The medical system here

I still haven't worked out completely how the medical system works here in America, but here are a few notes, just for those who are curious.

• Everything costs money. Usually the first question after name and DOB is what insurance I have. One of my friends goes to a specialist where even the gloves are a separate line item. So she doesn't know how much her visit is going to cost ahead of time.
• Insurance is organised through your employer - they do a deal with an insurer, who offers various packages, and you decide on a package, BUT - the employer doesn't pay - you pay the premiums, and the excess, etc!!! So, in hubby's work, they are merging with a much bigger firm, and the primary interest point is if the health insurance packages are going to get better. 
• Drs rooms then do deals with insurers, and have agreements. Some drs may not be able to see you, because your insurance isn't on their list. The closest comparison  I can think of is Medibanks 'preferred suppliers' - if you go to a certain dentist your out of pocket is minimal, because Medibank and that dentist have reached an agreement on fees. In fact, visiting a dentist in Australia is very much like visiting a health professional in the USA (with each procedure having a line item).
• Self Pay is what we are doing, because we then submit a claim to our insurance, who then pays us in Australian bank account, which sounds awkward, and probably would be if you had a cash flow problem. So, I just say Self Pay, rather than try and explain that I do have insurance, but I claim from them after paying up front. Self pay means often, I get a discount for paying upfront - so todays visit was 50% off!! (and still $112)
• What sort of insurance you have shapes how you approach your health. I tend to approach from a "you're the dr, please care for me", but I have seen articles on asking how much money things cost before getting procedures, checking if the dr investigating something will cost extra, phoning around to get cheapest lab costs, and also cheapest pharmacy costs. Some plans require you to order medical supplies from a certain supplier. The emphasis is on you being a consumer, and getting the best value/efficiency.
• My dentist recently suggested something, and his assistant suggested that she print out a plan for the procedure so I could get 'pre-approval' for the procedure. I suspect this must lead to small stuff growing into big stuff, just from needing to save your money! He also doubled checked if I wanted xrays of my teeth. The Dr made sure she was only ordering blood tests that were absolutely necessary, and gave me a choice about how to get the prescription filled, in case the tablets were expensive when I came to pay for them.
• Urgent care (colds, dr certificates, same day care) is often separate to Primary care. The children's dr has an hour each morning for walk in urgent care. 
• At a Dr's visit, your weight, blood pressure and temp (for children)/pulse (for me) are recorded at every visit by a PA (physicians assistant). Then you tell the PA what your visit is for, then the Dr comes in, with the notes from the PA.
• Pharmacy - you're asked what your nominated pharmacy is, and your scripts are sent electronically straight to the pharmacy. I do not get to hold any scripts in my sweaty little hand. This means you have to go there for refills too, I suppose. So we made sure we nominated a pharmacy close to home!