5 ms·

> Most of the time the system works for people who have good coverage. I'm sorry, but I just can't see how this is true. Do you only go to the doctor for a yea

by ohazi 5y ago

> Most of the time the system works for people who have good coverage. I'm sorry, but I just can't see how this is true. Do you only go to the doctor for a yearly checkup, or something? I've had "good" coverage (paid for by big employers with cushy all inclusive packages), and I've also had the cheapest option on CA’s exchange, and the only difference was whether I had to pay the receptionist $25 or $150. The "we won't cover this" and the "surprise, this costs 50x what you were told!" billing nightmare comes six months later. This has happened with every insurer I've ever had.

rootusrootus 5y ago
It really does vary by individual. My mom is going through cancer treatment right now. 35K/month in medication and she pays $250. I don't expect surprise bills later. She had surgery 8 years ago for the same cancer and that was also $250, for a week-long hospital stay. In my experience it does help to have an HMO. My mom uses Kaiser. So there's none of this in- vs out-of-network. One billing system, one insurance, etc. She has nothing but positive things to say about them. My dad had a similar experience towards the end of his life. He loved 'em. And nobody was left destitute as the result of his medical care.
- hef19898 5y ago
  That shouldn't be the exception, that should be the rule.
- nrmitchi 5y ago
  One of the problems with the how the US medical system works is that "35K/month in medication" is only "35k/month" because of some expectation that insurance is going to pay whatever the negotiated rate it (and I seriously doubt that it's 35k/month). Lets look at it this way: If that was the true price, what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
  - rootusrootus 5y ago
    In this case the insurance is paying $25K/month for the medication, so they definitely did negotiate it down somewhat. > what percentage of the US population do you think has the funds to actually pay $420k/year in for medication? Zero, plus or minus. That's why the manufacturers basically give it away to people who can't afford it. Because they can, and it helps them somewhat mitigate the bad PR.

by ohazi 5y ago

rootusrootus 5y ago

It really does vary by individual. My mom is going through cancer treatment right now. 35K/month in medication and she pays $250. I don't expect surprise bills later. She had surgery 8 years ago for the same cancer and that was also $250, for a week-long hospital stay. In my experience it does help to have an HMO. My mom uses Kaiser. So there's none of this in- vs out-of-network. One billing system, one insurance, etc. She has nothing but positive things to say about them. My dad had a similar experience towards the end of his life. He loved 'em. And nobody was left destitute as the result of his medical care.

hef19898 5y ago
That shouldn't be the exception, that should be the rule.
nrmitchi 5y ago
One of the problems with the how the US medical system works is that "35K/month in medication" is only "35k/month" because of some expectation that insurance is going to pay whatever the negotiated rate it (and I seriously doubt that it's 35k/month). Lets look at it this way: If that was the true price, what percentage of the US population do you think has the funds to actually pay $420k/year in for medication?
- rootusrootus 5y ago
  In this case the insurance is paying $25K/month for the medication, so they definitely did negotiate it down somewhat. > what percentage of the US population do you think has the funds to actually pay $420k/year in for medication? Zero, plus or minus. That's why the manufacturers basically give it away to people who can't afford it. Because they can, and it helps them somewhat mitigate the bad PR.