Ask Lemmy

nobody actually pays those bills. They're just some elaborate dance between insurance companies and hospitals.

Sometimes there is an elaborate dance between the two on pricing. Sometimes the insurance company dances on its own to determine why the service is not covered.

If you don't have insurance, the cost is lower

Depends what you mean by cost. insurance is always out to make money, that means paying less, and negotiating lower prices with providers. However, there are some situations where it benefits both the service provider and the insurance provider to inflate the initial price, and negotiate a steep “discount” to a final price (a portion of which the patient pays) that is higher than the non-insurance price. But I don’t remember the exact details, and I may be conflating this with some other healthcare industry scheme.

or removed entirely. Supposedly.

If a hospital is nonprofit, I believe they are required to have a (self determined) charity care policy that they must follow. If you make below a certain amount, you can apply for relief, but that also applies for to after-insurance costs, not just no-insurance costs. For-profit hospitals will rake you over the coals and send collections after you. Part of the problem with charity care, is that you may have to ask for it, and few people know enough about it to do so. And you may have to ask for it in the right way. If you aren’t specific enough, they may offer you “financial assistance” which is just a payment plan. Then they’ll treat you the same as a for-profit hospital would.

If you’re interested in a deeper dive, the Arm and a Leg podcast is a great show about healthcare costs in the US.

I forget what count is taken out of my check every 2 weeks, I think it's like 50 bucks for vision/dental and my work actually fully covers medical?

Went to the ER 2 months ago due to severe dehydration because I was puking and having diarrhea everywhere almost as badly as when I was e. Coli poisoned. 2 hours in a chair getting a saline drip cost 2750ish, plus the ambulance ride of something like 3200? Wife got the special pass thing they sell for $100 that comes with 3 rides a year if you're in our county, so we only had to pay 100 for the ride but still.

Just shy of 6k to be rehydrated and told "lol no idea what caused it buddy come back during normal hours and we'll scan you" as my wife had been in earlier that day for the same issues, gotten an MRI (cat or whatever scan it is) and got told "lol idk", but her insurance covered it completely

We could do it cheaper if we did it like any other civilized country but nope, it makes someone money

When I used to live in the states my family would pay something like $2500/month for health insurance that covered all of us. Don’t know what the deductible was but apparently this was a very good plan. This was back around 2000.

You essentially gamble a little bit. Most people get insurance through work (or they are part of a family plan). Generally, you'll have a few plans to choose from. If you are older, or have recurring issues, you might pick a plan that's a little more expensive, but covers more costs. If you are young and healthy, you might pick a cheap plan, essentially betting that you won't really need healthcare other than your yearly checkup and some vaccines.

The biggest thing with healthcare in the US is that it's very complex. Even if you have insurance that should cover something, it can be hard to find a doctor that's part of your insurance, so people often put off going to the doctor, which is part of the reason why costs are high. Teeth and eyes have separate insurance cause they are optional, apparently.

You basically have "premiums" that are your monthly payment. If you get your insurance through work, they cover a percentage of that; generally a pretty hefty amount of it. They usually don't outright tell you what percentage, though, so many people think insurance is cheap, and get a rude awakening when they lose a job, and suddenly can't afford $1000 a month when they used to be paying $100. Those premiums are taken out of your paycheck pre-tax, too, which gives you even more of a benefit if you have a job.

Depending on the "style" of the plans, they cover things differently. They all (I think) cover "preventative care" completely, which includes your yearly checkup, vaccines, and birth control for women. After that, some plans have "co-pays", which are set costs for a few things, like $25 for a normal doctors visit, $50 for a specialist, $100 for an emergency room visit. Some just cover a percentage of those costs, and some don't pay anything until you hit a limit (the deductible). Finally, there's an "out of pocket" limit. That's most you'll have to pay in a year, after which point the insurance covers everything.

All together, I pay less than $1000 a year for healthcare, but if I got really sick, and needed a bunch of expensive healthcare, I would quickly hit my out of pocket maximum, which I think is like $6,000. I could cover that, but many people cannot cover an expense like that on short notice.

The number on bills is very misleading. The hospitals know that insurance will negotiate down, so they start high, and then after the negotiations, insurance will pay some or all of the remainder. If you don't have insurance, you typically don't pay that whole number on the bill, either, cause the hospitals recognize that they dont have to adjust it up for the negotiation. You can still negotiate on your own, though.

For me, I recently got a checkup and some blood work done. It came out to free, I didn't have to pay anything.

I also have pretty good health insurance.

Here's my anecdote. I have Kaiser through my employer and pay about $200 a month for the best plan offered. I pay $10 for a 30 day supply of generic medication. Video/phone visits are free. I recently had to get lab work done twice and paid $90 combined for both, but I was able to just drop by whenever was convenient for me and was in and out in 10 mins. I had a mental health crisis last year and went through weeks of intensive outpatient group therapy plus months of ACT/DBT therapy all for free. My individual therapist is covered and I pay nothing. I recently had a physical exam, it was covered. Now I do have an autoimmune disorder that I do feel a bit neglected a bit by them, but I could advocate for myself more.

So from a non major life threatening emergency perspective, I feel pretty satisfied with my insurance.

A lot of it depends on what insurance you have and what insurance you have depends on who you work for.

I had EXCELLENT coverage with Kaiser Permanente, and other than a couple of hundred dollars a pay check and an in-office co-pay for treatment, I never had a bill.

When I had my heart attack, the Emergency Room was $150. 8 days in the hospital and open heart surgery from the head of the department was $100. The prescriptions and all the oxygen bottles I could carry was $100.

4 weeks into recovery, my company got bought. :( The new company didn't do Kaiser in Oregon. If I lived in California or Washington, I would have been fine, not Oregon.

So they switched my insurance to Aetna which meant I lost all of my doctors and had to start over at a new hospital. Kaiser is members only and I was no longer a member.

Naturally I started having complications, congestive heart failure. That was an ER visit followed by 7 days in the hospital.

Under the new insurance, they start by paying 80% and there is an out of pocket maximum of $6,500. Once you pay that, all other treatment is free the rest of the year. No co pays, nothing.

So I hit my $6,500 about 1/2 way through January. Goodbye signing bonus! But all the other complications I had the rest of the year were covered 100%.

Now... if I had NO insurance? 15 days in the hospital x 2 hospitals? Open heart surgery? All the tests and such? 24 oxygen bottles? A million dollars, maybe more?

I work at a large, private university health system.

Annual up front cost for insurance is $4967 for medical insurance and $609 for dental. Those cover me, my wife, and two of my three children. The insurance is a plan funded by my employer, but managed by Independence Blue Cross, AKA "Personal Choice".

There are three "tiers" of coverage.

First tier is for facilities that are part of my employer. Generally, for procedures performed at my employer's facility there is no additional charge. For a primary care provider who is part of my health system, there would be a $20 copay per visit. Specialist would also be $20, and an ER visit would be $200.

There is an "in network" tier, made up of external providers that accept personal choice. Primary care copay is $35, specialist is $50, ER $200.

The third tier is "out of network". If we see someone out of network, we would have to pay them directly, then try to get partial reimbursement from insurance.

There's also a prescription plan, but we get a discount by using the hospital's outpatient pharmacy.

Everyone always talks about the cost to give birth. All three of my kids were born at the hospital where I work, and none of the births cost us any additional money.

Your friend should let all the Americans going into bankruptcy each year due to medical debt that they imagined it all along.