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Totally agreed. My favorite is when you add this scenario to physically being somewhere without any in-network doctors. I cut my hand open climbing in northern

Totally agreed. My favorite is when you add this scenario to physically being somewhere without any in-network doctors. I cut my hand open climbing in northern New Mexico, bandaids and gauze weren't stopping the bleeding, so I went to the nearest town clinic/urgent care. Ultimately got 8 stitches. My insurance denied (almost) everything. They would later explain that I was supposed to drive myself several hours to Albuquerque to get my hand looked at instead. I say almost because the covered $70 for the lidocaine shot, but literally nothing else. Why they deemed the lidocaine necessary but not the stitches could not be explained. Clearly they had a way to pay the clinic, so wasn't that. Another whacky thing I discovered: the insurance company gets to decide how much, if any, of your uncovered, out-of-pocket bill counts towards your deductible. In this case they deemed $109 of $832 to be the right number, with no explanation as to how they arrived at that sum.

jrs235 5y ago
Should probably have gone to an ER. Emergencies are easier to argue and appeal. "Urgent" (yet less costly) and they assume you still could have waited... it wasn't an emergency yet. I hate our insurance/medical payment/determination system. It's a joke.
- vinceguidry 5y ago
  I went to an in-network urgent care for a particularly painful pinched nerve and got worthless drugs, and the uncovered part of the bill came out more than the covered part. Next time I'll just suffer at home and hope I don't die. It'll amount to the same result.
- Workaccount2 5y ago
  Given the location and possible severity, the only viable way to an emergency room might have been a helicopter. Which insurance almost certainly would not cover. So the insurance is saying "If you paid $80,000 for a medevac, we would have covered your hospital bill".
  - FireBeyond 5y ago
    Hell, a few years ago UHC made the news because they were denying coverage for Flight EMS from serious car accidents due to "lack of pre-authorization".
- ceejayoz 5y ago
  They're looking at clamping down on that, too. https://arstechnica.com/science/2021/06/biggest-health-insurer-plans-to-deny-er-bills-if-it-doubts-you-had-an-emergency/ https://arstechnica.com/science/2021/06/biggest-health-insur... > Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.
  - sidewndr46 5y ago
    This was my experience as well. I went to the ER with tremendous chest pain, it turns out I have some issue with my ribcage. Not my heart. UHC decided I did not in fact need to see a cardiologist or an ECG since I wasn't having a heart attack and declined to pay for anything. Multiple attempts on my part to resolve this yielded nothing. I contacted the state of TX, who brought suit against both parties (insurance & service provider). Somehow, the day before the court appearance they all agreed to settle the claim at no cost to me.
    - yellow_lead 5y ago
      Good on you for being persistent.
  - bradstewart 5y ago
    Perhaps unsurprisingly, I do indeed have United Healthcare.
- vitaflo 5y ago
  >Should probably have gone to an ER. Emergencies are easier to argue and appeal. ER visits for emergencies are also covered as in-network care under the ACA, even if you're half way across the country. I know cuz I was 1500 miles into a road trip when I went to the ER. My insurance covered it as in-network.
- bradstewart 5y ago
  The nearest ER was still much, much farther away than the urgent care facility. I would have undoubtedly put myself at more risk by trying to drive a vehicle down a highway for an hour. Thankfully the bill I did receive was somewhat reasonable, and I was able to pay it without much issue.
JadeNB 5y ago
> Another whacky thing I discovered: the insurance company gets to decide how much, if any, of your uncovered, out-of-pocket bill counts towards your deductible. In this case they deemed $109 of $832 to be the right number, with no explanation as to how they arrived at that sum. Not that I think much of the likelihood of success, but aren't you, for any such decisions, entitled to (a) receive a justification on request, and (b) appeal that decision?
- postoak 5y ago
  Yes, but when the insurance company controls the appeals process, they will likely deny it.
- handrous 5y ago
  Screwing around with insurance process bullshit can easily exceed the value of whatever you're trying to regain/figure-out. Hours, literally, of on-hold time, likely more than once, and if you're trying to get them to pay for something they don't want to, you're likely going to need to get state regulators or lawyers involved, which means even more time (and money, in the latter case). Probably you'll end up having to do the same thing with one or more hospitals or healthcare providers, playing go-between with them and insurance, and usually those places subject you to the same malicious-incompetence as the insurer does.
LorenPechtel 5y ago
I believe they count what it would have been in-network. As for saying you should have driven hours with bleeding you couldn't stop--do you have any sort of appeal process? That certainly doesn't sound right.
- handrous 5y ago
  It's pretty common for providers not to cover anything except ER visits, out of your home state. And that only because (I think) they're required to. And I bet they interpret that as narrowly as possible ("heart attack, went to the ER, but then moved to a bed in a normal room? We'll cover the ER care but not the room or any care that took place there, have fun with bankruptcy"). An urgent care might not count.
hef19898 5y ago
The only similar thing I know in the EU is needing medical care abroad, meaning out side the country you are living in (more accurate, the country you are insured in). Then it can be scetchy, especially if certain procedures are not accepted in your country. But even then you only pay the difference, you have in some cases, pay upfront before you get reimbursed by your insurance. These differences tend to be rather small. Again from a German perspective, supplemental insurance for travel (global, including repatriation flights if necessary, and even helicopter evac) is very affordable. E.g. through the ADAC, the German automobile club. Ot is even possible for German citizens living abroad (I think outside the EU) to pay into a special insurance to maintain the German health insurance. Around 100 bucks or so, but I would have to read up on it again. Which is nice, e.g. because you travel full time or are an expat (the US comes to mind). Edit: That's one provider, the 1 year plan is 35 Euro, ythe 5 year plan 59 per month. https://www.hansemerkur.de/langfristige-auslandskrankenversicherungen https://www.hansemerkur.de/langfristige-auslandskrankenversi... EDIT 2: Including the US and Canada prices increase by roughly 3 fold.

jrs235 5y ago

Should probably have gone to an ER. Emergencies are easier to argue and appeal. "Urgent" (yet less costly) and they assume you still could have waited... it wasn't an emergency yet. I hate our insurance/medical payment/determination system. It's a joke.

vinceguidry 5y ago
I went to an in-network urgent care for a particularly painful pinched nerve and got worthless drugs, and the uncovered part of the bill came out more than the covered part. Next time I'll just suffer at home and hope I don't die. It'll amount to the same result.
Workaccount2 5y ago
Given the location and possible severity, the only viable way to an emergency room might have been a helicopter. Which insurance almost certainly would not cover. So the insurance is saying "If you paid $80,000 for a medevac, we would have covered your hospital bill".
- FireBeyond 5y ago
  Hell, a few years ago UHC made the news because they were denying coverage for Flight EMS from serious car accidents due to "lack of pre-authorization".
ceejayoz 5y ago
They're looking at clamping down on that, too. https://arstechnica.com/science/2021/06/biggest-health-insurer-plans-to-deny-er-bills-if-it-doubts-you-had-an-emergency/ https://arstechnica.com/science/2021/06/biggest-health-insur... > Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.
- sidewndr46 5y ago
  This was my experience as well. I went to the ER with tremendous chest pain, it turns out I have some issue with my ribcage. Not my heart. UHC decided I did not in fact need to see a cardiologist or an ECG since I wasn't having a heart attack and declined to pay for anything. Multiple attempts on my part to resolve this yielded nothing. I contacted the state of TX, who brought suit against both parties (insurance & service provider). Somehow, the day before the court appearance they all agreed to settle the claim at no cost to me.
  - yellow_lead 5y ago
    Good on you for being persistent.
- bradstewart 5y ago
  Perhaps unsurprisingly, I do indeed have United Healthcare.
vitaflo 5y ago
>Should probably have gone to an ER. Emergencies are easier to argue and appeal. ER visits for emergencies are also covered as in-network care under the ACA, even if you're half way across the country. I know cuz I was 1500 miles into a road trip when I went to the ER. My insurance covered it as in-network.
bradstewart 5y ago
The nearest ER was still much, much farther away than the urgent care facility. I would have undoubtedly put myself at more risk by trying to drive a vehicle down a highway for an hour. Thankfully the bill I did receive was somewhat reasonable, and I was able to pay it without much issue.

JadeNB 5y ago

> Another whacky thing I discovered: the insurance company gets to decide how much, if any, of your uncovered, out-of-pocket bill counts towards your deductible. In this case they deemed $109 of $832 to be the right number, with no explanation as to how they arrived at that sum. Not that I think much of the likelihood of success, but aren't you, for any such decisions, entitled to (a) receive a justification on request, and (b) appeal that decision?

postoak 5y ago
Yes, but when the insurance company controls the appeals process, they will likely deny it.
handrous 5y ago
Screwing around with insurance process bullshit can easily exceed the value of whatever you're trying to regain/figure-out. Hours, literally, of on-hold time, likely more than once, and if you're trying to get them to pay for something they don't want to, you're likely going to need to get state regulators or lawyers involved, which means even more time (and money, in the latter case). Probably you'll end up having to do the same thing with one or more hospitals or healthcare providers, playing go-between with them and insurance, and usually those places subject you to the same malicious-incompetence as the insurer does.

LorenPechtel 5y ago

I believe they count what it would have been in-network. As for saying you should have driven hours with bleeding you couldn't stop--do you have any sort of appeal process? That certainly doesn't sound right.

handrous 5y ago
It's pretty common for providers not to cover anything except ER visits, out of your home state. And that only because (I think) they're required to. And I bet they interpret that as narrowly as possible ("heart attack, went to the ER, but then moved to a bed in a normal room? We'll cover the ER care but not the room or any care that took place there, have fun with bankruptcy"). An urgent care might not count.

hef19898 5y ago

The only similar thing I know in the EU is needing medical care abroad, meaning out side the country you are living in (more accurate, the country you are insured in). Then it can be scetchy, especially if certain procedures are not accepted in your country. But even then you only pay the difference, you have in some cases, pay upfront before you get reimbursed by your insurance. These differences tend to be rather small. Again from a German perspective, supplemental insurance for travel (global, including repatriation flights if necessary, and even helicopter evac) is very affordable. E.g. through the ADAC, the German automobile club. Ot is even possible for German citizens living abroad (I think outside the EU) to pay into a special insurance to maintain the German health insurance. Around 100 bucks or so, but I would have to read up on it again. Which is nice, e.g. because you travel full time or are an expat (the US comes to mind). Edit: That's one provider, the 1 year plan is 35 Euro, ythe 5 year plan 59 per month. https://www.hansemerkur.de/langfristige-auslandskrankenversicherungen https://www.hansemerkur.de/langfristige-auslandskrankenversi... EDIT 2: Including the US and Canada prices increase by roughly 3 fold.