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Something is very wrong with the whole medical insurance system in the US. Having recently been exposed to it, I keep discovering new surprises and being shocke

by jwr 8y ago

Something is very wrong with the whole medical insurance system in the US. Having recently been exposed to it, I keep discovering new surprises and being shocked regularly. What I found most bizarre is that Americans who are "temporarily" in the US (e.g. expats, visiting) can get health insurance with better terms and at about 1/10th the price of what residents are offered. Someone is being had, I'd say.

MrMorden 8y ago
That could be because for the really expensive stuff they'll pay for you to be transported back to your home country, where your primary insurance will treat you.
- nraynaud 8y ago
  I am a foreigner in the US, and I am not eligible to health insurance at home anymore, there is a residence condition.
- jwr 8y ago
  No, that is not the type of insurance I was writing about. To take an example, take a look at Patriot America Plus from https://www.visitorscoverage.com/visitor-health-insurance/plans/ https://www.visitorscoverage.com/visitor-health-insurance/pl... It does include the acute onset of pre-existing conditions, $250 total yearly deductible, 100% percent in-network coverage. But it is not available to US residents, only for short term (up to two years) stays.
  - IncRnd 8y ago
    From Patriot on that page, "Cannot accept an address in Maryland (MD)."
  - kalleboo 8y ago
    > The Patriot America Plus Plan is available for any non-US Resident , visiting the USA for a short period of time > Pre-existing conditions are not covered by Patriot America Plus Plan It requires you to already have insurance somewhere else, and they expect you to go home for anything chronic (expensive). It sounds exactly the same as any travel insurance you can get in your home country (and is included in many fancy credit cards) You said "expats" before, but ex-pat implies residency in the US. Tourists/business travelers are a whole other ballgame. They're just protecting against not getting hit by a car when they're at their week-long conference. They're all limited in scope of their costs by their visitor's visa duration (typically 90 days)
  - yc2050 8y ago
    Maximum coverage limits are low on these plans. This is definitely a contributing factor. Since the affordable Care Act passed, there are no maximum coverage limits. This has increased the cost of health care dramatically.
maxxxxx 8y ago
Nothing makes sense how billing in the US medical system works. It's a total ripoff.
howard941 8y ago
Does the insurance cover pre-existing conditions?
underwater 8y ago
Accident vs. long term sickness, maybe? If you’re a visitor to the US and are diagnosed with cancer you’re not going to stick around and rack up a 250k in medical fees (and I expect it’s not covered anyway).
larrysalibra 8y ago
Heathcard insurance premiums are using community rates - priced on the overall risk / claim rate of the population of people covered under a certain policy. My guess is that expats and visitors from other countries are a healthy and lower risk group (because they’re also wealthier) than the general population.
solatic 8y ago
Consider that the average healthcare consumer pays an insurance company a premium and a co-pay so that the insurance company can reimburse a doctor whose rates are higher to offset the cost of administrative salaries for assistants to deal with the insurance companies. If you think about it, it's basically a form of racketeering which happens to be legal because the doctors and the insurance companies aren't formally colluding to needlessly increase the administrative complexity of the system, and because there is no legal response, the insurance companies are incentivized to raise administrative complexity and cost over time (since inelastic demand has no effect on preventing revenues from rising from pure cost increases).
zb 8y ago
If you're an expat, you really need one of those insurance polices in addition to regular US insurance, as you'll discover when you try to claim. My colleague spent weeks on the phone arguing with the insurance company while debt collectors from the hospital hounded him after a simple ER visit. In the end someone at the insurance company paid his bill with their corporate credit card because they couldn't figure out a way to get it paid through the system. This despite the fact that the insurance company claimed to have a 'network'-type relationship with the hospital (which the hospital denied any knowledge of). They stopped offering coverage for the US altogether after that because it was too expensive. My parents are still trying to get their travel insurance to reimburse them after an ER visit while on holiday. Basically everyone is being had.

by jwr 8y ago

MrMorden 8y ago

That could be because for the really expensive stuff they'll pay for you to be transported back to your home country, where your primary insurance will treat you.

nraynaud 8y ago
I am a foreigner in the US, and I am not eligible to health insurance at home anymore, there is a residence condition.
jwr 8y ago
No, that is not the type of insurance I was writing about. To take an example, take a look at Patriot America Plus from https://www.visitorscoverage.com/visitor-health-insurance/plans/ https://www.visitorscoverage.com/visitor-health-insurance/pl... It does include the acute onset of pre-existing conditions, $250 total yearly deductible, 100% percent in-network coverage. But it is not available to US residents, only for short term (up to two years) stays.
- IncRnd 8y ago
  From Patriot on that page, "Cannot accept an address in Maryland (MD)."
- kalleboo 8y ago
  > The Patriot America Plus Plan is available for any non-US Resident , visiting the USA for a short period of time > Pre-existing conditions are not covered by Patriot America Plus Plan It requires you to already have insurance somewhere else, and they expect you to go home for anything chronic (expensive). It sounds exactly the same as any travel insurance you can get in your home country (and is included in many fancy credit cards) You said "expats" before, but ex-pat implies residency in the US. Tourists/business travelers are a whole other ballgame. They're just protecting against not getting hit by a car when they're at their week-long conference. They're all limited in scope of their costs by their visitor's visa duration (typically 90 days)
- yc2050 8y ago
  Maximum coverage limits are low on these plans. This is definitely a contributing factor. Since the affordable Care Act passed, there are no maximum coverage limits. This has increased the cost of health care dramatically.

maxxxxx 8y ago

Nothing makes sense how billing in the US medical system works. It's a total ripoff.

howard941 8y ago

Does the insurance cover pre-existing conditions?

underwater 8y ago

Accident vs. long term sickness, maybe? If you’re a visitor to the US and are diagnosed with cancer you’re not going to stick around and rack up a 250k in medical fees (and I expect it’s not covered anyway).

larrysalibra 8y ago

Heathcard insurance premiums are using community rates - priced on the overall risk / claim rate of the population of people covered under a certain policy. My guess is that expats and visitors from other countries are a healthy and lower risk group (because they’re also wealthier) than the general population.

solatic 8y ago

Consider that the average healthcare consumer pays an insurance company a premium and a co-pay so that the insurance company can reimburse a doctor whose rates are higher to offset the cost of administrative salaries for assistants to deal with the insurance companies. If you think about it, it's basically a form of racketeering which happens to be legal because the doctors and the insurance companies aren't formally colluding to needlessly increase the administrative complexity of the system, and because there is no legal response, the insurance companies are incentivized to raise administrative complexity and cost over time (since inelastic demand has no effect on preventing revenues from rising from pure cost increases).

zb 8y ago

If you're an expat, you really need one of those insurance polices in addition to regular US insurance, as you'll discover when you try to claim. My colleague spent weeks on the phone arguing with the insurance company while debt collectors from the hospital hounded him after a simple ER visit. In the end someone at the insurance company paid his bill with their corporate credit card because they couldn't figure out a way to get it paid through the system. This despite the fact that the insurance company claimed to have a 'network'-type relationship with the hospital (which the hospital denied any knowledge of). They stopped offering coverage for the US altogether after that because it was too expensive. My parents are still trying to get their travel insurance to reimburse them after an ER visit while on holiday. Basically everyone is being had.