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StewofPuppies t1_is49i19 wrote

Reply to comment by Exoddity in Pensioner with broken hip left lying on cold street for nine hours due to no ambulances by turbo_chuffa

Holy shit. As shitty as these medical bills are, this is worse than the states. It has only been this bad where I am during like covid. I'm sure ther are hospitals here just as bad if not worse though.

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CW1DR5H5I64A t1_is56dow wrote

And the vast majority of people in the US have insurance which covers the exorbitant fees that the hospitals charge. The problem with the system the US has is that benefits are tied to employment. Reddit tends to skew towards a demographic that work lower positions or entry level jobs which means we typically only hear the horror stories.

Most Europeans really don’t understand how the US system works or how much it actually costs the patient out of pocket for care. So I’ll just share my health plan costs to put things in perspective.

Enrollment Fees or Premiums $0 (This is not common, most people pay a few hundred dollars a month in premiums)

Deductible: $336 for my whole family. (I will pay the first $336 during the year before insurance starts to pay. This resets at the start of each year so I am guaranteed to pay at least $336)

Catastrophic Cap

$1,120 (This is the most I will have to pay out of pocket for my families care for covered care during the year.)

Health Plan Costs- primary doctor

Network: $16

Non-network: 20%

Outpatient Visit - Specialty

Network: $28

Non-network: 20%

Urgent Care

Network: $22

Non-network: 20%

Emergency Services

Network: $44

Non-network: 20%

Laboratory and X-Ray

Network: $0

Non-network: 20%

Ambulance

Outpatient:

Network: $16

Non-network: 20%

Inpatient: 20%

Ambulatory Surgery (Same Day)

Network: $28

Non-network: 20%

Mental Health (Inpatient)

Network: $67/admission

Non-network: 20%

Mental Health (Outpatient/Partial Hospitalization) - Primary Care

Network: $16

Non-network: 20%

Mental Health (Outpatient/Partial Hospitalization) - Specialty Care

Network: $28

Non-network: 20%

Mental Health (RTF)

Network: $28/day

Non-network: $56/day

Clinical Preventive Services $0

Durable Medical Equipment, Prosthetics, and Medical Supplies

Network: 10%

Non-network: 20%

Home Health Care $0

Hospice Care $0 (Medical equipment and pharmacy are billed separately)

Hospitalization (Inpatient Care)

Network: $67/admission

Non-network: 20%

Immunizations $0

Maternity (Delivery/Inpatient)

Network: $67/admission

Non-network: 20%

Maternity (Delivery/Birthing Center)

Network: $28

Non-network: 20%

Maternity (Home) - Primary

Network: $16

Non-network: 20%

Maternity (Home) - Specialty

Network: $28

Non-network: 20%

Newborn Care

Network: $0

Non-network: 20%

Skilled Nursing

Network: $28/day

Non-network: $56/day

Pharmacy

Generic (Tier 1) - Home Delivery $12

Generic (Tier 1) - Retail Network: $14

Non-network: $38 or 20% of total cost, whichever is more

Brand-name (Tier 2) - Home Delivery $34

Brand-name (Tier 2) - Retail Network: $38

Non-network: $38 or 20% of total cost whichever is more

So with my coverage I have the potential to pay a lot if I go out of network (20%) otherwise I’ll typically pay around $20-$30 for services. Luckily I have a major provider which has most doctors in network.

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mothboat74 t1_is5citb wrote

This is what you expect to happen. In my plan, it says 100% coverage for preventative services. However after my annual physical I get a bill for $200 because there was a lab fee that is not covered. There is always some bullshit charge they claim is not a part of your covered expenses.

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CW1DR5H5I64A t1_is64tn2 wrote

The worst is when a hospital or doctors office is in network, but individual doctors are in separate practices within those medical facilities that are out of network. It’s madness

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mothboat74 t1_is65bij wrote

Yes!!!!! Your hospital, surgeon, etc is all in network. However the anesthesiologist is out of network so you owe us $3,000. Oh, by the way, none of our anesthesiologist are in any network.

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StewofPuppies t1_is5hkjj wrote

And this is where some of thr states that are more expensive and have better policies for healthcsre are better. For example, our state is expensive to live in for the most part but it is easy access to healthcare due to the amount of capital we put into propping up safety nets. I work at a nonprofit and most of my patients are uninsured, undocumented or on the most basic free stuff tied to state not employment.

Florida by all means has as competent Healthcare standards but accessing it is much more difficult for the poor; thus in ranking system Florida drops pretty far in comparison to Jersey.

This doesn't mean people don't get screwed with fees but it tends to be more bearable than others.

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dittybopper_05H t1_is6lghf wrote

Wow. You pay more than I do, for everything. Annual checkups are $0. Other visits are $25. My son's visits are $0, regardless.

I pay $0 for Tier 1 and Tier 2 drugs, and $30 for Tier 3.

For the last 28 years, I've been without health insurance just twice, totaling just a few months, the last two times I was laid off (2000, and 2001). Oh, and for a couple of weeks when I changed jobs almost 2 years ago, because I left in the middle of the month, so the insurance from my old employer lasted to the end of the month and coverage at my new one didn't start until I had been there a month.

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CW1DR5H5I64A t1_is6x95o wrote

I feel like most people from outside of the US assume we are all drowning in medical debt and never get to use our healthcare because it’s cost prohibitive. Reality is most people with stable employment have easy access to medical care.

As most things in the US, there is little to no safety net. If you are successful you can thrive, but if you fall on hard times and loose coverage than there is nothing to help you out.

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dittybopper_05H t1_isa9tgd wrote

You're only partially right.

You are correct in that yeah, if you've got stable employment you've almost certainly got relatively easy access to healthcare. For some, like myself, it's built into my compensation along with my salary and the like.

For the elderly and disabled, we have Medicare. My father is retired, on a fixed income, and he's got Medicare. That's what paid for his ambulance ride and surgery. He paid very little out of pocket.

The distaffbopper is disabled, and is eligible for Medicare, but she hasn't bothered to sign up because she's covered under my insurance, along with the lifterbopper*. If I were to die right now, she could easily switch over to Medicare.

Back before we adopted the lifterbopper, he was a ward of the county, and I couldn't put him on my insurance back then because he was only our foster child. He was covered by Medicaid, which is like Medicare but it's for people with very low or no incomes. It paid for his medications, and even to have tubes put into his ears because he was getting constant ear infections.

Funny story about that, though: Because he was a foundling left under New York's Safe Haven law, he didn't have a name or social security number. Officially, until the adoption, he was known as "Boy Doe". That's who his Medicare card was made out to. But to the doctor's office, he was known by the name that we called him, but that wasn't made official until the adoption and issuance of a foundling birth certificate.

One day I'm at work and the distaffbopper calls me crying because the pharmacist accused her of trying to commit Medicare fraud, because the name on the antibiotic prescription didn't match the name on the Medicare card. He was new, and didn't know about our unique situation. A call to the head pharmacist at his home ended up clearing that one up, and the new guy apologized, but I could see where he was coming from.

Anyhoo, once we adopted him he went on my health insurance.

Oh, and we also lost WIC (I made too much), and Social Services no longer paid for daycare, nor did we get the monthly checks or clothing allowance.

And it was worth every penny that we lost.

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*Formerly the littlebopper, he's gotten into weight training. And he's in college, so "littlebopper" doesn't seem to apply anymore. Teenybopper doesn't seem right also.

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