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> Health insurance is good enough until surprise they don't want to cover you or you get surprise bills in the mail from the hospital. Constantly amazed this c
by aplummer 7y ago
> Health insurance is good enough until surprise they don't want to cover you or you get surprise bills in the mail from the hospital.
Constantly amazed this can be a thing in a first world country. Can this actually happen?
- inferiorhuman 7y agoYes
- Operyl 7y agoAll the damn time. It’s so infuriating.
- vikramkr 7y agoYeah it's pretty common. There's a reason health insurance is such a big political discussion in the US
- whymauri 7y agoA close friend of mine's wife paid their health insurance for decades, without fail. Their employer changed the insurance provider without notification, but somehow they continued paying the wrong provider. She recently got breast cancer, and now the new provider is denying all claims on the basis that she was paying the wrong provider. They are basically screwed now after maintaining a non-deliquent relationship with their healthcare provider for longer than I've been alive. If this is not emblematic of what's wrong with our healthcare... IDK what is.
- xenospn 7y agoMy friend paid his health insurance for years. Got diagnosed with cancer (leukemia). Hospital said treatment would cost $750k. Insurance told him to go fuck himself and isn't covering anything.
- RandomTisk 7y agoDo you know what the treatment option(s) were? That seems extremely expensive even for cancer. Makes me wonder what my family plan's maximums are.
- xenospn 7y agoI do not. They managed to raise about $80k through GoFundMe, and he just found a donor after months of looking. Assuming he will be in debt for the rest of his life, if he lives.
- ericd 7y agoDoesn’t seem unrealistic for a list price. List price for a standard baby delivery and 3 day recovery around here can be up to ~$80k. Of course, the real insurance contracted price is $10k. The list prices are completely absurd, and it’s even more absurd that hospitals try to collect that clearly fictional amount from patients without good coverage.
- zaroth 7y agoAfter ACA there are no lifetime maximums. If it’s an FDA approved treatment which he is eligible for (e.g. there are not other first line treatments which should be tried first) then AFAIK an insurance company cannot simply refuse to pay. Another option is to move to a Medicare expansion state and stop working, which will allow you to immediately qualify for free health care with generally some of the best coverage you can get.
- refurb 7y agoInsurance companies are free to not cover an FDA approved product. CVS publishes a list every year, although they tend to either be the branded drug when a generic is available or a drug where there are as effective, but cheaper products are available. It’s a cost versus benefit analysis and no different than what you see in single payer systems. I will say from experience that oncology is one therapeutic area where payers wield much less control. Insurers don't like bad press and denying cancer drugs is a great way to end up in the NY Times. That said, if a drug is regarded as "experimental" (either the FDA hasn't approved it for that type of cancer OR there is limited data to suggest it works) they will say "no". https://www.caremark.com/portal/asset/Formulary_Exclusion_Drug_List.pdf https://www.caremark.com/portal/asset/Formulary_Exclusion_Dr...
- mysterypie 7y ago> somehow they continued paying the wrong provider How does it happen that the wrong (old) provider still accepts money if they no longer cover you? Can this be used as a legal argument that the old provider is on the hook for coverage since they continued taking the money?
- londons_explore 7y ago"After review, it seems you are no longer eligible for our services. Have a refund"
- scarejunba 7y agoInteresting. Is a defense mechanism to this then to use the healthcare at least once every period you're comfortable with? I have Kaiser Platinum and looks like I'm about to start requesting monthly tests on things. Co-pay is about $10, so for $10 a month I can guarantee my healthcare is working.
- xenospn 7y agoNot only does it happen, it's more likely than not.
- ohazi 7y agoNot only can happen, this is often what happens by default. You go to a doctor, then the doctor and the insurance have several months of ping pong during which you get about half a ream of "This is not a bill" documents that show a different set of things with different dollar amounts every other cycle, and then eventually you get an actual bill for the largest amount. If it's wrong, you can spend another year fighting them to fix the billing codes. It's a total shit show.
- leeoniya 7y agocombine that with frequently incompetent medical coding, and your insurence ends up not covering stuff they would otherwise cover 100%. my wife is on 3-way phone calls between the billing dept and insurance every month fighting incorrect bills from 6 months ago that did not arrive until 3 months later. she is now basically a better medical coder than the provider. it's a fucking circus designed to make patients pay through attrition alone - it eats away at your morale and free time.
- jlarocco 7y agoIt happens all the time here; it's ridiculous. At my company's last benefits meeting (where they go over the yearly changes to our insurance coverage) a coworker described a situation where they had a surgery at an in network (accepted by our insurance) hospital, with in network surgeons and nurses, but was assigned an out of network anesthesiologist without his knowledge, and later got a giant bill for it (well over $1000, IIRC). Even when a person tries to follow all the rules, they find a way to screw you.
- drewg123 7y agoI'd like to see a legal limit to this out-of-network billing. If you limit them to the medicare reimbursement rate, I think this would stop happening.
- maxerickson 7y agoBanning networks would be less drastic than setting out of network prices to Medicare.
- craftinator 7y agoMaybe before a surgery, gather all of the hospital staff who are going to attend, and record a video while saying "I do not consent to working with anyone from out of network. If you are an out of network physician, I do not consent to be your patient." That ought to be interesting in court if they bill you. Really, the onus of responsibility is between your insurance company and the hospital (i.e. paying and billing party). If they fail, it needs to be something resolved between them. Because that's their fucking job.
- Ididntdothis 7y agoYou clearly haven't dealt with these guys. The hospital can charge whatever it feels like and the insurance pays whatever it feels like. And the patient sits in the middle and has to figure it out.
- 7y ago
- smitty1110 7y agoMy mom had a very mild form of breast cancer 10 years ago, caught in the earliest stages and hasn’t reappeared since. Last year, her oncologist had to get creative with billing codes, because the insurance company changed mom’s coverage so that yearly screening was no longer “preventative“, and thus not covered. No warning, just a huge bill when she went to pay the copay and leave. The insurance is through her job as a teacher in a large county, and is generally a very comprehensive plan. It would be a gold plan of some sort through an Obamacare exchange. Never underestimate the callousness of the American health system.
- dboreham 7y agoThis happens all the time. A colonoscopy is covered, but if some random not quite perfect thing is found that they snip out just to be on the safe side, then colonoscopies are never again covered.
- pkaye 7y agoYes it happens in many countries. For example in UK someone mentioned they have Phenylketonuria and their NHS will not cover a medicine Kuvan that would improves their quality of life by allowing them to consume a reasonable amount of protein.
- cheerlessbog 7y agoMost likely that was based on a cost benefit analysis involving QALY. Which is logically a reasonable way to figure out how to spend Healthcare dollars. The US system is not.
- mantap 7y agoThe NHS negotiates prices directly with drug companies. Usually this situation happens if a drug company refuses to offer a reasonable price. Yes this sucks for anybody who depends on such a drug, but there is no alternative.
- KuiN 7y agoThis is misleading at best. The NHS Comissioning Board has commissioned Sapropterin for use. However, due to its extraordinarily high costs and limited efficacy compared to maintaining a restricted diet, it is only prescribed in scenarios where there is an urgent clinical need for treatments like Sapropterin. The NHS Commissioning Board's report on Tetrahydrobiopterin/Sapropterin/Kuvan is here: https://www.england.nhs.uk/wp-content/uploads/2013/04/e12-p-a.pdf https://www.england.nhs.uk/wp-content/uploads/2013/04/e12-p-...
- dboreham 7y agoNot only can it happen, it happens regularly to almost everyone.
- nojvek 7y agoAlmost everyone I know has a nightmare healthcare story. We have the worst healthcare of a first world country. Many folks who have employer provided healthcare from top tier tech companies are kinda happy but anyone who is below the 50th percentile is living on the edge and playing a gamble. I’m a solopreneur and we’ve decided to go without health insurance. The ridiculous premiums + super high deductibles mean even if you were to go to the doctor, you’re still paying full cost. The gamble is you want to avoid any catastrophic visits which would cost 20k+ to offset the insurance deductible + premiums. Compared to Australia, US healthcare system would be considered a joke.
- charwalker 7y agoWe're already out of pocket about US$1000 this year with basic check ups, lab tests, and one allergy test (more to come) for my SO. That's with one of the best employer provided healthcare benefits I've ever had that has about $400 a month in premiums. If I need a sleep study or further surgery as already recommended then we are looking at $4-5k for that alone not including followup, medications, supplies, or other appointments. Without the ACA I might be dead today due to costs and availability like if I was denied insurance based on pre-existing conditions and could not afford medical care I needed over the last 5-8 years plus mental health care. My parents paid about $22k out of pocket for a surgery I needed during that time (and on their insurance). I'd have about $45-50k in the bank if my healthcare over the past decade was 100% covered. That is about 10x my current retirement savings or could be a down payment on a house. The USA is not representative of first world countries or at least should not be directly compared to them when it comes to health care.