Your sites seem to have a bizarre nitpicky definition of “single-payer” which includes only “one payer, multiple providers” as “single-payer” and “one payer, one provider” as … something else (that ridiculous term “socialised medicine” perhaps). Maybe that’s the official definition - I don’t know. It flies in the face of the English language, however since the UK NHS does, in fact, have one single payer for medical services.
Australia, btw, is not a single-payer system. It’s just government run. State governments run the hospitals, federal government pays private practise doctors (yes, this is in fact a really bad idea)
My experience has been the same as amarinth’s. I can’t get my insurance company to say if they’ll pay for something or not until after it’s done and they’ve been billed for it. Even prescriptions. The way my plan works is that I purchase the prescriptions and submit receipts to my insurance company for reimbursement. They won’t tell me if they’ll cover something or not until I submit it.
The best they’ll tell me is “we should cover it” but there’s always a bunch of disclaimers around it. The one that gives me pause is they say it “must be medically necessary.” From what I’ve heard, what my doctor thinks is medically necessary can be very different from what my insurance company thinks.
I’ve been lucky so far - they haven’t declined anything yet. But I keep waiting for the fight to begin…
What it comes down to for my policy, is that I will never have to pay more than $2000 out of pocket for any given year.
I also have a pre-tax savings through my employer that I can use for medical expenses. I chose to use it this year since I elected to have the shoulder surgery. I knew I was going to on the line for the whole $2000. Though my doc would not even ballpark the figure for me.
I have $2000 in that account. My employer is self insured.
I should be done.
Nope. The surgery center is billing me for 2200, the PT is billing me for 300 and the Doc is billing me for 250.
The anesthesiologist owes me 1018.
Insurance has sent me some random checks and paid directly to HCPs with others. And I’m waiting for the $2000 of my money to pay the rest. Provided it’s approved.
There are no due dates on any of the bills, but guess who is going to get badgered if they decide it’s late?
The wikipedia page doesn’t claim to be any sort of comprehensive list of single payer countries, so the fact that the UK isn’t listed is meaningless.
The single American author of your second cite (not “the British Medical Journal”) uses the term single payer system simply to differentiate between a universal healthcare system in which the government pays the bills but doesn’t directly administer the providers from one in which it does, ie. the NHS.