The insanity of American health insurance

[NickelChip 1,332]

Allow me to rant for a minute.

I have insurance, and I am lucky enough that it covered my surgery with a $1k copay after I hit my $2k annual deductible. So, I can't complain about my own outcome as far as that goes.

But I just got a look at the hospital charges. My insurance company was billed in the neighborhood of $42k dollars for my surgery and hospital stay. They then had a negotiated plan "discount" of $32k applied, bringing the total paid on my behalf to just under $10k. Plus my copay equals $11k, or $13k if you factor in that my entire deductible was made up of surgery related charges.

Why can't the hospital just say that a gastric bypass costs $13k? Because that is what they are going to get paid, and they know it, and my insurance knows it. Why the charade? Why must every single insurance policy "negotiate" different discount rates? This is stupid. And without insurance, would I just be left with a $42k bill that I had to pay out of pocket? I have a feeling I would be.

Rant over.

[catwoman7 11,223]

yea - I once accidentally got an invoice for $120K for all my plastic surgery. I called them. I told them I already paid for the surgery, I had to pre-pay since it was self-payed, and that it was $28K. They apologized for the error and explained the $120K was the insurance cost, if insurance would have covered it (and I'm sure the insurance company would have negotiated a discount so the total went down to close to what I paid for it). I don't get it, either..

(P.S. if you were self-pay, it probably would have been more like the $13K or whatever you mentioned. I think the hospitals and the insurance companies always do this crazy dance with the highly-inflated numbers and discounts, although I have no clue why they do this)

Edited March 14, 2024 by catwoman7

[ms.sss 15,748]

it's the same everywhere.

here in canada, dental charges are not covered by national insurance. but they are almost always fully covered by private insurance from your place of employment.

back when i was working (and had dental insurance) a single teeth cleaning session was billed at around $800 to my insurance provider.

now that i am retired and have no dental insurance, my dentist office now bills me $200 for the same cleaning.

*shrug*

[NickelChip 1,332]

I feel like it's the same strategy used by department stores. Macy's puts a price tag on a blouse for $100. As soon as the blouse goes on a rack, they have a super-duper 50% off sale. As soon as that sale ends, they have another sale, or a coupon. Pretty soon, the blouse goes on clearance. Everyone pays something slightly different for that blouse, but absolutely no one ever pays $100.

And yet a few years back, a new CEO was put in charge of JC Penney. He said hey, instead of all this "Door Buster" triple coupon special sale nonsense, we're going to put a price tag of $35 on that blouse instead of $100, and any day you come into the store, you will know the price you're paying is the best price you're going to get (at least until the item legit goes on clearance at the end of the season). And shoppers hated it. They wanted their 65% off special shopper coupons instead. They wanted to believe they got a total steal on a $100 blouse.

[FifiLux 542]

I am lucky that the government health care system here covered my operation and all I had to pay was a small subsidy, think 15 Euro, for each night I was in a shared room (even though most of the time no-one shared with me) I was in hospital which in turn then was covered by the health insurance of my employer.

Then for the weeks I was in a private room I had to pay that but it was 100% recoverable under the health insurance.

Of course, the subsidy should only have been about 30 Euro but as I was in hospital for much longer than the planned two nights it cost the bit more but not much in comparison to what others have to pay and as I say it all was recoverable.

It feels like it is all free but in reality my taxes go towards it all

Edited March 14, 2024 by FifiLux

[summerset 5,265]

Ah, dealing with health insurance... A guarantee to going crazy and insane in every country as it seems.

[summerset 5,265]

On 3/14/2024 at 4:50 PM, FifiLux said:

It feels like it is all free but in reality my taxes go towards it all

Social security money going in there here, meh.

Germany's health care system is unfair as f*ck (i. e. what insurance is paying for without even batting an eye and what patients have to fight for. Hint: one example of the stuff you have to fight for is everything obesity related, especially plastics which is all too often not covered, only partly covered (try getting a breast lift...) or covered only if you're the lucky one (there are some who get it all covered without any fight but the criteria seem to be rather random), like winning some kind of lottery).

If you don't want to experience a blood pressure crisis - don't take a closer look.

[FifiLux 542]

Yeah I haven't looked in to the plastics side of things as to what is covered for me. I do recall it being mentioned at one point by the psychiatrist I had to go see and I think he said it had to be a few years and then a decision process but at this stage it is too soon to be thinking about that. My big (literally and figuratively) problem area is my legs, thighs in particular. Even after loosing so much weight, with a bit more to go, there is no way I would wear anything that would show anything above my ankles.

As it is I have to go back into hospital next week for a few days to have the tube in my stomach removed and them to monitor me to see if my leak has fully closed.

[Nikki_p 0]

On 3/14/2024 at 5:25 PM, NickelChip said:

I feel like it's the same strategy used by department stores. Macy's puts a price tag on a blouse for $100. As soon as the blouse goes on a rack, they have a super-duper 50% off sale. As soon as that sale ends, they have another sale, or a coupon. Pretty soon, the blouse goes on clearance. Everyone pays something slightly different for that blouse, but absolutely no one ever pays $100.

And yet a few years back, a new CEO was put in charge of JC Penney. He said hey, instead of all this "Door Buster" triple coupon special sale nonsense, we're going to put a price tag of $35 on that blouse instead of $100, and any day you come into the store, you will know the price you're paying is the best price you're going to get (at least until the item legit goes on clearance at the end of the season). And shoppers hated it. They wanted their 65% off special shopper coupons instead. They wanted to believe they got a total steal on a $100 blouse. Insurance can be a real headache, especially when coverage doesn’t include something as important as bariatric surgery. Navigating through these situations often requires persistence and finding the right support. I’ve gone through a similar issue in the past, and it's always helpful to have quick access to customer service. If you’re dealing with insurance companies like Geico, having the best geico phone number can make a huge difference when you need answers fast. Anyone else here run into issues with insurance coverage or found great solutions? Would love to hear how you handled it!

The system seems so complicated and expensive, and it's tough when you're doing everything right—staying healthy, following doctor recommendations—and still getting hit with high deductibles or surprise bills.

Edited February 18 by Nikki_p