7 ms·

> who actually pays for this level of intensive care If you have decent insurance, you pay your maximum out of pocket and insurance pays the rest (at negotiate

> who actually pays for this level of intensive care If you have decent insurance, you pay your maximum out of pocket and insurance pays the rest (at negotiated rates). If you don't have decent insurance, you declare bankruptcy and the hospital ends up paying for all except the few dollars they are able to get out of you. This is pretty much the same situation as when homeless people show up at an ER, which is legally obligated to help them regardless of ability to pay.

lotsofpulp 7y ago
If the healthcare providers are in network, i.e. the insurance company and the providers have reached a pricing agreement. Otherwise the providers can bill you whatever they want.
duxup 7y ago
I think it is VERY hard to tell what is "decent insurance" anymore. It might say that your hospital stay is covered on paper ... but then at the hospital the robot (or another doctor) might not be billed through the hospital and some outside group that is suddenly out of network.... there's no way to know.
- ryanmercer 7y ago
  Even when you do have 'good' insurance... When I had severe hypokalemia and was effectively paralyzed several years ago [1] (sorta comical read) they never once asked me about my dietary intake, instead they assumed I had some rare genetic disorder (in the ER the doctor literally told me "we're googling your symptoms") and once I was admitted they paraded 3 doctors through my room and billed me for 5 or 6 'consults'. While I considered my insurance to be 'good' getting dinged for each of those 'consults', 2 times each, despite only ever having seen 4 doctors total (one an ER doc that was probably a year or two into his medical career) face to face once each I ended up paying 10-12 different 'consul' fees, then a portion of the ambulance, then a portion of the room, the two different physical therapists they sent by after declaring me a 'fall risk' since I came in functionally paralyzed, then a portion of all the tests. From the time I set foot in the ER until I left I was there about 37 hours. All they had to do was give me some oral and IV potassium and I was fine. I actually diagnosed it myself, with no medical training whatsoever, in the ER unable to move 45 minutes before they did. My mother was there and after I'd somewhat calmed myself (I could not move, I could barely move my fingers) I told her it was probably a sodium potassium imbalance and I could probably still make it to work for overtime that morning. I ended up paying a little bit under 7k$, 1/4 of my gross income at the time, with my 'good insurance'. Took me 4~ years to pay it all off. [1] https://www.ryanmercer.com/ryansthoughts/2013/2/19/flashback-to-the-hypokalemic-episode.html https://www.ryanmercer.com/ryansthoughts/2013/2/19/flashback...
- briffle 7y ago
  I had a minor procedure a few months ago. Hospital, surgeon, etc, are all 'in-network' the anesthesiologist, however, is not. And there is only one 'group' for anesthesiologists in our town.
  - gt_grc 7y ago
    I didn't even know that an out-of-network provider was involved in my surgery until after it was over. A couple of weeks after the surgery, my insurance company sent me an unexpected check for $3,000. I called and asked them about it. They said, "It's to pay the surgical assistant. They're out of network, so we can't pay them directly." I had no idea that a surgical assistant was even there. (I hadn't yet received the bill.) The insurance company told me that since I had already been anesthetized and couldn't ask the surgical assistant if they were in-network, I didn't have to pay anything out of pocket for the surgical assistant.
  - jcadam 7y ago
    Anesthesiologists are never in-network, it's usually the most expensive part of having surgery in the US. Another major annoyance -- if you have surgery, the hospital usually gets their money from you right away. However, you're going to spend the next 18 months receiving random bills from various different firms representing nurses, doctors, lab technicians, etc. related to your procedure, many of which come down to "stuff we decided to do while you were unconscious."
    - mguerville 7y ago
      That has been exactly my experience with a very minor event a few years ago. The bills kept coming at random intervals for about 18 months, some for a few tens of dollars, one or two for hundreds, others for literally $0. I just had no visibility into it and honestly would only be half surprised if now, 8 years later, I received a bill for $17 for procedure AU8-QB-12 from department CO9-s4 (and the bill would mention that my insurance paid the other $872)
- jartelt 7y ago
  Most plans have clearly stated out of pocket maximums. That is the most you are going to pay in a given year.
  - duxup 7y ago
    That doesn't really provide you much information as to coverage and how likely you are to hit those maximums.
- colechristensen 7y ago
  The ACA mandates the maximum [maximum out-of-pocket] that an insurance plan can require. There's no such thing as good or bad insurance when it comes to extreme medical events. "Good" or "bad" depends on how much of your premium your employer covers and how expensive it is when you only use a little bit of medical services. The worst-case max out of pocket for any insurance plan in 2020 is: $8,150 for self-only coverage $16,300 for family coverage In America, it is important to have liquid savings to handle life events like losing a job or a serious health issue. We get taxed less, have fewer safety nets, so we need to build our own safety net. You can argue that one way is better than another way as a big picture, but many people misconstrue the individualist vs. collectivist societies as a serious moral issue instead of a choice. Some of the details of each can be serious moral issues, but the big picture is simply a difference in priorities. Bottom line: If you can come up with $16k/year to cover medical expenses for a serious issue, you won't go bankrupt.
  - duxup 7y ago
    The maximum limit is just ... the maximum limit. How / when you might hit it is an unknown from plan to plan for the reasons I noted.
    - colechristensen 7y ago
      In / out of network is not relevant to max out of pocket.
      - duxup 7y ago
        In / out of network can dramatically impact what you pay out of pocket.
        colechristensen 7y ago
        Not if you hit the max. If you hit the max it is irrelevant, I am talking about hitting the max and going bankrupt.
- hinkley 7y ago
  Carpooled with a friend to the pharmacy. His family and I were all exposed to influenza A, and for different reasons all decided to take Tamiflu. My cost was 10 times his. His whole family for less than half the cost of just myself. My initial suspicion was he got generic and I didn't. Nope, same box. He's said before he has 'good insurance' but it's almost always just talk. Guess it wasn't in this case.
ebg13 7y ago
> you declare bankruptcy and the hospital ends up paying for all except the few dollars they are able to get out of you. Does that mean the entirety of your life savings and any liquidatable assets?
- lovich 7y ago
  Its complicated, there are usually certain assets you can keep in bankruptcy in the US like your primary residence
- Merrill 7y ago
  401Ks, IRAs and other retirement plans are usually protected unless the creditor is the Federal government, e.g. the IRS or the Department of Education.
  - dsfyu404ed 7y ago
    Combined with state bankruptcy protections practice this means that most middle class people who don't have tons of money in a bank account, a home that is not their primary residence (or in their primary residence above whatever value their state protects) are decently protected but the upper middle class who often does have those things loses them in bankruptcy.
  - ebg13 7y ago
    > 401Ks, IRAs and other retirement plans What about non-retirement investments? Aren't you only allowed to put so much into a retirement plan per year?
    - Merrill 7y ago
      Non-retirement investments are subject to seizure to pay creditors. Yes, retirement accounts are limited in terms of annual contributions. But bankruptcy protection is one factor to consider in whether to max your contributions and/or to pay ahead on the mortgage on your primary residence.
      - 7y ago
aguyfromnb 7y ago
>If you have decent insurance, you pay your maximum out of pocket and insurance pays the rest (at negotiated rates). I think the OP's question was more: who decides this person gets treated by a state-of-the-art robot, while this person gets a prescription and told to go home and rest?
merpnderp 7y ago
You don't always declare bankruptcy. Medical debt can't be deducted from your wages and is usually negotiable with zero interest payments and for massive reductions in amounts. And after enough time, most hospitals will just write it off. And in exchange you can walk into any hospital in the country and they have to provide you emergency services.
AWildC182 7y ago
> which is legally obligated to help them regardless of ability to pay. Which tangentially makes all the Rand Paul bullshit about doctors being slaves under a universal healthcare system kinda moot. I know intelligent people aren't making that argument but it's a reasonable counterpoint in case you come across one of them
- dahfizz 7y ago
  Your argument is inconsistent. If we accept the premise that being legally compelled to treat a patient makes a doctor a slave, it is perfectly reasonable for Rand Paul to argue against the expansion of such a law. Similarly, the current existence of such a law does not contradict his moral stance unless he advocates or supports the current system, which he does not.
  - AWildC182 7y ago
    I don't believe it is. Rand Paul's entire platform on the issue is based on a false premise. Nobody is putting guns to doctors heads, there is just a legal impetus for hospitals to treat sick people, rather than sitting around demanding payment while the house burns. He makes the argument entirely because he was searching for something to support his platform, not the other way around. He doesn't appear to even delve into the issue beyond healthcare == slavery but rather focuses on supporting his strange forever contradictory hyper-capitalistic vision. As such he waives any possibility to debate the issue from the position that he doesn't support the current solution because he doesn't support anything.
jacobwilliamroy 7y ago
Or option 3: they don't go to real hospitals, use perscription medicine, or see real doctors.

lotsofpulp 7y ago

If the healthcare providers are in network, i.e. the insurance company and the providers have reached a pricing agreement. Otherwise the providers can bill you whatever they want.

duxup 7y ago

I think it is VERY hard to tell what is "decent insurance" anymore. It might say that your hospital stay is covered on paper ... but then at the hospital the robot (or another doctor) might not be billed through the hospital and some outside group that is suddenly out of network.... there's no way to know.

ryanmercer 7y ago
Even when you do have 'good' insurance... When I had severe hypokalemia and was effectively paralyzed several years ago [1] (sorta comical read) they never once asked me about my dietary intake, instead they assumed I had some rare genetic disorder (in the ER the doctor literally told me "we're googling your symptoms") and once I was admitted they paraded 3 doctors through my room and billed me for 5 or 6 'consults'. While I considered my insurance to be 'good' getting dinged for each of those 'consults', 2 times each, despite only ever having seen 4 doctors total (one an ER doc that was probably a year or two into his medical career) face to face once each I ended up paying 10-12 different 'consul' fees, then a portion of the ambulance, then a portion of the room, the two different physical therapists they sent by after declaring me a 'fall risk' since I came in functionally paralyzed, then a portion of all the tests. From the time I set foot in the ER until I left I was there about 37 hours. All they had to do was give me some oral and IV potassium and I was fine. I actually diagnosed it myself, with no medical training whatsoever, in the ER unable to move 45 minutes before they did. My mother was there and after I'd somewhat calmed myself (I could not move, I could barely move my fingers) I told her it was probably a sodium potassium imbalance and I could probably still make it to work for overtime that morning. I ended up paying a little bit under 7k$, 1/4 of my gross income at the time, with my 'good insurance'. Took me 4~ years to pay it all off. [1] https://www.ryanmercer.com/ryansthoughts/2013/2/19/flashback-to-the-hypokalemic-episode.html https://www.ryanmercer.com/ryansthoughts/2013/2/19/flashback...
briffle 7y ago
I had a minor procedure a few months ago. Hospital, surgeon, etc, are all 'in-network' the anesthesiologist, however, is not. And there is only one 'group' for anesthesiologists in our town.
- gt_grc 7y ago
  I didn't even know that an out-of-network provider was involved in my surgery until after it was over. A couple of weeks after the surgery, my insurance company sent me an unexpected check for $3,000. I called and asked them about it. They said, "It's to pay the surgical assistant. They're out of network, so we can't pay them directly." I had no idea that a surgical assistant was even there. (I hadn't yet received the bill.) The insurance company told me that since I had already been anesthetized and couldn't ask the surgical assistant if they were in-network, I didn't have to pay anything out of pocket for the surgical assistant.
- jcadam 7y ago
  Anesthesiologists are never in-network, it's usually the most expensive part of having surgery in the US. Another major annoyance -- if you have surgery, the hospital usually gets their money from you right away. However, you're going to spend the next 18 months receiving random bills from various different firms representing nurses, doctors, lab technicians, etc. related to your procedure, many of which come down to "stuff we decided to do while you were unconscious."
  - mguerville 7y ago
    That has been exactly my experience with a very minor event a few years ago. The bills kept coming at random intervals for about 18 months, some for a few tens of dollars, one or two for hundreds, others for literally $0. I just had no visibility into it and honestly would only be half surprised if now, 8 years later, I received a bill for $17 for procedure AU8-QB-12 from department CO9-s4 (and the bill would mention that my insurance paid the other $872)
jartelt 7y ago
Most plans have clearly stated out of pocket maximums. That is the most you are going to pay in a given year.
- duxup 7y ago
  That doesn't really provide you much information as to coverage and how likely you are to hit those maximums.
colechristensen 7y ago
The ACA mandates the maximum [maximum out-of-pocket] that an insurance plan can require. There's no such thing as good or bad insurance when it comes to extreme medical events. "Good" or "bad" depends on how much of your premium your employer covers and how expensive it is when you only use a little bit of medical services. The worst-case max out of pocket for any insurance plan in 2020 is: $8,150 for self-only coverage $16,300 for family coverage In America, it is important to have liquid savings to handle life events like losing a job or a serious health issue. We get taxed less, have fewer safety nets, so we need to build our own safety net. You can argue that one way is better than another way as a big picture, but many people misconstrue the individualist vs. collectivist societies as a serious moral issue instead of a choice. Some of the details of each can be serious moral issues, but the big picture is simply a difference in priorities. Bottom line: If you can come up with $16k/year to cover medical expenses for a serious issue, you won't go bankrupt.
- duxup 7y ago
  The maximum limit is just ... the maximum limit. How / when you might hit it is an unknown from plan to plan for the reasons I noted.
  - colechristensen 7y ago
    In / out of network is not relevant to max out of pocket.
    - duxup 7y ago
      In / out of network can dramatically impact what you pay out of pocket.
      - colechristensen 7y ago
        Not if you hit the max. If you hit the max it is irrelevant, I am talking about hitting the max and going bankrupt.
hinkley 7y ago
Carpooled with a friend to the pharmacy. His family and I were all exposed to influenza A, and for different reasons all decided to take Tamiflu. My cost was 10 times his. His whole family for less than half the cost of just myself. My initial suspicion was he got generic and I didn't. Nope, same box. He's said before he has 'good insurance' but it's almost always just talk. Guess it wasn't in this case.

ebg13 7y ago

> you declare bankruptcy and the hospital ends up paying for all except the few dollars they are able to get out of you. Does that mean the entirety of your life savings and any liquidatable assets?

lovich 7y ago
Its complicated, there are usually certain assets you can keep in bankruptcy in the US like your primary residence
Merrill 7y ago
401Ks, IRAs and other retirement plans are usually protected unless the creditor is the Federal government, e.g. the IRS or the Department of Education.
- dsfyu404ed 7y ago
  Combined with state bankruptcy protections practice this means that most middle class people who don't have tons of money in a bank account, a home that is not their primary residence (or in their primary residence above whatever value their state protects) are decently protected but the upper middle class who often does have those things loses them in bankruptcy.
- ebg13 7y ago
  > 401Ks, IRAs and other retirement plans What about non-retirement investments? Aren't you only allowed to put so much into a retirement plan per year?
  - Merrill 7y ago
    Non-retirement investments are subject to seizure to pay creditors. Yes, retirement accounts are limited in terms of annual contributions. But bankruptcy protection is one factor to consider in whether to max your contributions and/or to pay ahead on the mortgage on your primary residence.
    - 7y ago

aguyfromnb 7y ago

>If you have decent insurance, you pay your maximum out of pocket and insurance pays the rest (at negotiated rates). I think the OP's question was more: who decides this person gets treated by a state-of-the-art robot, while this person gets a prescription and told to go home and rest?

merpnderp 7y ago

You don't always declare bankruptcy. Medical debt can't be deducted from your wages and is usually negotiable with zero interest payments and for massive reductions in amounts. And after enough time, most hospitals will just write it off. And in exchange you can walk into any hospital in the country and they have to provide you emergency services.

AWildC182 7y ago

> which is legally obligated to help them regardless of ability to pay. Which tangentially makes all the Rand Paul bullshit about doctors being slaves under a universal healthcare system kinda moot. I know intelligent people aren't making that argument but it's a reasonable counterpoint in case you come across one of them

dahfizz 7y ago
Your argument is inconsistent. If we accept the premise that being legally compelled to treat a patient makes a doctor a slave, it is perfectly reasonable for Rand Paul to argue against the expansion of such a law. Similarly, the current existence of such a law does not contradict his moral stance unless he advocates or supports the current system, which he does not.
- AWildC182 7y ago
  I don't believe it is. Rand Paul's entire platform on the issue is based on a false premise. Nobody is putting guns to doctors heads, there is just a legal impetus for hospitals to treat sick people, rather than sitting around demanding payment while the house burns. He makes the argument entirely because he was searching for something to support his platform, not the other way around. He doesn't appear to even delve into the issue beyond healthcare == slavery but rather focuses on supporting his strange forever contradictory hyper-capitalistic vision. As such he waives any possibility to debate the issue from the position that he doesn't support the current solution because he doesn't support anything.

jacobwilliamroy 7y ago

Or option 3: they don't go to real hospitals, use perscription medicine, or see real doctors.