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US and Canadian Health Insurance
Pages 6 (1506 words)
In this country 37 million uninsured face economic barriers to care, and the health of many suffers as a result. The "corporatization" of medical care threatens professional values with an unprecedented administrative and commercial intrusion into the daily practice of medicine.
The big difference here in the US is that there are multiple insurance companies. In Canada you really only have one (one for each province) those offering extended insurance for things like private hospital rooms, vision, dental, etc.
The next big difference is managed care. In regards to optometry, you can think of this as the insurance companies that only provide for well vision care contacts and glasses. If there is a medical eye problem (i.e. a disease) they do not pay for the necessary care (generally), and those things should be billed to the major medical. They also pay much discounted fee's compared to medical, Medicare (gov't insurance for seniors) and private pay patients.
Optometrists in the US also tend to directly bill the insurance companies, OD's in Canada tend to only bill their respective provincial insurance plans, veteran's affairs, or Indian affairs, while patient's not covered by the above are billed directly by paying cash. If those patients have supplemental vision insurance then they can submit a claim for reimbursement.
When KHE talks about insurance discrimination he means that there are many insurance companies in the US that will not pay an optometrist for services performed that they will pay ophthalmologists for, even if the optometrist is licensed ...
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