Possible to get huge healthcare bills even with insurance?

[fuzzybabybunny]

An acquaintance of mine has a coworker who had a heart attack, had an ACA approved plan, and still has a $75,000 hospital bill for the emergency room and ambulance.

Now, I've read some articles that say this is actually possible, because if, say, you're away from the insurance company's in-network hospitals, the out of network fees don't contribute to your yearly max out of pocket? Or they're not covered, period?

If this is the case, simply traveling around the US presents a huge risk (small risk, but game over if you do get injured), right?

 

[Mayne]

Thank fucking god I live in Canada.

 

[nakedfrog]

Yeah, it's possible.

 

[tortillasoup]

An acquaintance of mine has a coworker who had a heart attack, had an ACA approved plan, and still has a $75,000 hospital bill for the emergency room and ambulance.

Now, I've read some articles that say this is actually possible, because if, say, you're away from the insurance company's in-network hospitals, the out of network fees don't contribute to your yearly max out of pocket? Or they're not covered, period?

If this is the case, simply traveling around the US presents a huge risk (small risk, but game over if you do get injured), right?

$75K is still too much because even with out of network coverage, with blueshield I believe the OOP isn't anything above 12-$20K (individual vs. family). Certainly not $75k! Just because you receive a bill, it doesn't mean you're responsible for that amount!

 

[Homerboy]

Yeah regardless if in or out of network, the max OOP would not be $75K

 

[master_shake_]

An acquaintance of mine has a coworker who had a heart attack, had an ACA approved plan, and still has a $75,000 hospital bill for the emergency room and ambulance.

Now, I've read some articles that say this is actually possible, because if, say, you're away from the insurance company's in-network hospitals, the out of network fees don't contribute to your yearly max out of pocket? Or they're not covered, period?

If this is the case, simply traveling around the US presents a huge risk (small risk, but game over if you do get injured), right?

in canada when you leave the hospital you get a prescription usually.

america, fuck yeah!

 

[purbeast0]

just because he got the bill doesn't mean he's responsible for it. it could have been that it didnt go to the insurance at all just yet and he has to do that part himself and will get reimbursed or they will cover it before he has to fork out the majority of that.

 

[Fanatical Meat]

Abso-fucking-lutly sadly healthcare in the US is for profit until we all get smart and demand its not to make huge profits on.

 

[Fanatical Meat]

$75K is still too much because even with out of network coverage, with blueshield I believe the OOP isn't anything above 12-$20K (individual vs. family). Certainly not $75k! Just because you receive a bill, it doesn't mean you're responsible for that amount!

Here's the thing major events bring many professionals. He could see 8 out of network doctors.
Its lunacy why we tolerate medical billing that is outrageous and not itemized in a way a normal person can understand.

 

[Mayne]

its almost like hospitals want you to die in the states.

 

[highland145]

I have a $10K deductible and ER visits are at full price so I should be out of pocket the $10K and 100% covered after that. He would have to be at a 60/40 split and a $180K hospital bill.

 

[edro]

I specifically remember the HR lady talking about this specific issue.
This was one of the benefits of United Healthcare's large nationwide network.

 

[tortillasoup]

Here's the thing major events bring many professionals. He could see 8 out of network doctors.
Its lunacy why we tolerate medical billing that is outrageous and not itemized in a way a normal person can understand.

it's almost as if you don't understand medical billing. OOP max is per calendar year. In network and out of network sometimes combine their amounts (additive) and other times not. If you spend over the oop max, it doesn't matter how many providers you visit because you're above the oop max anyway. There is no scenario where you get an OOP of $75k unless it's not been paid for by the medical insurer.

 

[Strk]

As others have said, it shouldn't. There should be a max OOP. It's not a low number, but it shouldn't be $75k. It's probably $10-15k.

 

[Ferzerp]

Abso-fucking-lutly sadly healthcare in the US is for profit until we all get smart and demand its not to make huge profits on.

Well, we can see who has absolutely no real information on the subject right here. The main difference between non-profit and "for profit" acute care facilities (aka hospitals) is that the for profits are paying taxes. Money isn't being made on any sort of scale compared to other industries in healthcare by the providers. Now... If you have a beef, take it up with the "payors".

 

[Fanatical Meat]

Well, we can see who has absolutely no real information on the subject right here. The main difference between non-profit and "for profit" acute care facilities (aka hospitals) is that the for profits are paying taxes. Money isn't being made on any sort of scale compared to other industries in healthcare by the providers. Now... If you have a beef, take it up with the "payors".

So where exactly does one get free care?

 

[Ferzerp]

Here's the thing major events bring many professionals. He could see 8 out of network doctors.
Its lunacy why we tolerate medical billing that is outrageous and not itemized in a way a normal person can understand.

Are you aware that the format of billing is in large part the way it is because that is what is required for reimbursement from the government (via Medicare)?

 

[highland145]

So where exactly does one get free care?

Medicaid, maybe? Or you could be Juan Pablo fresh across the border.

 

[Ferzerp]

So where exactly does one get free care?

Probably the same place you get free electricity, free food, free water, free housing, etc. No where. Things have a cost and can't just be generated for free.

If the cost is hidden from you (paid via taxes, insurance, etc), it doesn't mean that it doesn't exist.

 

[master_shake_]

Probably the same place you get free electricity, free food, free water, free housing, etc. No where. Things have a cost and can't just be generated for free.

If the cost is hidden from you (paid via taxes, insurance, etc), it doesn't mean that it doesn't exist.

if you go to the forest and punch a moose in the face and eat it is it free?

 

[highland145]

if you go to the forest and punch a moose in the face and eat it is it free?

I would pay $$ to see that.

 

[master_shake_]

I would pay $$ to see that.

lol.

i could have easily said rabbit.

but who would punch a rabbit in the face?

 

[Ferzerp]

Looks like the license to hunt moose in Canada is about $60, or $3.50 USD, so while almost free if you can manage to punch one, not quite free.

That also ignores the healthcare burden you have created after the moose becomes angry with you, if you survive, that is. Otherwise, resources to dispose of your body have to come from somewhere. This is also ignoring the cost of the potential search to find your moose trampelled corpse.

 

[highland145]

lol.

i could have easily said rabbit.

but who would punch a rabbit in the face?

Shorty.

 

[dullard]

Note: this post applies to insurance covered costs. You can always rack up an infinite bill for items that the insurance doesn't cover. For example, if you want an elective surgery, or you want a doctor to fly with you to another country, or you want experimental drugs, etc.

If the insurance is legal to sell on the state/federal marketplace, then the out-of-pocket maximum for 2016 is $13,700 for a family with health insurance. Bill notifications to you before the insurance pays their part can be anything (which is usually the first letter you see), but what you are actually billed (which is often the 2nd letter) should not be more than that $13,700.

That means that yes, you can still get a life-changing miserable high bill (which may be hard to recover from). Even worse, do it on Dec 31 and you may get two of these bills, one for Dec 31 and one for Jan 1 of the next year. But, it won't be $13,700,000 either (which you can not recover from).