As I said in the other thread: Experiences with U.S. Health Care - Pt I: Treatment - In My Humble Opinion - Straight Dope Message Board - I had a recent run-in with the health care system which was great on the treatment side, but I haven’t seen the bills yet, nor do I know who’s going to pay how much of them.
So I’m interested in hearing others’ experiences in paying for health care - how did that work out, were you happy or unhappy with the system? Was it frustrating or easy?
Thanks…
I have private insurance through my employer.
Co-pay for my GP is $15, specialists are $25. Emergency visits that do not end in a hospital admission are $50. Physical therapy is a $10 co-pay, mental health is a $25 co=pay with a max of 26(?) visits a year. Hospitalization is covered. It is a BC/CS plan tailored to my University’s Health System.
When I had my hand accident/surgery, I paid $10 for my vicodin and antibiotics, and $10 for each PT visit (a total of $200). I didn’t have to pay for the follow-up to the surgeon to get stitches out or the post-PT visit to him to make sure all was well.
I am personally satisfied with my health care coverage. I pay $150 or so a month for it.
I wish everyone had the same level of coverage that I do, but I won’t get into that here.
I have a similar plan as Minnie Luna.
The one thing to watch out for is the various doctors billing you separately from the hospital. I don’t know how many times I’ve had to call the insurance company because I’ve been billed. It’s because the insurance companies are sometimes a little slow to pay, and the doctor’s office has automatic “backup” billing, sent to the patient.
It’s annoying, but better than paying it! My Dad gets bills like this, too, and he has Medicare as well as a supplement.
One situation:
I had to have an emergency appendectomy. My doctor sent me to a certain hospital. When I got the bill, I realized that the hospital was not in my network.
The doctor wrote a letter stating that it was ‘medically necessary’ for me to be treated right then. In effect, I didn’t have time to check which hospitals were on my plan, and choose one. In reality, I was disoriented from the pain etc. so as to be in no condition to be reading my health insurance policy. The insurance company still declined to pay. So I was going to be stuck with the bill.
One thing that they did do was to negotiate with the hospital and get the bill reduced by about 50%. Now I will be sending the hospital $100 a month for the next five years. (I’ve been paying on it for about a year and a half).
Another situation:
My son was carjacked and injured in the process. His sister took him to the nearest hospital, which happened to be in our network. The insurance company paid 80% of everything after the $4000 deductible.
Another situation:
My husband went to a GI who scheduled him for an upper GI scoping. Hubby’s insurance has a “healthy you” program where, if you’re over the age of 50, you get one free colonscopy every 10 years or something like that. The doctor did both procedures at the same time. The insurance company paid 100% of the colonoscopy, and 80% of the upper scope thingy after the $750 deductible.
Kind of a mixed bag, there.
I don’t have any huge issues, but there have been a number of times when I’ve had to to call up to resolve a problem where I was being billed for something I shouldn’t have been. Most of the time, the fault was actually with the health provider – they didn’t submit the paperwork to the insurance company properly, or they entered the information wrong, something like that. It is still a hassle to sort it all out.
I have two issues with my health insurance as far as payments go.
Hubby and I are both self-employed, so we pay for a private insurance policy.
The first is that the @#$! premiums go up like crazy - anywhere between $800 and $1000/year. If some kind of health care reform doesn’t go through, we’re going to be in big trouble in 4-5 years when our monthly premiums start to be over $1K/month.
The second is similar to NinetyWt’s out-of-network story (which I think is horrible and should be illegal - how can someone in need of emergency care be expected to figure out whether a hospital is in or out of network?). Luckily, my story isn’t nearly so bad - I just had to pay out of pocket for about $350 worth of lab tests that were drawn at an in-network clinic by an in-network provider. These were 3 of about 20 labs I had done that day. Unbeknownst to me, these 3 labs were not able to be processed at the clinic’s lab, and they were sent to an out-of-network provider, so I had to pay.
I’m hip to the in-network and out-of-network thing, but there should be a way that 1) they are waived for emergency care situations and 2) there’s some way to know that something is going to be done out-of-network. It’s draconian to expect me to figure out that 3 out of 20 labs ordered and taken at an in-network provider are going to be sent out-of-network. Emergency care definitely should be covered regardless of in- or out-of-network status.
I covered this in the other thread, but what the hey.
No insurance.
The private clinic made it clear that they preferred same-day payment, even though I had a zero balance and had made timely payments before. They give a 30% discount for same day payment. I can’t say for certain, but I think they would have sent me elsewhere if they thought I couldn’t pay, even though I’ve been going there for 15 years, most of those years with insurance.
The hospital was no problem. They gave me papers to fill out to see if I qualified for hardship assistance. I didn’t. They did all the tests and the surgery without any mention of payment. They said I could make monthly payments. I asked if I could get a discount for paying all at once and they agreed to 20%. My son gave me $13K and I borrowed the rest from my credit union.
I could have just walked away and not paid the hospital anything. I have no wages to garnish. All they could have done was file a lien on my house (and ruin my credit). I was tempted, for about a minute.
My only quibble* was bills from two outside pathologists who read the x-rays and the CT scan. Nobody told me there’d be bills from a third party. And one of them came four months after the surgery.
*Except for the outrageous price for a cholecystectomy. I did some research and apparently the average US cost is $5K to $8K. I paid $12K. It didn’t even involve an overnight stay – I was in at 7 a.m. and home by 4 p.m.
I agree they should be waivered - in fact I’m stunned that NinetyWt’s insurance company didn’t have such a plan in place. Shocking. What if he(she?) had been unconscious??? I’d say that is utterly crappy coverage. I’m actually stunned that this sort of thing is legal.
I knew of a situation where a family had a premature baby who spent quite a bit of time in the NICU. The hospital was in-network. However - the team of neonatologists who managed the NICU was not. They were fighting with the insurance company over that, last I heard (this was 10+ years back). I don’t know how that turned out. Of course, they could have taken the baby to another hospital.
But, of course, the next nearest NICU of the appropriate level was 3 hours away. And it’s generally not a good idea to transport a fragile neonate like that.
Our own experiences have often been horrible. **Typo Knig **had to go to the ER once for a CAT scan (visual disturbances a couple of days after a serious car accident). We at that point had dual coverage. The secondary insurance kept losing the claim for their part - for 6 months. It kept getting escalated and lost. The hospital sent it to collections at one point.
Another time, he had minor surgery. 80% or more of the cost was written off because of the negotiated rates (which leads me to believe the “rack” rate was pulled out of thin air; no way was a 1 hour sinus surgery really going to cost 60,000 dollars). And after everything, we were out of pocket for over 3,000 dollars.
Whenever we have any kind of hospital encounter, we get bills from the hospital, the doctor, the radiology people, the lab people, and probably a few others.
At one point, Typo Knig had a job interview at a university where, if he’d been hired, the health coverage would only have allowed for treatment at their medical center. I don’t know if emergency care would be covered, but I’d bet it would not have been. We’d have had to change all of our doctors, to go to a hospital with no particular reputation, in an iffy neighborhood 20 miles away from home. Fortunately (for many reasons) the job did not come through.
The only problem I’ve ever had was the fault of the hospital. They didn’t send the bill to my insurance company in a timely manner (within one year as was stipulated by their contract) so the hospital tried to bill me. It took a while to get that cleared up. Other than that one experience, I’ve never had a problem.
I’m a unionized government employee so I have really good insurance. Last year I spent several months in and out of hospitals and all I saw of it financially were bills that told me how much the actual bill was (OMG!) and how much of it I had to pay (generally in the $10-50 range). My biggest out-of-pocket expense was an office consultation with a doctor who was not covered under my insurance plan. That half hour conversation cost me almost four hundred dollars and was probably more than I spend on all my other bills combined.
It’s been a few years, but my former boss was involved in a protracted battle with his insurer which was refusing coverage for his daughter’s treatment in an out of network ER, claiming that she could have been taken to the in network hospital that was 5 miles away rather than the hospital that was 1 block away.
She’d been hit by a car while riding her bicycle. She had open fractures in both of her legs, vomited up blood shortly after the accident, and though she was wearing a helmet, lost consciousness for a frighteningly long period of time. but the insurer insisted that her injuries were not so significant that she couldn’t have been driven 15-20 minutes (in an ambulance they’d have paid 75% for) rather than literally rolled across the street and up a driveway.
Mine was billed out at a little over $14k. No explanation for that whatsoever.
Actually, what I’m hearing worries me a little bit - all my treatment was at a way out of network hospital (my network’s N. CA Kaiser, and the hospital is in Anacortes, Washington.)
I’m hoping I don’t hear anything about how I should have gone down to California before getting surgery.
Does anyone have any suggestions for heading that kind of thing off at the pass?
I have private insurance through my employer, which makes payment for services very easy. But when I didn’t have insurance, it was a nightmare. Not only would many doctors refuse to see me because of the lack of insurance, the ones that would would have me pay up front, which I could just barely afford because I was unemployed at the time. I went to a yearly OB/GYN exam and the exam alone cost me $250. That was the office visit only. I later received a bill for the standard testing, which was an additional $250. I remember that month having to decide between taking my seizure meds and buying food and paying my rent because that $500 I paid for one regular exam ate up a lot of the money I had allotted for that. It was awful.
I had breast cancer last year. I have health insurance through my employer. Not only did Aetna cover everything without a quibble, they called me up and gave me access to private nurses and dieticians I could talk to on the phone.
I had to pay $25 to see my doctors, and there were some hospital bills I had to cover, probably around $500-700 total. I will tell you, I got one bill from my oncologist where they were asking me to pay $25. I was up in arms…how dare they ask me to pay $25? I pay $25 every single time I walk into the office! What’s this for?
Then I looked at the itemized bill.
The Neulasta shot I was getting to keep my white blood cell count up was $6000.
I shut my mouth, got out my checkbook, and blessed Aetna.
Are you sure it’s out of network? I live in Michigan, but I’ve seen specialists in Boston that were in-network. Call your insurance company, and ask them if the hospital/doctor you saw were in-network or not.
The mind boggles.
Or you blessed all the employers and individuals who pay insurance premiums to Aetna. 
I gotta wonder – would health care costs be lower if people didn’t have insurance? Of course insurance has an impact on the market, but how much of an impact? If we paid out of pocket, would one shot cost $6K? Or would the shot not be available because there were no funds for research? Do our premiums help pay for research and development?
I mentioned to the chemo nurse about the cost of the Neulasta, and she said it’s a very specific drug and very expensive to make. I think it was an episode of *West Wing *where Josh said something like “The pills cost 25 cents apiece now, but it cost them $4 million to make the first one.”
Those are the kinds of things I wonder about, too.
I’ve had no issues for paying when I’ve had tests or issues, but I will say I am very pro-active.
For instance, I used to work overnights for about 10 years. That means you tend to wake up at 9pm to get ready for work and you’re sick. So I’d call and tell my doctor (or rather service) that I was really sick and needed to see someone. They would almost always say “Go to the ER,” which I did.
I never got a bill or had an issue, 'cause they covered it by authorizing me to go. Many people skip that step and think that is a billing problem. Well not really, you didn’t follow the rules.
The only plan I had was a 10%/90% plan which was actually pretty good. You paid the first $100 out of pocket then everything else, including prescription drugs, was paid for 90%. You could even choose the name brand instead of generic drug, because whatever the cost you paid 10% and the insurance picked up 90%
The only real problem with this is YOU had to pay upfront. It was fine for me 'cause I had credit cards, but it could be a problem. For instance, I had an EKG and I had to pay for it upfrong, which was not cheap. Then I submitted the bill marked “paid in full,” (I charged it. ). To their credit the insurance paid me back within 7 days.
They were really quick about paying but you had to present them with the bill and what you paid.
I often wondered how I’d go about paying a huge hospital bill. There must’ve been some work-a-round for that.
I actually wish I could pay out of pocket. I have a chronic condition and have to go to the doctor somewhat regularly and have to get meds every month, but if it meant lower healthcare costs overall to treat my health insurance the same way I treat car insurance (i.e., only there if I get in a bad crash), I would gladly pay for a doctor’s visit in full, particularly if standard tests were included like pap smears.