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Comment by smallgovt | Hacker News Reader

I’m confused. If you have medical insurance, shouldn’t you only pay up to your deductible? Is this saying people’s life assets don’t cover the deductible? Or, people are uninsured?

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The deductible might be huge, and there's also this magic new thing I've just discovered (or United invented out of nowhere) called "co-insurance" and "maximum out of pocket" which I call "deductible #2."

Then when you actually try to use the insurance you pay monthly for (but don't get to use until you reach the deductible #1 and #2?) they may just send the bill to you with a lot of legalese that amounts to "we don't cover this, or we do but we have better lawyers, get fucked peasant."

Luckily the debt collection industry is incompetent so all you gotta do is keep replying with "please mail proof of debt" and you're golden!

All of the terms you listed are easily understandable concepts clearly explained on healthcare.gov or any health insurance company's website, and they've been a thing for decades.

How much clearer can maximum out of pocket be?

Edit: I do think in network and out of network should be easier/faster to figure out though.

Isn't there also a maximum lifetime benefit most US insurances stipulate, that isn't that hard to reach (like $1M or so ?)

My understanding is that past that point, you become mostly uninsurable, but maybe I'm wrong.

Apparently, this has been outlawed. "Under the current law, lifetime limits on most benefits are prohibited in any health plan or insurance policy."

Sure. I'm lazy, I care more about being a better programmer than learning the esoteric rules around insurance. I probably could pay less taxes if I managed to Learn that, or get better return on my index funds. Or I could add another programming language to my tool belt, or learn more git commands, read a book on management... It's all choices I've gotta make. And I have the privilege of a high paid job and a 15 minute commute.

As for what's covered by my insurance, I strongly disagree that this is "clearly explained." It is not, some of it is outright "and other services," most of it is buried in pages of medical terms I don't understand.

There are plenty of times when in/out network is an impossible thing to determine or plan for.

I had an out patient surgery about a year ago and while my doctor and every admin I talked said that everything would be in network, I still had someone sneak in who was supposedly out of network.

Then came the bill of what should have been ~$300 was around $2500. I got that BS waived only by called my doctor's office and talking with them about it. Once we talked it all through, the nurses called the _head management of company that ran the out patient surgery clinic_ in order to get it removed. It feels like people have to do you favors in order to get your actual correct billing.

Our health care system is so royally f'ed in the U.S. It desperately needs fixing and I hope it does before something serious happens to myself or my wife because it's currently feels like gambling with ruination. No $2.5k isn't ruination but health care is the only thing in this country where I go in knowing NOTHING about what my final bill will actually be.

If you tell everyone who admits you "I don't consent to any procedures or care from out of network providers", could you sue any out-of-network providers who operate anyway for malpractice?

Or I wonder if a similar "HIPAA trap" could be constructed by categorically revoking consent to share your PMI with any out-of-network individuals and companies?

Typically the people performing the operations don't know if they are out of network. That's handled by a separate billing department.

There's a huge spectrum of what's covered under US insurance plans. Mine, for example, is a "good" plan for the size of company we are, but if I was rushed to a hospital that wasn't in-network in an emergency, or a hospital visit was later deemed "unnecessary" by the insurance company, I could be subject to huge bills.

I see. Are doctors unable to tell you which treatments are defined as “necessary” ahead of time? Or, do you have to do this research yourself?

Also, do ‘good’ insurance plans typically deem any signicantly life saving treatment as necessary?

Sorry, I’ve always been healthy so have never taken the time to understand this but my parents are getting old.

My understanding is "necessary" is determined by the insurance company, after the fact, and is subject to negotiation.

They were insured, and insurance covered treatment, but they lacked savings to begin with, so they drained assets to make up for lost income. Most Americans don’t save and only have “savings” in their house, which is usually mortgaged.

From the article: Since she's unable to work, the family lost her nursing salary.

From the article:

"Their high-deductible insurance policy meant they had to spend $6,000 before their insurance started covering her treatment expenses. They hit their annual out-of-pocket maximum of $10,000 well before the year was over."

Even with a lower deductible, many plans have annual and lifetime limits.

Ok, so basically the article says most ppl don’t have 20k in savings?

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