Ok, well here goes my first blog posting!
I decided to write about access to health care, as it is too important not to be discussed and I think I may have some helpful advice. As Luc wrote previously, it can be a daunting experience to deal with health insurance. Anyway, here are several suggestions:
1 - after arriving at CfA and enrolling in a health plan, you should check a physician's listing and call up a doctor asking if they accept new patients. You'll probably have to call up several doctors before you find one (don't forget to ask, of course, if they are covered by your health plan!).
2 - once you find a doctor, set up a "wellness consultation" as soon as possible. This appointment is meant to get you in the system as the doctor's patient and so that you can meet the doctor and he/she can familiarize himself/herself with your clinical history.
From my experience, if you are feeling sick and need to see a doctor the same day then, even if your doctor is not available, there will always be another doctor that can see you. At worst, a nurse practitioner will see you.
I urge you to follow steps 1 and 2 as early on as possible because then it will be so very much easier to see a doctor when you need one on short notice.
Alright, that's my fivepence of wisdom for today...
Saturday, February 16, 2008
Saturday, February 9, 2008
What I've learnt about health care in the US
I still remember the first days after I arrived in the USA as a cultural shock.
Among the various things that contributed to such an inconvenient mental state, there was one form sent by the Fellowship Coordinator: the health insurance.
Being raised in one of those countries having what Americans define, not without scorn, as "socialized health care", I never had any private health insurance. When I was sick, I knew I had to see my doctor (in the US, given the local love for acronyms that doesn't help foreigners, it is defined as PCP: Primary Care Physician), maybe he would refer me to a specialist, and I'd do some tests at the lab run by a friend of my mother's, just two blocks away from home. Everything necessary not to let this poor body of mine fall apart.
Now between me and the doctors, supposed to take care of me, there was something: I had to choose an insurance company. And a kind of policy. Should I prefer the insurance offered by the Smithsonian or look for another one? Should I go for HMO or PPO?
And above all: what are they talking about? What are HMO and PPO? How can I choose a company or another? Welcome to the jungle!
Of course I did what every homesick "socializedly health cared" foreigner would do: I just chose the insurance offered by the Smithsonian (acronym SI used hereafter).
I found out it was a PPO, which stands for Preferred Provider Organization. Private insurances are divided into two big kinds (there's something else, but I won't talk about that): PPO and HMO (Health Maintenance Organization).
I'm sure there are many differences, but the main one is that with an HMO you are obliged to have a PCP (you've got to cope with the acronyms, sorry). When you are sick, you go to your PCP, who decides your therapy or refer you to a specialist. You are not allowed to see a specialist without a referral (unless you want to pay out of your pocket). The insurance offered by SI doesn't work like this. With a PPO you are not obliged to have any PCP (though of course you can and should have one!) and you can see a specialist whenever you want to, without any referral.
There's a detail though. All these insurance companies have a network of health care providers (doctors, hospitals and other facilities): the providers in a company's network have special agreements with the company about their bills (the bigger the company, the bigger discount it gets). Once you are a member of an insurance, services obtained from an in-network provider are usually totally covered by the insurance, although you may have to pay a co-pay, that is a small contribution to the cost of the service (for example: $10 for an office visit, $50 for services at an Emergency Room). If the doctor or hospital is out-of-network, the insurance will pay only part of the bill (say 75%) if you have a PPO, or nothing at all if you have an HMO. Beware of the fact that with our PPO insurance you pay only 25% when out-of-network: 25% of A LOT can still be a lot. Whenever I need care now I know that I have to check on line, through the insurance web site which facilities are in the network.
I have also found out that I must always be prepared to unexpected and undesired surprises.
My very personal opinion is that one should always remember that the health care system is part of the market; the goal is not curing people, it's making money out of sick people.
Back to surprises. I happened to need immediate care, so I checked on line which not too far away facility was in the insurance's network. Sweet! There's a hospital 1 mile away. I'm in California without a car: I gotta walk there although it's summer and a quite hot day. Besides the fact that I had the fastest visit ever (I hadn't finished to name my symptoms, when the doc said what I should take and left), the surprise was in the bill, or better the bills. It can happen - but I couldn't imagine - that a hospital is in the network but not its ER doctors. Please, don't ask for logic. If you go to the ER in that hospital, the expenses related to the facility will be covered as in-network, the doctor's visit will be out of network and quite some money out of your pocket!
You will have another surprise if you decide to go to Harvard Health Services. I should never forget to be a predoc: nothing to do with Harvard, except using - not often really - its sport facilities. Harvard Health Service is not a hospital or a health care provider: it is a facility for the Harvard community, meaning all the people who have Harvard health insurance. Other potential customers/patients can receive only emergency care. Harvard Dental Services are open to the public.
By the way, it was with great disappointment that I found out our insurance does not include dental services, nor is any dental insurance available through SI. It does include vision coverage, which means I am allowed to see an eye-doctor or optometrist once a year to check my sight, and have discounts in buying contacts and glasses.
There's something funny about the vision coverage. It is provided by our insurance through a second company. If you need an ophtalmologyst for your annual sight check-up and pick him/her up in the medical insurance network, it is an out-of-network service! The doctor must be in the Davis Vision (the other company) network.
In principle, a medical condition (something that is pathological) should be covered by our medical insurance, even though it involves eyes or teeth. The rule of thumb is to check with Member Services if the specific condition you might have is covered or not, and at what level (50%, 80%, 100%?). "Hallo, there's this doctor who keeps saying I need some dunno-what therapy, will you pay for that?"
The first time I went to a pharmacy was also an experience. First of all a pharmacy in the US is a small supermarket, which is not necessarily bad. In my previous "socialized health" experience, a pharmacy used to be a place for medicines and health related products that are usually very good and very expensive. "It's sold only in pharmacies" used to mean "it's a pain for your wallet, but - man - this works". I never have this feeling in the US and I guess the fact that pharmacies sell cigarettes doesn't help me think they care about my health.
What I found odd was the way drugs are sold. There are two different places in the prescription drug area: one to order the medicine and the other one to pick it up. Apparently only over-the-counter drugs are pre-packaged: prescription drugs are stored in big amounts in the pharmacy and then packaged for every single customer. I had to wait about ten minutes to get a box of pills with a label on it and on the label my name, the doctor and the dosage. Fast food but slow drugs!
My resolution: I'll eat well, sleep long, do as much sport as I can (which doesn't mean much) and hopefully I won't have a stroke while yelling at the insurance Member Services on the phone.
Among the various things that contributed to such an inconvenient mental state, there was one form sent by the Fellowship Coordinator: the health insurance.
Being raised in one of those countries having what Americans define, not without scorn, as "socialized health care", I never had any private health insurance. When I was sick, I knew I had to see my doctor (in the US, given the local love for acronyms that doesn't help foreigners, it is defined as PCP: Primary Care Physician), maybe he would refer me to a specialist, and I'd do some tests at the lab run by a friend of my mother's, just two blocks away from home. Everything necessary not to let this poor body of mine fall apart.
Now between me and the doctors, supposed to take care of me, there was something: I had to choose an insurance company. And a kind of policy. Should I prefer the insurance offered by the Smithsonian or look for another one? Should I go for HMO or PPO?
And above all: what are they talking about? What are HMO and PPO? How can I choose a company or another? Welcome to the jungle!
Of course I did what every homesick "socializedly health cared" foreigner would do: I just chose the insurance offered by the Smithsonian (acronym SI used hereafter).
I found out it was a PPO, which stands for Preferred Provider Organization. Private insurances are divided into two big kinds (there's something else, but I won't talk about that): PPO and HMO (Health Maintenance Organization).
I'm sure there are many differences, but the main one is that with an HMO you are obliged to have a PCP (you've got to cope with the acronyms, sorry). When you are sick, you go to your PCP, who decides your therapy or refer you to a specialist. You are not allowed to see a specialist without a referral (unless you want to pay out of your pocket). The insurance offered by SI doesn't work like this. With a PPO you are not obliged to have any PCP (though of course you can and should have one!) and you can see a specialist whenever you want to, without any referral.
There's a detail though. All these insurance companies have a network of health care providers (doctors, hospitals and other facilities): the providers in a company's network have special agreements with the company about their bills (the bigger the company, the bigger discount it gets). Once you are a member of an insurance, services obtained from an in-network provider are usually totally covered by the insurance, although you may have to pay a co-pay, that is a small contribution to the cost of the service (for example: $10 for an office visit, $50 for services at an Emergency Room). If the doctor or hospital is out-of-network, the insurance will pay only part of the bill (say 75%) if you have a PPO, or nothing at all if you have an HMO. Beware of the fact that with our PPO insurance you pay only 25% when out-of-network: 25% of A LOT can still be a lot. Whenever I need care now I know that I have to check on line, through the insurance web site which facilities are in the network.
I have also found out that I must always be prepared to unexpected and undesired surprises.
My very personal opinion is that one should always remember that the health care system is part of the market; the goal is not curing people, it's making money out of sick people.
Back to surprises. I happened to need immediate care, so I checked on line which not too far away facility was in the insurance's network. Sweet! There's a hospital 1 mile away. I'm in California without a car: I gotta walk there although it's summer and a quite hot day. Besides the fact that I had the fastest visit ever (I hadn't finished to name my symptoms, when the doc said what I should take and left), the surprise was in the bill, or better the bills. It can happen - but I couldn't imagine - that a hospital is in the network but not its ER doctors. Please, don't ask for logic. If you go to the ER in that hospital, the expenses related to the facility will be covered as in-network, the doctor's visit will be out of network and quite some money out of your pocket!
You will have another surprise if you decide to go to Harvard Health Services. I should never forget to be a predoc: nothing to do with Harvard, except using - not often really - its sport facilities. Harvard Health Service is not a hospital or a health care provider: it is a facility for the Harvard community, meaning all the people who have Harvard health insurance. Other potential customers/patients can receive only emergency care. Harvard Dental Services are open to the public.
By the way, it was with great disappointment that I found out our insurance does not include dental services, nor is any dental insurance available through SI. It does include vision coverage, which means I am allowed to see an eye-doctor or optometrist once a year to check my sight, and have discounts in buying contacts and glasses.
There's something funny about the vision coverage. It is provided by our insurance through a second company. If you need an ophtalmologyst for your annual sight check-up and pick him/her up in the medical insurance network, it is an out-of-network service! The doctor must be in the Davis Vision (the other company) network.
In principle, a medical condition (something that is pathological) should be covered by our medical insurance, even though it involves eyes or teeth. The rule of thumb is to check with Member Services if the specific condition you might have is covered or not, and at what level (50%, 80%, 100%?). "Hallo, there's this doctor who keeps saying I need some dunno-what therapy, will you pay for that?"
The first time I went to a pharmacy was also an experience. First of all a pharmacy in the US is a small supermarket, which is not necessarily bad. In my previous "socialized health" experience, a pharmacy used to be a place for medicines and health related products that are usually very good and very expensive. "It's sold only in pharmacies" used to mean "it's a pain for your wallet, but - man - this works". I never have this feeling in the US and I guess the fact that pharmacies sell cigarettes doesn't help me think they care about my health.
What I found odd was the way drugs are sold. There are two different places in the prescription drug area: one to order the medicine and the other one to pick it up. Apparently only over-the-counter drugs are pre-packaged: prescription drugs are stored in big amounts in the pharmacy and then packaged for every single customer. I had to wait about ten minutes to get a box of pills with a label on it and on the label my name, the doctor and the dosage. Fast food but slow drugs!
My resolution: I'll eat well, sleep long, do as much sport as I can (which doesn't mean much) and hopefully I won't have a stroke while yelling at the insurance Member Services on the phone.
Friday, February 1, 2008
Alex's tiny tips
Hi CfA predocs, and future predocs,
I've come to the CfA on a 6 month research visit from the UK, and was pretty quickly welcomed into a warm community of predocs.
I'll put some stuff into this post that is not covered on the Fellowship Program Resources page (I'm putting a link here because it is a bit awkward to get to from the main CfA page).
The following are based on my own experience. Some items are a heads up for predocs from the UK, though you might find it useful too if you're coming from elsewhere.
Visa
Though I know it's not good practice to edit posts, I'll occasionally add some points to the above when they occur to me. This may be as a result of questions and comments to this post, which you are very welcome to post below!
Cheers!
I've come to the CfA on a 6 month research visit from the UK, and was pretty quickly welcomed into a warm community of predocs.
I'll put some stuff into this post that is not covered on the Fellowship Program Resources page (I'm putting a link here because it is a bit awkward to get to from the main CfA page).
The following are based on my own experience. Some items are a heads up for predocs from the UK, though you might find it useful too if you're coming from elsewhere.
Visa
- Consider applying for a visa interview at the Belfast Consulate rather than the London embassy. It's much faster and smoother. Make sure you have an alternative photo-ID to travel by plane if you need to, as you have to submit your passport.
- If you're staying for not more than 6 months go for the J1-short term scholar visa, rather than the J1-research scholar visa. The latter might get you into all sorts of trouble if you want to apply for a second J1-research visa, e.g. later when applying for postdoc positions.
- To find out more about the implications of each visa (sub)category,
- look at the London embassy webpage, which is pretty good, but a bit of a labyrinth of hyperlinks
- look into the webpages of universities in the US. They are most up to date regarding the recent changes in visa regulations, especially concerning the new regulations of the J1 research scholar visa with respect to re-entry and second-time applications.
- be careful with the US government webpages; they tend to be out of date.
- Why not ask on this Blog if someone knows of a room opening up.
- Otherwise, Craig's List is a good place to look for accommodation.
- Keep using Craig's List for everything!
- Get a paper map for 25 cents of Boston & Cambridge from the little kiosk on Harvard Square and carry it with you at all times.
- Get a bicycle. Unlike the UK,
- it's less hilly here
- distances are greater on maps than they look
- Go Salsa-dancing at MIT!
- Kotobukiya in Porter Exchange
- seatoyouboston at the Boston Fish peer for fresh sushi grade fish
- IACE travel agents for flights to Japan (Thanks to Takako for this tip!)
Though I know it's not good practice to edit posts, I'll occasionally add some points to the above when they occur to me. This may be as a result of questions and comments to this post, which you are very welcome to post below!
Cheers!
Sport Facilities Access
The Quadrangle Recreational Athletic Center is now open for our use for
the fall and spring semesters with some significant changes as follows:
- sign up can now be done online
- no longer any time restrictions
- fee is now $15 for the academic semester
- fee allows access to ALL Harvard recreational facilities
For more details and online registration follow THIS LINK
the fall and spring semesters with some significant changes as follows:
- sign up can now be done online
- no longer any time restrictions
- fee is now $15 for the academic semester
- fee allows access to ALL Harvard recreational facilities
For more details and online registration follow THIS LINK
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