALWAYS win except for a few in Nebraska. Robert Kerrey and Ed Zorinsky won as Senators.</description>
		<content:encoded><![CDATA[<p>It was the first and best president, George Washington, in his farewell address who warned America of people who have more loyalty to ONE PERSON or ONE PARTY than to the PEOPLE of America and the Constitution.  He was against poilitical parties.  I have been a Republican for forty years mostly because of Eisenhower and because in the areas that I have lived in the Republican nominees ALWAYS win except for a few in Nebraska. Robert Kerrey and Ed Zorinsky won as Senators.</p>
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		<title>By: exenrontexas</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-134</link>
		<dc:creator>exenrontexas</dc:creator>
		<pubDate>Sun, 13 Sep 2009 23:05:40 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-134</guid>
		<description>I AM against the Patriot Act as you say, it is UNCONSTITUTIONAL and a blantant attack on our liberties and protections.  I also believe that WH executives should ALWAYS be prosecuted for their crimes.  It was a mistake to pardon Nixon and I would have impeached FORD for doing it.  That is ALSO a usurpation of the Constitution.  If we put criminal politicians in prison, they might not be so bold in their crimes.</description>
		<content:encoded><![CDATA[<p>I AM against the Patriot Act as you say, it is UNCONSTITUTIONAL and a blantant attack on our liberties and protections.  I also believe that WH executives should ALWAYS be prosecuted for their crimes.  It was a mistake to pardon Nixon and I would have impeached FORD for doing it.  That is ALSO a usurpation of the Constitution.  If we put criminal politicians in prison, they might not be so bold in their crimes.</p>
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		<title>By: deandra</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-141</link>
		<dc:creator>deandra</dc:creator>
		<pubDate>Sun, 13 Sep 2009 21:14:10 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-141</guid>
		<description>Most insurance will cover the costs you mention if the doctor thinks it is medically necessary. Check out this site to find the best health insurance just in one minute,

http://best-free-health-insurance-quote-usa.blogspot.com/

Here you can get free quotes from different health insurance companies in your area, its the best way to find an afforable health insurance with a reliable company.

Best Wishes,</description>
		<content:encoded><![CDATA[<p>Most insurance will cover the costs you mention if the doctor thinks it is medically necessary. Check out this site to find the best health insurance just in one minute,</p>
<p><a href="http://best-free-health-insurance-quote-usa.blogspot.com/" rel="nofollow">http://best-free-health-insurance-quote-usa.blogspot.com/</a></p>
<p>Here you can get free quotes from different health insurance companies in your area, its the best way to find an afforable health insurance with a reliable company.</p>
<p>Best Wishes,</p>
]]></content:encoded>
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		<title>By: A86</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-133</link>
		<dc:creator>A86</dc:creator>
		<pubDate>Sun, 13 Sep 2009 20:50:27 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-133</guid>
		<description>Well at least you&#039;re consistent. I appreciate that.</description>
		<content:encoded><![CDATA[<p>Well at least you&#8217;re consistent. I appreciate that.</p>
]]></content:encoded>
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		<title>By: Alexltavares</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-130</link>
		<dc:creator>Alexltavares</dc:creator>
		<pubDate>Sun, 13 Sep 2009 17:03:22 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-130</guid>
		<description>Amen dude. The lies out there are outstanding, and the sheep believe what their hear from the lying liars whom they trust.</description>
		<content:encoded><![CDATA[<p>Amen dude. The lies out there are outstanding, and the sheep believe what their hear from the lying liars whom they trust.</p>
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		<title>By: A86</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-135</link>
		<dc:creator>A86</dc:creator>
		<pubDate>Sun, 13 Sep 2009 13:14:46 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-135</guid>
		<description>Um, okay. If you feel that way you should be against the Patriot Act which violates the 4th and 10th Amendments.

Healthcare reform isn&#039;t any more unconstitutional than having a public fire department or Medicare (it&#039;s basically an extension of Medicare).</description>
		<content:encoded><![CDATA[<p>Um, okay. If you feel that way you should be against the Patriot Act which violates the 4th and 10th Amendments.</p>
<p>Healthcare reform isn&#8217;t any more unconstitutional than having a public fire department or Medicare (it&#8217;s basically an extension of Medicare).</p>
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		<title>By: synchronised</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-140</link>
		<dc:creator>synchronised</dc:creator>
		<pubDate>Sun, 13 Sep 2009 09:14:34 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-140</guid>
		<description>You&#039;ve asked a very broad question.  There is no simple answer.

In truth, health insurance works a little differently in each state.

To answer your specific questions:
1) No, health insurance is not compulsory for everyone.  If you&#039;re lucky, you are able to join a group policy at work.  (If you&#039;re really lucky, it&#039;s a good policy and the employer pays at least half of it.)  Some states have recently made it compulsory, but that&#039;s such a recent change that there&#039;s no clear cut answer yet for how that&#039;s going to work. 

2) What happens if someone can&#039;t afford it is...  they don&#039;t get it, usually.  Except if your income puts you below the &quot;poverty level&quot;, in which case you qualify for Medicaid.  (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)

3) Health insurance rarely covers all the bills when you have a procedure done.  Most plans cover 50-80% after you meet your deductible.  The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.)  If you&#039;re really, REALLY lucky, you don&#039;t have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges.  (These plans are few and far between.  As in, you might have them if you&#039;re in Congress.)

4) Yes, the patient has some say over procedures.  However, if the patient opts for an &quot;experimental&quot; procedure, or one that isn&#039;t deemed &quot;medically necessary&quot;, then health insurance may refuse to cover any charges at all.

In the end, as with most things, the middle class takes the brunt of these costs.  This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)

** Edited to add:
It&#039;s not ALL about the money when a procedure is involved.  If it is, the state keeps track of complaints filed on behalf of consumers with &quot;managed care&quot; (ie. any type of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point of Service organizations -- also known as PPO, HMO, and POS) and may very well revoke a company&#039;s charter to do business in the state should the company be turning down too many legitimate claims.

However, insurance companies are sticklers for following the &quot;standard&quot; for medical care.  This is what makes it difficult to answer your question.  Because they should not deny anything that&#039;s considered standard for care in the given circumstances (should not and will not being two completely different things, of course.)  And there may be several options that would be considered &quot;standard.&quot;  If the patient wants treatment that isn&#039;t yet considered &quot;standard&quot;, they would balk.  Period.</description>
		<content:encoded><![CDATA[<p>You&#039;ve asked a very broad question.  There is no simple answer.</p>
<p>In truth, health insurance works a little differently in each state.</p>
<p>To answer your specific questions:<br />
1) No, health insurance is not compulsory for everyone.  If you&#039;re lucky, you are able to join a group policy at work.  (If you&#039;re really lucky, it&#039;s a good policy and the employer pays at least half of it.)  Some states have recently made it compulsory, but that&#039;s such a recent change that there&#039;s no clear cut answer yet for how that&#039;s going to work. </p>
<p>2) What happens if someone can&#039;t afford it is&#8230;  they don&#039;t get it, usually.  Except if your income puts you below the &quot;poverty level&quot;, in which case you qualify for Medicaid.  (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)</p>
<p>3) Health insurance rarely covers all the bills when you have a procedure done.  Most plans cover 50-80% after you meet your deductible.  The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.)  If you&#039;re really, REALLY lucky, you don&#039;t have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges.  (These plans are few and far between.  As in, you might have them if you&#039;re in Congress.)</p>
<p>4) Yes, the patient has some say over procedures.  However, if the patient opts for an &quot;experimental&quot; procedure, or one that isn&#039;t deemed &quot;medically necessary&quot;, then health insurance may refuse to cover any charges at all.</p>
<p>In the end, as with most things, the middle class takes the brunt of these costs.  This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)</p>
<p>** Edited to add:<br />
It&#039;s not ALL about the money when a procedure is involved.  If it is, the state keeps track of complaints filed on behalf of consumers with &quot;managed care&quot; (ie. any type of network arrangement including Preferred Provider Organizations, Health Maintenance Organizations, and Point of Service organizations &#8212; also known as PPO, HMO, and POS) and may very well revoke a company&#039;s charter to do business in the state should the company be turning down too many legitimate claims.</p>
<p>However, insurance companies are sticklers for following the &quot;standard&quot; for medical care.  This is what makes it difficult to answer your question.  Because they should not deny anything that&#039;s considered standard for care in the given circumstances (should not and will not being two completely different things, of course.)  And there may be several options that would be considered &quot;standard.&quot;  If the patient wants treatment that isn&#039;t yet considered &quot;standard&quot;, they would balk.  Period.</p>
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		<title>By: exenrontexas</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-132</link>
		<dc:creator>exenrontexas</dc:creator>
		<pubDate>Sun, 13 Sep 2009 05:49:40 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-132</guid>
		<description>You might want to watch Naomi Wolf&#039;s &quot;The End of America&quot; for a few other things that BUSH did that I am against.

/watch?v=RjALf12PAWc</description>
		<content:encoded><![CDATA[<p>You might want to watch Naomi Wolf&#8217;s &#8220;The End of America&#8221; for a few other things that BUSH did that I am against.</p>
<p>/watch?v=RjALf12PAWc</p>
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		<title>By: haydee</title>
		<link>http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future/comment-page-1#comment-144</link>
		<dc:creator>haydee</dc:creator>
		<pubDate>Sat, 12 Sep 2009 12:09:46 +0000</pubDate>
		<guid isPermaLink="false">http://www.csrunima.org/texas-health-insurance-a-step-ahead-of-the-future#comment-144</guid>
		<description>Health insurance can be very tricky. Since I live in Utah I&#039;m not sure about Florida laws and regulations, so I suggest you contact a nearby insurance agent. Check out this site to find the best health insurance just in one minute,

http://best-free-health-insurance-quote-usa.blogspot.com/

Here you can get free quotes from different health insurance companies in your area, its the best way to find an afforable health insurance with a reliable company.

Best Wishes,</description>
		<content:encoded><![CDATA[<p>Health insurance can be very tricky. Since I live in Utah I&#039;m not sure about Florida laws and regulations, so I suggest you contact a nearby insurance agent. Check out this site to find the best health insurance just in one minute,</p>
<p><a href="http://best-free-health-insurance-quote-usa.blogspot.com/" rel="nofollow">http://best-free-health-insurance-quote-usa.blogspot.com/</a></p>
<p>Here you can get free quotes from different health insurance companies in your area, its the best way to find an afforable health insurance with a reliable company.</p>
<p>Best Wishes,</p>
]]></content:encoded>
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