My mom had her mastectomy as outpatient surgery. Un-fucking-believable, I know, and my family actually has money, so I don’t know what the deal was with that.
Well-off healthy people can also opt for medical savings accounts instead of standard coverage.
But the biggest issue between wealthy insureds and poorer insureds is simply being able to afford what falls in the gaps. My husband was on my work insurance for a long time, with good coverage, but if he ended up in the hospital (which he did often) it was hundreds or thousands of dollars even with insurance. If you’re wealthy, you go ahead and get the treatment, surgery, etc. If you’re not wealthy, you can’t necessarily afford the 20%.
Just as an example, and please don’t take these numbers as gospel, we were told that my husband needed specialized heart surgery and that it would run $150-$200 thousand. Even if you have insurance coverage, and it’s one of the type that pays 80%, that could leave $40,000 for you to pay. The insurance we had at that time would have paid 100% after (I think) $10,000. That’s a fantastic deal, except it’s still ten thousand dollars. I can’t write a check for ten thousand dollars. Some people can.
I have to add that in hindsight, he didn’t need the surgery, so it might have worked out to be a great thing for us that we had to delay. I’m not complaining.
Nowhere I’ve ever worked has offered anything other than THE insurance plan that they have, although dental & eyes are separate.
For an answer to the OP… it works like this (and I’m nowhere near 200k) at my company for everyone- the lowest receptionist up to the head guy himself, the plan is one where it’s a $10 copay, and $10 prescription, and everything else is covered up to some maximum.
I had to get an echocardiogram at one point, and outside of the initial $10 doctor’s visit, the rest of it was free.
Without that, it would have likely run me into hundreds of dollars, if not thousands for that sort of diagnostic treatment.
I hadn’t encountered it until I got my present job and my husband got his. His job offers an HMO or a PPO with the PPO having a much higher employee contribution (nearly $1000 per month for family coverage). My job offers two types of HMO and a Point of Service plan with three levels: I can use one of their HMO network doctors, I can use another doctor of my choice who is in their PPO network, or I can use any doctor I want, but they pay a lesser percentage of the charges.
Before I just always had a PPO plan, although they seemed to switch carrriers every year.
I’ve never really pried into the type of health care a friend of mine had (it would seem a bit nosy/inappropriate I guess, and I’m relatively fit as a fiddle and generally worry very little about my health insurance which I pay each month but rarely if ever have to use) but he was a high income stock broker type working on Wall Street back in the late 1980s when he got HIV due to a high risk lifestyle (he pretty much fucked anything that moved, male or female, with no protection, and used intravenous drugs.) Well, he hasn’t worked since 1992 or so and his insurance still pays for pretty much everything, his regular care needs and all his prescription medications. He also somehow manages to get a “maintenance” income of around $60,000/year even though he doesn’t work at all. That may be investments paying out or annuities, I’m not sure, but my impression was it is somehow linked to his former employer/health insurance.
This guy was genuinely pretty wealthy when he got sick, but if he had been forced to pay all his medical bills out of pocket he would not have been able to afford it.
This makes me glad I wear eyeglasses, my hope is if one of my fishing buddies ever hits me in the eye like that the lenses will absorb most of the blows. :eek:
I discount the premise of the OP when it comes to special health plans but there is such a thing as ultra-premium care. The Boston area is filled with some of the best hospitals in the world and some of them have VIP facilities although this doesn’t always map well to net worth.
My second daughter went into seizures two days after she was brought home during my birthday party. The nearby ER doctors didn’t know what was wrong with her so they shipped my wife and baby off to the neo-natal intensive care unit at Children’s Hospital Boston which is affiliated with the best Harvard University doctors. Two days later, we were pulled into a meeting with some of the best doctors in the world. They didn’t know what was wrong with her but they knew she wouldn’t live. That would have been the end of it in many places but they were determined to find out what happened. Childrens Hospital Boston has a few apartments within the care units themselves and we got selected to live within the neonatal ICU with our daughter. This included staff 24/7 and everything money could buy to make us comfortable including a full movie library and food.
In the meantime, the doctors were having trouble finding out what went wrong. They brought in and sometimes flew in the best doctors in the world to figure it out. Finally, a MD/PHD suggested that he heard about something similar many years before. It was called Sulfite Oxidase Deficiency and it was ultra-rare with only 50 cases ever recorded in the world.
Sophie died 6 weeks later but the doctors were still determined to help us because this was one of the rarest genetic diseases in the world and there was no test for it. My wife got pregnant 2 months later and we were extremely worried that the same thing would happen to the next child. Several researchers from Harvard, France and the U.K rushed to develop a test based on the specific DNA sequence that was at fault. At the 5 month mark at our now daughter Olivia they gave the thumbs up to the abort - don’t abort signal. We now have a lively girl that is about to turn one.
The insurance statement that we got later said that they paid $250,000 for everything and the research portion was done voluntarily.
Mass General is one of the best hospitals in the world and it does have a VIP ward for some specialties. I know some people that got bumped up when the regular wards are full. They get the same doctors but extra attention and better rooms. The medical care isn’t necessarily better but the comforts are nicer. Likewise, McLean Hospital which is the psychiatric and substance abuse arm of Harvard medical school has isolated facilities for celebrities and others that wish to remain anonymous.
Other than that, a homeless person can walk into a prestigious hospital ER and get to see the same doctors as anyone else can.
The SIL said she may as well have drove by the hospital slowly and hung her boob out the car window.
OUTPATIENT? What the Ever Lovin’ Fuck! I’d come fucking unglued. I mean, this is not only MAJOR surgery, but the emotional toll it takes on many women is something that should be dealt with! I’m truly horrified.
Or you could consider having the shards of glass picked out of your eyeball…one by one…eyeball fluid leaking out down your cheek all the while. :eek:
My advice: Don’t fish. Evah.
My father is self employed and pays for my parents insurance out of pocket. When my mother was diagnosed with a brain tumor, she had an appointment with one of two or three most prestigious surgeons in the world in that type of tumor. She had surgery a week later. And she left the hospital after five days, because she wanted to. Mind you the tumor was on the interior of the brain about about the size of a baseball.
I don’t know if it’s money that counts, or being persistent, as my parents paid nothing but copays. Granted they pay 1400 dollars a month in premiums, but that’s life, as they see it. My mother decided that she wasn’t going to die and that was that.
Having spent much time in the hospital in the past 4 years I can tell you that I would much rather be an outpatient than not. Yes, I had to deal with drains and such. I can even tell you how much fluid came out of which drain, since I kept a running record.
At home you are in comfortable and familiar surroundings and (presumably) people who care about you. You get a much sounder sleep by being in a bed that you are familiar with and NOT having lights and bells and nurses checking on you regularly.
It was better for me both emotionally and physically and I always begged to be sent home as quickly as possible.
Also, many of the people in the hospital are contagious. IMO you stand a better chance for infection while being in the hospital than not.
Another way that well off people benefit that isn’t fixable by any outside source is ability to travel to where the best care is and ability to take enough time off work to get certain treatments or recover properly.
In some ways, life is simply unfair and will always be unfair. Still, many of these other issues can be helped.
I think you have 3 groups of people.
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The well-insured
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The poorly-insured
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The uninsured
If you’re in group 1, you’re better off in the US than anywhere in the world, I’d say. We have the best doctors, the best hospitals, and the best equipment. If you’re in 3, you might be worse off than if you were in Slovenia, or France, or myriad other places.
Heres a snippet from this article.
It all depends on the company. I offer two types of coverage to my employees. One is an HMO that the company pays the employee benefit in full and the other is a PPO that the employee must pay the different between the HMO contribution and the cost. (Dependent coverage is the employees responsibility in full with either plan) In my opinion, the PPO is better because you have an open access to doctors. If you go out of network, although benefits are reduced, you still HAVE benefits which is more than you’d have insured by the HMO plan. However, the cost is such that I myself can’t afford the premium as the HMO costs over $1000 per month and the PPO is nearly double that. So yes, the more wealth you have, the better insurance you can get.
My father, who is 90, had two stents put in for a major blockage, and was in the hospital two nights. My wife had several eye operations last year, major ones, and stayed only one night - and that because she was scheduled late, and they decided it was too late and she was too groggy for me to drive her 50 miles home. Hospitals aren’t great places to sleep, and they spread infection. I’m all for minimizing the stay.
As for the OP, my company has pretty much the same coverage for everyone, though you get more flex bucks with a higher salary. For medical, there are three options. The high one, which I always took, used to cover all hospital stays except for a $100 deductible, which was damn handy last year. Now it covers 90%, but you don’t have to lay out more than $2,000, I think. We have a PPO, and joined a big group with a lot of in-group specialists. HMOs are available, but not mandatory.
Hospital bills are so high that only really rich people (a lot richer than $200K salary) wouldn’t be hurt. The good thing about making a reasonable amount of money is you can put a bunch in your flexible spending account, and the deductibles don’t kill you. So, you can make decisions based on medical need, not money.
BTW, I don’t know anyone at work, all with good insurance, who uses health care frivolously. I can’t imagine anyone sitting in a doctor’s office for fun myself.