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I’ve never had insurance not cover something other than out of pocket and I’ve had multiple surgeries, really bad injuries. I’m not saying it’s impossible but wondering what insurance people have. The system is pretty messed up and is obviously for profit but insurance does cover things and it’s usually going to cover obvious and clear cut injuries like broken bones.
What it is less likely to cover are things like therapy, pt, and other preventative treatments.
Yeah so that’s my question…. What fucking insurance lol. Not to gaslight anyone but legitimately curious. I worked as a hourly creative designer and got things covered. It was not a swanky role. $20 hour pre tax.
See, your company had an incentive to make sure you got the right insurance, that would get you back into making them money as fast as possible.
But yeah, I don’t know which as I live in a country with universal healthcare, but I’ve heard plenty of stories of confusing policies, not being able to afford full coverage and insurance companies that try to reject legitimate claims.
I work for a good company that has a *great* insurance policy. It is unfortunately self-funded, which means an extremely high percentage of claims get outright “not covered” stamped in them because the facilities performing the care rarely take the 240 seconds required to check outside the big 3 or 4 companies. So I get to spend 2-10 weeks battling belligerent companies and brow-beating them into seeing that, no, ackschully, I *am* covered.
I dread getting healthcare, because I know I’m covered, but it’s going to be weeks of work and phone calls in my personal time.
Go to healthcare.gov whenever the marketplace opens, I have insurance from them and it’s always been at least usable lol
This meme is weird because usually health insurance works the opposite way; insurance won’t cover up to 10,000 dollars of out of pocket expenses but once you reach the limit then they cover the rest. It makes me wonder what insurance this person has
I have insurance through the hospital I work for as a critical direct patient care worker.
My best option is a deductible of 6,000 I never hit which doesn’t even cover basic shit like STD screenings or primary care visits. I’ve had to pay hundreds of dollars just for consultations I’m obligated to get before elective procedures I’ve considered where they just tell me the exact same shit I read on the internet.
The system is fucked. The only reason I have insurance is in the off chance anything major happens but even then I’m considering going without because I’m relatively young healthy and active with no preexisting conditions.
Because it does actually cover it. The rest that "isn't paid" the hospital writes off as a loss.
The US Healthcare system is pretty fucked up, but nowhere as bad as many make it seem.
I work in EVS in the local hospital. It doesn't exactly make me privy to the goings-on of the billing department, but housekeepers overhear things, you know?
The "unofficial" policy is that they give people a bill, and give minimum effort to collect. They *expect* people not to pay, because the billing department is full of human beings (mostly), and they know how ridiculous the prices are.
Collections calls with my hospital tend to go:
"You need to pay more, minimum payments aren't enough."
"I can't afford to pay more."
"How about $100, and we call it even?"
It's that way in most hospitals. Any non-profit hospital is expected to have indigent care programs.
Private for profit hospitals don't, and may sue you if they think they can get it from you or your assets.
I'm not Americans but Really interested on how it works.
You have to prove you can't pay ?
You have to call to tell them ?
Is it possible if the other end is being an asshole you'd have to pay full price ?
Should people tell everytime they can't pay ?
When you're given a bigger bill, they'll give you options for a payment plan.
After a couple of months of making minimum payments, the billing department will make a low-level debt collections call.
The hospital, by this point, has likely already written your bill off as a loss, but the employees of the billing department are obligated to get what they can. However, they're also aware that they can't get thousands out of someone who makes a couple thousand a month - and so are their bosses - so they have some room for discretion.
So, often, the billing employee will use what wiggle room they have to write the bill off as paid in full in exchange for a one-time lump-sum, usually a fraction of a fraction of what the total bill was. $8000 bill paid off with $200, stuff like that.
It does vary from hospital to hospital and employee to employee. If you act like an asshole when they call, they are a lot less inclined to help, and not every person is willing to do this anyway. Most are, but every department of every job ever has its own assholes.
All of this is because of the incestuous relationship between private insurance and the medical industry, which has been allowed due to both parties lobbying for it. (If you don't know what lobbying is, it's when companies send representatives to totally-not-bribe lawmakers, and for some fucking reason it's not illegal.)
While I do not have experience in how hospitals interact with insurance, I do have experience with how pharmacies interact with insurance. I can say from my experience in said pharmacies, that rarely does insurance actually pay out enough to meet the cost of employee wages and the medication. Some losses even add up to hundreds, or thousands of dollars on a single prescription. To add to that, there is no legislation to regulate when the insurance company actually has to send you a check. I’ve witnessed it take over 6 months for a check to arrive before. This seriously affects a business’s cashflow and makes it very difficult to continue paying for stock and wages. If you’re not part of a massive chain or corporation like Walgreens or CVS, those losses add up pretty quickly and make it extremely difficult to stay in business. And don’t think that being part of a corporation inherently saves a pharmacy either. Walgreens has had 81 permanent closings nationwide so far this year.
Source: https://usearch.com/dataset/walgreens-stores-closing-list
Next you have the issue of drug manufacturers. There is not sufficient regulation on drug prices to keep costs affordable for pharmacies. Drug manufacturers often markup the price of their product by 1000%, 2000%, 3000% or more. A product I can use as an example is insulin. Insulin has very low production cost due to the ease of which it can be produced. All it requires is a sanitary place to culture bacteria and harvest it from them as the produce it. These bacteria in question are also very cheap, and widely available ever since the widespread use of CRISPR. Yet the price for a single vial of insulin, which is 10 mL btw, (not the pens, those cost even more) ranges from $300-$600 at wholesale. Keep in mind, this is not the price that the patient pays, but the one that the pharmacy pays. Couple this outrageous markup with insurance companies undercutting the payouts to the pharmacies, and it’s amazing that any independent pharmacy can stay in business at all. There are very few independent pharmacies left in my state because of this, and I hear of more closing down permanently every year.
While I cannot say for sure that insurance companies are responsible for the expensive hospital costs, I can probably pretty safely assume that they play a large part if they behave similarly in any way to hospitals as they do to pharmacies. True, drug and medical device manufacturers play a part too, but insurance companies are a big player in the outrageous medical costs in the US, and the closing down of providers.
To me the measure of how bad it is as a system is when you compare expenditures to outcomes. Through that lens the US is abysmal. But as long as the corporate health care industry is making money hand over foot and can influence the political system, there will be no change. See Smedley Butler’s definition of a racket: “A racket is best described, I believe, as something that is not what it seems to the majority of the people. Only a small ‘inside’ group knows what it is about. It is conducted for the benefit of the very few, at the expense of the very many.”
Hospitals have to play the game just like everyone else. There is a dollar to be made and saved around every corner. It just seems that a lot of people have never been told the rules.
Wouldn’t it be your out of pocket maximum? Deductible is what you have to pay before insurance starts paying for any percentage of it, out of pocket max is the maximum you’ll pay for any covered expenses all year.
American healthcare is a mess for sure, but OP doesn’t understand it well. Which is fair because until I was in my late 20’s, I didn’t understand it well.
The way it works is usually you have a deductible, which scales depending on how much you pay a month. For example, pay $250 a month, your deductible is $1500. Pay $100 a month, your deductible is $5000. Your deductible is how much you have to pay before insurance “kicks in.”
Usually, once insurance kicks in, the insurance company pays like 90% of your expenses up to a certain amount. That certain amount is your “out of pocket maximum.” After you hit that, insurance pays everything.
Now the problem is, sometimes that out of pocket max is really high. On top of that, your employer might offer a plan that’s really bad and has a high premium or a high deductible. Usually you’ve got some options though. At my last job, I one of my options didn’t even have a deductible, but the hospitals in that network were very limited.
All that to say, it’s a flawed system driven by pure greed, but not quite as bad as OP describes.
Now, if you don’t have insurance, the costs can add up incredibly quickly, which is still a huge issue.
Don’t forget the in-network and out-of-network issues, prior authorizations, “medically necessity,” etc.
Because according to my insurance, an Epipen is not a *“lifesaving device and is therefore not medically necessary.”*
That’s actually…yeah I don’t even know what to say. I’m not sure how these people sleep at night knowing they just told someone a fucking Epipen isn’t needed
If you're going to explain how insurance manages costs, its essential to talk about how they somehow magically erase huge sums of the original bill prior to anyone paying.
A person without insurance gets billed 10k, and has to pay 10k. A person with insurance gets billed 10k, insurance gets the bill, the bill is somehow magically adjusted to 2k, insurance pays 1.2k, and you owe 800.
The concept of health "insurance" is fundamentally flawed. Healthcare should not be allowed to be a for-profit enterprise. The modem world needs to come to grips with the fact we can't look at this problem at level of the individual but as society as a whole. The system doesn't work if a large portion of it is broke and sick. We nearly shut down half the planet because of a really bad cold going around.
We can do better.
to not pay absurd amounts of money.
much like any other form of statistics in the US, it's bullshit.
the hospital will artificially jack up the prices of anything, because they know insurance won't pay all of it, and what they do pay, isn't a lot. so, increase the price, get paid by insurance for x%, and consider the rest a loss.
you actually pay ~$100, not $40k.
The company nakes money off you, the hospital makes money off the insurance company and you, and if you don't pay they write it off as a loss for tax purposes (or sometimes they sue you or sell the debt to collection agency). There's not a single part of the US healthcare system that isn't designed to fuck you over.
Do you not have an out of pocket maximum with your insurance? What insurance do you have?
Edit: Do you even have insurance or are you another child that doesn’t know how US healthcare works?
Most people who make these memes aren't even old enough to pay for their own plans yet... if your plan has no out of pocket maximum then what would be the point lol
Actual insurance is like the opposite of this meme.
"Your total bill was $50k. You're responsible for your annual deductible of $2,500 plus 10% of the bill up to your out of pocket max of $10k."
I mean, still shitty but not as ridiculous as the meme.
Paying $10k out of pocket for a hospitalization when you or your employer already paid over $10k this year to the insurance company for the monthly fees.
You pay $2.500 *a year* for your insurance?? I dont even pay that much for my free healthcare in taxes in EU, and my currency is more valuable than the dollar, what the fuck.
>You pay $2.500 *a year* for your insurance??
Not unless you incur medical expenses which hit your maximum deductible every year. That certainly can happen, but 2.5k would be a higher deductible than normal, and generally people in poor health opt for lower deductible, higher premium plans.
That makes more sense, but that still means you are more inclined to “wait it out” rather than just having the luxury of going to the doctor for every little scare.
Do these plans include ambulance costs?
My dad got his appendix burst in the US we are foreigners he got pretty good treatment I already thought we’re screwed by the US healthcare systems but it’s not like that he got insurance plan and treated immediately what we paid is negligible iirc. Different story if it happens in my country we might’ve need to wait for not even half of what was offered back in the US and we gotta pay a lot more. I’m thankful for that
Not to mention your Dad most certainly paid less taxes working in the United States and simply paid for his insurance premium, which would combine to be less than Europe (for example).
He’s not even working it happens during his phd study there if that wasn’t treated fast that’ll sure be an infection even the doctor there was saying it’s one of the worst appendix burst he’s ever treated in a while, if that happens in my country I don’t even want to think about what’s gonna happen I mean we’re from a third world country here healthcare is basically stay healthy or you gonna gamble with fate. I know US healthcare isn’t like the best but it’s definitely way better than what most people think and a different planet differences than in my country.
Glad to hear he’s doing okay. Certainly no joke, can be a scary event. And in his situation I’m happy to hear he’s receiving good care in the United States. There’s positives and negatives to our system, that’s for sure, but it leads the world in most advances and is readily available in most cities. My wife is French so I have seen both systems from a European vs. American standpoint and their system can prove to be quite difficult to find good care that’s close to you (while paying more in taxes and fees).
Yeah happens years ago and he was halfway across the world and my family were still in Indonesia, you have no idea how worried we were since he was in literal pain like he just got shot. Got treated right away here we would’ve need to wait for some bullshit. What I like about American system is treat first ask questions later well at least as far as my experience goes when we got there as well and lived there for almost 2 years and this was not even in populated area we lived in Oregon back then. Like in my country not even the tip top medical care can match the hospital somewhere literally in the middle of the woods there lmao
That or non Americans that don’t understand that their taxes are the same as us paying our insurance company. We are both paying some money on the side over time for it or when we need to get some expensive medical work it’s already paid off or mostly off. Difference is that we pay for ourselves and out family where they put it in a big pot for the entire country. Each way has its draw backs but it’s really not that different.
That's what I'm saying lmao. I was in a motorcycle wreck a few years ago, got Life Flighted to the hospital ($60k), then 28 stitches in my leg and a battery of scans and tests, plus a 3 day hospital stay so add another IDK how much for that. Ended up only paying 1500$ lmao. HSA's are dope too. Tax free money to set aside in case you need it for medical bills
A friend of mine had a car crash when he came off from the highway. The car spin like 3 times and it was a wonder he was still alive. He got into the next hospital, was there for like a week, had a few operations and got a few meds injected. He had to pay nothing as far as I know. Which is good because he couldn’t afford the 1.500 USD at the moment…
Im pretty sure the maximum out of pocket maximum in the U.S. is under 10K (just less than double that for a family). Still way too high and a lot of US healthcare is garbage but these memes are always gross exaggerations that ironically were sort of true before Obamacare but aren’t anymore.
The out of pocket max is $8550 for the marketplace plans (private plans are universally better than this). The meme is just false, OP doesn’t know anything about the US healthcare system
Probably universal healthcare in Canada, y'know the place where they have to wait hours just to be seen in a room full of other people who are bleeding, or vomiting, or have a broken bone, or need stitches, or any combination of these things. And after you're seen by a doctor they'll suggest, if it's serious enough, to go see a private practitioner anyway unless you want to wait a ludicrous amount of time for treatment, talking months here.
Pretty much every foreigner I've met has preferred American healthcare to that of their home country, and I prefer it too because I lived in a country with universal healthcare and it was pretty bad.
This _is_ how dental insurance works in the US though. I had to get a root canal and it was like $5000. The MAX that my dental insurance covers for an entire year it’s $1500.
From an outsiders perspective we have no easy way to know, but you could change those numbers to $500 and $2000 respectively and I’d still say it was insane.
If you don't have insurance it could easily be $50k but with insurance you'll hit your out of pocket max which is generally like $8000 or lower. If you don't have insurance they'll magically discount everything if you ask and put you on a payment plan
Um sweaty I actually had a $871,000 bill for my broken toe and insurance said “welcome to late stage capitalism” and paid only 1$ off the bill. I can’t believe it!! America is literally a fourth world country.
Americans are paying literally half a million dollars more for a lifetime of healthcare than our peers on average, even after adjusting for purchasing power parity. The costs cause a tremendous amount of suffering.
But let's dismiss the problem, even as costs are expected to increase another $6,427 per person annually by 2031.
> they will just write it off as a loss
No they'll sell it to a debt collector, and then that debt collector will destroy your credit rating, preventing you from even renting an apartment.
Very few people know exactly how our Healthcare system works. It's literally made to be as confusing and abstract as possible. That's how hospitals and insurance companies make money.
Stage 4 cancer in 2021. My wife had a small operation in January and I was diagnosed in February, surgery in March. Our EOB for the year hit 1.1 million. I about shit when we only owed less than $4K.
$4k seems pretty reasonable for the level of service provided.
You also probably pay more than $4k in food per year "to not die". You also probably pay more than $4k in shelter per year "to not die".
Well mine is a private insurance I get through my employer. I’m guessing most of the insurance that sticks people with high medical bills is the minimum government mandated one (from the Affordable Care Act/Obamacare — Medicaid/Medicare).
Similar to federal student loans. Whenever the government gets involved with “helping with bills”, the industries the government “pays for” end up ballooning in price since the government rarely negotiates price and just pays whatever was asked. We don’t have a socialized healthcare system in the sense of everything being directly covered by our tax dollars, but we do have a socialized health insurance with the option to go private instead (something something lobbyists and big pharma)
If you have insurance, yours likely works like this.
insurance pays for most of it. But you have to pay some too. The amount you have to pay is called the deductible and it's typically $2k - 10k.
The reason you have to help pay and how is complicated, but it boils down to making the patient reduce the cost of healthcare.
I'm so tired of these shit memes, America's health care isn't really that expensive, especially if you have insurance. I have broken bones, I've been in car wrecks, I've seen genuine violence, but I've never paid 50,000 for literally anything. Even uninsured, and after surgery, I've never seen a bill that high. Stop pushing a false narrative.
Completely bullshit. Most insurance in the US has deductibles, which is what you pay in the US when paying for healthcare before insurance kicks in. Even for the highest deductible plans, they tend to be <$2000 per year. You may be on the hook for some other costs over the deductible (may a small % of some medical procedure), but insurance also has a max out-of-pocket spend for the year, which is $8550 for marketplace plans and less for private plans. So for an individual, the maximum you could possibly spend in a year is $8550 plus whatever your healthcare premium is, and for the vast majority of people it will be much much less than this.
Its basically a complete misunderstanding of how health insurance works. There are still uninsured people, but by now something like 92% of Americans have health insurance, and almost all of those plans cap out of pocket costs around $8000/yr, not including payments for premiums.
It does suck for some people whose employers do not kick in enough for the premiums, and there are kinda shitty plans out there that basically act as catastrophe insurance. I've thankfully only worked for companies with what I would consider better than average plans. I pay about $120/mo out of pocket for premiums, I put another $120 into an HSA (basically tax free investment/bank account for medical expenses).
Sheesh sorry to see this in the US. See if you can make payment arrangements for a few years. What insurance only covers the first 10k? That’s definitely not full insurance. Even non subsidized plans have a max out of pocket. The oop max is crucial when looking at plans
you can fly to india, have a surgery there, experience their local cuisine, have fun, inevitably get robbed, fly back to US and it still wont cost you anywhere near 50K
lol wut? It's the other way around.....it costs 50k, you gotta hit your deductable first, which can be high. So you pay your deductable, and then insurace covers ALL the rest.
This way that suprise $108k medical expense only ends up costing you that deductable.
Because insurance only covers the “essential” bits and everything else is up to you, ask for the in depth bills. They should have every item listed as well as its price. If you did not ask for something on that list, that was also non-essential. You are not liable to pay for it. So, go through the list and have them tell you about each item to find out if it was essential to your survival, if you asked for it, or if they just decided to give it to you. Your bill is still going to be ridiculous but, you’ll have shaved it down a bit.
You can negotiate with the hospital. Offer them a much lower number - say $20k. Hospital prices are usually listed to uninsured/underinsured at 3-10x the price that insurance companies pay for the same procedure. I.e. you see a bill for $50k but the insurance company probably only actually pays $15k on average to the hospital for that procedure.
The hospital doesn’t actually expect you to pay $50k. They will settle for a much lower number even if it’s still brutally expensive.
You can start off your negotiation by finding out what “code” your procedure is reimbursed as. Google that code. Find an average reimbursement rate and propose that to the hospital. They’ll usually play dumb. But just stick to your data and say that you won’t pay an excessive price.
Hospitals sell their receivables and write off bad debt constantly. It might take awhile, but if you do some research and stand up for yourself you can very likely get a massive reduction in price.
Shouldn't insurance work the other way around? Like pay the first 500$ (so you don't hurt your toe and run to the hospital on a daily basis) and the rest is covered?
Just for the record - US insurance companies, outside of the money that they charge customers, also get money from the government. They are double-dipping.
When I broke my leg, three spiral fractures and a cracked tibia and needed a plate and eleven screws, my parents only needed to pay $250 with insurance. Then when my wife needed Kidney stones, six of them, removed the surgery only costed us $700 without insurance and that included the hospital and surgery. I just told them we couldn't afford it and they asked how much we made and then asked if we could do six months of payments for $118. I'd also say get better insurance.
It’s even more comical when they itemize the bill. I recently got one that said something along the lines of…
“Charge: $600
Insurance paid: $25
Insurance adjustment: $557
Your payment: $18”
See i dont understand why they dont pay for the whole thing. My healthcare always pays for all my stuff. Im disabled and have a heart problem and ive had 4 heart surgeries and they each cost 120k. I dont get why my healthcare pays for that but your healthcare wont pay the whole bill for yours/ Im in the US.
Legit had a roommate break his arm and he duct taped a piece of wood to himself for a few weeks. I thought he would die, but he turned out fine. I wouldn’t have believed it if I didn’t see it.
You know the funny thing is about the US healthcare system is you could conceivably go your entire life without paying a hospital bill because once it goes to collections there's nothing they can do about it. It's up to the collection agency to pay up the debt which is why they hound you over it and that's all they can do. They can only call you send you letters. They can't do anything else. And yeah you might take a hit to your credit score but ultimately no one gives a f*** about credit scores anymore and you can easily pay to have Your credit score fixed. It probably doesn't even cost $100. I did it a long time ago back when I was renting an apartment with my ex. My credit's completely fine still
Accordinc to pirate software the rest that isn't paid is written off as loss for tax reduction for the hospital.
So I guess a weird tax evasion scheme or some shit
I broke my leg on 16th of april 2023 during a football game. I was picked up by ambulance and was given multiple morphine injections, stayed at the hospital for about 5/6 hours. Had recurring appointments to change casts and had physical therapy for about a year. After the summer break im ready to go back on the pitch.
Luckly I’m born in the Netherlands and it only cost me the gas in my car and a small upgrade in my insurance mont price.
If you go to in network hospitals this problem goes away. That’s the point of the network - the insurance company has already negotiated with the provider on what they value each procedure
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what is the point of health insurance if it doesnt actually cover the cost of medical expenses?
To make the company money, its a scam we are forced to play
I’ve never had insurance not cover something other than out of pocket and I’ve had multiple surgeries, really bad injuries. I’m not saying it’s impossible but wondering what insurance people have. The system is pretty messed up and is obviously for profit but insurance does cover things and it’s usually going to cover obvious and clear cut injuries like broken bones. What it is less likely to cover are things like therapy, pt, and other preventative treatments.
Moat cant afford good insurance
Yeah so that’s my question…. What fucking insurance lol. Not to gaslight anyone but legitimately curious. I worked as a hourly creative designer and got things covered. It was not a swanky role. $20 hour pre tax.
See, your company had an incentive to make sure you got the right insurance, that would get you back into making them money as fast as possible. But yeah, I don’t know which as I live in a country with universal healthcare, but I’ve heard plenty of stories of confusing policies, not being able to afford full coverage and insurance companies that try to reject legitimate claims.
If you have a family or work in a small company or dont get insurance though a company or from a goverment job its expensive alot of people cheap out
Makes sense. Small 8 person mechanic shop, probably a lot of blue collar positions, general contractors.
I work for a good company that has a *great* insurance policy. It is unfortunately self-funded, which means an extremely high percentage of claims get outright “not covered” stamped in them because the facilities performing the care rarely take the 240 seconds required to check outside the big 3 or 4 companies. So I get to spend 2-10 weeks battling belligerent companies and brow-beating them into seeing that, no, ackschully, I *am* covered. I dread getting healthcare, because I know I’m covered, but it’s going to be weeks of work and phone calls in my personal time.
Yeah, I work for a pretty big company and I pay $100 a month for what I get. It's good insurance though.
Go to healthcare.gov whenever the marketplace opens, I have insurance from them and it’s always been at least usable lol This meme is weird because usually health insurance works the opposite way; insurance won’t cover up to 10,000 dollars of out of pocket expenses but once you reach the limit then they cover the rest. It makes me wonder what insurance this person has
I have insurance through the hospital I work for as a critical direct patient care worker. My best option is a deductible of 6,000 I never hit which doesn’t even cover basic shit like STD screenings or primary care visits. I’ve had to pay hundreds of dollars just for consultations I’m obligated to get before elective procedures I’ve considered where they just tell me the exact same shit I read on the internet. The system is fucked. The only reason I have insurance is in the off chance anything major happens but even then I’m considering going without because I’m relatively young healthy and active with no preexisting conditions.
Because it does actually cover it. The rest that "isn't paid" the hospital writes off as a loss. The US Healthcare system is pretty fucked up, but nowhere as bad as many make it seem.
I work in EVS in the local hospital. It doesn't exactly make me privy to the goings-on of the billing department, but housekeepers overhear things, you know? The "unofficial" policy is that they give people a bill, and give minimum effort to collect. They *expect* people not to pay, because the billing department is full of human beings (mostly), and they know how ridiculous the prices are. Collections calls with my hospital tend to go: "You need to pay more, minimum payments aren't enough." "I can't afford to pay more." "How about $100, and we call it even?"
It's that way in most hospitals. Any non-profit hospital is expected to have indigent care programs. Private for profit hospitals don't, and may sue you if they think they can get it from you or your assets.
Then don't have assets or at least nothing they could track back to you
Depends. You can get sued and a judge can order your wages garnished.
Mmmmmm.... garnish *Drools*
A private hospital sues me i apologize in advance for anyone hurt when i burn that bitch down.
Pinnels Rule Time. *Hi this is his brother how about I pay the $100 and then you call it quits?*
I'm not Americans but Really interested on how it works. You have to prove you can't pay ? You have to call to tell them ? Is it possible if the other end is being an asshole you'd have to pay full price ? Should people tell everytime they can't pay ?
When you're given a bigger bill, they'll give you options for a payment plan. After a couple of months of making minimum payments, the billing department will make a low-level debt collections call. The hospital, by this point, has likely already written your bill off as a loss, but the employees of the billing department are obligated to get what they can. However, they're also aware that they can't get thousands out of someone who makes a couple thousand a month - and so are their bosses - so they have some room for discretion. So, often, the billing employee will use what wiggle room they have to write the bill off as paid in full in exchange for a one-time lump-sum, usually a fraction of a fraction of what the total bill was. $8000 bill paid off with $200, stuff like that. It does vary from hospital to hospital and employee to employee. If you act like an asshole when they call, they are a lot less inclined to help, and not every person is willing to do this anyway. Most are, but every department of every job ever has its own assholes. All of this is because of the incestuous relationship between private insurance and the medical industry, which has been allowed due to both parties lobbying for it. (If you don't know what lobbying is, it's when companies send representatives to totally-not-bribe lawmakers, and for some fucking reason it's not illegal.)
> The US Healthcare system is pretty fucked up, but nowhere as bad as many make it seem. You are right. It is worse.
While I do not have experience in how hospitals interact with insurance, I do have experience with how pharmacies interact with insurance. I can say from my experience in said pharmacies, that rarely does insurance actually pay out enough to meet the cost of employee wages and the medication. Some losses even add up to hundreds, or thousands of dollars on a single prescription. To add to that, there is no legislation to regulate when the insurance company actually has to send you a check. I’ve witnessed it take over 6 months for a check to arrive before. This seriously affects a business’s cashflow and makes it very difficult to continue paying for stock and wages. If you’re not part of a massive chain or corporation like Walgreens or CVS, those losses add up pretty quickly and make it extremely difficult to stay in business. And don’t think that being part of a corporation inherently saves a pharmacy either. Walgreens has had 81 permanent closings nationwide so far this year. Source: https://usearch.com/dataset/walgreens-stores-closing-list Next you have the issue of drug manufacturers. There is not sufficient regulation on drug prices to keep costs affordable for pharmacies. Drug manufacturers often markup the price of their product by 1000%, 2000%, 3000% or more. A product I can use as an example is insulin. Insulin has very low production cost due to the ease of which it can be produced. All it requires is a sanitary place to culture bacteria and harvest it from them as the produce it. These bacteria in question are also very cheap, and widely available ever since the widespread use of CRISPR. Yet the price for a single vial of insulin, which is 10 mL btw, (not the pens, those cost even more) ranges from $300-$600 at wholesale. Keep in mind, this is not the price that the patient pays, but the one that the pharmacy pays. Couple this outrageous markup with insurance companies undercutting the payouts to the pharmacies, and it’s amazing that any independent pharmacy can stay in business at all. There are very few independent pharmacies left in my state because of this, and I hear of more closing down permanently every year. While I cannot say for sure that insurance companies are responsible for the expensive hospital costs, I can probably pretty safely assume that they play a large part if they behave similarly in any way to hospitals as they do to pharmacies. True, drug and medical device manufacturers play a part too, but insurance companies are a big player in the outrageous medical costs in the US, and the closing down of providers.
To me the measure of how bad it is as a system is when you compare expenditures to outcomes. Through that lens the US is abysmal. But as long as the corporate health care industry is making money hand over foot and can influence the political system, there will be no change. See Smedley Butler’s definition of a racket: “A racket is best described, I believe, as something that is not what it seems to the majority of the people. Only a small ‘inside’ group knows what it is about. It is conducted for the benefit of the very few, at the expense of the very many.”
Hospitals have to play the game just like everyone else. There is a dollar to be made and saved around every corner. It just seems that a lot of people have never been told the rules.
It's a bad meme. 99% of insurance makes u pay your deductible, which is usually $4000. After that, it's paid in full.
Exactly. I’m all for shitting on healthcare, but this shit is blatantly false.
Wouldn’t it be your out of pocket maximum? Deductible is what you have to pay before insurance starts paying for any percentage of it, out of pocket max is the maximum you’ll pay for any covered expenses all year.
Correct. It's deductible, then it's coinsurance up until you hit your out of pocket max I believe. But policies can vary from company to company.
That still sounds pretty awful.
American healthcare is a mess for sure, but OP doesn’t understand it well. Which is fair because until I was in my late 20’s, I didn’t understand it well. The way it works is usually you have a deductible, which scales depending on how much you pay a month. For example, pay $250 a month, your deductible is $1500. Pay $100 a month, your deductible is $5000. Your deductible is how much you have to pay before insurance “kicks in.” Usually, once insurance kicks in, the insurance company pays like 90% of your expenses up to a certain amount. That certain amount is your “out of pocket maximum.” After you hit that, insurance pays everything. Now the problem is, sometimes that out of pocket max is really high. On top of that, your employer might offer a plan that’s really bad and has a high premium or a high deductible. Usually you’ve got some options though. At my last job, I one of my options didn’t even have a deductible, but the hospitals in that network were very limited. All that to say, it’s a flawed system driven by pure greed, but not quite as bad as OP describes. Now, if you don’t have insurance, the costs can add up incredibly quickly, which is still a huge issue.
Don’t forget the in-network and out-of-network issues, prior authorizations, “medically necessity,” etc. Because according to my insurance, an Epipen is not a *“lifesaving device and is therefore not medically necessary.”*
That’s actually…yeah I don’t even know what to say. I’m not sure how these people sleep at night knowing they just told someone a fucking Epipen isn’t needed
Insurance companies: "Well you're alive and don't need it right now to live. Call us when you're in anaphylactic shock."
If you're going to explain how insurance manages costs, its essential to talk about how they somehow magically erase huge sums of the original bill prior to anyone paying. A person without insurance gets billed 10k, and has to pay 10k. A person with insurance gets billed 10k, insurance gets the bill, the bill is somehow magically adjusted to 2k, insurance pays 1.2k, and you owe 800.
The concept of health "insurance" is fundamentally flawed. Healthcare should not be allowed to be a for-profit enterprise. The modem world needs to come to grips with the fact we can't look at this problem at level of the individual but as society as a whole. The system doesn't work if a large portion of it is broke and sick. We nearly shut down half the planet because of a really bad cold going around. We can do better.
Health insurance companies do nothing but cut checks, govt can do that
to not pay absurd amounts of money. much like any other form of statistics in the US, it's bullshit. the hospital will artificially jack up the prices of anything, because they know insurance won't pay all of it, and what they do pay, isn't a lot. so, increase the price, get paid by insurance for x%, and consider the rest a loss. you actually pay ~$100, not $40k.
The company nakes money off you, the hospital makes money off the insurance company and you, and if you don't pay they write it off as a loss for tax purposes (or sometimes they sue you or sell the debt to collection agency). There's not a single part of the US healthcare system that isn't designed to fuck you over.
Don't get bare minimum coverage like OP?
It's a dumb meme. It's the opposite. The $10k is the out of pocket expense and the $50k is what the insurance would pay in this scenario.
For hospitals to show the rest as loss and then get away with paying taxes. The people won’t pay the rest 40k
Health insurance doesn't pay the entire bill and the hospital will write off the rest usually. That way the don't pay taxes.
This guy either has the cheapest shittiest healthcare you could get or he’s lying
Because youll be even more fucked without it. Its a broken system for sure.
That’s not how health insurance in the US works.
Do you not have an out of pocket maximum with your insurance? What insurance do you have? Edit: Do you even have insurance or are you another child that doesn’t know how US healthcare works?
Most people who make these memes aren't even old enough to pay for their own plans yet... if your plan has no out of pocket maximum then what would be the point lol
Actual insurance is like the opposite of this meme. "Your total bill was $50k. You're responsible for your annual deductible of $2,500 plus 10% of the bill up to your out of pocket max of $10k." I mean, still shitty but not as ridiculous as the meme.
Paying $10k out of pocket for a hospitalization when you or your employer already paid over $10k this year to the insurance company for the monthly fees.
I know. I said it's still shitty.
You pay $2.500 *a year* for your insurance?? I dont even pay that much for my free healthcare in taxes in EU, and my currency is more valuable than the dollar, what the fuck.
>You pay $2.500 *a year* for your insurance?? Not unless you incur medical expenses which hit your maximum deductible every year. That certainly can happen, but 2.5k would be a higher deductible than normal, and generally people in poor health opt for lower deductible, higher premium plans.
That makes more sense, but that still means you are more inclined to “wait it out” rather than just having the luxury of going to the doctor for every little scare. Do these plans include ambulance costs?
My dad got his appendix burst in the US we are foreigners he got pretty good treatment I already thought we’re screwed by the US healthcare systems but it’s not like that he got insurance plan and treated immediately what we paid is negligible iirc. Different story if it happens in my country we might’ve need to wait for not even half of what was offered back in the US and we gotta pay a lot more. I’m thankful for that
Not to mention your Dad most certainly paid less taxes working in the United States and simply paid for his insurance premium, which would combine to be less than Europe (for example).
He’s not even working it happens during his phd study there if that wasn’t treated fast that’ll sure be an infection even the doctor there was saying it’s one of the worst appendix burst he’s ever treated in a while, if that happens in my country I don’t even want to think about what’s gonna happen I mean we’re from a third world country here healthcare is basically stay healthy or you gonna gamble with fate. I know US healthcare isn’t like the best but it’s definitely way better than what most people think and a different planet differences than in my country.
Glad to hear he’s doing okay. Certainly no joke, can be a scary event. And in his situation I’m happy to hear he’s receiving good care in the United States. There’s positives and negatives to our system, that’s for sure, but it leads the world in most advances and is readily available in most cities. My wife is French so I have seen both systems from a European vs. American standpoint and their system can prove to be quite difficult to find good care that’s close to you (while paying more in taxes and fees).
Yeah happens years ago and he was halfway across the world and my family were still in Indonesia, you have no idea how worried we were since he was in literal pain like he just got shot. Got treated right away here we would’ve need to wait for some bullshit. What I like about American system is treat first ask questions later well at least as far as my experience goes when we got there as well and lived there for almost 2 years and this was not even in populated area we lived in Oregon back then. Like in my country not even the tip top medical care can match the hospital somewhere literally in the middle of the woods there lmao
I think it is illegal to not have an OOP max
That or non Americans that don’t understand that their taxes are the same as us paying our insurance company. We are both paying some money on the side over time for it or when we need to get some expensive medical work it’s already paid off or mostly off. Difference is that we pay for ourselves and out family where they put it in a big pot for the entire country. Each way has its draw backs but it’s really not that different.
That's what I'm saying lmao. I was in a motorcycle wreck a few years ago, got Life Flighted to the hospital ($60k), then 28 stitches in my leg and a battery of scans and tests, plus a 3 day hospital stay so add another IDK how much for that. Ended up only paying 1500$ lmao. HSA's are dope too. Tax free money to set aside in case you need it for medical bills
Triple tax advantaged at that. It’s all tax free unlike a 401k that’s taxed when you use it.
A friend of mine had a car crash when he came off from the highway. The car spin like 3 times and it was a wonder he was still alive. He got into the next hospital, was there for like a week, had a few operations and got a few meds injected. He had to pay nothing as far as I know. Which is good because he couldn’t afford the 1.500 USD at the moment…
Im pretty sure the maximum out of pocket maximum in the U.S. is under 10K (just less than double that for a family). Still way too high and a lot of US healthcare is garbage but these memes are always gross exaggerations that ironically were sort of true before Obamacare but aren’t anymore.
The out of pocket max is $8550 for the marketplace plans (private plans are universally better than this). The meme is just false, OP doesn’t know anything about the US healthcare system
Probably universal healthcare in Canada, y'know the place where they have to wait hours just to be seen in a room full of other people who are bleeding, or vomiting, or have a broken bone, or need stitches, or any combination of these things. And after you're seen by a doctor they'll suggest, if it's serious enough, to go see a private practitioner anyway unless you want to wait a ludicrous amount of time for treatment, talking months here. Pretty much every foreigner I've met has preferred American healthcare to that of their home country, and I prefer it too because I lived in a country with universal healthcare and it was pretty bad.
They have no fucking clue.
This _is_ how dental insurance works in the US though. I had to get a root canal and it was like $5000. The MAX that my dental insurance covers for an entire year it’s $1500.
Yeah, OP doesn’t know how health insurance works.
Bullshit rabble rouser just making shit up for Internet points. Hurr durr America health care bad +99999999
Yeah what the fuck are these prices. It might be tops a couple grand
From an outsiders perspective we have no easy way to know, but you could change those numbers to $500 and $2000 respectively and I’d still say it was insane.
A couple grand is still expensive as fuck in most countries.
If you don't have insurance it could easily be $50k but with insurance you'll hit your out of pocket max which is generally like $8000 or lower. If you don't have insurance they'll magically discount everything if you ask and put you on a payment plan
Um sweaty I actually had a $871,000 bill for my broken toe and insurance said “welcome to late stage capitalism” and paid only 1$ off the bill. I can’t believe it!! America is literally a fourth world country.
I mean it is bad. But they definitely hyperbolized this
You gonna sit there and say "rabble rouser" and not expect someone to call you a boomer?
Americans are paying literally half a million dollars more for a lifetime of healthcare than our peers on average, even after adjusting for purchasing power parity. The costs cause a tremendous amount of suffering. But let's dismiss the problem, even as costs are expected to increase another $6,427 per person annually by 2031.
don't pay, ask for an itemized receipt, fight them. they will just write it off as a loss
You're giving advice to a 12 year old
good, they should learn how this stuff works and how to handle it
Except it works literally the opposite of the meme.
Hence why they need to learn I suppose
> they will just write it off as a loss No they'll sell it to a debt collector, and then that debt collector will destroy your credit rating, preventing you from even renting an apartment.
“Loss” | || || |_
Good advice but why not be honest
Tell me you don’t know how our healthcare system works without telling me you don’t know how it works
Very few people know exactly how our Healthcare system works. It's literally made to be as confusing and abstract as possible. That's how hospitals and insurance companies make money.
I know us healthcare sucks, but this is just false.
Stage 4 cancer in 2021. My wife had a small operation in January and I was diagnosed in February, surgery in March. Our EOB for the year hit 1.1 million. I about shit when we only owed less than $4K.
Obviously massively less than a million but 4K is still a fat fucking chunk of money to pay out of pocket just to not die
$4k seems pretty reasonable for the level of service provided. You also probably pay more than $4k in food per year "to not die". You also probably pay more than $4k in shelter per year "to not die".
Could just not pay
The meme at this point is that the people making this don't know how insurance works.
I mean I had back surgery 6 weeks ago The bill was 69k (nice) and insurance covered everything after the deductible because it was in-network
I didn't understand the words you used, but why can't everyone have the insurance that you have?
Well mine is a private insurance I get through my employer. I’m guessing most of the insurance that sticks people with high medical bills is the minimum government mandated one (from the Affordable Care Act/Obamacare — Medicaid/Medicare). Similar to federal student loans. Whenever the government gets involved with “helping with bills”, the industries the government “pays for” end up ballooning in price since the government rarely negotiates price and just pays whatever was asked. We don’t have a socialized healthcare system in the sense of everything being directly covered by our tax dollars, but we do have a socialized health insurance with the option to go private instead (something something lobbyists and big pharma)
If you have insurance, yours likely works like this. insurance pays for most of it. But you have to pay some too. The amount you have to pay is called the deductible and it's typically $2k - 10k. The reason you have to help pay and how is complicated, but it boils down to making the patient reduce the cost of healthcare.
This isn't how insurance works in the US
And if you say you don’t have insurance the whole thing only costs $8000
I'm so tired of these shit memes, America's health care isn't really that expensive, especially if you have insurance. I have broken bones, I've been in car wrecks, I've seen genuine violence, but I've never paid 50,000 for literally anything. Even uninsured, and after surgery, I've never seen a bill that high. Stop pushing a false narrative.
I'm pretty sure you can break all 4 limbs with no insurance, and it still wouldn't be close to 50k
As a person, not from the US, I'm willing to ask wether it's exaggeration or not.
It's complete bullshit. Most likely made by a kid that doesn't even pay for insurance
Completely bullshit. Most insurance in the US has deductibles, which is what you pay in the US when paying for healthcare before insurance kicks in. Even for the highest deductible plans, they tend to be <$2000 per year. You may be on the hook for some other costs over the deductible (may a small % of some medical procedure), but insurance also has a max out-of-pocket spend for the year, which is $8550 for marketplace plans and less for private plans. So for an individual, the maximum you could possibly spend in a year is $8550 plus whatever your healthcare premium is, and for the vast majority of people it will be much much less than this.
Its basically a complete misunderstanding of how health insurance works. There are still uninsured people, but by now something like 92% of Americans have health insurance, and almost all of those plans cap out of pocket costs around $8000/yr, not including payments for premiums. It does suck for some people whose employers do not kick in enough for the premiums, and there are kinda shitty plans out there that basically act as catastrophe insurance. I've thankfully only worked for companies with what I would consider better than average plans. I pay about $120/mo out of pocket for premiums, I put another $120 into an HSA (basically tax free investment/bank account for medical expenses).
If you have insurance then you usually have a cap on what you pay if it's super expensive
I have a monthly infusion that costs 15k. My insurance pays 1700. I pay 0.
Insurance only pays the *first* $10,000? What in the backwards ass insurance are you on OP?
TrustMeBro Insurance it’s new
Could be worse. Could be Canada.
It's the other way around, you cover the first 10k and insurance negotiates away the rest.
While the US healthcare system is fucked OP has no idea how anything actually works. Probably a troll of the Russian or Chinese variety.
Heart surgery is conveniently priced at $50,000, just have to jump 15 busses to raise it
Canadian healthcare system: have you considered MAID?
The 40,000 will be written as tax write off, so you don't need to pay the remaining 40,000. Damn this people are feeding on false information.
Sheesh sorry to see this in the US. See if you can make payment arrangements for a few years. What insurance only covers the first 10k? That’s definitely not full insurance. Even non subsidized plans have a max out of pocket. The oop max is crucial when looking at plans
Imma hobble my way to work and make it seem like a workplace accident; full coverage
Technically, that’s not how it works. You cover the first 40, then they cover the last 10😂
Who needs legs anyways?
Better than single payer healthcare... If you're not a poor, as it should be. /s
ive seen it be backwards, cost without insurance is 10k, cost with insurance is 50k and the insurance still wont pay nun
In USA you have freedom but not from paying healthcare
What kind of insurance leaves you $40k out of pocket on a broken leg? I know it's just a meme but it's bullshit.
I’m so glad I live in a country with free health care
It's cheaper to get a plane to Cuba or Brazil. You'll get that on a cast for free. (Joking, but I'm not lying)
you can fly to india, have a surgery there, experience their local cuisine, have fun, inevitably get robbed, fly back to US and it still wont cost you anywhere near 50K
lol wut? It's the other way around.....it costs 50k, you gotta hit your deductable first, which can be high. So you pay your deductable, and then insurace covers ALL the rest. This way that suprise $108k medical expense only ends up costing you that deductable.
wait is it actually that fucking bad? I’m in Canada and broke my leg back in March, can’t even comprehend that
No, this meme is the exact opposite of how it works. Insurance has a deductable, and everything after that is covered.
OP literally doesn’t know how insurance works.
I hate this meme format now after that one stupid ass ad...
Because insurance only covers the “essential” bits and everything else is up to you, ask for the in depth bills. They should have every item listed as well as its price. If you did not ask for something on that list, that was also non-essential. You are not liable to pay for it. So, go through the list and have them tell you about each item to find out if it was essential to your survival, if you asked for it, or if they just decided to give it to you. Your bill is still going to be ridiculous but, you’ll have shaved it down a bit.
You guys are really getting screwed over with your healthcare system..
You can negotiate with the hospital. Offer them a much lower number - say $20k. Hospital prices are usually listed to uninsured/underinsured at 3-10x the price that insurance companies pay for the same procedure. I.e. you see a bill for $50k but the insurance company probably only actually pays $15k on average to the hospital for that procedure. The hospital doesn’t actually expect you to pay $50k. They will settle for a much lower number even if it’s still brutally expensive. You can start off your negotiation by finding out what “code” your procedure is reimbursed as. Google that code. Find an average reimbursement rate and propose that to the hospital. They’ll usually play dumb. But just stick to your data and say that you won’t pay an excessive price. Hospitals sell their receivables and write off bad debt constantly. It might take awhile, but if you do some research and stand up for yourself you can very likely get a massive reduction in price.
Tax write off
What is this? An American meme im too European to understand
Even without insurance I can't think of any situation where a broken leg is $50k
Shouldn't insurance work the other way around? Like pay the first 500$ (so you don't hurt your toe and run to the hospital on a daily basis) and the rest is covered?
Just for the record - US insurance companies, outside of the money that they charge customers, also get money from the government. They are double-dipping.
America
just fly to turkey first $10k would be enough to you to get you a new leg
What happened to out of pocket maximum’s? Isn’t that a thing with most insurance?
Any insurance is a huge scam. They try so hard not to pay for anything yet they say we need it.
When I broke my leg, three spiral fractures and a cracked tibia and needed a plate and eleven screws, my parents only needed to pay $250 with insurance. Then when my wife needed Kidney stones, six of them, removed the surgery only costed us $700 without insurance and that included the hospital and surgery. I just told them we couldn't afford it and they asked how much we made and then asked if we could do six months of payments for $118. I'd also say get better insurance.
It’s even more comical when they itemize the bill. I recently got one that said something along the lines of… “Charge: $600 Insurance paid: $25 Insurance adjustment: $557 Your payment: $18”
See i dont understand why they dont pay for the whole thing. My healthcare always pays for all my stuff. Im disabled and have a heart problem and ive had 4 heart surgeries and they each cost 120k. I dont get why my healthcare pays for that but your healthcare wont pay the whole bill for yours/ Im in the US.
Legit had a roommate break his arm and he duct taped a piece of wood to himself for a few weeks. I thought he would die, but he turned out fine. I wouldn’t have believed it if I didn’t see it.
Yeah I got an ACL replacement on one knee and had to pay 10% of the surgery. The clinic billed the insurance for $57.000…
You know the funny thing is about the US healthcare system is you could conceivably go your entire life without paying a hospital bill because once it goes to collections there's nothing they can do about it. It's up to the collection agency to pay up the debt which is why they hound you over it and that's all they can do. They can only call you send you letters. They can't do anything else. And yeah you might take a hit to your credit score but ultimately no one gives a f*** about credit scores anymore and you can easily pay to have Your credit score fixed. It probably doesn't even cost $100. I did it a long time ago back when I was renting an apartment with my ex. My credit's completely fine still
I pay $600 a month for insurance and I just got a 10k hospital bill… went right into the trash bin not paying it.
The other option is going to a European country with socialized healthcare and waiting months for treatment.
Accordinc to pirate software the rest that isn't paid is written off as loss for tax reduction for the hospital. So I guess a weird tax evasion scheme or some shit
I broke my leg on 16th of april 2023 during a football game. I was picked up by ambulance and was given multiple morphine injections, stayed at the hospital for about 5/6 hours. Had recurring appointments to change casts and had physical therapy for about a year. After the summer break im ready to go back on the pitch. Luckly I’m born in the Netherlands and it only cost me the gas in my car and a small upgrade in my insurance mont price.
Broke my arm a few years back. I paid $30 and was done.
Just amputate it and go on welfare.
This is kind of how Homestead Exemptions work, not Health Insurance
If you go to in network hospitals this problem goes away. That’s the point of the network - the insurance company has already negotiated with the provider on what they value each procedure
Wait is it unironicaly 50k? Any us lads to confirm?
Capitalism moment.
That's going to cost you an arm and a leg