RE: USA Gov v Private Distribution Network5 Feb 2022 13:09
You'll not get a simple answer on this one, it is very involved/complicated. Regulations and markets do change on a state by state basis as well. This is why we will need experienced professionals over there.
I do know (but well out of date) about the workplace medical (workers' compensation) from my old insurance days, but the personal medical insurance side is vastly complicated.
There are all sorts of coverage levels, differing co-pay options and deductibles. There are in and out of network charges. Basically you can have whatever you want, but the medical insurer will have the final say if they reimburse you fully, in part, or not. Get it wrong and it can get very costly very quickly!
On top of that there is the so-called 'Obama Care' - a way of providing medical insurance for the less well off - again may vary on a state by state basis. The final fall back is Medicaid for those at the very bottom of US life - not where you want to be.
So, the buyers are many and varied. Individuals, yes if coverage is denied and they have the cash. Hospitals, yes. Insurance controlled entities, yes. Federal Gov, yes (stockpiling and military use, basically). State Gov, yes but requirements will differ for each State.
When dealing with the US, you need to basically treat each State as a different country all loosely affiliated through an overarching federal structure. So it is complicated!
This is very much a simplification, I remember being once shown the regulation records room for a large US wide Workers' Comp insurer. It was basically a massive reference library with a pretty large team constantly employed in keeping their reference library updated. Anything that was done, or planned / explored would need to be researched by this team through all the regulation in each State before it could be actioned. Of course if you only operate in one State, you only have that State to worry about....
In short, yes we do need some very clever professionals on the ground over there.