Couldn’t you have enrolled in a plan that would have covered your treatment after the fact? I think you have 30 days to do so after losing coverage. I agree that the current system in the US is insane, but what was your plan originally for when you lost coverage?

GP could be referring to treatment being covered under the prior year deductible or max out of pocket.

I have a friend who was hospitalized on December 30th and released on January 2nd. And that's how they hit their max out of pocket two times over the course of 4 days.

It's an awful edge case. If they'd gotten terrible vertigo a couple days earlier or later, it would have cost them half as much.

doing this on an annual basis is such an obviously inefficient system (on both sides) that you'd think somebody would've developed a basic mathematical approach by now to disrupt the market.

but of course in practice, most US healthcare consumers don't really have an actual choice about who they buy their healthcare from.

Annual basis for what is a lifetime time frame is one of those things that's bonkers the harder you think about it.

I knew a guy. In 2008 his wife's company went under. So lost the health insurance she'd had for 15 years. No COBRA and in 2008 no ACA either. Her gall bladder got infected and they had to put a second mortgage on their house. Both of them had been paying for insurance for 25 years at that point.

Me I didn't have health insurance between 18 and 40 when I started working for a big corp. Two years later racked up $50k in medical bills. Insurance paid almost all of it.

Crazy.

Weird America-only medical bullshit: it costs way more money to have a pregnancy that spans 2 calendar years, than if you keep it all in one year.

> I left on 12/31 because the hospital could not tell me if my current insurance (COBRA) would cover the bills for days 5/6. Absurd.

For future reference, asking the hospital what your insurance covers will always result in a "we don't know" answer because they don't speak for your insurance. They can't risk saying "yes" when they aren't the ones deciding.

In these cases, call the insurance company. The reps deal with coverage questions like this all day long.

This is good advice, but I can just feel the egregious hold times, insufferable IVR (our choices have changed!), and explaining the same thing to 5 different people until you get an answer that winds up being incorrect but good luck proving that in Small Claims because smartphones are very good at preventing you from recording conversations for your own records.

I understand the reasons why we structure our world using adversarial systems but geez, sometimes it really shows.

>"…because smartphones are very good at preventing you from recording conversations for your own records."

If you don't want to deal with the plethora of scummy apps to record call, you can go old-fashion and buy a telephone pickup microphone[1] for $20.

[1] https://www.amazon.com/Olympus-TP-8-Telephone-Pick-up-Microp...

Yes, but the point is that it's insane that your advice is the correct advice. There should be borderline zero "barrier to entry" for knowing what monetary burden you are about to submit to, especially considering the state you are probably in, and the time-sensitive nature of health issues.

> In these cases, call the insurance company.

I did that once, they told me "we don't know because we don't know what the hospital will bill".

So I decided that I don't know if I'll pay..........

Is there a reason the hospital can't say "we don't know, call your insurance provider"?

As a physician probably my single most feared infection is a MRSA (or any Staph.) bloodstream infection. It’s a sticky bacterium that likes to destroy heart valves and joints. I’m personally a bit of a medical nihilist but antibiotics often work to treat it and I would not be eager to do the n=1 trial of the shortest effective duration.

Bankruptcy may very well do greater collective harm. Pretty horrifying to even have to weigh that variable.

As much as bankruptcy is horrible, it’s does not compare to the immediate harm of a disseminated MRSA infection.

Let’s not be hyperbolic.

I think you’re very fortunate to not have known anyone who has had to make that calculation.

There is no calculation to make. If you have an untreated MRSA infection, you will die. Now whether the treatment can be overly prosecuted is a different question.

You can set a broken bone yourself. You cannot treat MRSA. You do not walk out of a hospital with untreated MRSA AMA.

If the harm is so great to all of society, then surely all of society would ensure that no one ever has to even think about cutting any treatments short.

Or, even if it's just the knowledgeable and responsible medical profession who knows how important that is, then surely that same knowledgeable and responsible medical profession would ensure that no one ever has to think about doing something they claim to care so much about avoiding. Right?

This responsibility to others argument falls dead flat.

I would rather die than lose all my retirement savings and be forced to find a job in my 60s or 70s. No hyperbole at all.

With an untreated MRSA infection, you wouldn't live to your 60' or 70's. No worries.

> It’s a sticky bacterium that likes to destroy heart valves

Do those grow back crooked or something?

I don’t believe they grow back at all.

No they get destroyed leading to hear failure and shock needing surgical replacement if you survive

Adult heart cells (cardiac muscle) don't regenerate. Once they're gone, they're gone.

> I feel like I 'survived' the hospital system, not MRSA.

You survived the insurance system (or rather, despite it).

The hospitals can't tell you what is covered at the time of service, only well post facto (I literally got a call last week about a copay from surgery I had in May 2022). IMHO most of that blame lies with the insurance companies, but the hospitals are complicit.

The more exposure I have to the health insurance system, the more convinced I am that nobody actually knows what they're doing. For all the insight the average action has, the corresponding actor might as well be a computer program that only compiles on Borland Turbo C++ trying to parse a policy expressed in malformed XML edited by an unpaid intern a decade later.

I once got a bill nearly a year after the actual treatment, with a line item that differed only by the description field's whitespace and punctuation from a charge I knew I'd already paid. There was a smaller line item on that bill that I probably hadn't paid, but just through the magic of calling the phone number and sitting through hold, I was told not to pay anything.

American health insurance needs an additional layer of insurance where you pay in monthly and if you get sick a consultant with knowledge of health insurance coverage comes along and works out these things. Clearly you were mentally capable at the time, but many times people just get ripped off due to a combination of lack of understanding, will power or grief. The only other industry I can think of that waits until customers are at their most vulnerable before gouging for maximum profit is loan sharks.

On a similar insurance related note... I needed an emergency appendectomy and was sent home in pain by non-medical staff.

I had gone to an urgent care clinic with abdominal pain. They pressed on my abdomen to see where the pain was and told me to immediately go to the hospital down the street and there would be a CT scan order waiting. At the conclusion of the scan, I was told to go down the hall to the ER for emergency surgery.

At the ER check-in counter, they took my information. My insurance was a PPO for which the hospital was in-network. After 20 minutes on the phone, they told me that my employer (a 6K person public company, not a small company just figuring out benefits) hadn't paid their premium so they would not admit me. I knew the head of HR and called her directly. She said that premium payments are automated and there were no issues. To make sure, she called our contact at the insurance company, and they confirmed everything was good. I told all of this to the front desk staff, and they said there was nothing they could do. They said they would contact the insurance company again the next day and call me if anything had changed.

Looking back, I should have gone straight to another hospital. But I was delirious with pain and went home to rest because I was exhausted and freezing cold from sweating profusely. The next afternoon they called and said it had been cleared up and that I need to get there immediately as it was life threatening. I got to the ER, and they started a series of tests to determine if my appendix had burst (it hadn't!). A doctor came over to review the test results, saw that the CT scan was the previous day, and yelled at me for several minutes about how I risked my life by listening to the front desk staff. I asked if I should have forced my way back to find an empty bed and just jumped into it. He continued to yell at me until a nurse physically pulled him away. I finally had the surgery late that night (with another doctor that was not so agitated), and everything went well from there.

So, I initially left the hospital against medical advice, but at the insistence of non-medical staff. A different situation, but sometimes taking medical advice is not an easy option.

This is so depressing, I’m sorry you went through that.

That's insane. Luckily in the US this can't happen (post 1986) as EDs cannot deny care to anyone under EMTALA.

This was in San Francisco in 2016. Maybe it's not supposed to happen, but it can.

To Europeans, US is like the only place where this constantly happens.

> A doctor came over to review the test results, saw that the CT scan was the previous day, and yelled at me for several minutes about how I risked my life by listening to the front desk staff.

Has he tried yelling at the front desk staff yet? I hope you know his name and contacted him afterwards.

> I asked if I should have forced my way back to find an empty bed and just jumped into it.

I assume that would get you arrested, and maybe even dragged to jail. :S