> Health insurance is good enough until surprise they don't want to cover you or you get surprise bills in the mail from the hospital.
Constantly amazed this can be a thing in a first world country. Can this actually happen?
Constantly amazed this can be a thing in a first world country. Can this actually happen?
They are basically screwed now after maintaining a non-deliquent relationship with their healthcare provider for longer than I've been alive. If this is not emblematic of what's wrong with our healthcare... IDK what is.
How does it happen that the wrong (old) provider still accepts money if they no longer cover you? Can this be used as a legal argument that the old provider is on the hook for coverage since they continued taking the money?
Another option is to move to a Medicare expansion state and stop working, which will allow you to immediately qualify for free health care with generally some of the best coverage you can get.
It’s a cost versus benefit analysis and no different than what you see in single payer systems.
I will say from experience that oncology is one therapeutic area where payers wield much less control. Insurers don't like bad press and denying cancer drugs is a great way to end up in the NY Times. That said, if a drug is regarded as "experimental" (either the FDA hasn't approved it for that type of cancer OR there is limited data to suggest it works) they will say "no".
https://www.caremark.com/portal/asset/Formulary_Exclusion_Dr...
When we change insurance plans my kids have to change the brand name of insulin they get. Humolog, Admelog, etc. But the insurance company can't decide that they won't pay for fast-acting and slow-acting insulin. And if there is a medical reason a doctor will sign off on that indicates a specific brand is required, I believe that you can generally get even excluded medicines covered.
Can insurance companies refuse to cover an FDA approved drug that doesn't have a reasonable substitute? OP discussed treatment for leukemia. An ACA plan should cover approved treatments for leukemia, but it might not cover, e.g. the latest CAR-T treatment if it's still in Phase 3. You would need to get into the study, in which case treatment would be free.
Co-pay is about $10, so for $10 a month I can guarantee my healthcare is working.
You go to a doctor, then the doctor and the insurance have several months of ping pong during which you get about half a ream of "This is not a bill" documents that show a different set of things with different dollar amounts every other cycle, and then eventually you get an actual bill for the largest amount.
If it's wrong, you can spend another year fighting them to fix the billing codes.
It's a total shit show.
At my company's last benefits meeting (where they go over the yearly changes to our insurance coverage) a coworker described a situation where they had a surgery at an in network (accepted by our insurance) hospital, with in network surgeons and nurses, but was assigned an out of network anesthesiologist without his knowledge, and later got a giant bill for it (well over $1000, IIRC).
Even when a person tries to follow all the rules, they find a way to screw you.
Doubly so since, as a patient undergoing examination/treatment, you have zero chance of sussing out who is who, what organization they work for, how their billing works, etc.
All you know is someone came into the room to run a test or otherwise interact with you. It's not like you can interrogate them and then refuse their services -- among other things, they don't even know how their financial org is going to bill you.
The whole hospital seems designed to set a bunch of elaborate traps and all of these traps will cost you a lot of money. Whatever I hear there is almost no way to protect yourself besides being lucky.
And no, the onus isn't on the hospital. They want their pound of flesh even though they assumed you the procedure was covered on the basis of their staff calling your insurance company.
I’m a solopreneur and we’ve decided to go without health insurance. The ridiculous premiums + super high deductibles mean even if you were to go to the doctor, you’re still paying full cost.
The gamble is you want to avoid any catastrophic visits which would cost 20k+ to offset the insurance deductible + premiums.
Compared to Australia, US healthcare system would be considered a joke.
If I need a sleep study or further surgery as already recommended then we are looking at $4-5k for that alone not including followup, medications, supplies, or other appointments.
Without the ACA I might be dead today due to costs and availability like if I was denied insurance based on pre-existing conditions and could not afford medical care I needed over the last 5-8 years plus mental health care. My parents paid about $22k out of pocket for a surgery I needed during that time (and on their insurance).
I'd have about $45-50k in the bank if my healthcare over the past decade was 100% covered. That is about 10x my current retirement savings or could be a down payment on a house. The USA is not representative of first world countries or at least should not be directly compared to them when it comes to health care.
The NHS Commissioning Board's report on Tetrahydrobiopterin/Sapropterin/Kuvan is here: https://www.england.nhs.uk/wp-content/uploads/2013/04/e12-p-...