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> the number of Americans with health insurance is at a historic high, Biden bragged about it on Twitter last week I have "good" insurance through my employer.

> the number of Americans with health insurance is at a historic high, Biden bragged about it on Twitter last week I have "good" insurance through my employer. Over the summer I had appendicitis. The cost of the surgery and hospital stay after insurance would have bankrupted my brother and put any of my cousins in substantive medical debt. It would have been nearly a fifth of my retired mother's net worth. Having insurance is great because it makes lots of care attainable, but it's a vast overstatement to say that having it gives you access to basic care. A majority of Americans have less than $1000 in savings—that's not even an ambulance ride.

lotsofpulp 4y ago
FYI, out of pocket maximum in the US is $8,400 for an individual for a calendar year. If the appendicitis happened Dec 31, and treatment was received across 2 calendar years, then two years worth of oop max would apply, so $16,800. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
- deleted 4y ago
  [deleted]
- BigRedDog1669 4y ago
  I used to be me worried until I realized about the out of pocket maximum. But I'm still not sure how it works in practice. Are there ways that hospitals could charge for things that are considered separate from that number, like out of network or not covered things in the insurance plan? There always seem to be extra charges from what the health plans advertise, so I hesitate to trust their out of pocket maximum too.
  - lotsofpulp 4y ago
    The big risk used to be getting billed by an out of network provider while you are at an in network facility. Such as getting a surprise bill for $10k from an anesthesiologist that you had no idea was out of network since you thought your hospital was in network and there was no need or ability to check. But as of Jan 1, 2022 that is no longer a concern: https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill... The other concern was getting out of network care due to an emergency where you cannot choose in network care, but that is also no longer a concern per above link. I have had two child births in the past 6 years, and both years we hit our family oop max (~$5k), and after that, we did not have to pay a cent. We took the opportunity to get a whole bunch of healthcare like seeing an ENT, dermatologist, vasectomy, physical therapy to recover from childbirth, etc and all were fully paid for. I always use the insurer’s website to find in network providers, and I can even get a procedure/diagnosis code and get estimated costs before a visit.
    - mariojv 4y ago
      Thank you for posting this! I had no idea that surprise out of network billing and surprise emergency billing were no longer allowed. Among many, many other things, that was one of my biggest gripes with the US healthcare system. Walking down the street you run the risk of bankruptcy from simply existing, if you have to get emergency care while unconscious.
xhkkffbf 4y ago
Can you give some round numbers? I'm curious. And do you know why insurance didn't cover all but the deductible? Was it the crappy balance billing that's so common now?
- lotsofpulp 4y ago
  Insurance does not pay for copay/coinsurance amounts between deductible and out of pocket maximum. After out of pocket maximum is when insurance pays all of it. Surprise balance billing is no more since Jan 1, 2022: https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill...

lotsofpulp 4y ago

FYI, out of pocket maximum in the US is $8,400 for an individual for a calendar year. If the appendicitis happened Dec 31, and treatment was received across 2 calendar years, then two years worth of oop max would apply, so $16,800. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

deleted 4y ago
[deleted]
BigRedDog1669 4y ago
I used to be me worried until I realized about the out of pocket maximum. But I'm still not sure how it works in practice. Are there ways that hospitals could charge for things that are considered separate from that number, like out of network or not covered things in the insurance plan? There always seem to be extra charges from what the health plans advertise, so I hesitate to trust their out of pocket maximum too.
- lotsofpulp 4y ago
  The big risk used to be getting billed by an out of network provider while you are at an in network facility. Such as getting a surprise bill for $10k from an anesthesiologist that you had no idea was out of network since you thought your hospital was in network and there was no need or ability to check. But as of Jan 1, 2022 that is no longer a concern: https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill... The other concern was getting out of network care due to an emergency where you cannot choose in network care, but that is also no longer a concern per above link. I have had two child births in the past 6 years, and both years we hit our family oop max (~$5k), and after that, we did not have to pay a cent. We took the opportunity to get a whole bunch of healthcare like seeing an ENT, dermatologist, vasectomy, physical therapy to recover from childbirth, etc and all were fully paid for. I always use the insurer’s website to find in network providers, and I can even get a procedure/diagnosis code and get estimated costs before a visit.
  - mariojv 4y ago
    Thank you for posting this! I had no idea that surprise out of network billing and surprise emergency billing were no longer allowed. Among many, many other things, that was one of my biggest gripes with the US healthcare system. Walking down the street you run the risk of bankruptcy from simply existing, if you have to get emergency care while unconscious.

xhkkffbf 4y ago

Can you give some round numbers? I'm curious. And do you know why insurance didn't cover all but the deductible? Was it the crappy balance billing that's so common now?

lotsofpulp 4y ago
Insurance does not pay for copay/coinsurance amounts between deductible and out of pocket maximum. After out of pocket maximum is when insurance pays all of it. Surprise balance billing is no more since Jan 1, 2022: https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill...