certain health plans will cover prescriptions and other prescriptions that are on the insurances approved list are available for a cheaper price. If a prescription is not covered by insurance, then the full price will need to be paid out-of-pocket. If there is a medication that is necessary but not covered by the individual’s insurance plan the individual can follow the company’s drug exception process. This may allow the individual to get the medication that would not be previously covered (“Getting Prescriptions”, n.d.) 2b. Through the NHS in order to see a specialist a referral from the covering physician must be provided. Prior to sending a patient to a specialist the physician will probably suggest the patient try other treatment options to see if there is an improvement in their condition. The physician may deny a request to see a specialist if they do not feel it is necessary. The only exception to see a specialist without
Ana Willis C489 Task 3 a referral is when accessing a sexual health clinic or emergency treatment (“Referrals for Specialist”, 2016). In the US certain types of insurance plans do not require a referral to see a specialist. However there are many specialists who will still require records to ensure there is an actual need to see them. Other types of insurance plans require a referral from the patient’s primary care physician (Frantz, 2015). 2c. In the United States an individual can not be denied coverage for a pre-existing condition. Insurance companies are also not allowed to charge a person more for pre-existing condition and are also required to cover treatment for the pre-existing condition (HHS Office, 2017). In Great Britain existing conditions and any medical conditions from the past 5 years may not be covered. Individuals can still obtain medical insurance but there are restrictions on the amount that is paid out for pre-existing conditions. Coverage may be started after an individual has been symptom free for 5 years (D., 2018). 3. In Great Britain people with pre-existing conditions will have to spend a lot of money to pay for their medications. Some people may not have the means to pay for their prescriptions which leads to hospitalizations and even death. However in a healthy individual without any pre-existing conditions then the Great Britain healthcare system is very beneficial and saves them a significant amount of money. In the United States healthcare is very costly and for that reasoning not everyone has insurance coverage. In the US some people go without coverage because it is too expensive, and they do not meet the income requirements for insurance through the government which puts their healthy in jeopardy.
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- Fall '18
- Health insurance in the United States, Ana Willis