Understanding the Healthcare System
Healthcare in the US is privatized and expensive. To help cover the cost of doctor, dentist and hospital visits you will need to purchase health insurance from a health insurance company. Many employers will offer health insurance as part of their employment benefits package. If not, you can purchase it in NY State through the Health Insurance Marketplace1.
The health care system can be complex and each insurance package is different. Most employers have a plan administrator who will help you navigate the system and can explain the coverage your health insurance provides. You will want to know, for example, if your health insurance covers (in addition to care when you are sick) eye glasses, dental care or psychotherapy, depending on your family’s needs. As you explore the health insurance options, some useful terms to know are:
In-network
These are healthcare providers (doctors, dentists etc) who have a contract with a health insurance company to provide care at a negotiated rate. This means the cost to you is lower. Health insurance companies will have a directory of in-network providers on their website.
Out of network
These healthcare providers do not have a contract with your health insurance company, which will result in higher costs to you if you use them.
Co-pay
Is a fixed fee determined by your health insurance that you pay each time you use a service. It is usually displayed on your health insurance card.
Deductible
Is the amount of money you will pay for healthcare services before your health insurance company starts covering your costs. The deductible is accumulative over the course of a year. It can be anywhere from $20 to $1000 or more depending on your plan.
Pre-authorization
This is the approval you need to obtain from your health insurance company by contacting them directly, prior to receiving certain tests, treatments or services. Failure to obtain pre-authorization may mean you will be personally responsible for payment of the service.
Getting started
You will want to select and schedule an appointment with your health care providers as soon as possible after you move. Some of the medical professionals you may want to schedule an appointment with are; a primary care physician (PCP), pediatrician, family dentist and/or pediatric dentist and obstetrician-gynecologist (OB-GYN.) You will want to establish a relationship with your providers and familiarize yourself with their office protocols before you need a sick visit or an have an emergency. In addition, any children will need to have a physical examination and a NY state health form2 filled out by a pediatrician to enroll in school. Ask neighbors or local friends for recommendations and consult the in-network directory for your health insurance company (found on their website) to help with your selection.
It is also a good idea to do a little reconnaissance and note the location of the nearest Urgent Care Center, your preferred hospital emergency room and a late night pharmacy, so that you have this information should you need it.
Healthcare providers
A primary care physician (PCP) can be a general internal medicine physician (An internist - also known as a GP in some countries) or a pediatrician (a doctor specializing in children) and will be the person you see on a regular basis for annual health checks, sick visits and ongoing healthcare. Americans typically visit their PCP at least once a year for an annual physical exam. Often, a family will sign on with an internist for the adults and a pediatrician for the children. An appointment with a pediatrician will be necessary to complete the examination and health forms required by NY State for your child to enroll in school. It will also give you an opportunity to ask about the procedure to see a physician if you or your child is sick. At most doctor visits you will be required to fill out paperwork asking you for your medical history and your health insurance information. Make sure you bring your or your child’s medical records including:
- Vaccination records
- Prescription and over-the-counter medications
- Surgeries
- Radiology and/or bloodwork reports
If you have a health condition that requires the care of a specialist, your primary care physician can refer you to the appropriate doctor. In fact, your health insurance may require a referral from your PCP to cover any specialist care.
Obstetrician/gynecologist (Ob-gyn)
Many internists do not offer Pap smears, mammograms or breast exams so most women will also enroll with an ob-gyn as part of their primary healthcare team. An ob-gyn will provide these routine services in addition to healthcare during pregnancy and birth.
Dentist & optician
Not all health insurance plans cover dentist and optician services. You may need to take out additional insurance to cover these or pay out-of-pocket.
Specialist Healthcare
Westchester residents are fortunate to have easy access to a wide range of world class specialist doctors such as oncologists, cardiologists and dermatologists. Most are affiliated with one of the renowned research and teaching hospitals in NYC or in Westchester county. If you require the care of a specialist, your PCP can make recommendations.
Emergency care
Life threatening or serious emergencies require a trip to the Emergency Room (ER) at the hospital. If you require an ambulance to transport you to the ER you should dial 911.
For medical conditions that require immediate attention, but that are not life threatening, a visit to an Urgent Care Center might be appropriate. These centers are often open outside doctors office hours and can provide immediate care for fevers and headaches, ear infections, respiratory infections, and small cuts that may require sutures.