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I did nasal surgery (deviated septum) and I asked around for quotes on how much it'd cost. I was verbally quoted about $2500 out of pocket expenses. I have a r

I did nasal surgery (deviated septum) and I asked around for quotes on how much it'd cost. I was verbally quoted about $2500 out of pocket expenses. I have a really good hdhp plan that covers $1500 hdhp before a 10k max coverage at 90% coinsurance. I ended up costing close to $7000 out of pocket anyhow... The medical insurance system is really stupid in America. It's basically fraud. Coinsurance coverage doesn't work as intended because the hospital can charge any amount they want, meaning your forced to pay close to your max coverage even if you have a high % coverage. Your forced to sign a "please bill me on anything you want" to get medical services rendered. I got billed $400 per post visit just for a camera to be shoved up my nose. The anesthesia was out of network and didn't get covered by insurance

Zircom 5y ago
>The anesthesia was out of network and didn't get covered by insurance This actually is specifically illegal, it's a pain in the ass to fight it against both the hospital and your insurance but if you insist hard enough they will cover it and you'll only pay what you would normally through your insurance. As long as the hospital itself is in network they aren't allowed to play "gotcha" with specific doctors/providers just not being in network all the sudden.
- lotsofpulp 5y ago
  I thought this was only just made illegal as of Jan 1, 2022.
  - Zircom 5y ago
    So for any kind of emergency care they are not allowed to "gotcha" with out of network providers at in network hospitals, this has always been the case. However, according to my quick Google research apparently anything else is state-law dependent so what I said doesn't apply equally in the country.
- ir123 5y ago
  This is soo strange! Why do _you_ have to insist for anything? Why is this thing even legal?
  - Zircom 5y ago
    It's not legal, but the amount of people that will just rollover and take it is incredibly high, and the absolute worst case scenario is that end up having to pay what they would have anyways so there's literally no downside for them pulling this bullshit.
erosenbe0 5y ago
You are not correct about coinsurance when using in-network hospital and providers. There is a contracted rate with the insurer and your out of pocket is usually 20%+ of that up to your out of pocket limits. The hospital does have arbitrary made up prices called a chargemaster which is just essentially numbers pulled out of a hat but when you are using an in-network provider there is a fixed rate for every covered code.

Zircom 5y ago

>The anesthesia was out of network and didn't get covered by insurance This actually is specifically illegal, it's a pain in the ass to fight it against both the hospital and your insurance but if you insist hard enough they will cover it and you'll only pay what you would normally through your insurance. As long as the hospital itself is in network they aren't allowed to play "gotcha" with specific doctors/providers just not being in network all the sudden.

lotsofpulp 5y ago
I thought this was only just made illegal as of Jan 1, 2022.
- Zircom 5y ago
  So for any kind of emergency care they are not allowed to "gotcha" with out of network providers at in network hospitals, this has always been the case. However, according to my quick Google research apparently anything else is state-law dependent so what I said doesn't apply equally in the country.
ir123 5y ago
This is soo strange! Why do _you_ have to insist for anything? Why is this thing even legal?
- Zircom 5y ago
  It's not legal, but the amount of people that will just rollover and take it is incredibly high, and the absolute worst case scenario is that end up having to pay what they would have anyways so there's literally no downside for them pulling this bullshit.

erosenbe0 5y ago

You are not correct about coinsurance when using in-network hospital and providers. There is a contracted rate with the insurer and your out of pocket is usually 20%+ of that up to your out of pocket limits. The hospital does have arbitrary made up prices called a chargemaster which is just essentially numbers pulled out of a hat but when you are using an in-network provider there is a fixed rate for every covered code.