Work Reform

hideshow 9 child comments

[–] ArmoredThirteen@lemmy.zip 19 points 2 months ago* (3 children)

I had a max out of network out of pocket of $5k and insurance told me after my surgery that it didn't count because they didn't have a contract with where I went. So basically they needed to be in network to count towards out of network? $28k later they said they miscalculated and I owed another $14k I told them I'm living in a different country now so try and get it and they dropped the extra amount

hideshow 3 child comments

parent

[–] wonderingwanderer@sopuli.xyz 2 points 2 months ago (2 children)

$28k later they said they miscalculated and I owed another $14k

Who did? The insurance or the healthcare provider? Cause why the fuck would the insurance company tell you that you owe them money after they didn't cover the healthcare expenses that you were paying for a plan for them to cover?

hideshow 2 child comments

parent

[–] ArmoredThirteen@lemmy.zip 4 points 2 months ago (1 child)

So this is a bit of a complicated thing that I admittedly still don't fully understand and I did word it a bit wrong. I paid a bunch of money to the hospital/surgery, insurance reimbursed them, hospital reimbursed me, insurance said woopsies we reimbursed too much, the hospital paid back that amount to insurance, then the hospital asked me for money. I told insurance and the hospital tough fucking titties they better figure it out because they're not getting that money back.

I was originally told I would pay the hospital, then I would hit my out of network out of pocket max, the hospital would be reimbursed the full amount after my max, then the hospital would reimburse me. I got fucked from both sides and eventually their woopsie was my "I have enough money to fight you but nobody wants that because even if you win you have to get it from me across the world" so they folded

parent

hideshow 1 child comment

[–] wonderingwanderer@sopuli.xyz 1 point 2 months ago

Damn, that's fucked up. There are scams that work the exact same way. They'll write you a check then tell you to pay it back.

parent

[–] johan@feddit.nl 7 points 2 months ago* (1 child)

I'm not from the US. Do you know how much of your income tax goes to the health care system?

I live in the Netherlands and we actually have a pretty weird system of private insurance companies, but they're not allowed to make a profit and it's mandatory to have insurance. Anyway, my partner and I together pay about €300 per month, which actually doubled is about what you pay for 4 people (though for kids here it's free).

Copay is not a thing here. The legal minimum deductible is €385 per year. You can raise it to max €885 and then you pay less for insurance every month. I have the max deductible, my partner has the lowest.

$4500 seems like an insane amount! I have never reached that or even gotten close. The government here sets the limit for deductibles and that's always a big political discussion. There's some talks now of removing the deductible altogether, though that would mean raising taxes elsewhere.

How do deductibles even work in the US? I had my appendix removed and here you then never pay anything because it's like a life threatening thing. I think you do pay for things like medicine and the ambulance ride until you reach your deductible, but for things like going to the GP or life saving surgery it's just covered.

And here if you're not working or earn less than certain thresholds it becomes cheaper or free. But isn't that similar in the US, like medicaid or something?

I pay quite a lot of income tax too of course which also partially goes to the health care system. I think it's actually quite expensive here for people who have a reasonable income. If you don't earn anything it's mostly free but you still have plenty of health related costs like the deductible but also stuff that isn't automatically included with insurance like dental care.

Last question: what do you mean by "max out of pocket $15000"? Is that like your combined max deductible for your family?

parent

hideshow 1 child comment

[–] unitedwithme@lemmy.today 1 point 2 months ago

Income tax will vary because we have a federal tax plus state, plus local municipal/city. We're around 28-30% total taken out when I review my pay information.

Technically, because insurance is based on employer negotiations, it varies greatly with coverages, deductibles, "in-network" doctors or hospitals, etc. We go through my wife's employer as it's better coverage. It's a higher deductible plan because, like you, if you have a high deductible it's less out of pocket per month. If we opted for the better coverage and lower deductibles, it'd be around $1,200/mo.

Several years ago, I had a CT scan done and was "billed" $9500. Insurance "negotiated" that down and it was, at the time, a $2500 deductible. I went back later for a MRI and that was over $11k. Another deductible because it was through another visit at another facility. My individual max out of pocket was achieved at $5k-6k I don't recall, and it took a few years to pay that off (like a loan).

2 years later, my wife had pulmonary embolisms (blood clots) that hospitalized her. That was up to $7k plus medications and monthly follow ups. We amassed over $20k medical bills within a few years, and that's no where near as bad as some people have it.

We're alive, in medical debt among other debt, but healthy again. I guess in the long run we should be happy we're healthy, but again not everyone is so fortunate. What bothers me is almost having to choose if I could "afford" to live or not.

And yes, 15k maximum out of pocket for anything medical for all 4 of us. I don't Recall if we have coinsurance after that, thankfully we've never hit that limit to find out. Coinsurance would be we're responsible for 20%of anything over the 15k. If it were $20k, we'd pay 15k max plus $1k for the 20% over.

Financially we can afford it, yes, for now; but just crazy to think how quickly our finances could change with layoffs, then with that you lose insurance, and quickly lose your house, etc. That's why I would run for office just to get to push for real beneficial change.

parent

[–] supcoop@thelemmy.club 1 point 2 months ago* (1 child)

Who do you have? I pay that much for just myself in FL marketplace (bronze plan, high deductible)

parent

hideshow 1 child comment

[–] unitedwithme@lemmy.today 1 point 2 months ago

BCBS through my wife's employer. They're about 1800 employees so maybe have better negotiated benefits

parent

[–] Tollana1234567@lemmy.today 1 point 2 months ago*

as a single person no, but if you earn enough to pay that its feasible. also different insurance have different types of coverage. employee seems superior to individually bought plans(often dont cover much for major stuff like emergencies, or surgeries)