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Comment by quintin | Hacker News Reader

Thanks for this.

Are you in the US? If so, how much did the ordeal cost?

Yes, we are in the US. Her situation was unique in many respects. She was on her father's health insurance plan (Blue Cross and Blue Shield) and also had secondary health insurance from being a student athlete at our university. (The first of the three strokes occurred during a meet! The other two occurred within a day after being transported to the hospital.) Everything would have cost well over $100,000 had she not had insurance, but thankfully all visits/procedures were completely paid for.

I'm unsure how much it would have cost (uninsured) had it been a more straightforward path toward treatment. However, I left many details out of the story. Doctors were unsure if the stroke was simply caused by a PFO; they thought she may have had a more serious heart defect. Thus, she was airlifted to a better hospital for a more thorough diagnosis and later ended up having robotically-assisted heart surgery (i.e., not the simple, cheaper PFO closure procedure described in this article).

Another thing: her father was very persistent with the insurance companies throughout this entire ordeal. Had he not paid attention to the way things were being billed (i.e., between primary and secondary insurance), some costs may have been pushed onto her family.

>Had he not paid attention to the way things were being billed (i.e., between primary and secondary insurance), some costs may have been pushed onto her family.

How does one pay attention to this in a time of crisis? Is there a good guide to navigating it somewhere?

Last summer I woke up with a monster headache and suddenly stopped being able to put words to thoughts. Tried calling a taxi, couldn't say where I wanted to go, so he called 911. On the way to the hospital in the ambulance I was just praying I was making the right decisions. The paramedics couldn't understand me and that frustrated them. They asked me what hospital, being an intern and totally new to the city I wouldn't know what to tell them even if I could. I was worried they'd treat me like I was on some kind of drug.

Turns out I had contracted a meningitis. The ambulance ride was $1000.

There are services which offer medical bill review for patients, usually via nurses or others with clinical and medical billing knowledge.

I know of these largely through news coverage, and cannot speak to how effective they are (or what the costs are).

The stories I've heard, though, of the absolute complete and total nightmare that is the US healthcare scam, are heartbreaking.

I'm looking for online references but cannot find any at the moment, maybe others here have more information.

Did you get a bill after the fact? You could call them up and negotiate. If you have two insurance plans, then it's mostly talking with a particular office/section that deals with coordination of benefits.

Until my family members and I individually ended up switching to insurance with nice low flat rates for services, I used to negotiate everything from office visits to ER bills. Before service if you can (especially for elective/outpatient type things), otherwise they really like cash in full. They tend to prefer working outside of insurance too, since it means more money for them even if they're halving your bill.

I'm sure there are services, and occasionally you'll find more tips on places like reddit (/r/frugal comes to mind). I have no immediate suggestions for how to do this in a time of crisis - it mostly depends on someone that knows you well giving enough of a shit, and when they'll try to bill you for services. :(

Why this is a thing is beyond me, but while it's the case...

>> Did you get a bill after the fact? You could call them up and negotiate.

IMHO negotiation is one of the problems causing high health care costs. Prices are crazy high by default, but insurance companies are able to negotiate lower prices from providers. This means the uninsured are billed higher by default. It turns out that individuals can negotiate lower prices too - sometimes. I advocate that a given service provider should be forced to charge the same price for the same service to all patients. This might result in competition and lower prices, but in the mean time it should lower costs for the uninsured.

This is my question as well. I'm not only afraid of something like this happening but that I'd be ruined financially if it did (and it really doesn't have to be something this big. Simply going to the emergency room would cost me thousands).

Is health insurance not an option?

I do have health insurance but it only covers around 47% of my medical costs (at least when I go for a primary care visit, I suspect they might even cover less for a more expensive procedure).

I understand that my coverage is not all that common, although most providers do an 80/20 split. So for a procedure costing $100k (an ambulance ride and a few nights in the hospital would easily run this high) you'd have to pay $20k out of pocket.

Many health insurance plans have a yearly cap on how much you pay out of pocket. So you might pay 20% up to a few thousand dollars, and then get 100% coverage after that.

Actually, with the passage of the ACA, the limit is a requirement for all health insurance plans (a few were grandfathered in, but they will disappear over the next few years).

It goes up each year (adjusted for inflation), but as an individual, your maximum out of pocket (includes everything: deductible, co-pays, co-insurance, etc) is ~$6,750.

See: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

I'll never forget the year I had laproscopic surgery to remove my gallbladder, not because of the experience (although being asked for $3000, in cash, before they'd let me into the OR, was interesting, but welcome to America), but because I ended up hitting my $5000 or so out-of-pocket maximum, between that and co-pays for a few other visits. For the remaining 6 months of the year, I joked that I was living it up Canadian style, and actually visited the doctor to get regular exams and to get medicated for influenza, you know, the things everyone should do, but a large double-digit percentage of Americans can't. Ahh, the good life...

> I do have health insurance but it only covers around 47% of my medical costs (at least when I go for a primary care visit, I suspect they might even cover less for a more expensive procedure).

Actually, it's the opposite. For the vast majority of insurance plans, there's an annual limit to your copay.

To be honest, if there weren't that limit there would be no purpose to insurance at all.

Do you mean the insurance company has a limit for what they pay? [1]? I can't find a source for the limited co-pay that I think you're suggesting.

1.http://www.hhs.gov/healthcare/rights/limits/

It's called "out of pocket limit". After you meet your deductible the insurance company will pay for every covered cost except for the copay and coinsurance. Once you've met your out of pocket max they will pay for every dollar of every covered cost.

Except prescription drugs. I am not fully informed on how the ACA affected this, but it used to be that insurance plans could exclude certain classes of prescription drugs from out of pocket max.

This is how many people are financially ruined by long-term chronic illnesses. For some less common diseases, medications can easily cost >$10,000 per month – which might not be covered by your health insurance for various reasons or only partially covered. Read the fine print.

A few years ago there was no annual limit on my plan. Not with co-pays, just co-insurance. I ended up needing outpatient treatment almost every day for over a month. Each day was a $25 co-pay. I then moved on to a once a week treatment for close to the next year. I could afford that, many people cannot. I was also lucky to be able to collect my pay while I was getting treated because my employer provided me disability. The cost just skyrocketed beyond belief and while I already maxed out my co-insurance my treatment was billed like an office visit so co-pays are treated differently.

Don't "suspect," know. Your insurance will have an extensive description of their coverage. You should go read it, and if you find it to be inadequate, you should go shopping for new stuff. This is really important and not something to ignore.

you just have to step in the wrong hospital to break the agreement and end up with massive bill

Any vaguely decent insurance will cover emergency procedures in any hospital.

There will be things that your insurance plan will just randomly decide not to cover or worse, you just don't have the right kind of insurance for what you need.

Both my parents have suffered strokes. My father had to go to a step down unit which requires Long Term Care Insurance, something that I'm willing to bet most people aren't familiar with. Even that, due to changing regulations, your LTCI that you purchased decades ago most likely no longer covers today's prices. Unfortunately you just can't prepare for everything.

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