# What happens in the US when an uninsured person needs health care? **URL:** \ **Category:** Factual Questions\ **Created:** [September 9, 2011, 10:06am UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711 "2011-09-09T10:06:50Z")\ **Posts on this page:** 9\ **Page:** 7
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [September 12, 2011, 5:36am UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/121 "2011-09-12T05:36:54Z")
> [@Maastricht](#): > > I’ve been reading all stories and datapoints with interest, thank you all. > > Here’s my Dutch data point: > I make 2740 euro a month before taxes. Of that, 200 euros go to my part of my health insurance. My employer also pays about that. But If I didnt’t have a job, my unemployment benefits or my welfare would pay for my health insurance. It would just be a more basic health plan, but it would still contain all the basics. My daughter spent her junior year in Germany. While my insurance would theoretically cover her, we decided it would be so complicated that it was worth getting German insurance, which cost roughly what you gave. What you guys pay is in the noise around here. Those of us who work for big companies at high levels get really good benefits, but as you’ve seen trying to get insurance by yourself is an expensive nightmare. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [September 12, 2011, 5:44am UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/122 "2011-09-12T05:44:18Z")
> [@Maastricht](#): > > That could be it, **Muffin**. However, I’m sure that if I studied both systems more in-depth then I want to do now, I’d find more info on how each works out. It is true that even with no-treshhold medical care, many people here are reluctant to go see a doctor. They don’t have the time, or don’t want to consider having a serious problem. Yet, the government here, as wel as elsewhere, often complains about healthcare costs rising and rising. Yet others see that not as a sign of a sick socity, but as added wealth. A lot of it is due to the availability of treatments. 20 years ago my wife would be totally blind in one eye when her retina detached. Today they were able to lase it back on, and even able to wrap a cord somehow to keep it on. Amazing technology, but not cheap. What I don’t understand about the “they’ll just flock to the doctor” position is why these people aren’t also against private insurance plans. I can go to the doctor anytime with a very small co-pay. I don’t, but when I got rejected from blood donation because of a racy pulse I could go because money wasn’t an issue - and it might have saved my life, and might have prevented treatment for a heart attack, which is expensive. In the US doctors get fee for service, and often work in big clinics, so to some extent the more tests they order the more money the clinic makes. Insurance companies have ways of reducing this, but it is complicated. Also, every doctor or dentist, no matter how small, has one person doing nothing but interacting with insurance companies. Do you have this? ---
**Author:** ![Capitaine\_Zombie](https://avatars.discourse-cdn.com/v4/letter/c/e95f7d/32.png) [@Capitaine\_Zombie](https://boards.straightdope.com/u/Capitaine_Zombie)\ **Post date:** [September 12, 2011, 5:45am UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/123 "2011-09-12T05:45:07Z")
> [@Leo\_Bloom](#): > > Obamacare. But doesn’t kick in yet, and still might be overturned. > :smack: Or did you mean “car”? Christ, I think it’s one of the reasons I couldnt understand much of what was being said to me. YES, I meant car (and it’s not even a Freudian slip, it’s just two letters next to one another on my keyboard). but I think my question has been partly answered. That is car insurances are mandatory, but the policy covers you and your vehicle, nothing about damages done to someone else or someone else’s property. Frankly, just peeking from abroad, it seems as scammy as your healthcare (private or public) labyrinth. ---
**Author:** ![Bookkeeper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bookkeeper/32/281_2.png) [@Bookkeeper](https://boards.straightdope.com/u/Bookkeeper)\ **Post date:** [September 12, 2011, 6:15am UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/124 "2011-09-12T06:15:59Z")
> [@chiroptera](#): > > Another data point: A little over two years ago I had no insurance. I had been having intermittent chest pains for weeks - which, having no insurance, I ignored. Until I decided it was stupid to ignore chest pains, friends urged me to get it checked out…so I went to the city hospital ER because I knew they would do cardiac testing and whatever first and ask questions later. > > I was there for about seven hours after being admitted right away (coming in with a chest pain complaint means you don’t get stuck in the waiting room.) They did an EKG, blood tests, a chest/lung x-ray and stuck me in a bed with a needle in my arm and various monitors stuck to me. Thne cardiologist wasn’t due for rounds again until the next morning, and the ER doc urged me to stay overnight so I could be seen by the cardiologist and go through stress testing or something. > > But I was already getting nervous about how much this was going to cost me, and since every test they ran indicated a perfectly healthy heart and possible a chest-muscle pull, I discharged myself before dinner, against “doctor’s orders.” My heart is absolutely fine - it was probably a chest-wall muscle pull which can mimic heart attack symtoms. > > The bill was $1,900 and change. I think they’d already discounted the charge since I was uninsured - someone with insurance probably would have been charged a lot more. That’s been my previous experience when uninsured - most medical practitioners cut uninsured people a big break on charges, but stick it to the insurance company (probably compensating for lowered charges for uninsured people.) The billing department was totally cool about letting me pay it off over about six months. > > I really resisted getting checked out because of the cost, but finally decided I’d feel really stupid (and maybe dead) if what I was ignoring was a heart attack, or an incipient heart attack. This happened to me a couple of months ago. I had been having intermittent chest pains for a while (hmmm, I wonder if??? Nah!), then woke up in the middle of the night with severe chest pain and numbness in my left arm. Having recently seen a PSA about not being a macho idiot in exactly this situation, I had an attack of the smarts, woke my wife, and called 9-1-1. I spent about 18 hours in ER, with a couple of chest X-rays, visits by several ER doctors and a cardiologist, a followup stress test and consultation with another cardiologist, with the final diagnosis that my heart was pretty much normal and my pain was likely just a pulled muscle. Total charge to me - $45 co-pay for the ambulance. My mother had a fainting spell just this week, and ended up with her doctor neighbour calling 9-1-1 and sending her to the hospital, where they put in a temporary pacemaker to tide her over the holiday weekend until a permanent one could be implanted on Tuesday. Total charge to her - again $45 for the ambulance. This in contrast with about $15,000 when she had a kidney stone attack in Florida (luckily mostly paid by her travel insurance). A friend spent several weeks in hospital last year after suffering a stroke. He’s back in again after being admitted with double pneumonia and having major coronary artery blockages discovered when they examined his chest X-rays, so that he is now scheduled for a triple bypass. Since he was taken in by a friend, not an ambulance, he will probably be charged $0. Comparing these experiences with what I read here and elsewhere about US health costs and insurance woes, and what my stepsister, who is a charge nurse in a US hospital tells us, I can’t believe that so many ordinary US citizens will actually fight against changing your current system. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [September 12, 2011, 6:38am UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/125 "2011-09-12T06:38:37Z")
> [@Broomstick](#): > > Or, if you’ve been to one hospital and not the other the one you’ve been to has your prior medical records which, particularly if you have a long-standing chronic illness, might be preferable from the standpoint of providing the best possible care. And considering that in the US you may have to pay for copies of your records/analysis/plates (I had to pay for a copy of my mammogram), needing to have medical histories in several places is yet another thing that adds cost, not just the time spent remembering whether your tonsils came out when you were 6 or 7. Contrast that with the Spanish system, which has gotten real complicated in recent years but hey, it’s also gotten computerized: the system is not single-payer anymore, not exactly. Every employed person pays Social Security, which covers Public Healthcare among other services; then each Region gets a chunk of this money distributed their way with each year’s budget; each Region has its own Public Healthcare System. Last year I had to go to the doctor in Andalusia, a Region where I hadn’t done so before: procedures to do this vary by region. In Catalonia, Euskadi and Navarra, you just go to the nearest medical center and state you need to see a doctor and you’re a “passerby” - in Catalonia each center has a doctor with a lower patient-load, who takes all passersby; in Euskadi and Navarra they just assign you whomever is available. In Andalusia, I had to do some paperwork to request a doctor and then do some more to show that I was “active” (paying SS); this would have been waived in an emergency (I would have had access to the same medical care if I’d been “passive”, unemployed/retired/on disability and therefore not paying SS; depending on why I was passive I would have had more benefits). Still, as soon as I’d been assigned a doctor, she had my medical history in the computer; the Catalans have decided to assert their identity by having a data format incompatible with the one used by everybody else, so in their case the transfer requires a couple of days. Still, except for the Catalans, any Public System doctor in the country can access my history straightaway. **Maastricht** , I’m self-employed so I pay both the employee and employer’s parts, but on the lowest “rung”: comes up to 254€/month - self-employed usually pick a “payment level” rather than have to calculate income each month and prove it to SS. For people employed by others, in Spain SS payments are 7.5% of base salary (that is, items such as performance bonuses and seniority don’t count) paid by the employee and another 7.5% by the employer. How much you’re paying affects the _other_ SS benefits (retirement, unemployment) but not your medical care. ---
**Author:** ![Maastricht](https://avatars.discourse-cdn.com/v4/letter/m/a88e57/32.png) [@Maastricht](https://boards.straightdope.com/u/Maastricht)\ **Post date:** [September 12, 2011, 6:40am UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/126 "2011-09-12T06:40:09Z")
> [@Voyager](#): > > A lot of it is due to the availability of treatments. 20 years ago my wife would be totally blind in one eye when her retina detached. Today they were able to lase it back on, and even able to wrap a cord somehow to keep it on. Amazing technology, but not cheap. True, I guess that is what was meant by added wealth. It would be an interesting debate for GD how much of this kind of wealth is " enough". > [@Voyager](#): > > What I don’t understand about the “they’ll just flock to the doctor” position is why these people aren’t also against private insurance plans. I can go to the doctor anytime with a very small co-pay. I don’t… True, I hadn’t thought a bout that, and it ties in with what Muffin said. People, unless they are hypochondiracs, don’t go to the doctor for fun. > [@Voyager](#): > > Also, every doctor or dentist, no matter how small, has one person doing nothing but interacting with insurance companies. Do you have this? Good point. No. Doctors will usually have an assistant, but dealing with insurance companies is only a small part of her job. ---
**Author:** ![Shot\_From\_Guns](https://avatars.discourse-cdn.com/v4/letter/s/ccd318/32.png) [@Shot\_From\_Guns](https://boards.straightdope.com/u/Shot_From_Guns)\ **Post date:** [September 13, 2011, 9:24pm UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/127 "2011-09-13T21:24:44Z")
> [@Fear\_Itself](#): > > So If I had a major hospitalization like I had in 2008, it would cost me over $17,000. Thanks for insuring me against catastrophe, motherfuckers. That’s one of the beautiful (:rolleyes:) things about health care in the U.S. $17k \*isn’t \*catastrophic–not by a long shot. Your type of insurance is designed to “protect” you from things that would cost six or seven figures or more, things like severe chest trauma or cancer. > [@Broomstick](#): > > Also, if you approach the accounting/billing department BEFORE things become overdue you can often negotiate payment plans. IIRC all of my bills have made this very plain: they’re willing to make arrangements, but you have to call and let them know when and how much you can pay. (I actually just did this, to delay part of a bill until the next quarter’s deposit into my HSA.) You can’t just send in a partial payment and get the same kind of consideration. Unfortunately, I think a lot of people have been conditioned to completely avoid all creditors by the usual hounds you get with, e.g., credit cards. > [@OttoDaFe](#): > > The terms “in network” and “out of network” have been used in this thread, but perhaps not fully clarified. Basically, it refers to whether or not a provider is a “preferred” provider (in other words, whether he/she/it has accepted the insurer’s pricing schedule). Using an out of network provider usually means that the insurer will cover a smaller amount, with no assurance that the provider will waive the difference. With some insurers, however, it could mean that the procedure will not be covered at all (this is most likely to happen with an HMO). HMOs\* (or, more commonly these days, EPOs\*) work exclusively on in-network care: they cover varying amounts of in-network care (usually with some sort of copay or coinsurance to the insurance holder), but nothing out of network. PPOs,\* conversely, usually have a split schedule, where you’ll pay one copay/coinsurance at an in-network provider and another, higher copay/coinsurance at an out-of-network one. However, I don’t know of any provider where the in-network/OON provisions apply to \*emergency \*care. If you’re having a heart attack and the ambulance takes you to the nearest hospital, your insurance should cover it regardless of whether or not the hospital is in its network. There may be hoops you have to jump through in order to get this approved retroactively, though, and IIRC you’re generally required to transfer to an in-network provider as soon as possible. \*Glossary HMO = Health Maintenance Organization EPO = Exclusive Provider Organization PPO = Preferred Provider Organization ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [September 13, 2011, 9:47pm UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/128 "2011-09-13T21:47:29Z")
> [@Shot\_From\_Guns](#): > > That’s one of the beautiful (:rolleyes:) things about health care in the U.S. $17k \*isn’t \*catastrophic–not by a long shot. I would have to file medical bankruptcy. That is a catastrophe. > [@](#): > > Your type of insurance is designed to “protect” you from things that would cost six or seven figures or more, things like severe chest trauma or cancer. Wow, I am so fortunate they will take on that remote risk, all for only $700+ a month! ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [September 13, 2011, 10:11pm UTC](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711/129 "2011-09-13T22:11:07Z")
> [@Capitaine\_Zombie](#): > > I’m not sure I understand your question, but an insurance that covers up to one million dollars of damage doesnt require you to first give them one million dollars. Ain’t the point of an insurance to redistribute the costs among all the other insured that havent suffered any damage? No, the point is that if you are insured for a million dollars and the bills you are liable for come to $1.5Million - you personally are liable for the extra $500,000. Comparison points: When my wife needed a gall bladder operation in Canada, the largest expense I encountered was the parking fee at the hospital parking lot. When her 85-yo grandfather reached to pull the door open for her grandmother, fell and cracked his hip - they gave him a hip replacement that same night; he neded up wit a major infecton, in the hospital for 2 months. Total cost - nothing. (since he fell at the door to the hospital - otherwise the ambulance ride might have been $100 or so). One of my friends relates how his uncle was found lying in his bed with a stroke by a friend. The fool had gone to Arizona for the winter and had no health insurance. They visited a doctor, declined hospitalization (I think they said) put him in the back of the vehicle and drove round the clock fo the Canadian border. Here, he got the best of care. [Previous page](https://boards.straightdope.com/t/what-happens-in-the-us-when-an-uninsured-person-needs-health-care/595711.md?page=6)