4 ms·
The last time I attempted to get a quote on how much a medical visit would require under a PPO, I couldn't. The price was literally unknown, and seeking medical
by deathanatos 6y ago
The last time I attempted to get a quote on how much a medical visit would require under a PPO, I couldn't. The price was literally unknown, and seeking medical attention meant unknown, unlimited liability.
The FTC article you cite is actually in favor of the type of transparency lamented by the comment you are responding to.
> The staff comment explained the risk that the latter type of transparency might harm competition by enabling competing providers to coordinate or collude on price
Where "latter type" referred to "plan structures and contracted fee schedules between health plans, hospitals, and physician service entities." (The "former type" was "actual or predicted out-of-pocket expenses, co-pays, and quality and performance comparisons of plans or providers" which is what would effect parent's experiences; the FTC "encouraged" that type of legislature.)
I don't necessarily agree with the FTC here, but their comment isn't covering the lack of information that causes consumers have no idea what the bill is until they've already incurred the bill.
- mypalmike 6y ago> under a PPO... seeking medical attention meant unknown, unlimited liability. Most, if not all, health plans in the US have annual out of pocket maximums on the order of $10,000 per individual.
- deathanatos 6y agoAh, that's a fair point, "unlimited" was a bit strong. The last PPO my employer offered has a maximum on the order you cite. (It does have a few exceptions and situations it doesn't apply to, however.) My own experience here is driven by having gone in for what I expected to be a $50-$100 visit (a doctor took a look at my vocal chords); it was $4,000. How that is justified, I still don't know. (Thankfully, insurance covered some of it, but for such a minor visit, it was still way more expensive than I expected.) I don't know that "well, it can't be more than $10,000" is much comfort when you're walking in for something that seems minor, such as lingering effects of a cold (this example) or an infected finger (I was unable to obtain any pricing for this, prior to the visit). A few years later, surgery would have cost me ~$300. (But that was under an HMO. And I got a quote, in advance!) (While my initial post specifically mentioned PPOs, as that is what I'm used to, there are also those without insurance, which doesn't have the max out-of-pocket of an insurance plan.)
- ta1234567890 6y agoAre you saying that if you get a $500k[1] bill from the hospital, "most, if not all health plans in the US" will cover at least $490k? [1]: Given that a mere c-section (30min, super standard procedure) + 3 days at the hospital can be $85k. It's probably pretty common for hospital bills to exceed a few hundred thousands for anything more complicated or requiring a long stay at the hospital.
- refurb 6y agoYes, that was actually passed as a part of ACA, which set requirements for maximum out of pocket for ACA-compliant plans.[1] For 2020, it's ~$8k for an individual and ~$16k for a family. Most non-high deductible plans are a few thousand for an individual and high-deductible plans can be close to $10k. [1]https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
- skinnymuch 6y agoYeah. So when you don’t have insurance or your insurance plan has an issue and doesn’t cover the absurd bill you got that is incentivized to be high because of this system, you can be royally screwed. I think medical is the biggest reason for bankruptcy.
- skinnymuch 6y agoAround 10% of people don’t have health insurance. I’d be surprised if there aren’t some crappy health insurance plans around for another portion of people that ends up not covering enough when things go bad.