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A few months ago I had a persistent irritation on my right eye, as if some dust was stuck there. Worried about it, I went to Urgent care and got billed $3400 (d

by inerte 1y ago

A few months ago I had a persistent irritation on my right eye, as if some dust was stuck there. Worried about it, I went to Urgent care and got billed $3400 (dollars) for antibiotics, WHICH WERE WRONG, an actual ophthalmologist said I had it scratched and just had to apply some drops. $250 for the ophthalmologist and about $50 for the drops. This week I am in Brazil for vacation, and my mother-in-law had a lot of back pain. We went to a private "urgent care" (or equivalent here), and it was R$ 200 for the visit, R$ 300 for the X-rays, and R$ 80 for the medicine. That's about $100 dollars. And the only reason why we went to private is because the public hospital wait was about 3 hours, otherwise it would have been free (yeah I know taxes). And I have good health insurance in the US, but navigating co-pays vs. deductibles vs. in network vs. this particular person isn't on network (like the anesthetist for my wife's C-Section which we only learned about when we were already there at the hospital for the surgery) and just overall everything is so freaking expensive... The system is broken, and no amount of startup trying to shave off 5% of some random administrative cost using AI will save it.

kccqzy 1y ago
> And I have good health insurance I think your example illustrates how low people's expectation can be when it comes to calling health insurance "good" in the U.S. If I were asked to pay $3400 for urgent care or $250 for an ophthalmologist I would not consider the health insurance "good" for its intended purpose of insuring against medical expenses. (It might be good for other purposes like enabling you to invest without taxes.) My health plan simply asks me to pay $35 for urgent care and $25 for a specialist like an ophthalmologist. That I consider good. Your insurance isn't.
- ImPostingOnHN 1y ago
  Yeah, I wouldn't consider any HDHP (High-Deductable Healthcare Plan) to be "good insurance".
  - SoftTalker 1y ago
    Why not? Do you expect to not pay any part of your normal, expected annual heath care costs? Insurance is for unexpected expenses that (a) you cannot foresee and (b) would be catastrophic to your finances. Thinks like major storm or fire damage to your house. A car accident that results in a total loss or worse, liability for someone's injuries. Your annual physical, eye exam, and dental hygiene vists, and other routine medical expenses are as predictable as your utilites or grocery expenses. You can plan and save for those in an HSA, and your HDHP can cover anything catastrophic.
    - ImPostingOnHN 1y ago
      Insurance is for unexpected expenses that (a) you cannot foresee and (b) would be catastrophic to your finances I do not agree with that view, and I'm not sure that is how it is used in the US at least. In the US, for many people, health insurance is the only realistic means to obtain any healthcare, not just catastrophic care. I get injured at least annually due to mostly-outdoor physical activities, and have a chronic health issue or two, so the prospect of paying thousands of dollars out of pocket before my insurance even kicks in, doesn't sound great (and wasn't, when I had HDHPs for years). I think the issue is that pretty much everything which isn't preventative care is considered "catastrophic" under this logic (because it requires paying hundreds or thousands out of pocket), even non-major issues, so "catastrophic" happens a lot.
      - BobaFloutist 1y ago
        I guess the idea is that you put a deductible amount of money into the account annually, and the tax-advantaged investment makes up for any difference between the deductible and the savings you get on premiums for having a HDHP (I.E. HDHP premiums + deductible - tax savings ≈ normal premiums + deductible). It's an insane way to run health insurance, and it just goes to show that expected value and mathematical benefit isn't the end-all be-all, but it's supposedly mathematically coherent.
        deleted 1y ago
        [deleted]
  - whateveracct 1y ago
    It is when you take into account the tax advantages of an HSA. If you're like me and can shake off a few grand medical expense out of pocket, suddenly it's the best plan. I have a HDHP and paid less than $10k all year for my family's medical expenses and we had a freaking baby lol.
    - BobaFloutist 1y ago
      Right, but it's also nuts that a lot of people are on a health insurance plan that encourages avoiding medical care because it offers tax-advantaged investing. You get how that's nuts, right?
      - whateveracct 1y ago
        It doesn't seem nuts to me? I have a good emergency fund and a stable job and no big debts (cuz I'm good with money generally), so I can choose to use my health insurance to make a little more money. That's only fair given all the pre-work I did to set it up for myself.
        BobaFloutist 1y ago
        Of course it's fair, my criticism isn't with your outcome but with designing an insurance plan to work this way. It's weird to tie your little extra money to your health insurance plan.
        whateveracct 1y ago
        That's why it's not the only option. It's a benefit not a restriction. The powers that be saw an opportunity for insurers to cover less and insurees to leverage that into a different benefit. It's all just about shifting risk around and taking a little off the top. It's a nice incremental addition to the existing system. Way more feasible than changing the system.
        BobaFloutist 1y ago
  - lesuorac 1y ago
    It's pretty good when your employer funds a good chunk of the high-deductable.
  - prasadjoglekar 1y ago
    Au contraire, that is much closer to the definition of insurance. We don't want people to get bankrupt with an unforseen medical issue like cancer. Insurance should cover that. Routine care, including shit that's a little unlucky should be paid for out of pocket. In the US, health care and health insurance have become synonymous such that all the good bits of insurance are out the door and all the bad ones have stayed. And polluted the true cost of getting simple, routine care.
    - tossandthrow 1y ago
      In that vain health insurance is never insurance. Getting a kid is not an accident for most modern people, and should never be seen as an event that could bankrupt anybody. Hence, deferring to the definition of insurance is futile. Then again - the US is the only country I know of that insists that health is something you insure.
      - prasadjoglekar 1y ago
        You need to broaden your horizons then - look at the medical plans that are on offer in India. Or the travel medical insurance that every EU country requires you to carry. They are classic insurance. Having a kid without complications should not cost $50K. It should be a few grand at the most. If the kid now needs NICU, then yes, that's what insurance is for.
        tossandthrow 1y ago
        So, I exanped my horizon Besides the states there is south Africa who treat having a kid as some catastrophic event that might bankrupt you. In EU countries the spirit of health insurance is socializing the cost / solidarity which we explicitly do not consider in the thread - please read the parents of that was not clear.
        kamaal 1y ago
        >>- look at the medical plans that are on offer in India. The one's that companies offer are quite good, actually. I'd have depleted my life savings, and gone bankrupt several times around COVID years with my parents health, if I didn't have company health insurance. Good for me, because I knew people in hospital sitting in the waiting lobby literally crying because they were done financially. Like finished for life. Having said, this in India the market for this things is still building up, and given how big India is it will take years before it reaches the US stage of profit seeking.
ipython 1y ago
I would demand an itemized bill from that urgent care and play hard ball with that provider. That's absurd, even by US standards. I've had ER visits that total less than that. My son had a cast that fell off while on travel in Florida, and we stopped by an ER (only place that was open and could fit a new cast). Total cost out the door _at the ER_ was less than $500, which while expensive, is nowhere near what you're talking about.
- bestouff 1y ago
  Your country is crazy. I wouldn't want to end jobless there, that's a potential death call.
marcusverus 1y ago
> persistent irritation > went to Urgent care You waited until it became a problem, then went to an expensive option instead of contacting your GP and getting a recommendation for an in-network care? And were surprised that it was expensive? This is healthcare 101 in the US. You could have gotten the same care for a reasonable price had you done 1 hour of due diligence. We do not need to remake the system--which will result in far greater inconveniences than the 1 hour of dd you found to be unreasonable, not only for you, but for people who are perfectly capable of navigating the current system--to save you from yourself.
- alexjplant 1y ago
  ...in what world does it make sense to charge the cost of a motorcycle for a few minutes of a doctor/NP's time and $15 worth of drugs? Jumping through bureaucratic hoops to avoid this is a waste of everybody's time.
  - BobaFloutist 1y ago
    Urgent care is pretty widely known to be a scam that preys on those too impatient to "jump through buerocratic hoops (make an appointment in the future with a highly-paid professional instead of paying the premium for the surplus staffing it takes to always have someone available for walk-ins)"
    - aidenn0 1y ago
      That's interesting because my co-pay at urgent care is the same as with my GP. Maybe there are regional differences? (ER on the other hand I know I won't walk away without many thousands of dollars in bills, on top of a much larger copay, because even though the ER is "in network" none of the contractors working there are)
    - nemomarx 1y ago
      "make an appointment for several months for now or get treatment this week" is maybe a better explanation. your GP is good if you have a long term medical issue you want to ask about, less so if you think you've just gotten injured or sick in some way.
ruralfam 1y ago
Just got my bill for a recent 20 minute doctor visit (with one of the best HC insurance coverages in my state: $1,600 cost, $1,400 adjustment, $200 out-of-pocket given my $3,000 OOP limit was not reacehd). Absurd. The USA will likely never get to an efficient govt. single pay system (unlike every other industrialized company). Given this, the option I hope for is that the FedGov passes a law that requires all Master Charge prices to be based on "Acitivty Based Accounting". ABC would provide insights for greater operational efficiency, and the 1600>1400>200 magic hand-waving would disappear. There would be a great loss of employees for health insurance portfolio analysts, but most of them could move into cost accounting roles for hospitals. Please GOP/DEM consider this.
- ponector 1y ago
  >> The USA will likely never get to an efficient govt. single pay system (unlike every other industrialized company). Not really efficient. Due to low pay there is a huge shortage of medical workers. Also for non life treating conditions there are waiting lists for the next few years. Had a light knee injury during football game? Your surgery is scheduled for 2027. Real story of my friend from Poland. And you pay 9% of your income for this "care".

by inerte 1y ago

kccqzy 1y ago

> And I have good health insurance I think your example illustrates how low people's expectation can be when it comes to calling health insurance "good" in the U.S. If I were asked to pay $3400 for urgent care or $250 for an ophthalmologist I would not consider the health insurance "good" for its intended purpose of insuring against medical expenses. (It might be good for other purposes like enabling you to invest without taxes.) My health plan simply asks me to pay $35 for urgent care and $25 for a specialist like an ophthalmologist. That I consider good. Your insurance isn't.

ImPostingOnHN 1y ago
Yeah, I wouldn't consider any HDHP (High-Deductable Healthcare Plan) to be "good insurance".
- SoftTalker 1y ago
  Why not? Do you expect to not pay any part of your normal, expected annual heath care costs? Insurance is for unexpected expenses that (a) you cannot foresee and (b) would be catastrophic to your finances. Thinks like major storm or fire damage to your house. A car accident that results in a total loss or worse, liability for someone's injuries. Your annual physical, eye exam, and dental hygiene vists, and other routine medical expenses are as predictable as your utilites or grocery expenses. You can plan and save for those in an HSA, and your HDHP can cover anything catastrophic.
  - ImPostingOnHN 1y ago
    Insurance is for unexpected expenses that (a) you cannot foresee and (b) would be catastrophic to your finances I do not agree with that view, and I'm not sure that is how it is used in the US at least. In the US, for many people, health insurance is the only realistic means to obtain any healthcare, not just catastrophic care. I get injured at least annually due to mostly-outdoor physical activities, and have a chronic health issue or two, so the prospect of paying thousands of dollars out of pocket before my insurance even kicks in, doesn't sound great (and wasn't, when I had HDHPs for years). I think the issue is that pretty much everything which isn't preventative care is considered "catastrophic" under this logic (because it requires paying hundreds or thousands out of pocket), even non-major issues, so "catastrophic" happens a lot.
    - BobaFloutist 1y ago
      I guess the idea is that you put a deductible amount of money into the account annually, and the tax-advantaged investment makes up for any difference between the deductible and the savings you get on premiums for having a HDHP (I.E. HDHP premiums + deductible - tax savings ≈ normal premiums + deductible). It's an insane way to run health insurance, and it just goes to show that expected value and mathematical benefit isn't the end-all be-all, but it's supposedly mathematically coherent.
      - deleted 1y ago
        [deleted]
- whateveracct 1y ago
  It is when you take into account the tax advantages of an HSA. If you're like me and can shake off a few grand medical expense out of pocket, suddenly it's the best plan. I have a HDHP and paid less than $10k all year for my family's medical expenses and we had a freaking baby lol.
  - BobaFloutist 1y ago
    Right, but it's also nuts that a lot of people are on a health insurance plan that encourages avoiding medical care because it offers tax-advantaged investing. You get how that's nuts, right?
    - whateveracct 1y ago
      It doesn't seem nuts to me? I have a good emergency fund and a stable job and no big debts (cuz I'm good with money generally), so I can choose to use my health insurance to make a little more money. That's only fair given all the pre-work I did to set it up for myself.
      - BobaFloutist 1y ago
        Of course it's fair, my criticism isn't with your outcome but with designing an insurance plan to work this way. It's weird to tie your little extra money to your health insurance plan.
        whateveracct 1y ago
        That's why it's not the only option. It's a benefit not a restriction. The powers that be saw an opportunity for insurers to cover less and insurees to leverage that into a different benefit. It's all just about shifting risk around and taking a little off the top. It's a nice incremental addition to the existing system. Way more feasible than changing the system.
        BobaFloutist 1y ago
- lesuorac 1y ago
  It's pretty good when your employer funds a good chunk of the high-deductable.
- prasadjoglekar 1y ago
  Au contraire, that is much closer to the definition of insurance. We don't want people to get bankrupt with an unforseen medical issue like cancer. Insurance should cover that. Routine care, including shit that's a little unlucky should be paid for out of pocket. In the US, health care and health insurance have become synonymous such that all the good bits of insurance are out the door and all the bad ones have stayed. And polluted the true cost of getting simple, routine care.
  - tossandthrow 1y ago
    In that vain health insurance is never insurance. Getting a kid is not an accident for most modern people, and should never be seen as an event that could bankrupt anybody. Hence, deferring to the definition of insurance is futile. Then again - the US is the only country I know of that insists that health is something you insure.
    - prasadjoglekar 1y ago
      You need to broaden your horizons then - look at the medical plans that are on offer in India. Or the travel medical insurance that every EU country requires you to carry. They are classic insurance. Having a kid without complications should not cost $50K. It should be a few grand at the most. If the kid now needs NICU, then yes, that's what insurance is for.
      - tossandthrow 1y ago
        So, I exanped my horizon Besides the states there is south Africa who treat having a kid as some catastrophic event that might bankrupt you. In EU countries the spirit of health insurance is socializing the cost / solidarity which we explicitly do not consider in the thread - please read the parents of that was not clear.
      - kamaal 1y ago
        >>- look at the medical plans that are on offer in India. The one's that companies offer are quite good, actually. I'd have depleted my life savings, and gone bankrupt several times around COVID years with my parents health, if I didn't have company health insurance. Good for me, because I knew people in hospital sitting in the waiting lobby literally crying because they were done financially. Like finished for life. Having said, this in India the market for this things is still building up, and given how big India is it will take years before it reaches the US stage of profit seeking.

ipython 1y ago

I would demand an itemized bill from that urgent care and play hard ball with that provider. That's absurd, even by US standards. I've had ER visits that total less than that. My son had a cast that fell off while on travel in Florida, and we stopped by an ER (only place that was open and could fit a new cast). Total cost out the door _at the ER_ was less than $500, which while expensive, is nowhere near what you're talking about.

bestouff 1y ago
Your country is crazy. I wouldn't want to end jobless there, that's a potential death call.

marcusverus 1y ago

> persistent irritation > went to Urgent care You waited until it became a problem, then went to an expensive option instead of contacting your GP and getting a recommendation for an in-network care? And were surprised that it was expensive? This is healthcare 101 in the US. You could have gotten the same care for a reasonable price had you done 1 hour of due diligence. We do not need to remake the system--which will result in far greater inconveniences than the 1 hour of dd you found to be unreasonable, not only for you, but for people who are perfectly capable of navigating the current system--to save you from yourself.

alexjplant 1y ago
...in what world does it make sense to charge the cost of a motorcycle for a few minutes of a doctor/NP's time and $15 worth of drugs? Jumping through bureaucratic hoops to avoid this is a waste of everybody's time.
- BobaFloutist 1y ago
  Urgent care is pretty widely known to be a scam that preys on those too impatient to "jump through buerocratic hoops (make an appointment in the future with a highly-paid professional instead of paying the premium for the surplus staffing it takes to always have someone available for walk-ins)"
  - aidenn0 1y ago
    That's interesting because my co-pay at urgent care is the same as with my GP. Maybe there are regional differences? (ER on the other hand I know I won't walk away without many thousands of dollars in bills, on top of a much larger copay, because even though the ER is "in network" none of the contractors working there are)
  - nemomarx 1y ago
    "make an appointment for several months for now or get treatment this week" is maybe a better explanation. your GP is good if you have a long term medical issue you want to ask about, less so if you think you've just gotten injured or sick in some way.

ruralfam 1y ago

Just got my bill for a recent 20 minute doctor visit (with one of the best HC insurance coverages in my state: $1,600 cost, $1,400 adjustment, $200 out-of-pocket given my $3,000 OOP limit was not reacehd). Absurd. The USA will likely never get to an efficient govt. single pay system (unlike every other industrialized company). Given this, the option I hope for is that the FedGov passes a law that requires all Master Charge prices to be based on "Acitivty Based Accounting". ABC would provide insights for greater operational efficiency, and the 1600>1400>200 magic hand-waving would disappear. There would be a great loss of employees for health insurance portfolio analysts, but most of them could move into cost accounting roles for hospitals. Please GOP/DEM consider this.

ponector 1y ago
>> The USA will likely never get to an efficient govt. single pay system (unlike every other industrialized company). Not really efficient. Due to low pay there is a huge shortage of medical workers. Also for non life treating conditions there are waiting lists for the next few years. Had a light knee injury during football game? Your surgery is scheduled for 2027. Real story of my friend from Poland. And you pay 9% of your income for this "care".