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

Factual Questions
61

A good friend, who’s been unemployed for about two years, was recently hospitalized for about a week with heart problems. His bill is over $50k USD. I’m quite sure that would have been at least a year’s *gross *pay for him, even when he was still working. It’s still up in the air how much he’ll actually have to pay; he recently got on disability due to other health issues, but he also has some money left in savings that he’s been living off of while looking for a new job, so he may not be eligible for government-provided health care coverage.

When I had a pulmonary embolism two years ago, I was in the hospital for about two days (ER and then ICU, just for the telemetry). IIRC, the total bills were about $15,000 USD; fortunately, I had health insurance at the time, so I was only responsible for less than 10% of that total.

Not all policies have a lifetime maximum; most lifetime maxes I’ve seen are around the $2M range; and IIRC one of the benefits of healthcare reform is that lifetime maximum benefits on essential care will be against the law, so those will all go away if they haven’t already.

Base costs vary wildly from provider to provider, and there’s no good way to compare them. The tools are* just now *starting to be built to allow people to “comparison shop” for procedures they can plan for.

Then, on top of that, plans tend to be structured *very *differently, with different kinds and levels of coverage. Copays, coinsurance, deductibles, lifetime maximums, out-of-pocket maximums, and premiums all factor into how much even a person *with *insurance will pay for care they’re given. Individual insurers also all negotiate separately for their costs with each provider, so costs can even vary between similar plans from different providers.

Except that there are systems currently active that are demonstrably better than the U.S. one (better outcomes at a lower cost). So that analogy doesn’t work at all.

62

Jesus Christ you guys have it bad. And people think universal health care is a bad thing.

Even in Pakistan if you are ill you will get attention and not worry about any bill and fairly small costs for meds. Unless you go the private route bin which case you are fucked. But “fucked” seems to be the default in the US.

63

And not only that, but also we’re allowed to call the Queen a loon.[sup]1[/sup]

Please be assured that I don’t have any personal animus towards Canada or the Monarchy, but I did think this was one of the funnier Get Fuzzy strips in a long time.

[sup]1[/sup]Get Fuzzy installment; if you read this today you’ll see the right one, otherwise you’ll have to search for it.

64

And then you think you’ve followed all the rules.
You check with the hospital and the insurance company and the hospital is in-network. You check with the surgeon and the insurance company and the surgeon is in-network. You heave a sigh of relief and think this will all be covered by your insurance minus just the co-pay. Well, it turns out that the freaking anesthesiologist, whom you didn’t pick and whom you’ve never even met, is not in-network and charges more than what the insurance company considers “reasonable and customary” for out-of-network providers. You end up paying more for the anesthesiologist than the surgeon and hospital combined.

Or you need to go to the emergency room and you carefully pick a hospital that is in-network. But the hospital contracts with a doctors’ professional corporation to staff the emergency room and the doctors are not in-network.

65

This is only true if you own possessions outside of usual household items. They won’t come and take your TV (even your 60" LCD HDTV) or your Wii. You may have to liquidate possessions like leisure boats, vacation homes (but not necessarily investment properties if they generate income), and maybe your second (or subsequent) car, but not if it necessary for both spouses to commute.

Also not necessarily true. Getting and maintaining homeowners and auto insurance may be more costly, but not necessarily more difficult. A doctor will require you to pay like anyone else who self pays, up front or billed, as per their practice standard. Getting credit will be more difficult but there are credit card companies that specifically seek out people toward the middle-ish of a term of bankruptcy to “help” them rebuild their credit (with fairly steep terms, but still an opportunity).

Our household just came through a bankruptcy, it ended last month. Our lives are anything but ruined. We’re actually significantly better off than we were when we entered into it. Our credit is* better*, we didn’t lose our home to foreclosure, we no longer have any consumer debt save for our mortgage. Is it the best thing in the world? No. But is it the worst? Absolutely not, and not ruination, by a long shot.There’s no need to be both a doomsayer and a fount of complete misinformation, especially in GQ.

The long and short of it is that it will depend greatly on where you are, what sickness you have, and what is necessary to treat it. What sort of hospital you go to, what sort of work you do, what your family situation is (single vs. married, parent or not, etc.), what sort of savings you have, there are just too many variables to say flat out.

66

I think you are misunderstanding what was said. The comment was about how much the policy was worth, i.e. the maximum it will pay out, not what the premiums are.

67

(bolding mine)

They will let you keep homes that you’re renting out? :confused:
Well, if you have it hard regarding healthcare, you have it easy regarding banckrupcy. The closest equivalent over here will only be validated if you can show that your chances of ever being able to reimburse your debts are pretty much nil (say, you’re a 50 year old former housewife who never worked and has no realistic chance of being employed as opposed to a 25 yo with a good education), and anyway, you would have to sell first pretty much anything you own (kiss good bye to “your 60” LCD HDTV") . And even that option is a rather recent improvment. Before, you couldn’t ever discharge your debts and could be stuck with them for your lifetime.

68

The last quote for catastrophic health insurance I got was $700 a month, with 60% co-insurance and $9000 deductible. 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.

69

A couple more data points for you, Maastricht:

Four years ago I had an attack of appendicitis and my husband took me to a particular hospital. When it was all said and done, my insurance company refused to pay because the hospital was ‘out of network’.

I had been too ‘out of it’ to check on which hospital I was supposed to go to, and hubby and our regular doctor didn’t think about it.

The surgery and four day’s care in the hospital came to about $18,000. The hospital agreed to charge me what they would have charged the insurance company, which was a little less than half that. I agreed to pay them $100 a month. Needless to say, I am still paying on that bill.

Last spring my niece was in a car accident and was taken by ambulance to hospital, where she recieved Xrays and an MRI (everything checked out okay). The bill for that was $2,400. The hospital agreed to give me a 20% discount if I paid in cash, which I did.

70

Oh, and regarding the vulture clerks in the ER: last time I took hubby to the ER, we had not been there ten minutes when a clerk came around and wanted to know if I could go ahead and pay the deductible for his insurance, which is $500.00.

71

I just looked up our claims record for this year. My wife had a problem with her shoulder, that was billed at $1500, and the follow up physical therapy sessions were about $200 each. My 5 minute appointment to get my INR checked once a month is $26. My wife’s checkup with here retina doctor was a bit over $200. She had three retinal operations, only one of which resulted in an overnight stay (they finished so late they didn’t want me to drive her back) and that cost somewhere around $50,000 all told, not counting the cornea replacement and lots of office visits.
The online record doesn’t go back far enough to cover some other interesting procedures.

72

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.

73

I speak from direct experience that most of the time an uninsured person CAN get a significant discount from retail if they ask about it, which many don’t because they don’t realize they can negotiate.

Typically, it’s referred to as a “self-pay discount”, but there are other terms.

When I was 8 months without insurance in 2008 I was typically getting 40-60% knocked off retail medical prices because I knew to negotiate. Doc visits, tests, medications… if you’re uninsured it ALWAYS pays to ask if there is a discount, option, program to help you pay, whatever.

Also, if you approach the accounting/billing department BEFORE things become overdue you can often negotiate payment plans. The hospital usually prefers to get something rather than drag you to collections or court.

74

It is possible to recover from it, with time - I personally know someone who was forced to declare bankruptcy due to medical bills and over time (about 6 years) was able to rebuild his credit rating back into the 800’s.

Admittedly, not everyone does that, but while it’s absolute crap to go through it doesn’t mean your life is ruined forever.

75

Just to be clear, I was listing the likely consequences of declaring bankruptcy, not the certain ones. You happened to have better credit coming out of bankruptcy (which seems quite contradictory) but that is certainly not typical. Typically, bankruptcy makes dealing with a chronic illness very difficult. Typically, bankruptcy makes it more difficult (or expensive, if you prefer) to obtain insurance, a good job (as many employers do background and credit checks), non-emergency medical care, or credit. The cost of medical care, and associated bankruptcy rates, absolutely ARE ruinous for many people. You should be thankful you happened to come out on top, not calling it “misinformation” because the disaster happened to pass by you in particular.

76

I suppose “ruin your life” was a bit of hyperbole. I did not mean that after bankruptcy you’re doomed to wander the earth a restless spirit of despondency, with rotten fruit tossed at you by sneering hordes cursing your name. I meant “ruin” in the colloquial common usage sense, where your financial progress is erased, and it is much less likely you will recover and become successful again any time in the near future. Medical bankruptcies are not a walk in the park! They’re even worse than non-medical bankruptcies, because even after the bankruptcy, often you’re still sick! Being sick is very, very expensive in America.

77

Back when I was uninsured I tried to get cost estimates before having something done. And it’s damn near impossible. First, they equivocate with “well… if A then B but if it’s C then…”

I’d ask “How much text XYZ?” and it was impossible to get a straight answer: “It depends on insurance and if they find A or B on results”… Then, finally, you get an answer for the cost of test. So you get the test done and pay and think it’s over.

Then weeks later you get a bill from a doctor who “interpreted” the test, a doctor you never met and never knew about. Then a bill for, maybe, some sort of assistant or consult. Then a bill from the pharmacy, or for use of a special room, or… Well, you suddenly find yourself on the hook for two or three times what you had been told you would be.

Then you have to go and try to negotiate those prices down from “retail”.

No, there’s no cultural taboo about asking “how much will this cost?” The problem is, no one in medicine seems to have a freakin’ clue how much anything costs, and there’s always extra stuff being tagged on to the bill.

78

Excuse you. You’re the one, in a GQ thread, who said “bankruptcy can *and absolutely will *ruin your life.” That is not only a ridiculous generalization, it’s a pure falsehood. If you don’t want to get called on the carpet, don’t make incorrect and, in this case, shamelessly fearmongering assertions that are not based in fact.

79

That’s what happened to me last time I went to an ER with breathing problems - they threw me on a bed (almost literally) and treated me first, THEN asked about insurance. Breathing problems is about the only time they do it in that order, though.

I guess it would look bad if you died mid-sentence saying “My insurance is ---- AACK!” thud

80

Last year, a diabetic friend - thankfully insured - was admitted to hospital for a “simple” bladder infection. Complications ensued, including being prescribed a wrong medication that made her kidneys shut down, then getting MRSA, resulted in her being in the hospital for over a month.

So, I’m thinking that hospital staff or doctors are going to be understandably hinky about giving a cost estimate for all but the most basic of procedures in case they’re called on the carpet later in a lawsuit.