After Diagnosis, Does Insurance Matter

cruizer101

Not sure if this is the right forum may be better in health science but thought would put here for the moment. My question is after the point of diagnosis does having health insurance make much of a difference.

So hypothetical situation Joe has a problem an goes to his GP who says yes you have a problem you need a scan and consultation. At this point there are 3 options. first Joe the public patient who goes on 9 month waiting list, second Joe has health insurance and gets appointment for following week, third Joe hasn't insurance but pays the couple of hundred for the scan and consultation.

So forgetting about the first one, now Joe has been assessed by consultant and he needs a procedure. Is the wait time for procedure based on whether he has insurance or not, (lets assume if he doesn't he isn't going to pay the thousands it is for procedure) or is the wait time after diagnosis based purely on triage, i.e. how bad is he.

I've heard different opinions on this and am led to believe once diagnosed that triage is the deciding factor not ability to pay, maybe it is a bit of a combination. Can people confirm or refute this?

coffeepls

Very very rough outline - based on what I know.

If Joe's procedure isn't a matter of complete urgency (as in if he doesn't have it within days he will die) then as a public patient he will go on to a waiting list. Depending on the procedure, that list may mean Joe doesn't get seen to for up to a couple of years. If Joe has health insurance, he can pick the hospital, and have the procedure asap. If Joe wants to pay for the whole shebang because he has no health insurance, he can also pick the hospital and have whatever done asap.

Joe might have a cardiac when he finds out the cost of consultants fees etc etc if he chooses to pay.

Marcusm

Whether the person has insurance does matter in many cases as there may, in many circumstances, be a requirement to get the procedure approved by the insurer - this will vary depending on the procedure, the insurer and the facility. Remember that if Joe does not have health insurance then obtaining it post diagnosis will not generally cover him as it will be a pre existing condition. Ie if Joe does not have insurance then his likely options are wait on the public list or fund it himself.

My experience is that the triage factors in both cases, i.e. whether you're on a private or public 'list' the decision on how quickly you're seen via either avenue is based on how high priority your issue is. Unless the private folks are hanging around doing nothing/very little in which case Joe would be seen pretty quickly.

I've had some exploratory procedures done to rule out cancer via the public system lately and can't fault it really. I may have been seen marginally more quickly if I had health insurance but because of how bad my symptoms were (and how aggressive the particular type of cancer is that they thought I may have) I had a sequence of procedures pretty quickly.

Fred Swanson

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