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Forgive me for asking but does your insurance not have a max out of pocket associated with your plan? Btw I understand and feel you how rough the hospital is,
by kneebonian 3y ago
Forgive me for asking but does your insurance not have a max out of pocket associated with your plan?
Btw I understand and feel you how rough the hospital is, had 4 little ones each spending several months in the NICU hold on it gets better and the debt will eventually be gone.
- missedthecue 3y agoThis is what I don't get about discussions of US healthcare online. Everyone has a max out of pocket. Yes, 7% of the US isn't insured, which is a lot, but it's hard to believe they make up 99.9% of healthcare discourse. Are people genuinely getting $100k in debt, or are they only telling the internet how much the total bill was and forgetting to add that their insurance picked up $94k of that.
- projectileboy 3y agoI’m 51 and had this conversation too many times to indulge this. All I can say is that I wish you luck if you or your loved ones ever have a serious medical issue in the US. And you may be lucky. Or you may spend years on telephone calls trying to get a pharmacy benefits manager to send you the prescription your doctor prescribed. Or calls with your insurance company to get them to pay what they are supposed to pay.
- throwaway173738 3y agoYeah been there with my partner. She spent at least two days a week on the phone with the insurance company from 2021 to January of this year. Private insurance is the worst, and open enrollment is terrible. We should’ve outlawed employer-provided insurance but required employer stipends for insurance and forced everyone to buy through the marketplace with open enrollment once a month. As a patient you have zero control over your insurance while your employer has no incentive to get good insurance.
- nerdponx 3y agoI have a close family member who has had multiple significant surgeries, and it was all covered, and they didn't pay a penny over their annual out-of-pocket maximum. Maybe the difference is that it was all "elective" and therefore planned out weeks or months in advance, with ample time for insurance pre-approvals? I've had a harder time getting reimbursed for psychotherapy than they had getting covered for their surgeries.
- projectileboy 3y agoInteresting, I’ve had somewhat similar experiences. Big one-time events were handled no problem. But chronic illnesses have always been a nightmare - for my daughter to get her meds, she pretty much has to have the same chain of conversations once a quarter with doctor, pharmacy benefits manager, and insurance. PBMs are the worst though, by far.
- lotsofpulp 3y agoNowadays, I assume it is mostly clickbait. However, prior to the No Surprises Act, you could get hit with unlimited costs from out of network providers in the event of an emergency. For example, if an anesthesiologist that was not employed by the hospital put you under, and you get a separate out of network bill from them (but that should not happen since 2022).
- deleted 3y ago[deleted]
- eyelidlessness 3y agoNot 100k, but I recently dumped most of my then current savings (12k) to cover a family member’s medical bills after what insurance covered. It wasn’t the first time, and it’s a lot easier to imagine it adding up the second time. Never mind that not everyone just has 12k lying around to cover those bills, or that they start collecting interest once they get scooped up by debt consolidators.
- aaomidi 3y ago> This is what I don't get about discussions of US healthcare online. Everyone has a max out of pocket. I'm not sure if you know how hard a surprise 10-20K bill can be. And some out of pocket maximums are huge (generally, the worse the plan is)
- missedthecue 3y agoI know people get huge bills. Meeting that $4k or $5k oop is tough for the average person. It's the hundreds of thousands or millions of debt that I don't get.
- tmpz22 3y agoWhat about the people who don’t fight it? Folks who don’t know how the system works or get an especially aggressive billing department? Folks who are depressed or suffer from mental illness? These systems aren’t in place for the people who fight back. They’re in place for the people who give up.
- MrFoof 3y agoAh, but you forget the fun thing that can happen: You go in for X. Insurance company defines X as a set of ICD-9 procedure codes for that health care organization, for that treatment for that indication. Not all providers will use all of those codes, usually some subset as the exact treatment may vary across providers under that health care organization. The health care organization instead sends over claims for those ICD-9 procedure codes, plus some other ones that your insurance company feels aren't appropriate for your treatment. You then get an explanation of benefits from your insurance company, stating that they covered X, Y and Z, but A, B, C, D, E, F and G are your responsibility, because it exceeds the negotiated or "allowable rate" between the insurance company and that health care organization. Or worse, the whole claim was merely coded incorrectly by the health care organization. Insurance company feels it's then not their obligation, and straight up denies the claim. A through G is some amount of money that would absolutely crush the average person. Your insurance company stands behind what they laid out in their statement of benefits for the claim, and won't budge beyond that, saying the rest of the costs are your responsibility. After all, they feel those procedures weren't relevant for the treatment, and it exceeds the negotiated allowance with that health care organization for that treatment. The health care organization's billing department is aggressive, and says since your insurance company won't pay, you need to. TL;DR: "Balance billing." -- ----- Here's a case where your child falling off a bicycle and needing stitches could cost you $19,000 if you don't lawyer up: https://wamu.org/story/20/11/25/a-kid-a-minor-bike-accident-and-a-19000-medical-bill/ https://wamu.org/story/20/11/25/a-kid-a-minor-bike-accident-... Entirely unrelated to the specific scenario I laid out is ending up in an out-of-network emergency room. Again, easy to end up with a $20,000 hospital bill for falling off a bicycle because your insurance company says it's not their problem: https://www.vox.com/health-care/2019/1/24/18195686/vox-zuckerberg-hospital-emergency-room-bill https://www.vox.com/health-care/2019/1/24/18195686/vox-zucke...
- vladgur 3y agoWhat a terrible thing that is, but fortunately I happen to reside in one of handful of states where balance billing is illegal.
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- Spooky23 3y agoThere’s lots of different insurance plans. I had a legacy PPO from a large public employer that covered everything with copays between $20 and $100. When I had back surgery a few years ago, my out of pocket was something like $600. The surgery itself and inpatient was $250k, PT and follow ups went on for a year. For most HMO patients, it would be more like $5000 or more. Stuff like the supportive vest you wear for weeks is typically uncovered, cost $2500. Some plans will only cover PT for a few weeks. Today with a high deductible plans, it’s nutty - my brothers 4 kids got a nasty infection, which required an antibiotic that costs $15. Total cost? $1200 out of pocket for the visits, etc. For chronic conditions like diabetes, supplies and scripts get expensive quickly. For cancer, if you work for Google or the US Government you’ll get treatment at MD Anderson, Dana Farber, MSK, etc for $0 and get travel reimbursement. If you have a high deductible plan, you’re going to be shelling out $10k or more a year just for the deductible, and may find yourself paying out of pocket for labs, drugs, etc.
- riku_iki 3y agoI think people mostly talking about cases when insurance denies payments, so max out of pocket is not applied.
- _p3fk 3y agoWhen I lived in the United States, the annual deductible was in the many thousands, even with a fairly good health insurance plan, you could easily end up with a bill for $10,000 if you spent a few nights in the hospital. This was also the fact that the insurance would only cover up to a certain percentage of the total bill, so even if you are left owing five or 10%, that could still be quite a lot of money when the hospital is charging well into the six figures.
- Thorrez 3y ago>This was also the fact that the insurance would only cover up to a certain percentage of the total bill, so even if you are left owing five or 10% But only up to the max out of pocket, right? Once you hit the max out of pocket, you stop paying the 10%.
- _p3fk 3y agoDepends on the policy, but in my experience the out of pocket deductible is usually before any insurance is used, so you pay 100% up to the max deductible (no help from insurance on many costs), then you pay 5-10% of bills after that. But that was a few years ago so maybe policies are different now (though I doubt it).
- hellojesus 3y agoThat is accurate, but most of the plans I've seen/been on are only about $1500-$300 deductible and $6-7k out of pocket max. So while you pay the full burden of the first $1500-$3000, you only pay a percentage of anything after that and not one penny more than your max.
- Thorrez 3y agoThe max out of pocket and the deductible are 2 different things everywhere I've seen them. I don't know what an "out of pocket deductible" is. Do you have a link to a real policy like you're talking about?
- briHass 3y agoAlso, take note that out of pocket medical costs are only deductible on Federal taxes once they exceed 7.5% of your AGI, and of course, only the amount above that counts. Assuming an average AGI of 65K, the government certainly doesn't feel any pity for you until you pay almost 5K per year. A few thousand to meet the OOP max shouldn't break you, or at least the government isn't going to cut you a break.
- bcrosby95 3y agoThe reality is your health insurance will deny shit until it's blue in the face. In the meantime you have an angry hospital breathing down your neck and sending you bills for $xxxxxx. They don't necessarily talk much to eachother so its now your part time job to make sure everything happens smoothly. We had a surgery that wasn't completely resolved until about 8 months after the fact after spending 10-15 hours per week on phone calls. The hospital billing told me this was all normal and they usually have to resort to lawyers before stuff gets paid. SOUNDS LIKE EFFICIENCY TO ME! This is just one of a half dozen shitty experiences I've had even with $3k/mo health insurance. So yeah, in my experience it sucks even if you are insured. The whole system is a dumbass way to do things and a huge waste of fucking time.
- McSwag 3y agoI could rant for DAYS about my awful experiences with the US medical billing system but I’m too tired after spending literally months of my life on paying US medical bills and even more time removing erroneous collections claims from my credit report.
- StanislavPetrov 3y ago>Everyone has a max out of pocket. For "covered" expenses. Have to go out of network for a specialist? Not covered. The insurance company considers the life-saving procedure you need "experimental"? Not covered. The insurance company rejects the optimal treatment for your injury, disease or malady as being not necessary? Not covered.
- jjav 3y ago> This is what I don't get about discussions of US healthcare online. Everyone has a max out of pocket. Max out of pocket doesn't mean what the insurance company marketing arm wants you to believe (and most people believe). When you actually have large medical expenses, the insurance company will use the full strenght of their lawyer army to deny everything, claim it was all unnecessary and unauthorized and deny deny deny. Your "max out of pocket" doesn't apply to any of that since they get to unilaterally say it wasn't covered. That's how you end up with hundreds of thousands in debt even though the paperwork claimed your max out of pocket is 7K or whatever. As others mention here, you can fight it but it will become a full time job for a very long time and you'll be an amateur fighting full-time professionals at denying. You can win some but it'll be an uphill battle.
- nradov 3y agoAll medical insurance plans regulated under the Affordable Care Act have an out of pocket maximum per year. This can be as high as $18K. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
- missedthecue 3y agoBut the US average max oop is a hair over $4k.
- flagrant_taco 3y agoIf that number is too high, and it really does seem ridiculous, we need to be questioning why care is so expensive rather than what insurance policies are available.
- _p3fk 3y agoTrue, there is a reason why many international health insurance plans will cover services anywhere in the world except the United States. The US is quite an outlier on what it charges for healthcare compared to most of the rest of the world. And the odd thing is that the care is not justified by the price, it’s not like it’s significantly different than what you get in most European nations.
- CogitoCogito 3y agoWell of course the prices are just fraud. Maybe it’s legal fraud, but it’s fraud nonetheless. I mean you’ll see bills for 20k that insurance would have covered for 1k. It’s just bullshit. Frankly negotiated prices should just be illegal. They should just provide prices for services. Insurers should have plans on how much they’ll cover you, but they don’t change any pricing. The hidden bullshit smoke and mirrors producing fraudulent pricing that may or may cover you depending on a million different reason is as far from market competition as it gets.
- sillysaurusx 3y agoOh hey, thanks for asking! Apparently ours is max $10k per individual. I honestly had no idea that max out of pocket was a thing. Was fully ready to go bankrupt from this.
- bombcar 3y agoThere's also a per-family maximum (and somewhere deep in the documents may be a maximum total the insurance company will pay out, but they can't do this for essential health benefits anymore; doesn't mean they won't try). Sadly, if you're sitting around a hospital room, researching and reading up on insurance billing is probably a worthwhile use of time.
- ScoobleDoodle 3y ago“Max out of pocket” only applies to the bill amount the insurance accepts. If the bill is for $100k and insurance says it should cost $30k and your “max out of pocket” is $10k then you owe $80k ($10k for the max + $70k that insurance says shouldn’t be billed.)