How would this help the lady in the above situation?
And honestly i would have expected a little more compassion from you considering your line of work. You see people at their worst all the time.
I read the entire article, unlike a few people in this thread. The woman is 29 and now she is facing bankruptcy. And she didn’t do anything wrong. She’s not even fat, so people can’t even say she deserved the cardiac arrest. :rolleyes:
Healthcare is fucking ridiculous in this country. Any one of us could have this happen to us: get hit by a bus, have a heart attack, whatever - and BAM! Our fiscal responsibility is worthless.
This is a huge problem, both with facilities and with doctors in in-network hospitals!
I would call my insurance company and argue that mid-cardiac-arrest isn’t exactly a time when one can be reasonably be expected to access the website and check that the hospital I’m being transferred to by ambulance is in-network.
Even if she’d gone to an in-network hospital, it’s entirely possible that at least one of her docs – and maybe more – was non-par. This happens all the time. No one tells you THAT when you’re going into surgery, either. “Hi, I’m Doctor Bob and I’m your anesthesiologist.” That’s what you get.
This crap needs to stop for emergencies. It’s wrong.
I know you’re just being a dick for its own sake, but the heart attack occurred in September 2013. The relevant provisions of the ACA went into effect in October 2013 at the earliest.
I am pretty sure Florida requires insurers to cover emergency care provided out-of-network at 100% of the in-network rate. I’m a little surprised to discover that’s not the norm.
Really has done little to affect health-care costs. It was more about insurance reform.
“So she would have been better off without insurance?” Maybe. How did having insurance help her? How much did she pay per month for this non-coverage?
My son went to the doctor for strep throat. His cost for insurance is $150/mo. Let’s see what insurance didn’t cover. $500 hospital visit + $400 for the doctor which was literally 10 min to look at throat, say yes that’s strep and prescribe some medicine. So this year that one visit (assuming he doesn’t get sick in the next month) cost $2700 and guess what - next year the deductible is refreshed so we’ll have to pay out of pocket again. The time actually spent on his triage & examination was 30min which mean our health care cost this year work out to
$5400 per hour
So please explain how Obamacare helped him or would have helped the lady in the story considing she’s a victim of health-care costs and non not having insurance? What we need is health-care COST reform - not insurance reform (although that was a good start).
What?! You mean make insurance companies actually pay out for health care? What do you not understands about “Pay hundreds of dollars every month and then we still won’t pay because you haven’t met your annual deductable that resets every Jan 1 so you’ll never actually pay it off.”
What she needed to do was file an appeal with her insurance. It would be rubber-stamped denied at the first level. Then she would file a second-level, plead her case to a panel of “reasonable people” and get it covered most likely. Emergency procedures are frequently covered out-of-network at in-network rates.
The article says she is facing bankruptcy. Whether declaring bankruptcy is or isn’t a good idea, it is generally possible to arrange a payment plan with a health care provider. It may be $100 a month for the next 50 years, but they can’t say she isn’t paying.
First of all, if you’re going to a hospital (presumably the ER?) for a sore throat, you are using the most expensive form of health care. You were paying not only for the care you got, but for the care available. We don’t pay for a health care by the hour. We pay for the years of training that enable a doctor to know in ten minutes what is needed. IANAD, but in my experience and from my reading, a strep throat cannot be diagnosed by what it looks like. You need a culture to test what’s there. If there are no bacteria an antibiotic is worse than useless.
I cannot imagine that a doctor would charge $900 for an *office *visit.
I’m sympathetic, but at the same time comforted to learn that I apparently have several gazillion dollars in my retirement account. And here I was worried!
Because Obamacare was a promised health-care or at least health-care cost reform. While ACA apologists point to where it is supposed to reduce cost theoretically, the fact remains for many of us, relatively minor health issues are still expensive even with insurance.
To MLS: Yes it was urgent care because hr took a turn for the worse after hours. I know healthcare is expensive under those circumstances but what is rarely taken into account is the monthly cost for minimal coverage. Insurance is phenomenal for catastrophic coverage. If I didn’t have Kaiser my daughter’s long-term illness and death would have bankrupted us. But is you look at “everyday” coverage like strep throat (and the prescription was for pain killers), ingrown toenail (cost $400) etc. PLUS the monthly cost (insurance ain’t cheap) PLUS that there is a deductable to pay off every year before the serious coverage occurs. It boils down to this:
For thousands of dollars per year in premiums, does the insurance company save me thousands in medical cost. If not, it is a net loss and so why am I better off having insurance?
Also, I vehemently disagree with the paying for knowledge. 10 minutes of time = $400. That means I paid $2400 per hour for him to confirm it was strep throat. Bear in mind the doctor was told that my stepson currently had a horrible case of strep throat and no culture was taken. Honestly the only use of the doctor was to write a prescription for pain-killers so he could sleep and swallow the tylanol a little easier. Really? You want to justify that the legal ability to sign a script is worth $2400/hr? And how does having insurance help that when they say “Fuck you for having a serious health problem late at night and not already meeting your thousands in deductable.”
In the mentioned case the insurance paid the absurd charge, though the guy was willing to help them fight it. The “assistant” surgeon wasn’t in network and so the price was not negotiated with the insurance company. If it had been it would have been like $5k, and it would have been even cheaper if the assistant was from the hospital which was what was supposed to have happened.
In the last decade health care costs went up 8 - 9% a year. Now they are going up 4 - 5% a year. Some of this is due to the economy, but some is due to ACA. ACA for instance capped the percentage insurance companies could take as overhead, that was a decrease right there.
A lot of the eventual decrease will be from evidence based medicine and publishing costs per hospital, which should force expensive hospitals to cut costs or else lose business. But this is going to take a while. It’s been in effect less than a year, you can hardly expect all the benefits to happen.
If you get a high deductible policy you are gambling that you either have almost no expenses, and just pay the reduced insurance costs, or have only catastrophic expenses where you get the benefit. These policies existed before ACA also, and we discussed them here. I wrote that they could be a bad choice for exactly this reason.
I have good employer provided insurance, and paid maybe $400 total for $50K of eye operations for my wife.
Anyhow the real benefit of ACA is to let me get insurance if I retire long enough before 65 for COBRA to run out. Before I would have been SOL. Now I can get it.
The benefit of insurance is not just the amount you get back. If that was true term life would be a rip off all the years you didn’t die. The value is the expected value of the insurance, which is the average cost of care time the probability of needing that care, with some value of not having to worry thrown in. When I was younger they made a lot of money off of me, except for a year or two. They still are, but not as much, but I could be a big winner at any time if I had a heart attack.
Anyhow, emergency rooms are expensive because they have to be ready for real emergencies, while a GP can have relatively minimal equipment and thus minimal costs. Your son being sick at the wrong time is not an indictment of the medical system.
Hospitals have a list price and a price they charge in-network insurance companies. They can differ by a factor of 75 or more.
If you are an insurance company, you negotiate the low rate with your network of hospitals. If you are an individual, you pay the high rate. If an out of network assistant surgeon can game the system, he can charge the insurance company the high rate. The high rate is untethered from reality.