Pause music above if it bugs you.

Deciphering USA's Health Insurance System

NOTE: I created this info page (Jan. 2016) with generous help from James Pusavat, a MEDLAB-L subscriber from the USA.

QUESTION: Do U.S. transfusion services bill patients for lab tests and blood
products such as the following, which may or may not be covered by public
insurance such as Medicaid (for the poor) or Medicare (for the elderly), assuming they qualify, or have employment-based private insurance?
Where does 'Obamacare' (Affordable Care Act) fit?

Type and screen
Antibody identification
Antigen-negative red cells
Transfusion with multiple blood products
Transfusion with special blood products such as irradiated red cells

U.S. transfusion services may bill patients for lab tests and blood
products IF is it NOT covered by Medicare AND the patient has signed the
Advance Beneficiary Notice (ABN) PRIOR to providing the services. It is
consider fraud if the service provider asks the patient to sign ABN after the
services have been completed or denied by Medicare.

More details.

Advance Beneficiary Notice (ABN)

Medicare Waiver/Advance Beneficiary Notice (ABN): Frequently asked questions

What are Medicaid and Medicare?

The components of Medicare  /  Medicaid

Affordable Care Act (Obamacare) does not pay for medical services directly, it helps
lower and some middle income families pay for health insurance through
subsidies based income, age, and family size.

The Affordable Care Act actually refers to two separate pieces of
legislation — the Patient Protection and Affordable Care Act (P.L. 111-148)
and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152)
— that, together expand Medicaid coverage to millions of low-income
Americans and makes numerous improvements
to both Medicaid and the
Children's Health Insurance Program (CHIP).

"Medicaid and the Children’s Health Insurance Program (CHIP) provide free
or low-cost health coverage to millions of Americans, including some
low-income people, families and children, pregnant women, the elderly, and
people with disabilities. Some states have expanded their Medicaid programs
to cover all people below certain income levels."

The Affordable Care Act, Section by Section
All 10 Titles of the Affordable Care Act, with
amendments to the law called for by the reconciliation process. Click on
each Title to see a brief outline and then read the law section by section.


A quick guide to the Health Insurance Marketplace

Consumer Reports

How to use your health insurance / High deductibles, provider networks, and FSAs

What's the difference between a deductible and an out-of-pocket limit? /You need to know to make a smart plan choice

Health insurance deductible and out-of-pocket costs made simple / How to understand the difference

That CT scan costs how much? / Health-care prices are all over the map, even within your plan’s network

Hazardous health plans / Coverage gaps can leave you in big trouble

Junk health insurance / Stingy plans may be worse than none at all

6 ways to avoid having a health insurance claim denied / You pay for insurance. Make sure it pays your medical bills.

Avoid Medical Bill Sticker Shock

Sample private health insurance plan

Employee Health Benefit Contributions

Summary of Benefits – Comparison Chart

Twitter:  @bogeywheels / @transfusionnews
Blog:  Musings on Transfusion Medicine