4 ms·

Maybe what they are asking is how someone making an average of 115k, who is also in healthcare doesn’t have better health coverage and still decides to have a k

Maybe what they are asking is how someone making an average of 115k, who is also in healthcare doesn’t have better health coverage and still decides to have a kid.

ziddoap 4y ago
The American Dream. Must make 115k+ (what is that, 2x or 3x the average American?) and pay out the ass for coverage just so you can have the privilege of having a kid without being judged by random people on the internet.
- culopatin 4y ago
  I’ve made much less than 115k for most of my working life and I never had such shitty coverage. I don’t agree that having twins or whatever should be 80k, don’t get me wrong. But if you’re in healthcare and make enough to have a decent plan and choose not to, and on top of that you decide to have kid/s, you know what you’re getting into. At 38k a year I had a max out of pocket of 7k. It can be done. It’s as if I opened a web server in my home with all the ports open, a password that is “changeme” and then complained that someone else should’ve been protecting me.
willcipriano 4y ago
She wouldn't of had any coverage at all. Obamacare puts the out of pocket max well below 80k. At that income level and field, that's a choice. Is the idea that I'm supposed to pick up the tab or feel sorry for her? I make less than she does and I pay for my health insurance.
nonameiguess 4y ago
That's not at all a normal cost of having a kid. It says she ended up with twins and they were born prematurely. That said, I have no idea why it wasn't covered or how she ended up getting stuck with the bill. I've had catastrophic occurrences like this, too, years worth of spine surgeries in which I racked up a few million dollars of expenses, but my out of pocket max was $4,000 and that was all I ever had to pay in a year. Any charges denied by the insurance were just dropped by the provider, not pushed to me. So it raises the question of what kind of shitty coverage she had that was able to do this, or if she just had no coverage at all for some reason, which as far I understand, is supposed to be illegal after PPACA (you can always buy from the exchanges and they can't say no).
- lostcolony 4y ago
  >> Any charges denied by the insurance were just dropped by the provider, not pushed to me. That's a provider choice, and not guaranteed.
  - nonameiguess 4y ago
    Sure, but it's not uncommon, either. If you ever find yourself in a fight with a chronic or long-term condition, check the statement of benefits your insurer sends you every month. They're denying massive amounts of things that you never get a bill for. I even asked my main surgeon's office manager about this once, and he explained to me that insurance companies don't have any sort of upfront published caps on what they're willing to pay and for what, so both sides are kind of winging it. The providers simply bill some very large number that they know is so ridiculous that it has to be larger than the max that will get reimbursed, figuring that by doing so they'll at least guarantee they get that max and not inadvertently sell themselves short. So when you see things like a $14,000 charge for someone consulting over video for 10 minutes of work, or $800 for a bandaid, and you wonder how the hell a charge can possibly be that high, the answer is often that it isn't. That's just an artifact of this blind bidding thing going on between providers and insurers where providers send the largest conceivable bill they can to insurers knowing damn well they won't actually get that much. This also feeds back into why insurance companies have such a horrible incentive to default deny everything. They know the providers are overcharging and charging for bullshit. Both sides are forced into taking equally extreme baseline negotiating positions by the total lack of pricing transparency. It points at a very specific dysfunction of our system that goes well beyond the question of whether the government or private insurance purchasers should bear the bulk of the cost. This is a totally separate and orthogonal problem that both buyer and seller, no matter who they are, treat all transactions, no matter how mundane, like it's a blind silent auction for a rare Vermeer that hasn't seen a public market in 300 years.
    - lostcolony 4y ago
      Oh, I know the incentives. I strongly suspect there's even an additional one you don't list - tax writeoffs. And you're going onto a tangent that I am very much in agreement with (that the whole system is massively broken and suffers all sorts of perverse incentives), but -my- point, if you'll recall, is that not everything gets written off. People still get unexpected medical bills -all the time-, for things their insurance didn't fully cover; this despite their deductible and/or max out of pocket. Or, as I commented before, and which you're...agreeing to, in a whole lot of words, it's a provider choice, and not guaranteed. I.e., every time you go to the doc you're rolling the die; doubly so for emergency stuff that you can't get pre-authorized. "It doesn't happen -that- often" seems to maybe be your argument, but it happens enough, and the consequences of it happening at all are devastating.

Maybe what they are asking is how someone making an average of 115k, who is also in healthcare doesn’t have better health coverage and still decides to have a kid.

ziddoap 4y ago

The American Dream. Must make 115k+ (what is that, 2x or 3x the average American?) and pay out the ass for coverage just so you can have the privilege of having a kid without being judged by random people on the internet.

culopatin 4y ago
I’ve made much less than 115k for most of my working life and I never had such shitty coverage. I don’t agree that having twins or whatever should be 80k, don’t get me wrong. But if you’re in healthcare and make enough to have a decent plan and choose not to, and on top of that you decide to have kid/s, you know what you’re getting into. At 38k a year I had a max out of pocket of 7k. It can be done. It’s as if I opened a web server in my home with all the ports open, a password that is “changeme” and then complained that someone else should’ve been protecting me.

willcipriano 4y ago

She wouldn't of had any coverage at all. Obamacare puts the out of pocket max well below 80k. At that income level and field, that's a choice. Is the idea that I'm supposed to pick up the tab or feel sorry for her? I make less than she does and I pay for my health insurance.

nonameiguess 4y ago

That's not at all a normal cost of having a kid. It says she ended up with twins and they were born prematurely. That said, I have no idea why it wasn't covered or how she ended up getting stuck with the bill. I've had catastrophic occurrences like this, too, years worth of spine surgeries in which I racked up a few million dollars of expenses, but my out of pocket max was $4,000 and that was all I ever had to pay in a year. Any charges denied by the insurance were just dropped by the provider, not pushed to me. So it raises the question of what kind of shitty coverage she had that was able to do this, or if she just had no coverage at all for some reason, which as far I understand, is supposed to be illegal after PPACA (you can always buy from the exchanges and they can't say no).

lostcolony 4y ago
>> Any charges denied by the insurance were just dropped by the provider, not pushed to me. That's a provider choice, and not guaranteed.
- nonameiguess 4y ago
  Sure, but it's not uncommon, either. If you ever find yourself in a fight with a chronic or long-term condition, check the statement of benefits your insurer sends you every month. They're denying massive amounts of things that you never get a bill for. I even asked my main surgeon's office manager about this once, and he explained to me that insurance companies don't have any sort of upfront published caps on what they're willing to pay and for what, so both sides are kind of winging it. The providers simply bill some very large number that they know is so ridiculous that it has to be larger than the max that will get reimbursed, figuring that by doing so they'll at least guarantee they get that max and not inadvertently sell themselves short. So when you see things like a $14,000 charge for someone consulting over video for 10 minutes of work, or $800 for a bandaid, and you wonder how the hell a charge can possibly be that high, the answer is often that it isn't. That's just an artifact of this blind bidding thing going on between providers and insurers where providers send the largest conceivable bill they can to insurers knowing damn well they won't actually get that much. This also feeds back into why insurance companies have such a horrible incentive to default deny everything. They know the providers are overcharging and charging for bullshit. Both sides are forced into taking equally extreme baseline negotiating positions by the total lack of pricing transparency. It points at a very specific dysfunction of our system that goes well beyond the question of whether the government or private insurance purchasers should bear the bulk of the cost. This is a totally separate and orthogonal problem that both buyer and seller, no matter who they are, treat all transactions, no matter how mundane, like it's a blind silent auction for a rare Vermeer that hasn't seen a public market in 300 years.
  - lostcolony 4y ago
    Oh, I know the incentives. I strongly suspect there's even an additional one you don't list - tax writeoffs. And you're going onto a tangent that I am very much in agreement with (that the whole system is massively broken and suffers all sorts of perverse incentives), but -my- point, if you'll recall, is that not everything gets written off. People still get unexpected medical bills -all the time-, for things their insurance didn't fully cover; this despite their deductible and/or max out of pocket. Or, as I commented before, and which you're...agreeing to, in a whole lot of words, it's a provider choice, and not guaranteed. I.e., every time you go to the doc you're rolling the die; doubly so for emergency stuff that you can't get pre-authorized. "It doesn't happen -that- often" seems to maybe be your argument, but it happens enough, and the consequences of it happening at all are devastating.