As an international student or family member of an international student, it is imperative you understand some things about the United States healthcare system.
The healthcare system in the United States is privatized. Each individual can decide where to go to get his or her healthcare and how to pay for it. The healthcare system is not managed by the government in the United States. This means the patient has a lot of choice in their health care.
The United States healthcare system is decentralized. There is not one organization that manages the healthcare for everyone. Physicians and other practitioners are not connected to one another unless they choose to practice together. They do not know if a patient has been treated elsewhere or what that treatment was unless the patient tells them. This means the patient has a lot of responsibility in their own health care.
Healthcare in the United States is more expensive than anywhere else in the world. Because individuals, and not the government, are responsible for paying their own medical expenses, insurance is necessary.
The Affordable Care Act (ACA) requires all United States citizens and permanent residents to purchase health insurance that meets the minimum requirements established by the United States government. This also applies to anyone in the United States on a nonimmigrant student visa. Therefore, all international students and their dependents are legally required to have health insurance that meets the minimum requirements under the ACA.
Healthcare Options
Dallas is a major city, so there are many options for students to receive health care. Choosing the right place to go can be confusing. When deciding where to go for health care, it is important to consider the following things:
- What type of care you need?
- How you will get to the healthcare provider?
- What type of insurance do you have?
How Medical Insurance Works
To be covered by an insurance policy, you must complete the application, pay the premium, and have your application accepted by the insurance company in order to be covered. DTS has a healthcare policy students can enroll in. Students are not automatically enrolled and must complete the enrollment process.
If you are enrolling in DTS health insurance, you do not have to wait for your application to be approved. If you are choosing to have other health insurance, you must wait for approval before your insurance goes into effect.
After you have been approved, you will receive a health insurance card in the mail. This card is your proof of insurance coverage. You should carry this card in your wallet at all times. When you need medical care, you will be required to show this card. Your insurance policy is only valid if you continue to pay the health insurance premiums on time.
Keep in mind all insurance plans are only issued for a certain amount of time. They have a date the coverage begins and ends (known as effective dates). In order to continue your insurance plan, you will need to pay the premiums and renew the insurance coverage. If you do not do this, your insurance will lapse or be terminated for non-payment.
Using Your Insurance
When using your insurance, you will need to locate the appropriate place to receive treatment. Many insurance companies have contracts with certain physicians, hospitals, or other medical professionals who will provide care for the insured patient at a reduced cost. Your insurance company will provide you a list of these health care providers who are within network (also known as “preferred providers”). The insurance will also cover a higher percentage of the care when are using someone within the insurance network. When visiting a healthcare provider, it is important to check to see if they are in network and will be covered by your insurance. If the healthcare provider is not in your network, they are considered “out-of-network providers.”
- Most providers will take your insurance information and file a claim (a formal written request for payment) directly with the insurance company. After the insurance company receives the claim and makes their payment, the provider will send you a bill for the remaining amount that you owe.
- Some providers will require you to pay a copay at the time of your payment. A copay is a shared cost that you pay for each medical visit. The copay is determined by your insurance company and may be different for different types of care being received. The healthcare provider will file a claim (minus the amount of the copay) with the insurance company and will notify you of the remaining amount AFTER the insurance company has paid its part.
- Some providers will require you to pay the full fee before you leave the office. They may send a claim to the insurance company and have them reimburse you directly. Or, they may give you the itemized receipt so that you may request reimbursement from the insurance company. It is important to know if you need to file a claim with the insurance company directly or if the healthcare provider will do it.
If you need to seek medical care, it is important to look for a preferred provider. Please keep in mind preferred providers offer the same type and quality of care as out of network providers. The reason they are less expensive is because they have a contract with your insurance company that reduces or waives the deductibles and copayments for treatment received. Sometimes out of network providers are not covered at all by your insurance company. Receiving care from someone out of network may result in you having to pay the full cost of the treatment.
Confidentiality
By law, medical records in the United States are confidential. They cannot be released to third parties (meaning anyone other than the patient or medical provider) without written consent from the patient (or in the case of children, the parent). There are VERY rare exceptions to this.
In order to determine if your medical expenses are covered under the insurance policy, the insurance company needs records of your treatment and diagnosis. The medical provider you consult will have you sign a form allowing them to send those records to the insurance company. You have the right to decline this request, but if you do, you will be asked to pay the full cost of the treatment yourself.
