If anyone knows why care providers high ball the rates on bills when insurers have negotiated rates, I'd love to hear it. Is it something in the insurer's contract that gives insured the illusion that insurance is saving them a lot?
In any case I've received first medical bills in the many thousands of dollars only to have them go through four or five revisions before settling down to hundred dollars. This is because the first bill you receive reflects all of the claims to insurance (e.g. if your insurance covers 80% you're on the hook for 20%) but as the insurer and the care provider negotiate and revise the billing the price falls.
In my opinion it's a horrible experience for the insured and the added stress of the huge bills certainly doesn't help with recovery.
I really wish people would talk about these sorts of soft costs more often.
I grew up in the UK, moved to the USA in my mid 20s. While growing up, my parents divorced and my mother had to take care of me and a sibling. All 3 of us had medical conditions that needed regular care/checkups.
Not once did my mum ever spend hours on the phone chasing down bills or insurance rejections. We never paid out of pocket for prescriptions, doctor visits, A&E (USA translation: ER) visits, etc.
That stress, or lack of, is a huge factor in quality of life for a family.
Unfortunately this sort of discussion is heavily politically charged. I really don't want to start an argument thread comparing how taxes pay for socialized care, etc.
It can get even worse and more subtle than that. I don't even get care in some situations that feel optional because I don't know what the true cost will be. I have money and insurance, but I'm instinctively uncomfortable about electing for services that I won't know the true cost of until weeks later after the care provider and insurance company have done their dance.
There's the deductible which I understand but that's not a blanket thing where everything is free after that. There's always fine print and a cloud of uncertainty about where the limits are for each category.
I'm starting to break this instinct, Blue Cross seems transparent enough when I call them and have a specific question. But that's because I'm getting older and taking health more seriously. I went through a long period when I was younger just ignoring symptoms when I could. Nothing bad happened to me but I've seen friends get diagnosed with cancer that might have been more treatable if found sooner. How many insured people don't get care that they should because they're confused or cynical about the system being set up to extract money from them?
Healthcare in the US is screwed up beyond belief.
In the usa my insurance lets me go to 10 doctors for differing opinions. I can go straight to a specialist. When I need non urgent surgery it's scheduled with a few weeks instead of months.
Only if you have good insurance. Insurance companies have been cracking down on this behavior. For example, there are certain specialists which are straight-up not covered unless you have an explicit referral. Likewise, networks of providers will vary. For example, sometimes your area's top hospital won't be "in network", so you're now paying significantly more out-of-pocket for going out of network.
If you currently are enjoying this benefit, please anticipate that privilege to be gone within a decade, regardless of what direction the US healthcare market goes.
1. Doc recommends a long list of blood tests for reasons she can’t seem to articulate. She’ll also recommend a testing lab. Oh, and see this specialist!
2. Now I have to figure out:
a) which tests do I actually need and which ones are just being recommended out of abundance of caution or because the doc needs to protect herself legally?
b) will my insurance cover the tests I’m going to do? If not (or even if so) how much will they cost me?
c) will my insurance work at this particular lab? The lab often won’t know.
d) do I really need to see this specialist or is my doc just tossing some juicy business to her med school buddy?
e) is the specialist in my insurance’s network?
f) how much is the specialist’s bill likely to be?
g) how much will my insurance pay?
3. Do all the things (or not)
4. Random bills for random amounts start landing in my mailbox over the next few months. They could be anywhere between $100 and $10,000, totally impossible to know ahead of time. I now have to pick up the phone and start negotiating with the doctors and my own insurance company, figuring out what I can pay now, what will have to wait, etc. Usually the insurance company will say something about a deductible and “you have to pay LOL.”
The stress is enough to give me an ulcer (which I’d need to visit yet another specialist for, is this one in-network or out?)
There are still a occasional billing hiccups but the big tradeoff is that I can only visit the Kaiser hospitals except if I'm traveling and have an emergency.
Only thing I paid? The taxi ride home. For anything else there was my insurance card.
This is the same type of insurance plan 89% of the population uses – including the unemployed, middle managers, elderly, students, chronically ill, and always healthy.
Oh, so you don't pay for your insurance card? Nice deal! Because I also have public health insurance in Germany, and last time I checked, it cost 14% of my gross salary.
For employees, half of the fee is payed by their employer.
If you have to pay the fee on your own and miss at least two months (which can't really happen for regular employees as the fee is taken directly out of their paycheck) the fees can be collected with exactly the same procedure as other taxes. Until this happens you are only covered in an acute illness or pain situation, pregnancy, and for some preventive checkups. Health insurance (both private and public) can never be cancelled for nonpayment.
> I can go straight to a specialist.
Me too. But if I schedule an appointment with any specialist it's going to be at least a month. And after that appointment, the followup will be in another two months. The appointment costs at least $400 and gets me about 10 minutes of face-time with the doctor but about one hour with the administrative/support staff.
> When I need non urgent surgery it's scheduled with a few weeks instead of months.
That is true, because that's the bread-and-butter of the McMedicine world. If however you need to do something which is not an emergency and slightly off the beaten path in terms of symptoms or which crosses medical specializations, good luck coordinating medical care. You will be scheduled in a couple of months to minimize liability, so that perhaps it goes away or you go away.
Not all insurances are equal, you or your employer are paying for that privileged and can obviously afford it.
You should price out insurance options for a minimum wage job and compare it to your own to see just how lucky you are.
> I can go straight to a specialist.
Cadillac insurance, PPO? Most people have HMOs which don't allow that.
In socialized medicine doctors usually aren't profit driven and their job/salary are dependent on the level of care they provide and not the number of patients they churn through.
The difference is if I couldn't afford to pay, I would've been seen based on the urgency of the condition at no charge anyway.
For those who can afford that class of insurance, maybe. I had to wait 3 months to set up my primary care physician, and for a specialist the initial wait of 4 months turned into 6 after they rescheduled me. I lived in Boston where you pretty much can't throw a rock without accidentally hitting a physician.
Also, as someone who has lived in Germany and has family in Germany, these conservative anecdotes about the quality of American care in comparison to Europe always strike me as full of shit. They don't align with any reality.
When my daughter is old enough, if she wants to go to university or college, I will do my best to pay for as much as I can. The great thing about this country is that if she gets seriously sick I won't have to choose between her health and her education.
The US healthcare system is barbaric.
What insurance covers 9 second opinions?
You can still go to 10 doctors, and pay for 9 of these visits.
US companies operating in the UK even tend to provide private healthcare insurance. Such "perk" makes UK employees chuckle, but hey, if you want private healthcare, the same US/multinational corporations operate in the UK too.
All told it was ~18 weeks of hospitalization (the only major procedure was the c-section, and obviously the NICU care is a little more intensive than average, but neither of the twins needed super high acuity care). Total bill was a bit over a million dollars. We were out of pocket ~$5k (our annual out of pocket max at the time).
The percentage of the population who don't have anything like that kind of money in savings is huge. And that is after you already pay huge amounts for insurance.
Additionally, the less money you make, the worse coverage you probably can afford, leaving you even more exposed.
You're absolutely right that it's insane that Americans talk about this as if it's just the only way things could work.
https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-...
I constantly hear economists saying people are spending outside their means, but when the price of getting sick with a throat infection is beyond their means, or will set their savings back by months or even years, is it really the people who are at fault?
Maybe if we don't want people spending beyond their means, we shouldn't have highly paid professions entirely devoted to getting people to spend without regard to their means.
Those who are fortunate to have good benefits are also usually able to set aside money for medical expenses. On the opposite side of things you end up having people with poor to no insurance with medical bills of more then they can afford to ever pay.
How do you do that though? The video which started this discussion is a young healthy woman who suddenly discovered she had a brain tumour. It could happen to anyone.
Fair enough, if I have a large amount of savings I might try to reduce the monthly payment by increasing the amount of risk I'm taking. But aren't those the people who would be most likely to have their insurance as part of their benefits package and so aren't paying for it directly anyway?
In my case we are offered a HSA plan that the employer ends up paying us a small amount by contributions into your HSA account. That is a high deductible plan though so you will pay for everything until you hit that deductible. We are also offered more traditional 80/20 and 90/10 plans which have a much higher monthly cost but spaces out the cost of things more as the deductible is much lower.
The HSA plan is very risky for the first year as my max out of pocket was more then I was legally allowed to contribute to my HSA. The second year I had enough savings put away where even if I ended up with a giant expensive issue I had enough put away for that max out of pocket number. This plays well into the scenario in the video. I have to protect myself going forward from the unforeseen medical issues. In my current situation that means making sure I have at least 1 years worth of my max out of pocket expenses saved up. Now I am covered even if unexpected things happen.
As a single adult with a good job it is much easier then if I had a family or was working a lower paying job. Even then you can do all the calculations but the risk factor goes up with the more people you have as the unknown portion grows. There is no good solution, that I know of, with our current healthcare system. I just try to play the game and do my best to stay healthy and prepare for the day when I am not.
Like gun control the issue has reached a stable equilibrium of political stupidity and I don’t see how it could change in the current climate.
I have no sympathy whatsoever for my hostage-takers, but I'm unlikely to fight my way out of this one, so might as well go back to talking about out-of-pocket maximums until I can make a shiv out of this toothpick.
I will tell you it's HEAVILY dependent on the zip code and procedures.
Private insurance is a whole different mess, likely going to hit deductible and be done. Last time my partner had to have surgery and billed insurance she paid $1000 and the insurance picked up the other $10k+ (precancerous mass removal, 45 minute surgery).
https://www.vox.com/2018/2/27/16936638/er-bills-emergency-ro...
There is no publicly available source for price cross lookups. This is largely due to the fact that billing, coverage and pricing varies not only from hospital to hospital but even within the same provider on the same service (a given CPT). So now, there is no way to know the likeness of billing/coverage and it's also highly likely that if she disputes the claim, or there is a renegotiation then she will end up paying significantly less.
EDIT: Ok, she lives in San Fransisco now. Didn't know.
That $5k (for me) resets every year.
I really, really wish insurance was less confusing though! So many copays, coinsurances, deductibles, out of pocket maximum, lifetime maximum, different tiers of drug prices, etc etc.
That stuff should be made simple by law.
(I have no knowledge of health care in the US - both countries I lived in have free health care)
As for that bill -- I'm curious: is there any resource I can look up to see how much of that the average Medicare/Medicaid/private insurance plan pays?
I ask because I just had two teeth repaired after a bike accident and it'll cost me ~$100 after insurance covers the other ~$500. By that ratio, she'd be looking at ~$38,000 bill.