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I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

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Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#51
post #18

Earlier quoted context omitted.

Meanwhile, it's entirely possible to be out of 3000 dollars after an animal bite with a regular insurance plan. Nothing more than an x-ray and a couple stitches, and the out-of-pocket cost was 3000 dollars. One wonders where the premium goes.

The premiums go to subsidize other people's even more expensive care, like $80k helicopter rides, or $100k heart surgeries.

It's not really a subsidy though (it's a set of actuarial models and contractual agreements).

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#52
post #37

I'm generally a fan of HDHPs, but I echo some of the same complaints made in the article. For example, just a few months ago, my toddler was complaining about horrible pain in his stomach. Now, being 5, it's awfully hard to determine exactly how much he's hurting, and of course, the strong recommendation from every nurse, doctor, and UC clinic we talked to was to bring him to the ER. A UC clinic or PCP won't take the…

Yeah avoid the HDHP if you have children or know you comsume a large amount of healthcare services. Otherwise, HDHP, the associated HSA account, and typically an employer contribition create a triple tax free investment that can't be beat. Sucks though we have to guess how much health care we might use in the coming year. On a postivie note if you hit your family max for the year, try and stuff in as much medical car…

One relief was that it happened in March, not on Dec 31, so it's not like I wouldn't have paid some of that bill in care, which is now 'free'

The other thing I learned, since the hospital was unwilling to negotiate on total price is that they just want you to commit to paying and will give you a long, low monthly, zero interest payment plan to make that happen. I'm a 'no debt' kind of guy, but if they'll float me a loan for free, I plan to just keep adding future visits to this network to my payment plan indefinitely.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#53
I have zero medical expertise, but were the two blood tests and an xray really necessary for what seems like a simple case of dehydration?

Anecdotally, I recently got a simple blood test to keep an eye on something that’s been borderline in the past. Unbeknownst to me, my doctor ordered nearly 30 things to be checked in the blood panel, at $50-$100 a piece. Luckily my insurance negotiated a much lower price and covered most of it, but I can’t imagine paying $2,000+ just to check e.g. your cholesterol level.

I think the problem is alignment of incentives: for a doctor, over-testing has little to no negative consequences, but under-testing could lead to guilt due to a patient dying, loss of reputation because something was missed, lawsuits, etc.

As a society, is this how we should be using our limited medical resources? What if we made fewer xray machines and instead spent more on something like cancer screening? How many net lives could we save?

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#54
post #4

Aren't you assuming that the healthcare system operates for the good of the patients? From my point of view, that doesn't seem to be the case in the U.S.

In all these cases, there is one constant: the patients get treated, and treated well. That's not the issue. It operates for the good of the patients (whereas for example, the NHS often gets criticized ...) It's the billing afterwards that's the issue.

The NHS is being systematically destroyed by the Tories who want this broken US system in the UK because it makes them money.

Aussie healthcare is the best I've seen (and I've seen a few). Basically free, with more speed or better care (or whatever) if you want to pay for it. Health insurance is like US$75 a month and not tied to employment.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#55
post #52

Earlier quoted context omitted.

Yeah avoid the HDHP if you have children or know you comsume a large amount of healthcare services. Otherwise, HDHP, the associated HSA account, and typically an employer contribition create a triple tax free investment that can't be beat. Sucks though we have to guess how much health care we might use in the coming year. On a postivie note if you hit your family max for the year, try and stuff in as much medical car…

One relief was that it happened in March, not on Dec 31, so it's not like I wouldn't have paid some of that bill in care, which is now 'free' The other thing I learned, since the hospital was unwilling to negotiate on total price is that they just want you to commit to paying and will give you a long, low monthly, zero interest payment plan to make that happen. I'm a 'no debt' kind of guy, but if they'll float me a l…

They aren't going to negotiate with the insurance company and then also negotiate some more with the covered party.

Of course, why the insurance company agreed to some ridiculous price is a pretty fair question.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#57
post #18

Earlier quoted context omitted.

Meanwhile, it's entirely possible to be out of 3000 dollars after an animal bite with a regular insurance plan. Nothing more than an x-ray and a couple stitches, and the out-of-pocket cost was 3000 dollars. One wonders where the premium goes.

The premiums go to subsidize other people's even more expensive care, like $80k helicopter rides, or $100k heart surgeries.

Helicopter rides are pretty much never covered.

> The average cost of life flight within the U.S. ranges between $12,000 and $25,000, according to NAIC (National Association of Insurance Commissioners). This is based on a 52-mile trip, which is also the average distance. This figure represents an out-of-pocket cost when not covered by insurance or calculated before an insurance company steps in. International flights can easily cost 3 to 5 times that amount. … In December 2020, Sean Deines was diagnosed with acute lymphoblastic leukemia (a fast-growing blood cancer) and took an air ambulance from Colorado to North Carolina, which also included ground transportation between hospitals and airports. His total bill was $489,000.

https://www.emergencyassistanceplus.com/resources/what-is-th...

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#58
post #52

Earlier quoted context omitted.

One relief was that it happened in March, not on Dec 31, so it's not like I wouldn't have paid some of that bill in care, which is now 'free' The other thing I learned, since the hospital was unwilling to negotiate on total price is that they just want you to commit to paying and will give you a long, low monthly, zero interest payment plan to make that happen. I'm a 'no debt' kind of guy, but if they'll float me a l…

They aren't going to negotiate with the insurance company and then also negotiate some more with the covered party. Of course, why the insurance company agreed to some ridiculous price is a pretty fair question.

This is one of the big problems: if one went without insurance entirely, the hospital may negotiate 50-75% of the inflated charges away for cash on the spot, but with insurance involved, I have no control over the price I pay for that $150 Tylenol, which insurance knocked down to $75. On a HDHP, I'm out that $75, because the hospital 'isn't allowed' to negotiate further after insurance.

An obvious example of this is with prescription drugs. I have a monthly script that is something insane like $250 'U&C' charge, but after insurance, it's $90. However, at a particular pharmacy, with GoodRx, it's $21. Paying 'cash' with GoodRx ends up being the better deal, even though it doesn't count towards my OOP/deductible with the insurance, because I'm not likely to hit that with a HDHP.

Would my total cash outlay for a hospital visit be cheaper without insurance? Maybe, but the fact that I can't determine that upfront unlike what I can do with a script is what is infuriating.

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#59
post #14

Earlier quoted context omitted.

One of the problems here is that the patient can believe they're at an in-network provider — and be correct about that — and still get hit with "out of network" charges. One of the linked articles[1] explains it slightly better: > Surprise medical bills happen when a doctor or other provider who isn’t in a patient’s insurance network is unexpectedly involved in a patient’s care. Patients may go to a hospital that acc…

This +1000. The whole billing / insurance system is intended to wear you down in a cascading swarm of bullshit. You want to know if a doctor is in network? Good luck, because the insurance company clearly states that they only provide that information on a best effort basis. The doctor can’t answer, as they refer you back to your insurance company. You want an outpatient surgery? Great! Make sure your doctor and faci…

There was legislation that changed this a couple years ago.

https://www.cms.gov/nosurprises/ending-surprise-medical-bill...

Re: I'm a Former Surgeon General and I Couldn't Believe My $10k Medical Bill

#60

Earlier quoted context omitted.

I believe that's the way it works. And then you have to transfer to in network provider as soon as humanly possible (perhaps not as humanely possible...)

One of the problems here is that the patient can believe they're at an in-network provider — and be correct about that — and still get hit with "out of network" charges. One of the linked articles[1] explains it slightly better: > Surprise medical bills happen when a doctor or other provider who isn’t in a patient’s insurance network is unexpectedly involved in a patient’s care. Patients may go to a hospital that acc…

Why are randos allowed to bill you directly if you didn't sign a contract with them? Shouldn't anyone working at the hospital be under contract with that hospital? Why did the hospital share your personal information with those people without your explicit consent?
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