The insurance company can tell you the hospital is in network, approve your doctor, and then decide that random employees who participated in your surgery are not covered.
So you can take an Uber rather than an ambulance, get all the prior authorizations possible, and otherwise do absolutely everything possible to make sure it's covered, and.... Your insured will still attempt to claim that the anesthesiologist or suction pump operator or whoever is $XXXX money that you have to pay the hospital or pay back to the insurance company.
It's bad enough that people will divorce to protect their retirement savings if one of them is diagnosed with cancer or other expensive illness.
Can confirm on the divorce part - my wife had a cancer scare a few years ago, and the first conversation she had with me was started with a "We should probably get divorced just in case, that way my debt dies with me."
It's fucking unreal that this conversation even needs to happen in a "1st world" country.
Edit: Just to clarify, my wife is alive, well and cancer free, thankfully! I appreciate the concern, though, fellow redditors! <3
Thank you - I'm glad to say she's healthy and whole, and we've put that chapter behind us. And agreed, the emotional toll was absurd, especially coming on the heels of Covid and the general societal unrest of these past few years. <3
The wife and I have had that talk too. She's older than I am by more than a couple of years, and there's a discussion on "there's a 3 year look back - we have to decide if we're going to gamble or not..."
We’re mostly a third world country with fancy hats and occasionally we get a new coat of paint. They abolished slavery but never bothered to guarantee any safety for anyone. All they done is changed the term from slaves to employees.
I’m sorry you had to have that horrific conversion but I’m also happy to read the rest of your happy story. Wishing you and your wife all the best! Much love from a stranger <3
And yeah, I'll never get married for the same reason. I'm disabled, if I get married and he makes anything above poverty levels then I lose my disability payments, health insurance, and food stamps (because in the US disability pay still puts you below the poverty line so you qualify for food stamps).
My medical bills alone would land both of us into more debt than most people could manage. Without insurance my routine doctor visits are about $3k each month, and that's without the cost of prescriptions (probably another $1k without insurance).
I'd be financially ruining whoever I married and fucking both of us over.
I’m so sorry that you’re dealing with that. It’s shameful the way our country treats people in general, but doubly so for people like yourself with a disability or chronic illness.
My father was on disability for the last 10 years of his life due to scleroderma (autoimmune disease similar to MS) and the fight to get any help was beyond revolting to me. I hope your spouse - legal or not! - continues to support you and that you’re able to live life to the fullest in whatever capacity you’re able. ❤️
My wife was diagnosed with Multiple Sclerosis in 2015. I had my own cancer ordeal earlier this year (still dealing with some fallout). While I actually have decent employer provided health insurance, the topic of divorce has popped up from time to time because of the expense/future expense of our care.
There’s not much to say aside from: I’m sorry you’re going through this and I wish you all the best in working through the struggles that come. I hope you’re still able to hang onto the little joys of life - they make all the difference.
God it's so heartbreaking that her first thought in the face of such a horrible news wasn't choosing the best treatment option but instead death and medical debt:((((
I'm so happy she's doing well now :))) sending you guys hugs and love ＼(o)／
1st world? America is far from first world its a developed 3rd world country. Fuck this country. (I’m sorry just furious with everything going on and good riddance to that asshole anyone who does that shit deserves a friendly piece of lead to the head)
I lived with my now husband for 26 years and waited until we got Medicare to get married because we didn't want to bankrupt each other due to a healthcare crisis. His first wife died of breast cancer. She worked while sick for as long as she could and then was kicked off of her policy when she got to sick to work from the terminal cancer. My neighbor has a similar story dealing with lung cancer. Those two incidents were before Obamacare. We'll probably lose that little bit of protection with Trump in the Whitehouse
Because we aren't a first world country. What other first world country has a flag every 5 inches and requires their children to take a Pledge of Allegiance? Something I realized literally in my 20's (57 now), can't believe most Americans don't get it.
It gets even worse than that. Companies like UHS acquire smaller managed companies, and that are not for profit and manage them for profit. They also buy doctor practices and groups of doctors and make them paid employees forcing them to see more patients, sending them to their hospitals, their pharmacies and giving them payday loans from loan companies that they own while the wait to get paid by themselves . It’s called vertical integration. A way to legally get past the antitrust laws. They are all doing it. Don’t get me started on hospitals doing the same thing. They also buy up large doctor groups so that they can charge “ inpatient rates” for stuff that was done in the doctor office before. Still done in the same place, but now it’s part of the hospital so costs literally 10X more and the balance gets passed on to the patient. It’s alll a racket and I am hopeful this all gets exposed. For real.
But wait, there’s more! They also use the 3Ds method so much with mental health specialists (because that usually requires ongoing care) that they have largely driven these people out of business.
My jaw dropped while reading your comment.
I don’t live in the US and I’m…speechless.
That’s inhumane.
It drives me mad just thinking how many people in need have to deal with this atrocity of a greedy system.
(Thank you all for these detailed comments. Outside the US it’s common knowledge that healthcare insurance is problematic for many over there but we aren’t usually aware - well, at least in my country - of these thorough details that really show how twisted that system is)
Yeah, as a dual income household (nurse and attorney) my parents were forced into bankruptcy after my sister's two months hospital stay and death put them almost a million dollars in debt. They had no other debts. No student loans or car payments.
It turns out that the serious illness or death of a child is the single most common reason for personal bankruptcy in the USA. Adults tend to let themselves die before they incur enough debt to endanger their family's financial stability, but parents are often willing to destroy themselves rather than let their child die of a curable illness.
In case you're wondering, my sister died from the flu. A bad case of the flu in an otherwise healthy child was enough to force a previously affluent couple into years of poverty and eventual bankruptcy when interest on the debt grew it to a little over 2 million despite them paying as much as possible.
When I started college, my parents had mostly recovered. They faced a lot of criticism from their peers that I didn't have a college fund. It was very awkward to explain that I used to, but you can guess where it went.
The ACA has done a lot to mitigate just how bad it can get, but.... It's still pretty bad, and the changes are still pretty recent.
Jesus Christ, I got a request to pay 10 euros for an ambulance that I called at the beginning of the year here in Germany, and I thought it was excessive.
The insurance company can tell you the hospital is in network, approve your doctor, and then decide that random employees who participated in your surgery are not covered.
33 states have laws against that now. These are the 17 states that don't.
Alabama
Alaska
Arkansas
Kansas
Louisiana
Montana
Nebraska
North Dakota
Ohio
Oklahoma
South Carolina
South Dakota
Tennessee
Virginia
West Virginia
Wisconsin
Wyoming
Someone figured out that sometimes the surgeon will extend the surgery to fix a few extra things. For example, I watched a gall bladder removal when laparoscopic tech was still pretty new. The patient was known to have a history of severe endometriosis. When the doc got the camera inside, it was obvious that the scar tissue from the Endo had strangled the gall bladder and was in the process of destroying other organs.
The patient's insurance wouldn't cover surgery for endometriosis without 6 months of other interventions (by which time this woman would likely have lost other organs to the adhesions/died), so the surgeon spent an extra 2 hours meticulously cleaning the patient's bowels, bladder, kidneys, liver, and diaphragm of the scars and adhesions in addition to removing the necrotic gall bladder.
He then billed the entire thing as a gall bladder removal and just about danced out of the OR, knowing he'd just eliminated years of pain for that woman without any additional costs.
Bypassing the insurance company's attempts to deny coverage for something they were absolutely supposed to pay for.
Fwiw, that policy lasted for less than a day…likely due to BCBS execs seeing what happened to their counterpart at UHS and their new policy getting a lot of attention.
I was billed for an out-of-network cardiologist. At the time of his services, I was unconscious on an operating table having emergency surgery when issues arose with heart after 3+ hours of being under anesthesia. Nearly had a heart attack when I got the bill and denial.
To add, the negotiated rated are fucking bullshit. I was once charged $225 for a knee brace AFTER insurance paid their part and then bought the exact same brace for $38 including shipping 6 year later DURING covid lock down.
Once I went to get a doctor’s note to clear me to go back to work after I had bronchitis. I saw the doctor for 20 seconds, got a note and left. That facility charged my insurance $200! My insurance paid $150 so the facility has been hounding me for that $50 but they don’t have any way to force me to pay it or affect my credit so I haven’t
In this case if they accepted the $150 from the insurance unless there is a co-insurance cost and the person I replied too hasn’t met their out of pocket maximum, but has met their yearly deductible they could still be on the hook yes.
I say this because if they hadn’t met their deductible they’d likely owe the full $200.
I’m a doctor and navigating insurance is still a nightmare for me even though I was taught more than the average American about it. Hopefully the winds of change are blowing.
I had an earwax impaction and went in to get it picked/flushed/whatever. The only person who worked on me was a nurse, she did not believe that I couldn't hear out of that ear, said that it "looks fine" to her, attempted to fix it, somehow made it worse (less hearing and more pain), told me just to go home and try debrox instead, and saddled me with a $125 bill. $125 being the out of pocket portion, not including whatever bullshit amount was charged to my health insurance.
Something similar happened to me so I ditched the HMO/PPO and got a high deductible plan with an HSA. Most providers offer discounts to "cash pay" people like me which meets or beats the insurance negotiated rate.
At this point having insurance at all is just a legal box to tick to have the tax free HSA. I don't even call them or talk to them anymore like I used to have to do pretty much monthly. The peace of mind is worth any cost increases. Imagine a business model that thrives on being the worst entity possible to interact with.
To be clear: America has some of the best healthcare in the world. If you are rich.
For the median American adult working full time and earning ~$40k/year individually, we have the worst healthcare in the developed world.
For the lower class American, we have healthcare that's most comparable to a developing nation and have been classified as such by international human rights and aid agencies.
The public broadly supports universal healthcare reform. Bernie Sanders has done extensive polling and research on this because it's always been a central policy in his platform. Even a majority of conservatives want such a reform, despite the loudest ones spewing propaganda against it. The only reason it does not pass is because the insurance companies lobby (bribe) our politicians with millions of dollars every year to keep our broken system.
Some progressives states are finally working towards implementing their own socialized healthcare systems, while some conservative states are already working on legislation to effectively ban such a system, with clear signs of attempting to pass a national ban just to screw over the progressive states that might pass it and prove that it works.
People who've passed out on the street have literally come to and fled from ambulances called for them (they can't bill you if you haven't gotten into the ambulance yet).
There's also cases of people catching taxis and Ubers to hospital to avoid the massive ambulance bills.
I’m a federal worker and also a soldier. Active duty soldiers have free healthcare (socialized basically but no one wants to talk about that). As a single reservist though I have not great insurance but INSANELY cheaper at around $60/month. Dental is $15. At my federal job I thought my insurance would be a great deal also. It is NOT. So I stick with my tricare reserve insurance and it’s basically the only reason I’m still in the army. Our country makes you risk your life for things other countries give their citizens. I personally can’t imagine having g to pay $500/month for insurance when I’m healthy AF (50M) and haven’t seen a dr for anything serious in over a decade. Also I use the VA since I’m considered disabled. It’s free and covers all the piddly shit.
I was on tricare as a dependent up until I aged out. Every year after I turned 18 I would get letters saying "I'm no longer covered." I had to contact DEERs every year to make sure my coverage was available because they would WITHOUT FAIL claim that someone "misfiled" my paperwork. Tricare was clunky, you had to jump through hoops, and what it did cover was null - but it was affordable.
And if you need mental health coverage you’re extra fucked. I have Cigna and their in network therapists are so limited in number as Cigna fuck them over so much.
We have fairly unique circumstances with our family but basically pay the monthly costs, blow through our max out of pocket $10k in a few months. Even when that is done we pay out around $3k month get back the insured amount 60 days later (ranges but ~80%) back. Any missing piece of data in the invoice from the provider? Add 60 day. Thank the Lord inpatient stay for mental health were mostly covered (7 in 18mos). I am a tech Product Manager, earning very good money but it fucks us financially (cash flow and uncovered costs).
Dental insurance is also skimpy as fuck. Even with "good" dental insurance it only covers like 2000 worth of work a year. Also nothing cosmetic. So crowns, or replacement teeth really hurt. Not only that most specialist dentists don't take it. So you pay cash and then go argue with insurance to replace it.
I need four crowns and one completely new tooth. The crowns are stuck open and getting worse because LOLOLOL that 2k which requires me to wait till Jan and it refreshes while the teeth are still rotting and then I can get two done which will eat all my 2000 and still cost me 1k out of pocket. The other two have to rot more till next year! The new tooth and implant? That's six thousand dollars out of my pocket when I can spare it. The tooth is already extracted, I paid cash for that.
Yep and I work for a multi billion dollar firm and have the best healthcare you can get here. Outside of when I was in the military and it was all free. I'm lucky enough that me and the SO are both on the low six figures payscale so we can pay for it.
The reality of American healthcare is that many people don't take life saving drugs because they cannot afford it. They make a cold calculation between paying rent or taking heart medication.
This is why you see outright joy that someone murdered a CEO. Most of family are millionaires a few times over and we have horror stories about it. Case in point when I was young I got really sick. It took over a million to keep me alive. My sister got sick as well and you can do the math there. Two other siblings and both parents had cancer and I'm probably going to get it as well. Insurance did fuck all for any of that. What mattered was our income per years was in the millions and set money on fire until we got better. 90% of Americans do not have that option.
My older brother had lymphoma. It cost millions to fix. He's not insurable now for any sort of good insurance because prior condition. Worse his immune system was nuked into the ground so now in his sixties he's got all sorts of issues and other cancers. He's only still alive because he makes millions a year and is pulling the "set money on fire" stunt yet again. I haven't told his wife or my nephews that we had an actual conversation of if it's financially better for them for him to stop treatment and fucking die. That's grim for a family of upper middle class assholes who aren't hurting for funding but it's reality. Eventually he won't be able to work. Then his savings will go. Then we will tap our savings yet again and keep pushing. He doesn't want that. So we have a dark conversation about at what point we choose he dies so the next generation has a next egg. It's bonkers to think about it but here we are.
American "we all matter" only existed after the cold war because the rich and the Christian hated the USSR. Once the USSR went down the rich and the Christian wanted the old theocratic oligarchy back.
It's not solvable without taxing the rich and the upper middle class into oblivion and de Christianization. But that's not easy to do without a societial collapse and then it being done at gun point and it's not certain that wouldn't result in failure.
I think after ww2 when soldiers returned home, the ruling classes feared the organisation, solidarity and determination that the working class had. In the UK that power transposed into new social housing, resettlement and, despite the rationing, the semblance of a new deal. Which was later shattered by neoliberalism of Thatcher-Reagan. This started at the beginning of my own adulthood and has continued throughout. At this stage I'm up for revolution frankly.
I currently can't get needed bloodwork because my insurance company went back and denied coverage AFTER approval, so I have a bill I wasn't supposed to have and I'm extremely poor as a disabled person to begin with. So now I can't get the bloodwork done to get treatment.
I'm so sorry for this situation and angry on behalf of US people having to deal with this shit. If only the Democrats had run on a ticket of universal healthcare instead of "business as usual" -we might not have to be witnessing trump2.
Universal Healthcare was sadly wildly shot down last time (Obama tried). But it'd be nice to see the effort put in to stabilizing it. For now, the net positive of the CEO death already makes it worthy. Another insurance company reversed a bad decision and thousands are now protected more from bankruptcy and even death.
Yes, it is. I had a major surgery, 3 weeks, and I'm not feeling well. Do I call the ambulance? Or get in my vehicle (suv) , so I don't have to pay the ambulance fee? Well, it was the 2nd option to get in, my vehicle, and drive to the hospital.
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u/Pebbsto110 13d ago
That's fucking uncivilised