What happens in the US when an uninsured person needs health care?

Factual Questions
1

I know that hospitals/ER won’t turn away uninsured people in the US. And I know that in people without any money, the costs are written off by the hospital.

But what happens if a normal somebody (having a job and a bit of savings) without insurance gets sick and needs to be treated by an hospital? How much, on average, will the debt be they can incur in just a few days? How agressive is the hospital in wanting them to pay off the debt?

It seems to me, that a debt of about 20.000 dollars is very easy to incur, and might take a decade or more of very austere and frugal living to pay off.

It also seems to me that under those circumstances, the average person will do anything to prevent getting in a hospital, and will also do anything to get out of the hospital as soon as possible, even when he is still sick. How often does that happen? And how often will such people refuse additional tests and treatments because they don’t want to bear the cost?

How often will patients be cost-conscious critical of their docters? “No thanks, Pubmed and wikipedia say that test is not necessary yet, besides, it will cost me the college fund of my kids”

And what happens if someone gets in the hospital because of someone elses fault? For instance, a car accident? Will an unisured person have to sue the other to cover their medical bills? Will that usually bankrupt the party at fault?

I’m not looking for extreme cases, just what generally happens. I can’t imagine living in a country without god medical insurance.

2

Very generally, when an uninsured person gets sick, they are stabilized at the hospital and then released. They don’t pay their bill, are sent to a collections agency, reported to the credit services, and may end up declaring bankruptcy, at which point whatever savings they may have are taken and distributed to their creditors, including the hospital.

It is very common to attempt to collect damages from an “at fault” party. If the at fault party has insurance, their insurance company will be liable to pay for the injured person’s medical expenses. This may end up costing more than the policy is worth, at which point the policy holder is on the hook for the rest. This could result in the at fault party having a court judgement against them, which he may or may not be able to pay. I believe bankruptcy in this case will not absolve him of his debt to the injured party.

3

I don’t know anything about costs, as I don’t work in the inpatient part of a hospital and haven’t had significant medical bills lately. (Maybe after my husband wakes up I’ll ask him how much his short ER visit plus testing cost before insurance paid, for comparison.)

Most non-profit hospitals have plans for those who do not have insurance. Where I work, at least 50% is discounted to start with. Then you can sit with a social worker at the hospital and talk about other options and payment plans.

My brother-in-law worked as an apartment building’s “super” (maintenance/cleaning that wasn’t too in-depth) until he had to go to the ER for coughing up blood. Alcoholic liver failure. His kidneys shut down too, and he had a stroke while in the hospital. He was hospitalized for months, and finally his kidneys and liver started coming back. He’s got the remnants of a tracheotomy, plus a lifelong condition of disability even after the months of physical therapy he had to go through. Bills-wise, he was “fortunate” that he was disabled by this, and that he lived in Chicago - he went to the county’s hospital which charges a sliding scale for the poor, and because he became disabled in the process, he was eligible for Medicaid.

I think savvy uninsured people will look up procedures. Less bright/resourceful might just ask about getting generic-brand medications.

4

Actually, no. Hospitals and ERs will turn away uninsured people, unless the patient is in actual danger if s/he doesn’t get treated in a timely fashion.

I’m diabetic. If I let my blood sugar get too high or low, and get rushed to the ER, I’ll get treated for the high or low. However, I won’t be treated for the diabetes, I’ll be told to make a follow up appointment with my regular doctor, or to find a doctor for regular treatment. If I waltz into an ER/hospital/doctors’ office without having an actual emergency, and without having insurance, the ER/hospital/doctor is legally able to refuse to treat me.

Many people in the US are similarly confused, by the way, and think that ERs are required by law to treat anyone who shows up, no matter what the problem is.

And yes, anyone without insurance will still get a bill, and the accounting office will attempt to collect on that bill, and then send it to a collections agency. As Mosier said, some people have been forced into bankruptcy because of medical bills.

There’s a great deal more to this issue, but it would probably be better in GD rather than GQ.

5

What they said on the uninsured and emergency care, by the way. ERs can’t turn you away unless you are in need of stabilization from some emergency situation. Once that happens, you need to figure out what to do from there. Depending on what you need to have done, you may be able to set up a payment plan.

My husband said his 3 hours in the ER, EKG, chest x-ray, a few liters of saline via IV, and blood testing cost a bit under $1000 before insurance. He paid $85 of that. That was without an inpatient admission and all the charges associated with that.

6

Oh! That is doable. In the Netherlands, hospital stay is about 600 USD per day, not including other medical treatment.

Lynn, how much would your treatment for high blood sugar be?

7

I have a friends undergoing treatment for breast cancer at the moment, and I have wondered how much that would cost her. It must be over 40.000 euro’s, if she would have had to pay for it herself.

How often do people decide against treatment, just walk out of the hospital and hope for the best?

I’m asking because those people are a kind of test group for the effectiveness of medical treatment. A control group, as it were. It would be interesting to see what percentage of those people actually ARE allright afterwards. That would indicate how often medical procedures are not necessary, but done because of risk avoidance by doctors.

Posters said that the worst thing that can happen is to have ones savings confisquated and declared bankrupt. What does bankruptcy usually entail? Forced selling of your house or posessions? Or just a bad credit rating so you can’t loan any more money from any source?

8

The real problems start when you are stabilized and leave the OR with instructions to seek further treatment and you have no money an insurance. Then you are royally screwed. I would go on if there were not GQ, but what I’ve said is factual.

9

The problem is that I often hear this, but I have no idea what that means, factually. That is why I posted it in GQ.

So in your scenario, how much money would a person have to pay for an average, common treatment? Say breast cancer, diabetes or a broken arm? And how much of the average net yearly salary would that be? I want to get a sense of how much of a financial disaster it is to get sick without insurance.
Is it: “we need to spend our life savings” " to “no vacation for the next four years, but after that we’re okay” to “goodbye to the kids’ college fund” to “our family is now homeless” .

10

Broken bone treatment in the ER - I had a broken wrist and went to the ER. They examined me, did an x-ray and saw that the bone was broken but in place, put a splint on it, and sent me out with a prescription for Vicodin and a referral to an orthopedist in the area a few days later. I opted to go a different orthopedist, at the hospital where I work. That’s where I got the actual cast put on, more x-rays, and a number of follow-up visits, followed by physical therapy.

I’m not sure how it might differ for an uninsured person - probably it’d be much the same. X-ray, splint, be on your way. It would probably be around $500, I think, judging by how much my husband’s ER visit cost for a longer time there and more stuff done? Maybe more? I don’t remember any longer how much it was.

For something more complex, I guess it’d depend on where you broke it and how bad the break was. I’d guess a fracture where the bone was displaced and broke the skin would get you sent right to the operating room, and that would cost a lot.

11

But Maastricht, some of that would also depend on how much money the person makes, and the health plan they have.

For one semester, the deductible on my graduate school’s health plan was $10K. That means, the person insured would have to pay $10K out of pocket before insurance covers anything else (well, that plus a $250 deductible fee). Oh, and they would cover ambulance up to $500, if it costed more, one would have to pay for the difference (I had to).

Please keep in mind that was a health plan designed for graduate students… Now, I’m “lucky”, in that $10K is about a third I make per year, before taxes. For many other graduate students, $10K can be from half to almost all their yearly salaries, before taxes.

Eventually, they lowered to $2500 deductible (it has risen up to $4K this year, but I digress). I was lucky that I broke my arm as soon as that deductible was lowered, because the total costs of transportation and repair ended up being about $15K, or half my yearly income. Instead, since I’m such a penny pincher, I was able to pay it in installments of $500 per month, for about half a year. But had the deductible been lowered, it would have been a very hard year, and I would still be paying, even with installments. And I would’ve been unable to take the couple of trips I’ve taken since the fracture.

12

The OP asked about someone with NO health plan/insurance.

13

I can answer this for diabetes.

My insurance is such that I have no co-pay; I pay up to my deductible limit every year, which is around $4K, and after that, they pay 100% of everything, as long as I stay in-network for everything (which is easy - their network is big, and I have yet to find a local doc or facility that’s not in-network). The side effect of this is that I see every bill, in full, as there’s no complex money manipulations like “for procedure X, your co-pay is Y”.

3 years ago, I was diagnosed with Type 1 diabetes. Out-of-pocket charges for ongoing treatment without any insurance would is about $700/month - that’s just for insulin, test strips, and pump supplies.

Add in a couple yearly doc visits and lab tests at the tune of about $200/visit, for a total of $400/year.

Once a year glucagon pen (a shot that will bring your blood sugar up VERY fast in case of emergency, and expires once a year), $100 or so. Misc supplies like alcohol pads, glucose tabs, etc will easily add on another $100.

So ongoing basic costs for diabetes, assuming no ER visits or complications, and no insurance at all, runs around $9000 a year. Those are off-the-shelf, no-discount prices; I know at least a few of the things I need have programs for low-income people where the prices come down quite a bit. If I didn’t have a pump, the prices would be lower by about $300-$400/month, so that’s a big savings. IMO a pump is worth it, but then again, I have insurance.

My part of all this is paying my monthly insurance payments (a little over $500 atm), and the deductible ($4000). That’s for me and Mr. Athena. So in a given year, we pay about $10K for insurance for both of us, and that should be the full amount we pay regardless of how sick either of us get.

The monthly rates go up every year by about $80-$100 per month. I can’t “shop around” for a lower rate, because being a Type 1 diabetic is an automatic refusal to every insurance company I’ve found. Note - that doesn’t apply for group rates, which is what you get if you receive your insurance through your employer. Group insurance can’t refuse anyone (though they can jack up the rates). I’m self-employed, so my situation is different than anyone who is employed and the employer offers insurance.

Another anecdote: I was in the ER a couple weeks ago for an allergic reaction in my eye. I was there maybe an hour; they did nothing other than examine my eye, give me a steroid eye drop, and tell me it was not serious, just an allergic reaction. The cost for that was $800 (which my insurance paid in full, because I’ve reached my deductible).

14

60% of all bankruptcies in the U.S. are caused by medical bills that people can’t pay:

http://articles.cnn.com/2009-06-05/health/bankruptcy.medical.bills_1_medical-bills-bankruptcies-health-insurance?_s=PM:HEALTH

15

This is quite the opposite of what is typical. If you look at your hospital bill after insurance pays it, it explains the work done for you, the cost the hospital charged, and the negotiated cost the insurance company pays. Insurance typically settles medical payments for much, much lower than the hospital would have charged an uninsured person. The reason for this is that the insurance company has the power to negotiate, as it represents hundreds or thousands of potential customers for the hospital. The discount at a hospital is for insurance, not a lack of it!

16

Bankruptcy typically will not leave a person homeless. Some possessions will be confiscated, liquidated, and distributed to your creditors. You will have a difficult time getting insurance, finding a good job, finding a doctor willing to work with you unless you pay up-front, or getting credit in general. Bankruptcy can and will absolutely ruin your life, especially if you are sick.

17

I’m not disputing that. My husband paid less than $100 in fees after his nearly-$1000 ER visit, because he does have health insurance. What I’m doing a poor job of explaining is that non-profit hospitals have a requirement to provide a certain amount of charity care to patients - unlike the for-profit hospitals - and so where I work, they start with that and see what else can be done from that point.

18

Over 60% of bankruptcies in America are due to medical bills:

And that study is two years old. I doubt the situation has improved, with more people out of work and without insurance.

19

No, I think it is pretty typical for universities/NFP hospitals. When I had a $2,000 bill with University of Michigan Hospital, they let me pay it off “any amount a month” at no interest. I had a payment plan for $50/mo, but Billing told me, as long as I sent them ANY amount of money every month they would consider me in good standing. They charged me the same as what they would have charged the insurance, except for the fact that insurance rejected the bill. I know other people with the same arrangements with other University hospitals, including someone who has been paying off a helicopter medevac for about 20 years to University of Virginia Medical Center.

In my experience, hospitals don’t get their jollies sending people to collections. They would prefer to be paid voluntarily, slowly, but completely as opposed to partially or not at all if the person ends up in collections or bankruptcy.

20

Fear Itself, am I invisible?