How does medical insurance work exactly?

Well, my best friends girlfriend was diagnosed with cancer a few months back. She had been sick a LONG time and by the time they figured it out it was stage 3 lymphoma cancer.

Now the doctors in Montgomery cant do anything to make her better. Everything they do makes her worse..including diagnosing her with the wrong thing for a year, even though on one of the doctor reports it said "This is sarcoidosis we think, God forbit it be Hodgkins Lymphoma Cancer" (which it turns out being 8 months later)

They are now going to take her to Atlanta to a better hospital. Now I know for a fact all of this costs ALOT.and I know for a fact their insurance isnt that good.

So how does this all work? Are they just gonna be stuck with hundreds of thousands of dollars in medical bills once this is all over because insurance stopped paying at one point? Or do they pay the whole way? Or.. i mean..should they even have to pay if she dies? I dont think so.. i feel like you should get a refund, lol.

If they have insurance, the company will cover some, but not most, of treatment. Likely, they will be stuck with thousands of dollars of medical bills. I have insurance, and still have to pay for some medical care.  And, unfortunately, they will still have to pay if she passes away. They still spent money, time, equipment, and energy trying to save her.

What her insurance pays for (or doesn't pay for) depends entirely on what sort, type, and amount of health insurance she purchased.  Some insurance policies have caps which limit the amount of out-of-pocket costs the insured is responsible for, other policies don't.  Obviously, the better coverage policies tend to cost more than policies that don't cover as much.

By the way, it works the same way for car insurance ... not all policies and companies are the same, and you get to choose (and pay for) the coverage that you want. (Some people want rental coverage, some don't. Some people want roadside assistance, some don't. Some want a high deductible, some don't. Some want $15,000 of coverage, some want $300,000 of coverage.)

In this country, medical insurance does not work.

It really depends on her plan. My mom had horrible insurance when she was diagnosed with terminal gall bladder cancer.  And we (me and the hospital) had to fight but we got most of everything covered.  I discovered that when it comes to situations like cancer insurance plans can be manipulated with the aid of her case manager at the hospitals and not taking no for the answer. 

First of all unless this girl is a minor, has an estate or married no one else can be held responsible for her medical bills if the worst happens.  But under no circumstances can anyone else sign any of her paper work on her behalf. (hospital forms, doctors stuff etc..) If they do (depending on the form and what the small print is) then the person who signed it could be held responsible.  If the patient can't do the paper work have a nurse or someone from the dr's office do it. It sounds cold but it just protects everyone.

Also if the worst happens or if she beats it, those left over doctor bills are negotiable.  The hospitals not so much.  I was able to negotiate the bills after my mom past to a fraction of what they were which left some money in her estate to split between me and my bro.

Also never listen to the insurance case managers, their only goal is to save money.  Befriend a nurse and listen to his/her insight as to whats best when decisions and choices need to be made.  Then get the hospital case manager to work for you. 

And remember they can't force you to do anything.  If, for example, they want to send her home to be in peace and the family isn't ready for it or isn't able to do it say no.  They will not put her out on the street or stop treating her.  When they said they couldn't do anything else for my mom and wanted to send her home.  They made it sound like it had to happen in the next day or so.  I started stressing I Was still working full time, she was too sick to be home alone, I had no medical equipment in the house and it wasn't wheel chair ready.   (please note my moms insurance didn't cover in home care or nursing home care) Well I went to my moms case managers office and flipped out...literally tears yelling complete breakdown...anyway I said I wasn't doing anything they wanted to bring her home until my conditions were met.  They includes the medical equipment delivered before she got home (they usually send you home and then do and evaluation and then send the stuff you need),  some of her aid paid for by the insurance and the last was she wanted to come home. (my mom wanted to die in the hospital with out being a burden on me) anywho...The insurance caved after 3 days of me refusing to even look at paper work and I had the equipment delivered the same day she was released and I got 4 hours a day in home care paid for by the insurance.  Don't let them bully you or your friend. And my favorite phrase be came if .......fill in the blank...... doesn't happen then I am calling an ambulance and bringing her back to the hospital and amazingly whatever was wanted or needed was approved by the insurance.

I know there are also great variations by state and they need to familiarize themselves with all the rules and regs of the different stated when it comes to hospital and doctors etc...  Also Hospice was a wealth of information and help for me. 

I know this was long and there are so many more things I learned during my ordeal which I wish I had known before.  If you want to pm me if you have more questions please feel free. I am not an expert but I have been there.