10 ms·

I'm paying nearly 20k (parents+child) on insurance I don't have time to use (and luckily no serious need) and once my son went to see his pediatrician and our '

• pfarnsworth 7y ago
  I was in the hospital over Christmas because of a very severe infection. I was there for 2 weeks, and am lucky to be alive. The costs were over $150k, but I ended up paying $1500 in various deductibles to Kaiser, etc. I was happy to pay $1500 and am alive because of the care that I got. I pay about $6000 a year in medical insurance per year through my employer and it ended up being totally worth it. Not a few weeks previous, one of my children was rushed via ambulance to the same hospital because of an anaphylactic reaction. So yes, much of your costs are for possible emergencies and especially as you get older, your costs increase.
  • onemoresoop 7y ago
    Yes, I know and that's why I am still paying. But seriously, we are paying for emergencies, this should be stated when paying for the insurance. Second, why were the costs $150000?
    • nthj 7y ago
      It’s right in the name. It’s called Insurance, not Healthcare as a Service.
      • scarejunba 7y ago
        Kaiser platinum is pretty close to Healthcare as a Service.
        • dillondoyle 7y ago
          Can confirm I love Kaiser but both the best and worst parts for me are the bureaucracy -> time/$ savers. Great when it's fast and cheap, can email Dr to get meds/treatment, get meds mailed 3 for 2 price - but frustrating when wait to see a specialist is more than a month or being rushed through in person visits like cattle. And I feel well taken care proactively with multi-DR/NP team. Plus they actually did a good job reimbursing me for costs when I had to get care in a non-kaiser state no hassle or haggling.
          • onemoresoop 7y ago
            Just curious, what are your total yearly expenses on Kaiser? And how much does the employer pays on top of that, do you know? Thanks
            • dillondoyle 7y ago
              I own our company with a partner, so it's me paying for it either way. I buy on the market but company pays for it. I think the overall costs are lower for Kaiser, I think I have one of the gold plans and it's only like $20-40 copay for fairly specialist visits and most medicine is really affordable. I pay labs costs and I think looking at bill I remember them being more than the actual Doctor and they seem fairly expensive. In past years I've found I barely have any costs or recently with a 'high health' year a few of the more rate big costs helped me the out of pocket pretty quick. Just googling found this: http://info.kaiserpermanente.org/healthplans/colorado/individual/pdfs/2019-On-Exchange/KP_CO_Gold_0_20_RX_Copay.pdf http://info.kaiserpermanente.org/healthplans/colorado/indivi...
  • arebop 7y ago
    $6000/year sounds very low for healthcare in the U.S. When you say "I pay" are you really only counting the employee contribution? For purposes of analyzing aggregate healthcare costs for a whole country, we ought to be using combined employee+employer costs (W2 DD) and not just the (usually small) employee portion highlighted by HR at benefits season.
    • beat 7y ago
      I prefer to look at per capita cost, especially when comparing with other nations. It's appalling that we pay twice as much as anyone else, and that almost everyone has better care than we do in terms of outcome.
    • mrep 7y ago
      Not op, but you got me curious so I checked my W-2. $8,800 for me and I think mine is top notch (2,600 is my max out of pocket per year limit)
      • deleted 7y ago
        [deleted]
      • arebop 7y ago
        fwiw mine is about $20k with a $5k oop max, for a family of 2 in California. This compares to a worst-case ACA cost of about $65k.
  • Retric 7y ago
    The bill might have shown 150k, but costs to a hospital for 2 a weeks stay due to an infection should be a long way from 150k.
• madengr 7y ago
  I assume you are in a high deductible plan (HDP)? They don’t pay anything until you hit ~$4k/person, then 80% until OOP maximum of $7k for a family. But yes, a physical should have been 100% covered. Yeah, so between my employer and I, it is $20k for my HDP for family of 4. Then I sock away the HSA max of $7k every year to pay for the actual costs (including dental, which I don’t have).
• codegeek 7y ago
  For a family of 4, I pay total of about 20K per year as well (employer + employee cost) and even after that, we have a $5000 deductible AND on top, we have to be concerned about in-network/out of network bullshit. So for me, unless $25,000 has been spent, insurance company would not even come in the picture AND I am always scared if I wil get a bill that was out of network. This madness has to end and I don't give a shit that we are trying Single Payer. Everyone talks about Cost but what about Administrative issues ? Fighting incorrect claims, billing errors and what not. As far as I am concerned, this is one area where I am totally against Profit making motive. Let me correct myself. I am totally ok with Doctors and Hospitals directly making some profit but not insurance companies. Private insurance companies can go suck it. I am sick and tired of paying for their profits. Status quo has to change, that's it. EDIT: I am not against Insurance of some sort but they should only exist for Catastrophic illnesses. I need to go see my doctor for preventive care ? No need to involve Insurance company and wasting time on filing a claim that by definition requires more money to pay for the people involved unnecessarily.
  • A4ET8a8uTh0 7y ago
    Holy crap. I am in the process of "fighting" with insurance over meds we paid out of pocket even though they were supposed to cover it.. long story. We thought we hit a wall and we contacted one of the enforcement agencies. All of a sudden, we get an individual refund form and a place to mail it to. The amount was not astronomical ($1.5k), but not something I can just ignore. And that happens all over the country. Not everyone has my time to call, write and complain. Those are the moments I am ready to change the system. It is not really working for me. It is merely acceptable to a few.
    • codegeek 7y ago
      yep. Dont even get me started on how many times I had to fight with the insurance/billing/admin departments to even understand why I received a bill and for what. They must have a team of smart cryptographers to generate those crazy bills and invoices /s
      • 7y ago
• beat 7y ago
  This is where I think political leaders (Democrat or Republican) could do really well. It's not just making sure people are covered. It's the existential dread of dealing with opaque, unpredictable, and incomprehensible bureaucracy that can make life-and-death decisions or drop financially crippling bills in your lap, even if you have good insurance. The American health care system isn't just bad for the poor. It's bad for everyone. We just can't deal with it, because we are exposed directly to unnecessary complexity. But the fact that the people with money and good insurance are suffering from the system as well as the poor seems to be lost on Democrats, and the Republicans are just paralyzed by the whole idea of fixing health care. It's a massive political failure for both parties.
  • onemoresoop 7y ago
    Most political leaders both dems and reps are in bed with the insurance companies who are heavily lobbying to keep things as they are. But why not, they're cashing in big and the system is so convoluted that you cannot point any fingers.
  • pnutjam 7y ago
    This is literally the argument that Liz Warren and Bernie have been making, not to mention other Democrats.
    • beat 7y ago
      Eh. I'm watching it pretty closely, and I don't hear them talking in detail about how difficult it is.
      • pnutjam 7y ago
        https://elizabethwarren.com/plans/health-care https://elizabethwarren.com/plans/health-care
  • codegeek 7y ago
    "isn't just bad for the poor. It's bad for everyone" Thank you for saying that. I am amazed at how so many people don't see and understand this. It is not just about Cost which is insane alright. It is about the BS we have to go through after a visit to a doctor or hospital. I am scared about the type of bills and claim fights I have to do if I visit a doc. Not because I cannot afford it necessarily. But because I have to spend may be like 5 hours calling doctor's offices, insurance admins, billing departments and what not.
• apta 7y ago
  > And on top of it I get a better deal if I use no insurance at all for prescriptions. Interesting. So is it also the case that you can "negotiate" medicine prices? Is the actual price then different from what is on the tag?
  • onemoresoop 7y ago
    The price, at least in the US is as much as they could ask for. If they could get from you $1,000,000 on aspirin they would, trust me. It's called free market. They say that the market will fix any problem. But in reality it's not really free market. The manufacture price is insignificant but the bulk of the price is pinned on other things like R&D and other costs the pharmaceuticals claim. There are costs but there's also a huuuuuuuge profit to be made.
  • pkaye 7y ago
    Drug companies are using price discrimination to maximize their profits. Charge a lot to the insurance companies but less to others with no or poor insurance. If a drug only costs $10 to make, they can mark it up to $100 for the insured people. Then insurance charges a $20 copay. The drug company now gives a $20 copay assistance card to make it "free". The net profit is $100-20-10=$70. This is why California recently made is illegal to provide copay assistance to drugs where generics are available. I have a drug which cost $800/month to the insurance. My copay was $80/month. The manufacturer was so helpful to give me a $75/month copay card to cover this. Around some point the patent expired but the manufacturer continued to give that card out. Eventually the drug became generic and my pharmacy offered the generic version at $10/month. So my copay is higher but insurance cost is much lower. In fact the original manufacturer bugged me to petition the state legislature to change back that law.
    • elihu 7y ago
      It also can go the other way. I was once quoted two prices for a CT scan because they weren't sure if my insurance would cover it. If it did, they'd bill one amount to the insurance company. If they didn't cover it, I would be billed directly for an amount that was somewhere around double what the insurance would have been billed. I got the CT scan somewhere else.
• retrac 7y ago
  > I am paying nearly 20k a year for possible emergencies? Kind of, yes. The vast majority of healthcare spending is, unsurprisingly, on very sick people. Insurance is for the outlier cost. The difference from other insurances is that almost everyone faces that outlier cost eventually in their lives, assuming they don't get hit by a bus in their 20s.
  • panzagl 7y ago
    Yeah, they face that outlier cost when they're on Medicare and the government is paying anyway...
• lotsofpulp 7y ago
  Why would the insurance company send you a bill? The healthcare provider sends the bill, as they are the party that is owed.
• BurningFrog 7y ago
  The trap to be aware of here is that the fact that the current system sucks is no guarantee that any proposed alternative will be better.
  • tzs 7y ago
    You could put on a blindfold and then throw a dart at a map of the of first world countries, and if we just adopted whatever system is used where that dart lands it almost certainly would be a big improvement. If making a better health care system was a problem that everyone else sucked at also then I'd be more inclined to worry that trying to improve ours could make it worse, but with so many good examples--using a variety of different approaches--of how to do it better I'm not worried that trying to fix ours would make it suck even more. Even if, somehow, we actually do manage to make it suck more we can just try again. Eventually we'll have run out of new ways to suck and will have to stumble onto one of those good approaches that the other first world countries use.
    • onemoresoop 7y ago
      Good point. Wherever the dart falls is not corrupted yet. A new system comes into existence, it is efficient for a while then gets corrupted again and the cycle repeats
  • D-Coder 7y ago
    Unless the alternative includes forks to the eyeball, it could hardly be worse.
• grecy 7y ago
  I live in Canada, and haven't even earned $20k of income in a few years, but I still have excellent cover. I broke my nose, was seen within 5 minutes and it was straightened (after anaesthetic). I got hit by a car on my bike, was seen in 5 minutes, no worries. Needed and x-ray for my lugs to get residency. Took 10 minutes. Free. My brother broke his leg horribly. Multiple surgeries, a month in hospital, etc. etc. There are no bills, just taxes - though it's very manageable.
  • bureaucrat 7y ago
    Don't forget 6 months waiting time for breast cancer diagnoses. Don't forget over a months waiting time for a simple antibiotic shot, which my friend died while waiting. Don't forget, can't see a doctor for two freaking weeks for a simple stomatitis. Don't forget 3+ months and waiting for a freaking endoscope procedure. For everyone not in critical situation, your country's health care is shit. Don't even deny that it's fucked up. Thanks god I moved out of that country after my friend died due to sepsis because of the fucked up system that made him wait months to get his antibiotic shot.
    • grecy 7y ago
      It depends entirely on where you live. Out West there is no waiting and I've never experienced any of what you're talking about. I've only heard stories about how it is in the East, I've never met anyone first hand that has experienced it, or really hates it.
      • bureaucrat 7y ago
        Because you haven't experienced a problem in your body that is rotten deep inside but shows little to no symptoms. My friend died in Alberta. It took two weeks to even see a doctor and more to wait for antibiotic shots. Doctors try hard to not make problem a problem because the system is fucked in a way that doctors benefit from less patients. They don't try to cure. They wrap up the symptom and makes patients think it's a small problem. Oh yeah, there is a way to be cured without waiting in Canada. When you're on the verge of death. I despise hypocrites praising health-not-care in Canada. It just makes me sick.
• sf_rob 7y ago
  My SO has insurance through/at her med school and has to dispute bills every time she goes in because they bill them as non-covered. Oh and imaging in the same building / under the same hospital wasn't covered. It's crazy that even medical professionals can't get good/clear services.
• sitkack 7y ago
  They will send you to collections w/o warning. Good luck getting the credit hit removed.