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Many of these things you state as fact do not match my reality. > I have never heard of an insurance policy in the US that allows you to consume as much, and w

Many of these things you state as fact do not match my reality. > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. That’s basically my plan. I work for a FAANG, and have a low 2k/year max out of pocket for in-network, which is almost everything I encounter. I just book specialists when I want, and I see them as many times as I need. I can do PT 365 times per year, so as long as I don’t go more than once a day (which would be silly), I consume as much as I want. I recently chose to go to the Mayo Clinic — out of state, no referral, and everything is covered. I keep getting estimates from them of $0 since I hit my max out of pocket. The only thing I’ve been denied for is Botox for TMJ which they say is not medically proven (seems to be the opposite, but I understand why they’re wary). I’ve never had a medication, procedure, or doctor visit denied.

_DeadFred_ 1y ago
Yes, the US system works great if your are at the social peak, such as working at a FAANG. Thanks for reminding us of the level of class disparity as we struggle to pay our bills or get our children medical care. When I was a kid, everyone no matter economic level had pretty much the same pediatric doctor group. Now the working class people around me don't really have a pediatrician, but an overworked 'nurse practitioner'.
- azinman2 1y ago
  From the GP: > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. Quite the opposite is most people's experience. You have to justify any visit to a specialist before going, you don't get to choose the specialist, many times the insurer will simply deny a payment request for care already received. On many plans, you have to spend 5 figures per year before they will even cover anything. These do not apply to me. I cannot be the only one. In fact when I was a 2 person startup things weren’t so terribly different from my current situation as well. No need to accuse me of classism when I’m simply refuting the premise with my own data and lived experience.
dghlsakjg 1y ago
"in-network" is the key phrase here. You cannot consume as much and whatever type of healthcare. You have to consume from the pre-approved list of doctors that have negotiated rates with your insurer. I also do not believe for a second that if you found a doctor willing to give -for example - daily electrolyte IVs for your post workout recovery, that the insurer would touch that claim. Same thing with cosmetic or elective surgery. Will your insurer cover a facelift? Will they cover Ozempic for vanity reasons? Will they cover the full cost of all name brand drugs after your deductible is spent? And you still have to pay $2k before any of that is in effect. Mind you, your extreme outlier reality is one that is essentially never experienced by >95% of people, and it still has constraints.
- azinman2 1y ago
  Except I’ve only ever encountered 1 doctor who isn’t in network. I have a 4k max out of pocket for out of network. Even my acupuncturist is in-network. I’ve never found a doctor who would do anything daily, but if there was a medical need, I’d expect it to be covered. Where in the world is a facelift covered? No healthcare system covers that. What a silly thing to point out. If a doctor is willing to rx ozempic I’m sure they’d cover. I already get a glp-1 covered. Brand name drugs are covered fully. Yes I have to pay my $500 deductible and co-insurance until I hit my 2k max. What constraints?
  - dghlsakjg 1y ago
    The primary constraint that you are glossing over is that there is a premium that must be paid that most people cannot afford (if they can even access a plan like this outside of a group). Add in the co-insurance, deductibles, uncovered procedures, etc and that becomes a VERY hard constraint on most families. Are you not aware that healthcare affordability is one of the main political arguments for the past few decades? You must recognize that you are in a position of extreme privilege. Most people simply do not have access to a plan like yours, or cannot casually afford the many thousands of dollars on top of premiums it takes for the insurance to start paying for things. It is not a given that every employed person has 1. a health insurance plan 2. that is paid for in any way by their employer. Simply put: money is the constraint. You are wealthy enough that you fail to see that spending thousands of dollars is a constraint. Lucky you. That you have never even heard of daily medical treatment tells me that you are also extremely privileged to have never been chronically ill or even known the health needs of someone who is. I can't speak for your insurance policy, but my experience with chronic illness and US insurance companies is that an insurance company that paid for daily treatments without at least making someone jump through many hours of hoops is incredibly rare.

_DeadFred_ 1y ago

Yes, the US system works great if your are at the social peak, such as working at a FAANG. Thanks for reminding us of the level of class disparity as we struggle to pay our bills or get our children medical care. When I was a kid, everyone no matter economic level had pretty much the same pediatric doctor group. Now the working class people around me don't really have a pediatrician, but an overworked 'nurse practitioner'.

azinman2 1y ago
From the GP: > I have never heard of an insurance policy in the US that allows you to consume as much, and whatever type of healthcare that you want. Quite the opposite is most people's experience. You have to justify any visit to a specialist before going, you don't get to choose the specialist, many times the insurer will simply deny a payment request for care already received. On many plans, you have to spend 5 figures per year before they will even cover anything. These do not apply to me. I cannot be the only one. In fact when I was a 2 person startup things weren’t so terribly different from my current situation as well. No need to accuse me of classism when I’m simply refuting the premise with my own data and lived experience.

dghlsakjg 1y ago

"in-network" is the key phrase here. You cannot consume as much and whatever type of healthcare. You have to consume from the pre-approved list of doctors that have negotiated rates with your insurer. I also do not believe for a second that if you found a doctor willing to give -for example - daily electrolyte IVs for your post workout recovery, that the insurer would touch that claim. Same thing with cosmetic or elective surgery. Will your insurer cover a facelift? Will they cover Ozempic for vanity reasons? Will they cover the full cost of all name brand drugs after your deductible is spent? And you still have to pay $2k before any of that is in effect. Mind you, your extreme outlier reality is one that is essentially never experienced by >95% of people, and it still has constraints.

azinman2 1y ago
Except I’ve only ever encountered 1 doctor who isn’t in network. I have a 4k max out of pocket for out of network. Even my acupuncturist is in-network. I’ve never found a doctor who would do anything daily, but if there was a medical need, I’d expect it to be covered. Where in the world is a facelift covered? No healthcare system covers that. What a silly thing to point out. If a doctor is willing to rx ozempic I’m sure they’d cover. I already get a glp-1 covered. Brand name drugs are covered fully. Yes I have to pay my $500 deductible and co-insurance until I hit my 2k max. What constraints?
- dghlsakjg 1y ago
  The primary constraint that you are glossing over is that there is a premium that must be paid that most people cannot afford (if they can even access a plan like this outside of a group). Add in the co-insurance, deductibles, uncovered procedures, etc and that becomes a VERY hard constraint on most families. Are you not aware that healthcare affordability is one of the main political arguments for the past few decades? You must recognize that you are in a position of extreme privilege. Most people simply do not have access to a plan like yours, or cannot casually afford the many thousands of dollars on top of premiums it takes for the insurance to start paying for things. It is not a given that every employed person has 1. a health insurance plan 2. that is paid for in any way by their employer. Simply put: money is the constraint. You are wealthy enough that you fail to see that spending thousands of dollars is a constraint. Lucky you. That you have never even heard of daily medical treatment tells me that you are also extremely privileged to have never been chronically ill or even known the health needs of someone who is. I can't speak for your insurance policy, but my experience with chronic illness and US insurance companies is that an insurance company that paid for daily treatments without at least making someone jump through many hours of hoops is incredibly rare.