790
What I'm paying to find out I don't have breast cancer. I have insurance. (Ultrasound and mammogram in the USA)
(lemmy.world)
this post was submitted on 03 Feb 2024
790 points (97.8% liked)
Mildly Infuriating
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For those unaware how Health Insurance works in the states.
You can have health insurance all you want. Especially if this bill is recent, they will cover a large part of the cost, but most people are still on the hook for Usually between $1000-1500 of all healthcare before insurance REALLY kicks in. This is called the Deductible (and Out of Pocket) expense. You also pay a 'Premium', essentially a subscription cost that normally comes directly out of your paycheck.
For single coverage, just yourself, it's about $1200. For family coverage, where your insurance covers everyone in your house, It's usually double that. So ~$2,500-3,000.
So this person probably hasn't had any bills yet this year. Once they pay about $1500 in costs, everything after that becomes (mostly) free. Depending on what you have, insurance will pay anywhere from only 80% - 100% of the cost from whatever the procedures and meds are.
Then funny part is that some places in America the cost is so high, this might be a situation where their insurance DID kick in already and their insurance is still making them pay that much. Or it's a case where you get a bill for that much but your insurance hasn't paid it yet... so it looks like you're supposed to... so you do... then two months later you get a check for that amount.
It's so. Damn. Silly. And I resent Republicans every day for it. That's not even the Fascist MAGA Theocracy republicans. Just your stock standard ones lmfao.
$1000-$1500...?
Most people are on high deductible plans, so it's more like $3000-$5000
That could be true, but do you have a source for that? A significant portion of people are on Medicare/Medicaid, which usually doesn't have deductibles that high.
i can't give you a source for "most people," but personally my out-of-pocket is $6k for myself, $12k for my family. about the only thing covered before that number is met is yearly physicals. i pay about $500 a month for this (after my employer's contribution). dental separate, no vision.
So if I had insurance like that and I actually had cancer I'd pay the first $2,000 and then literally all treatment after that would be free regardless of cost and then I just pay like the standard insurance price?
Presumably your insurance would then go up after that or does it only go up for other cancer related stuff?
well it depends.
for major surgeries, no. after you satisfy your deductible, you're likely to pay a co-insurance on your procedure.
co-insurance is the percentage you're personally responsible.
so lets say your procedure is billed by hospital for 50,000. and your co-insurance is 20%.
you would be paying 20% of the 48000, so 9600.
up to your "out of pocket maximum", which can be like 15000 to 30000 or whatever.
if you've already paid like 10k already this year then you would just be paying up to 5k for ur cancer treatment.
confusing? yes. fuck health insurance so much.
No the treatment would not be free, most plans will also only cover a certain percentage of the overall procedure so on top of your annual deductible which mine for example is 7,500, there's also certain procedures that are not covered at all and the rest of the procedures are at a 70-85% coverage, which is still better than them not covering anything I guess but still pretty dog shit for an insurance that you're paying over $100 a month that's tied to your employer
It's pretty confusing, but basically your insurance won't cover much until you meet your deductible for the year. After that, your coverage depends on the policies of your insurance company. Some stuff may be totally covered, some partially, some not at all. And there's really no way to know what costs what until you get it done.
This is the part that drives me bats. For any other service in any other industry you can get a quote first, but for some fucked up reason healthcare in America doesn't work that way. The hospitals and insurance companies just do whatever the fuck they want, and you get to find out afterwards if you could have afforded it, i.e. after it's too late. It's such bullshit.
Indeed, I hate it when people are like "you shouldn't pay that much, you need to shop around". Assuming you even have multiple hospitals to choose from, tell me you don't get "I don't know" 9/10 times when you ask about the cost of a procedure.
you can absolutely ask the hospital for a good faith estimation.
I really don't understand why there is anyone against universal health insurance in the states.
Pretty much everyone is guaranteed to get major hospital bills at some point in their life. They are paying massive fees to insurance companies to line their pockets instead of hospitals to provide better service.
Sure, taxes will go up a bit to cover it, but what you'll pay in taxes over your lifetime is going to be no where near what you pay in insurance and healthcare procedures.
I pay $0 annually for insurance, and I can walk in to see my doctor at any moment to consult on something for $0, and if something needs to happen I can get blood work and X-rays for $0, then go to the hospital for surgery for $0 (maybe a $5 parking pass).
You should also hate Joe Lieberman. He scuttled a public option for the ACA, which likely would have prevented a lot of the shenanigans insurance companies pull, as they would be competed right the fuck out of business with a robust public option. Japan has private and public insurance and costs are generally low for health care. Most kids get it completely free
IDK about how Japanese insurance works, but of course they will want kids' healthcare free. If not then their already dropping population would drop even faster.
Those amounts you mention. The 1200-3000 dollar ones. Call me silly, but I have no clue if that’s monthly or annually. The whole situation there seems so alien. Healthcare, but also salaries and cost of living. (E.g., $45k/year is a pretty good salary here, while I think it is a junior-ish salary in the states, right? >$100k/year is rare as rocking horse shit here at least.)