Possible to get huge healthcare bills even with insurance?

[fuzzybabybunny]

Every plan I have ever been subscribed to had a HUGE network, even when you are outside of your normal zone. For example, I just looked up my plan coverages for California for emergency medical care (I'm in Michigan) and there are 18,000 hits. My plan also covers hospitals in most (or maybe nearly every?) country

I can see how some (or perhaps many) people in certain states wouldn't have the benefit of choosing between affordably-priced insurance plans from world-class insurance companies though.

 

[tortillasoup]

Yes. This is a HUGE issue.

Say I buy a health insurance plan in California and the only in-network providers are within a certain radius of my city.

I get into a car accident while in Colorado and get sent to the emergency room. Since the Colorado hospital is out of network, and out of network charges do not count towards the annual OOP maximum, by *default* I will be footing the entire bill of the Colorado hospital. Maybe I'll get lucky and the hospital will only charge me the fees that an insurance company would normally pay, but it could still be a *massive* bill, subject to no limitations on amount.

you don't know what you're talking about. who is your insurer? I have BCBS and I'm on the Bronze HSA compatible plan.

 

[fuzzybabybunny]

you don't know what you're talking about. who is your insurer? I have BCBS and I'm on the Bronze HSA compatible plan.

And.... your point?

 

[Ns1]

@FBB

Can you link to an actual insurance document that says out of network doesn't count towards max oop? I'm with BCBS PPO and my understanding is in/out network applies towards the same max oop.

I've been googling for 10 minutes and cannot find anything that says otherwise.

Re: that healthcare.gov link I believe it only refers to balance billing by out of network providers

https://www.healthcare.gov/glossary/balance-billing/

 

[fuzzybabybunny]

I just did a quick lookup of plans in the Bay Area, California.

https://www.coveredca.com/shopandcompare/2016/#healthplans

Zip code of 94043.

"Valley Health Plan Bronze 60 HMO" - $245 a month

Here's their network of hospitals (choose Hospitals on the drop down list):

https://www.valleyhealthplan.org/sites/ccp/pn/Pages/Provider-Search.aspx

4. FOUR. Now consider that out-of-network providers balance bills don't apply to your annual OOP max.

 

[fuzzybabybunny]

@FBB

Can you link to an actual insurance document that says out of network doesn't count towards max oop? I'm with BCBS PPO and my understanding is in/out network applies towards the same max oop.

I've been googling for 10 minutes and cannot find anything that says otherwise.

Re: that healthcare.gov link I believe it only refers to balance billing by out of network providers

https://www.healthcare.gov/glossary/balance-billing/

I think that the issue really may be just the balance billing. Since it has the capacity to significantly increase your out of pocket bill.

http://www.forbes.com/sites/christinalamontagne/2015/01/26/what-is-balance-billing/

"In your case, your provider charged $2,076 for your services. Though your health insurance policy covers 50% for out-of-network care, this 50% is limited by how much they allow for each service. Looking at the numbers you gave me, it appears as if your insurance company only allowed $800 for the services you received. They paid half of this, $400, and the remaining $1,676 is your responsibility.

The specialist you saw is now stuck with an unpaid balance of $1,676, a balance for which he is free to bill you."

The maximum that the insurance company is willing to pay for out-of-network costs is a number set by the insurance company. I'm making these numbers up - for heart attack treatment, say that the maximum out-of-network your insurance company will pay is $15,000. The hospital decides to charge $90,000, because... it can. That's nothing stopping it. The ACA doesn't actually stipulate maximum amounts that hospitals can charge.

You then have a balance-bill of $75,000 - and it's all on you.

 

[iamwiz82]

I just did a quick lookup of plans in the Bay Area, California.

https://www.coveredca.com/shopandcompare/2016/#healthplans

Zip code of 94043.

"Valley Health Plan Bronze 60 HMO" - $245 a month

Here's their network of hospitals (choose Hospitals on the drop down list):

https://www.valleyhealthplan.org/sites/ccp/pn/Pages/Provider-Search.aspx

4. FOUR. Now consider that out-of-network providers don't apply to your annual OOP max.

This is the gamble. $245/mo is incredibly cheap for health insurance, it is the bottom of the barrel. Citizens of more socialist countries will tell you how great their free healthcare is, but it isn't free. They are just paying for it as a tax (For example, I believe Germany is just about 8% of salary with another 7-8% coming from the employer).

I would be willing to wager that private health insurance in any first world country is around the same cost.

 

[tortillasoup]

An example of Blue Cross Blue Shield's OOP limits.

I think that the issue really may be just the balance billing. Since it has the capacity to significantly increase your out of pocket bill.

http://www.forbes.com/sites/christinalamontagne/2015/01/26/what-is-balance-billing/

"In your case, your provider charged $2,076 for your services. Though your health insurance policy covers 50% for out-of-network care, this 50% is limited by how much they allow for each service. Looking at the numbers you gave me, it appears as if your insurance company only allowed $800 for the services you received. They paid half of this, $400, and the remaining $1,676 is your responsibility.

The specialist you saw is now stuck with an unpaid balance of $1,676, a balance for which he is free to bill you."

The maximum that the insurance company is willing to pay for out-of-network costs is a number set by the insurance company. I'm making these numbers up - for heart attack treatment, say that the maximum out-of-network your insurance company will pay is $15,000. The hospital decides to charge $90,000, because... it can. That's nothing stopping it. The ACA doesn't actually stipulate maximum amounts that hospitals can charge.

You then have a balance-bill of $75,000 - and it's all on you.

california and 12 other states have restrictions on balance billing for emergency room services for out of network.

I think that the issue really may be just the balance billing. Since it has the capacity to significantly increase your out of pocket bill.

http://www.forbes.com/sites/christinalamontagne/2015/01/26/what-is-balance-billing/

"In your case, your provider charged $2,076 for your services. Though your health insurance policy covers 50% for out-of-network care, this 50% is limited by how much they allow for each service. Looking at the numbers you gave me, it appears as if your insurance company only allowed $800 for the services you received. They paid half of this, $400, and the remaining $1,676 is your responsibility.

The specialist you saw is now stuck with an unpaid balance of $1,676, a balance for which he is free to bill you."

The maximum that the insurance company is willing to pay for out-of-network costs is a number set by the insurance company. I'm making these numbers up - for heart attack treatment, say that the maximum out-of-network your insurance company will pay is $15,000. The hospital decides to charge $90,000, because... it can. That's nothing stopping it. The ACA doesn't actually stipulate maximum amounts that hospitals can charge.

You then have a balance-bill of $75,000 - and it's all on you.

california and 12 other states have restrictions on balance billing for emergency room services for out of network.
http://kff.org/private-insurance/st...iders-balance-billing-managed-care-enrollees/

 

[fuzzybabybunny]

An example of Blue Cross Blue Shield's OOP limits.

california and 12 other states have restrictions on balance billing for emergency room services for out of network.


california and 12 other states have restrictions on balance billing for emergency room services for out of network.
http://kff.org/private-insurance/st...iders-balance-billing-managed-care-enrollees/

I guess that explains it. The person with the $75k bill is from Colorado, which does not have restrictions on balance billing. This really needs to be mandated on a federal level.

 

[fuzzybabybunny]

This is the gamble. $245/mo is incredibly cheap for health insurance, it is the bottom of the barrel. Citizens of more socialist countries will tell you how great their free healthcare is, but it isn't free. They are just paying for it as a tax (For example, I believe Germany is just about 8% of salary with another 7-8% coming from the employer).

I would be willing to wager that private health insurance in any first world country is around the same cost.

I think this is part of the problem, and was a huge problem pre-ACA. Health costs in this country are very expensive, yet insurance plans can be super cheap.

Why? Benefits aren't the same. And the people who buy cheap plans have a risk of getting completely screwed. As in "Game Over" screwed.

The ACA made some progress by stipulating a minimum of coverage that any plan needs to have, but it's clear that there are unfortunate loopholes that are still hurting people.

You can argue that it's the consumer's choice and buyer-beware, but on the other hand health insurance is quite complicated, can be hard to get straight, and the online marketplaces oftentimes oversimplify the comparison process. It was a multi-step process on Covered California to dig up the list of in-network providers, for example, but the UI of the Covered California website is designed in a way to make it seem like comparing plans is straightforward.

 

[tortillasoup]

I guess that explains it. The person with the $75k bill is from Colorado, which does not have restrictions on balance billing. This really needs to be mandated on a federal level.

http://www.healthinsurancecolorado.net/network-care-emergencies-balance-billing/

start reading where it says "But what about Colorado?"

so yeah, you can get balance billed in colorado. that sucks majorly

 

[fuzzybabybunny]

http://www.healthinsurancecolorado.net/network-care-emergencies-balance-billing/

start reading where it says "But what about Colorado?"

so yeah, you can get balance billed in colorado. that sucks majorly

Thanks. Sucks for Colorado. The guy was obviously in an emergency situation, so he didn't have a choice of provider. Looks like the ambulance picked him up and went to an out-of-network provider (not intentionally, of course).

"But if the facility is out-of-network, even in an emergency, balance billing is generally not prohibited."

 

[tcsenter]

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

 

[Meghan54]

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

That was what I was going to post for tortillasoup. What's in that article is rampant....drive-by doctors/surgeons, etc. Saw it all the time while I was working as an RN over 3 decades in various ER's, ICU's, OR's and a few MD's offices.



Also, a quick read on bankruptcies from med. bills:

Bankruptcies resulting from unpaid medical bills will affect nearly 2 million people this year—making health care the No. 1 cause of such filings, and outpacing bankruptcies due to credit-card bills or unpaid mortgages, according to new data. And even having health insurance doesn't buffer consumers against financial hardship.

http://www.cnbc.com/id/100840148



The source material for the article above:

https://www.nerdwallet.com/blog/health/medical-costs/medical-bankruptcy/

 

[IntoxicatedPuma]

I used to work the the administration of a hospital and finally dropped my health insurance completely when i started noticing some patient bills. You can get the same discounted rate that insurance companies brag about getting, just by promising to pay the hospital when you call the billing department. Tell them you don't have insurance but want to pay - bam 50% discount on your bill. Can find lots of other reasons to deduct from the bill if you are persistent about it.

 

[Fanatical Meat]

This.

But also, this is what is wrong with America. If you send someone a bill, you should be held accountable that YOU did YOUR due diligence before sending a bill saying someone owes $X.

Due dilligence means that if your health insurance isn't covering it (for whatever the reason such as wrong code, not having your insurance info up-to-date) before sending YOU a bill saying YOU owe us some obscene amount, they should be calling you first before saying you are responsible for $X amount. That shit just grinds my gears.

We don't agree often....we agree here.
Your insurance bill shouldn't be like your cable or satellite radio bill after your contract expires. They shouldn't send out a huge bill and hope you don't notice how much it is, see my earlier comment about why bills are close to impossible to understand.
Disgraceful

 

[SlitheryDee]

A lot of the time it seems that hospitals with send you a huge bill for stuff even when your insurance technically covers it. They're probably hoping you'll end up paying it because they charge you more than they do your insurance, and your insurance is probably hoping you'll pay it so they won't have to. I think most people will just send the bill on to their insurance company until they finally get off their collective asses and write a check.

 

[Jumpem]

The problem with in-network and out-of-network is that you have no time to investigate where to go during an emergency.

 

[Jumpem]

@FBB

Can you link to an actual insurance document that says out of network doesn't count towards max oop? I'm with BCBS PPO and my understanding is in/out network applies towards the same max oop.

I've been googling for 10 minutes and cannot find anything that says otherwise.

Re: that healthcare.gov link I believe it only refers to balance billing by out of network providers

https://www.healthcare.gov/glossary/balance-billing/

My insurance has two sets of deductibles and out of pocket maximums. One for in-network, and one for out-of-network.

 

[Jumpem]

The solution to all of this a federal law that removes the ability to classify medical facilities and practitioners as in-network or out-of-network. Essentially make every medical provider in-network.

Single payer health care would remove all of these worries, and prevent people from going bankrupt due to medical needs.

 

[Fanatical Meat]

I am still amazed by people who think this is a normal way to provide care as shown by some earlier posters. I can't fathom that someone is aware they could be one accident, emergency or chronic problem away from life long crushing debt even with insurance and they think its normal or praise what good work is done in healthcare. I find it completely mind blowing.

 

[mikeford]

It may take years for the full train wreck of Obamacare becomes apparent. Many seem to think the idea was to ruin the healthcare system forcing a government take over. Just think we could all get the same quality of care now provided to veterans.

 

[tortillasoup]

I used to work the the administration of a hospital and finally dropped my health insurance completely when i started noticing some patient bills. You can get the same discounted rate that insurance companies brag about getting, just by promising to pay the hospital when you call the billing department. Tell them you don't have insurance but want to pay - bam 50% discount on your bill. Can find lots of other reasons to deduct from the bill if you are persistent about it.

50% of a 500K bill is still too much. My dad's hospital is in network and his bill was around $6K for a $500k visit. You have to assess whether you think your health insurance is going to pay for itself or not. With the rate premiums are going, probably not worth it soon enough.

 

[Jumpem]

It may take years for the full train wreck of Obamacare becomes apparent. Many seem to think the idea was to ruin the healthcare system forcing a government take over. Just think we could all get the same quality of care now provided to veterans.

Or we could all get the quality of care offered in most other developed countries with single payer health care.

 

[highland145]

Or we could all get the quality of care offered in most other developed countries with single payer health care.

So since we've already jumped the shark...


In the interim, I'm getting fucked into bankruptcy. Awesome.