4 ms·

> One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for th

> One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. As a general rule this is not an unusual characteristic. Get a procedure done in another country that turns out not not be covered and they presumably will bill you for it. The mess comes about because of attempting to control prices with networks and pre-approvals, which is a fairly recent mess as they tried to control prices and govt layers requirements and escapes/loopholes on them. It would be better to just wipe that all away and get policies that say if you get sick you get a flat payment to spend as you wish. I.e., actual insurance.

arcticbull 6y ago
In many places there aren't non-covered services on offer. And where there are, a fee schedule is published, publicly, in advance.
- unishark 6y ago
  > And where there are, a fee schedule is published, publicly, in advance. So you're saying the patient is responsible for the payment when the service is not covered...
  - arcticbull 6y ago
    There's a bit more nuance to it than that. 1. What services are medically necessary that you think aren't covered by the health service in another country? You'd likely be hard pressed to find any in the first place. I think that's an important aspect. 2. But say you had non-medically-necessary surgery, that isn't somehow covered by the health system. In that case... a. The prices are actually listed ahead of time. b. Who is owed the money may vary: it's not necessarily the service provider who may be owed, it could be the health system. But yeah, in case 2, the patient is ultimately responsible, though my point is in most countries case (2) either doesn't exist or is extremely limited, or limited only to non-medically-necesary procedures. > I.e., actual insurance. Medical insurance isn't insurance. Insurance is something you get to cover you in the event of an unexpected cost. Humans will get sick, they will get cancer, they will get heart attacks and they will die. Something that pays for that isn't insurance, it's more of a structured payment plan. Your house probably won't burn down. You almost certainly, if all goes well, will die of cancer.
  - kace91 6y ago
    > So you're saying the patient is responsible for the payment when the service is not covered... I'm talking just about my country, but the procedures that aren't covered are in the practical totality of cases elective - things like braces for aesthetical reasons, plastic surgery that is done for vanity reasons (still covered when the lack of it seriously affects your life like burning victims), things like that.
rsynnott 6y ago
So in Ireland we have a split system. The public system, it's not an issue; the state pays. If you have private health insurance and go to a private hospital, they'll... check with your insurance that it's covered beforehand. Which just seems like common sense, really; do they not do that in the US? I suppose emergency medicine is done in US private hospitals, which to a large extent doesn't happen here; private hospitals would typically do elective stuff. But presumably that doesn't apply in the case in the article, so why on earth wasn't the hospital required to check first?

arcticbull 6y ago

In many places there aren't non-covered services on offer. And where there are, a fee schedule is published, publicly, in advance.

unishark 6y ago
> And where there are, a fee schedule is published, publicly, in advance. So you're saying the patient is responsible for the payment when the service is not covered...
- arcticbull 6y ago
  There's a bit more nuance to it than that. 1. What services are medically necessary that you think aren't covered by the health service in another country? You'd likely be hard pressed to find any in the first place. I think that's an important aspect. 2. But say you had non-medically-necessary surgery, that isn't somehow covered by the health system. In that case... a. The prices are actually listed ahead of time. b. Who is owed the money may vary: it's not necessarily the service provider who may be owed, it could be the health system. But yeah, in case 2, the patient is ultimately responsible, though my point is in most countries case (2) either doesn't exist or is extremely limited, or limited only to non-medically-necesary procedures. > I.e., actual insurance. Medical insurance isn't insurance. Insurance is something you get to cover you in the event of an unexpected cost. Humans will get sick, they will get cancer, they will get heart attacks and they will die. Something that pays for that isn't insurance, it's more of a structured payment plan. Your house probably won't burn down. You almost certainly, if all goes well, will die of cancer.
- kace91 6y ago
  > So you're saying the patient is responsible for the payment when the service is not covered... I'm talking just about my country, but the procedures that aren't covered are in the practical totality of cases elective - things like braces for aesthetical reasons, plastic surgery that is done for vanity reasons (still covered when the lack of it seriously affects your life like burning victims), things like that.

rsynnott 6y ago

So in Ireland we have a split system. The public system, it's not an issue; the state pays. If you have private health insurance and go to a private hospital, they'll... check with your insurance that it's covered beforehand. Which just seems like common sense, really; do they not do that in the US? I suppose emergency medicine is done in US private hospitals, which to a large extent doesn't happen here; private hospitals would typically do elective stuff. But presumably that doesn't apply in the case in the article, so why on earth wasn't the hospital required to check first?