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Comment by lotsofpulp | Hacker News Reader

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families:

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.

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> you are protected from expenses above $17.4k per calendar year per family.

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.

The relatively new surprise billing and emergency care from out of network providers to be treated as in network providers legislation changes that:

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.

Sort of. You get to initiate a fight with the insurer through an unaccountable arbiter.

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.

This is the problem with the US system, all the crap falls to the patient to deal with in the end.

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.

That is ridiculous. I have not had such blatant negligence / corruption happen to me yet.

The worst part is we only got this service because it was represented to us as free. It was a genetic test that was nice to have but not strictly necessary. We would not have gotten it if we'd known we would be billed $6k.

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.

If this is NIPT don’t pay the bill. The companies will write it off.

You can't indemnify health, only property. Personal costs related to health have no bounds; for instance if you lose your job because of health, your "out of pocket" is your whole salary. Which real insurance would cover.

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!

> 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.

To your last point I wonder what the effect of not allowing a provider to charge a different price for the same service/product would be.

This is a really interesting idea. Seems like it would kind of level the playing field and might help guide us toward what I think is the ideal situation - no one needs health insurance other than for a catastrophic event because prices are known and reasonable and you just pay them, like literally every other service we need and consume.

That is supposedly the goal of high deductible health plans and HSAs.

For reference, in NL I believe I have about €250 out of pocket maximum. Could be €500 now, not sure.

It is a spectrum of course, but a 500 Euro out of pocket maximum is probably better described as taxpayer funded healthcare.

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.

Health insurance premiums are between €125 - €150 / month here.

The parent is referring to known condition vs an unknown emergency event.

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.

Yes, it is difficult to pin down an exact definition of insurance in cases where the cost is all but guaranteed.

I can see their point now, but at the time I was thinking relative to other taxpayer funded healthcare systems.

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