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> 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 t

> 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 ago
Ah, 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 ago
Are 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 ago
  Yes, 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 ago
  Yeah. 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 ago
Around 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.

> 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 ago

Ah, 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 ago

Are 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 ago
Yes, 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 ago
Yeah. 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 ago

Around 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.