Hey there,
not sure if this belongs in this forum or the BF Pub, but I'll put it here and see what happns.
My mother in NY mentioned in an email that people always ask her about my medical coverage (for those who don't know, I'm from NY but been living in Germany for 16 years. Also, Brigitte is my wife, Isabella is our 12-year old daughter). I just finished a really long email to her, trying to explain how things work here, and just thought it might be interesting reading for some of you. It's not fine-edited, maybe I'll get to that some other day. Here it is, typos and all, my email to my mother:
Nobody over there understands how things work here at all. I think it's because the media completely distorts the truth in one direction or the other, depending on the political bent they want to spin. Either we get "excellent free medical care" or we have a "Broken Socialist Medical System", one or the other. But in reality, we just pay insurance, just like 90% of Americans. It's usually 50/50 employee/employer contribution. Self-employed people have to buy insurance above a certain income level (I guess that's called a "mandate" in the US) and the premiums vary based on your income. There are a lot of nuances that I'm leaving out, and plenty of things I don't really understand, but that's pretty much it in a nutshell.
Some things that I think really are a lot better here:
Well, I really didn't like him, I didn't feel like he was doing enough for me. I asked around and got a glowing recommendation for another Orthopedist in Bayreuth, the next city over, where Claudia [my S-I-L] lives. The guy has an impressive website and a very fancy practice. He lists all kinds of alternative therapies for problems like mine. I called my GP and said I want another referral for Orthopedic (one that specifies Sports Medicine). They printed it up and I went and got it, no problem. I called up the Orthopedist, got an appointment in two weeks time.
Well .... he turned out to be a huge DUD. He didn't even look at me. He just looked at the MRI pic, read the analysis from the hospital and said, "You'll get a shot", and turned to leave... I stopped him and asked, "What shot???" He said, "A cortisone shot in the neck ... Oh, by the way, you have to pay for it out of pocket, it's not covered by insurance, but I'd do it if I were you" And off he went... :/
Well, my first impulse was to just leave. But I wound up getting the shot (it's done with an x-ray video camera, kind of complex), paid my 30 Euro and left. I thought, well, if it works, great. I don't have to love the guy and just want my problems to go away. He also gave me a referral for a neurological exam, which I got done a couple days later.
Then I started educating myself on these cortisone shots. Turns out they're not a cure for my problem, they would only be a way to dampen the pain, and I'd be getting them regularly, every couple weeks, for life.
No. Way.
I called up the practice and told them forget it. And it was a couple days later that I had the really horrible pain that sent me to the hospital for the operation (which the first orthopedist had predicted in the first place).
So... that's how medicine works here. If you're willing to do the leg work, you can get anything done and you can keep trying till you get satisfaction. Nobody stands in your way, you don't have to wade through a cesspool if insurance bureaucracy. I could have gone off to another Orthopedist to try my luck, but then I ended up in the hospital. I have never once in all my years here had to speak with anyone at any insurance company for anything. Some people just go to the GP and do exactly what they're told, they don't question doctors. And some people take a more active role in there treatment. In any case, any time you go to a doctor, you just give them your insurance card, and that's it.
Final point: We're in the "mandatory" system. Self-employed people like me and salaried people above a certain income level can opt out of the mandatory system and buy "private" insurance. Those policies are less regulated and do offer more luxury coverage (they pay for a lot more alternative medicine, get you private rooms in the hospital, quicker appointments with specialists, etc) but those policies are very very expensive (probably comparable with private insurance in the USA, I guess).
Brigitte actually makes enough to go into the private system - but then we would also have to pay separately for Isabella. And the premiums are just too high altogether. And with that system, you actually do have to deal with the insurance company a lot more. As I understand it, you basically pay everything out of hand, and get reimbursed - and then they might quibble about things more. The couple people we know with private insurance seem to think it's not worth the hassle. But even if you make enough to opt out of the mandatory system, you don't get kicked out of it. You simply have the choice. That's why Brigitte has the basic coverage, and I'm also buying into the mandatory system even though I'm self-employed.
Really the last thing: Basic dental is part of all this, as well.
PS - my mother already knew this so I didn't write it in the email, but my hospital stay cost me 10 Euro a day co-pay. And that's it. MRI, C/T, X-Ray, three visits to P/T, great food, pain medicines, everything included. And I think the co-pay is only for the first two weeks of a hospital stay, after that you don't pay anything (not 100% sure on that, though).
not sure if this belongs in this forum or the BF Pub, but I'll put it here and see what happns.
My mother in NY mentioned in an email that people always ask her about my medical coverage (for those who don't know, I'm from NY but been living in Germany for 16 years. Also, Brigitte is my wife, Isabella is our 12-year old daughter). I just finished a really long email to her, trying to explain how things work here, and just thought it might be interesting reading for some of you. It's not fine-edited, maybe I'll get to that some other day. Here it is, typos and all, my email to my mother:
Nobody over there understands how things work here at all. I think it's because the media completely distorts the truth in one direction or the other, depending on the political bent they want to spin. Either we get "excellent free medical care" or we have a "Broken Socialist Medical System", one or the other. But in reality, we just pay insurance, just like 90% of Americans. It's usually 50/50 employee/employer contribution. Self-employed people have to buy insurance above a certain income level (I guess that's called a "mandate" in the US) and the premiums vary based on your income. There are a lot of nuances that I'm leaving out, and plenty of things I don't really understand, but that's pretty much it in a nutshell.
Some things that I think really are a lot better here:
- We hardly ever have to deal with the insurance companies. They don't try to dispute treatments or refuse to pay. We don't have to justify anything to them. If the doctor orders it, it gets paid (duh).
- Co-pays are very small, more like token contributions on the customer's part.
- We can go to any doctor in the country, no limits. If I get a referral for Orthopedic, I can just go to any Orthopedist I want. If there's a specialist in Munich I want to see, I just get the referral from my GP and make the appointment. I can change GPs, too. Or just go to any one I want at any time.
- Kids are always covered for everything, no exceptions. And no co-pays. (that kind of has a dark side, too. A lot or mothers take their kids to the Pediatrician for every little runny nose or bump on the knee, really annoying, and pushes costs up needlessly).
- "Single-Payer" - so long as I wasn't making enough to have to enter the mandatory insurance system, all three of us have been covered by Brigitte's insurance.
- Transportable insurance. Changing jobs doesn't effect your insurance coverage at all. (this is also true for workers' pensions, btw)
- Switching carriers. There are dozens of insurance companies here and we can cancel a policy at any time and switch to another. I think the grace period is three months. So, cancel today and in three months time, your new insurance company takes over your coverage, seemlessly.
- and we never have to "pay out to the doctors", what ever that means [my mother mentioned this in her email, but didn't explain what it means]. Doctors offer plenty of alternative therapies that aren't covered directly by insurance, but that's a private matter. Insurance here isn't just some bottomless barrel of cash that we can throw around limitlessly; there are limits to the coverage, obviously. Duh.
Well, I really didn't like him, I didn't feel like he was doing enough for me. I asked around and got a glowing recommendation for another Orthopedist in Bayreuth, the next city over, where Claudia [my S-I-L] lives. The guy has an impressive website and a very fancy practice. He lists all kinds of alternative therapies for problems like mine. I called my GP and said I want another referral for Orthopedic (one that specifies Sports Medicine). They printed it up and I went and got it, no problem. I called up the Orthopedist, got an appointment in two weeks time.
Well .... he turned out to be a huge DUD. He didn't even look at me. He just looked at the MRI pic, read the analysis from the hospital and said, "You'll get a shot", and turned to leave... I stopped him and asked, "What shot???" He said, "A cortisone shot in the neck ... Oh, by the way, you have to pay for it out of pocket, it's not covered by insurance, but I'd do it if I were you" And off he went... :/
Well, my first impulse was to just leave. But I wound up getting the shot (it's done with an x-ray video camera, kind of complex), paid my 30 Euro and left. I thought, well, if it works, great. I don't have to love the guy and just want my problems to go away. He also gave me a referral for a neurological exam, which I got done a couple days later.
Then I started educating myself on these cortisone shots. Turns out they're not a cure for my problem, they would only be a way to dampen the pain, and I'd be getting them regularly, every couple weeks, for life.
No. Way.
I called up the practice and told them forget it. And it was a couple days later that I had the really horrible pain that sent me to the hospital for the operation (which the first orthopedist had predicted in the first place).
So... that's how medicine works here. If you're willing to do the leg work, you can get anything done and you can keep trying till you get satisfaction. Nobody stands in your way, you don't have to wade through a cesspool if insurance bureaucracy. I could have gone off to another Orthopedist to try my luck, but then I ended up in the hospital. I have never once in all my years here had to speak with anyone at any insurance company for anything. Some people just go to the GP and do exactly what they're told, they don't question doctors. And some people take a more active role in there treatment. In any case, any time you go to a doctor, you just give them your insurance card, and that's it.
Final point: We're in the "mandatory" system. Self-employed people like me and salaried people above a certain income level can opt out of the mandatory system and buy "private" insurance. Those policies are less regulated and do offer more luxury coverage (they pay for a lot more alternative medicine, get you private rooms in the hospital, quicker appointments with specialists, etc) but those policies are very very expensive (probably comparable with private insurance in the USA, I guess).
Brigitte actually makes enough to go into the private system - but then we would also have to pay separately for Isabella. And the premiums are just too high altogether. And with that system, you actually do have to deal with the insurance company a lot more. As I understand it, you basically pay everything out of hand, and get reimbursed - and then they might quibble about things more. The couple people we know with private insurance seem to think it's not worth the hassle. But even if you make enough to opt out of the mandatory system, you don't get kicked out of it. You simply have the choice. That's why Brigitte has the basic coverage, and I'm also buying into the mandatory system even though I'm self-employed.
Really the last thing: Basic dental is part of all this, as well.
PS - my mother already knew this so I didn't write it in the email, but my hospital stay cost me 10 Euro a day co-pay. And that's it. MRI, C/T, X-Ray, three visits to P/T, great food, pain medicines, everything included. And I think the co-pay is only for the first two weeks of a hospital stay, after that you don't pay anything (not 100% sure on that, though).
