The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't hurt themselves and need care).
This is also a consequence of our legal/tort system. At one of my business, a person claims to have stepped on a landscaping rock and damaged their ankle or knee or something. They took pictures of this roughly 2in x 2in x 2in rock in the parking lot, maybe a foot away from the curb that separated the landscaping rocks and the parking lot surface.
This lawsuit has been going on for 3 years now, and I can only assume $10k+ in lawyer time has been spent asking the employees if they saw a rock there and when they last checked the parking lot to see if it was clear of rocks, etc.
With the courts accepting cases like these, and businesses needing to protect themselves from cases like these, it is no wonder as a society, we end up wrapping ourselves in insurance. Specifically in this case, the person or family suing has been found to have a history of these types of lawsuits. And yet still, the case drags on.
https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...
With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family.
The fact that most Americans probably cannot afford this is a separate matter, but it is more insurance than it has ever been in the US.
The US is pay $400 to $1,200 per person per month from age 0 to 64, and then pay up to $8,700 individual / $17,400 family per calendar year.
At age 65, the government starts paying for your hospital care assuming you or your spouse paid Medicare taxes for at least 10 years, and you then have to buy a nebulous blend of subsidized care / insurance for other things like medication, doctor visits, etc.
Given that this applies to in-network costs only, as you noted above, it seems very inaccurate to describe it as genuine protection. Any random provider in your current care situation can be out of network, it is very hard to know or have any control over especially in a crisis situation, and it is these providers that usually end up billing you through the nose.
It would be irresponsibly misleading to call your life insurance "protection" if the insurer just rolls a dice or consults the day of the month to determine if they'll pay your claim.
https://www.cms.gov/nosurprises
https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule...
For non emergency care, it should be easy to login to insurance company’s website and see if doctor or doctor group is in network or out of network.
Insurer websites have lied to us in the past, claiming X was in network (zero cost!) and then sending us a denial resulting in a giant out of network bill for that exact X. Same service, same provider.
Truly incompetent and evil system. Fills me with rage.
Now I feel like I will have to screenshot and archive every digital representation that is made to us about whether X will be covered and be prepared to initiate a lawsuit over it.
In the meantime we will simply not be paying the bill. I've been thinking about doing this for many other medical bills we receive as well. It's all so arbitrary and uncontrollable. I simply don't feel I have an obligation to pay a bill in a made-up amount for made-up reasons I have nothing to do with.
I am a very reliable bill payer and normally see it as a basic matter of personal responsibility, but this broke me.
It won’t help you now, but before any expensive visit, you should call your insurer and confirm they are in-network (doctor and clinic). A note will be made in your file as proof.
Your example is leagues of laws and regulation on top of a scam, a pyramid model that affords top care for those who can afford modest premiums and really do get expensive care for $5 copay, at the cost of everybody else who has to fight their employer via federal politics for the right to go bankrupt.
Indeed, I would say that using insurance to pay your insulin bill is coming out on top of the scam, because some books are getting cooked (+/- paper costs) at the expense of mutual indemnity (taxes, social security). An insulin user is a health insurance voter, but that is a weak expediency for actually fixing the price of insulin and ending the tyranny of insurance companies over healthcare, and it turns whole populations into do-or-die partisans.
Thanks, Obama!
Yes, thanks for getting the only legislation passed in the past 30+ years that expanded access to healthcare.
FYI, ACA is what made it possible for people to even purchase healthcare coverage without an employer. And also, taxpayer funded healthcare (“public option”) was preferred by the Obama administration, but had to be whittled down to meet the compromises needed since there was basically zero support from across the aisle.
The tax benefits of health coverage via employers is a separate matter, and while it should have been addressed, I am not surprised nor would I blame Obama for that, since it was already hard enough to get what we currently have passed.
As an analogy in the case above the car owner is having their insurance company pay for their gasoline - where you are referring to an insurer paying for a car accident.
I can see their point now, but at the time I was thinking relative to other taxpayer funded healthcare systems.