5 ms·

"You didn't check that the second doctor in your surgery, who came in while you were unconscious was in-networking? Well, too bad, you should have done your due

"You didn't check that the second doctor in your surgery, who came in while you were unconscious was in-networking? Well, too bad, you should have done your due diligence more carefully!" When we had a kid, it was $10K out-of-pocket, and we had a bunch of "out-of-networking" bingo due to mostly lab tests or a doctor out of network at an in-network ER. Since then kid themselves also had an ambulance ride (seizure), and that too was "out of networking" in spite of being the only ambulance provider available within 15+ minutes.

lotsofpulp 6y ago
The involuntary treatment by out of network providers and them being able to charge you whatever they feel like definitely needs to be outlawed.
- deleted 6y ago
  [deleted]
learc83 6y ago
What you're describing is completely illegal now. Under the Affordable Care Act, which applies nationwide, insurers are required to cover out-of-network emergency care as if it was in-network care, which means your deductible and coinsurance can't be higher than the regular in-network amounts.
- lotsofpulp 6y ago
  As far as I understand, the out of network provider can still come after you for whatever the insurance doesn’t pay them. In the US, you basically provide your healthcare provider with a blank check.
- Someone1234 6y ago
  Everything I said happened under the ACA. It was "only" $10K because of the ACA's out-of-pocket maximums. A quick google suggests this is common: > It's important to understand, however, that the out-of-network emergency room does not have a contract with your insurer, and is not obligated to accept their payment as payment in full. If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay.
  - learc83 6y ago
    You said >Since then kid themselves also had an ambulance ride (seizure), and that too was "out of networking" in spite of being the only ambulance provider available within 15+ minutes. That's the illegal part.
    - Someone1234 6y ago
      If you say so. The $1,500+ ambulance bill still existed, I still paid it, and my kid wasn't even born until five+ years after the ACA came into force. The insurance company was "nice" enough to let me count it towards my kid's deductible for that year, but I paid every cent.
      - learc83 6y ago
        People will gladly collect money they aren't legally owed. In this case, unless there is more to the story, you shouldn't have paid it.
        HarryHirsch 6y ago
        In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming.
        learc83 6y ago
        >In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming. Stop using "victim blaming" as a way to shut down discourse. In every country in the world people run scams. Universal healthcare would make these particular kinds of scams a lot harder, but I guarantee you, you could still find this kind of anecdotal evidence of criminal behavior relating to healthcare.
    - surfmike 6y ago
      I’ve had that experience too. What makes you think it’s illegal?
WarOnPrivacy 6y ago
sidebar: In 1991 we birthed a child at home and the absolute total was around $3500. It was all out of pocket. At the time, insurance would not cover midwives, nevertheless a home birth.
- lostapathy 6y ago
  My neighbor did that 3 times. Didn’t work out so hot for the third kid. I would never consider asking if they regret that choice, but I cannot imagine the grief from losing your child in a home birth scenario.
  - WarOnPrivacy 6y ago
    There's a lot of factors that go into the decision making. I don't want to speculate on their birth team - our midwives only accepted the lowest risk mothers. For our first birth, a hospital would have been a terrible, terrible option. By the time of our 4th birth (10y later, twins), hospital birthing environments had vastly improved. Our OB/GYNs practice was 100% women w/ midwives on staff. The only thing we missed was having a doula.

lotsofpulp 6y ago

The involuntary treatment by out of network providers and them being able to charge you whatever they feel like definitely needs to be outlawed.

deleted 6y ago
[deleted]

learc83 6y ago

What you're describing is completely illegal now. Under the Affordable Care Act, which applies nationwide, insurers are required to cover out-of-network emergency care as if it was in-network care, which means your deductible and coinsurance can't be higher than the regular in-network amounts.

lotsofpulp 6y ago
As far as I understand, the out of network provider can still come after you for whatever the insurance doesn’t pay them. In the US, you basically provide your healthcare provider with a blank check.
Someone1234 6y ago
Everything I said happened under the ACA. It was "only" $10K because of the ACA's out-of-pocket maximums. A quick google suggests this is common: > It's important to understand, however, that the out-of-network emergency room does not have a contract with your insurer, and is not obligated to accept their payment as payment in full. If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay.
- learc83 6y ago
  You said >Since then kid themselves also had an ambulance ride (seizure), and that too was "out of networking" in spite of being the only ambulance provider available within 15+ minutes. That's the illegal part.
  - Someone1234 6y ago
    If you say so. The $1,500+ ambulance bill still existed, I still paid it, and my kid wasn't even born until five+ years after the ACA came into force. The insurance company was "nice" enough to let me count it towards my kid's deductible for that year, but I paid every cent.
    - learc83 6y ago
      People will gladly collect money they aren't legally owed. In this case, unless there is more to the story, you shouldn't have paid it.
      - HarryHirsch 6y ago
        In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming.
        learc83 6y ago
        >In normal countries you don't have that kind of criminogenic environment. Also, do stop the victim blaming. Stop using "victim blaming" as a way to shut down discourse. In every country in the world people run scams. Universal healthcare would make these particular kinds of scams a lot harder, but I guarantee you, you could still find this kind of anecdotal evidence of criminal behavior relating to healthcare.
  - surfmike 6y ago
    I’ve had that experience too. What makes you think it’s illegal?

WarOnPrivacy 6y ago

sidebar: In 1991 we birthed a child at home and the absolute total was around $3500. It was all out of pocket. At the time, insurance would not cover midwives, nevertheless a home birth.

lostapathy 6y ago
My neighbor did that 3 times. Didn’t work out so hot for the third kid. I would never consider asking if they regret that choice, but I cannot imagine the grief from losing your child in a home birth scenario.
- WarOnPrivacy 6y ago
  There's a lot of factors that go into the decision making. I don't want to speculate on their birth team - our midwives only accepted the lowest risk mothers. For our first birth, a hospital would have been a terrible, terrible option. By the time of our 4th birth (10y later, twins), hospital birthing environments had vastly improved. Our OB/GYNs practice was 100% women w/ midwives on staff. The only thing we missed was having a doula.