Possible to get huge healthcare bills even with insurance?

[dmcowen674]

Possible to get huge healthcare bills even with insurance?

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?

When we had our motorcycle accident in Florida, the ambulance took us to a Hospital not in Network and we were hit with $65,000 bill.

 

[highland145]

Bankruptcy, after all of the bills have come in, Dave. I asked earlier how the wife was...Good, I hope.

 

[IntoxicatedPuma]

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.

I don't think your dad had a 500k "visit" - that sounds like a couple weeks in intensive care with multiple surgeries and specialists.... If he only paid 6k whenever everything was said and done then his insurance is insanely good.

 

[DCal430]

I was confused at first as this type of balance billing is illegal in California. But I see it was in Colorado. Sucks, more states need to pass laws against balance billing like California has done.

 

[tortillasoup]

I don't think your dad had a 500k "visit" - that sounds like a couple weeks in intensive care with multiple surgeries and specialists.... If he only paid 6k whenever everything was said and done then his insurance is insanely good.

he needed a lot of blood platelets because internal bleeding in stomach.

 

[boomhower]

Sheesh that's nuts. But emergency care billing in certain states can be nuts with some of the current laws. My wife had back surgery last year to the tune of $180k. We paid around $2k out of pocket.

 

[Fanatical Meat]

Just heard from a guy at Church his Brother(?) was speaking with the Anesthesiologist on the operating table about what to expect then a billing agent from the hospital came in and said the surgery can't be done his insurance won't cover it. He left then got a $5,500 hospital surgery prep bill. He didn't mention what the surgery was all he said was its important but not life threatening.

$5,500 because the Hospital didn't do their check until moments before the surgery and then have the balls to bill for it.

 

[BarkingGhostar]

Friend unexpected wound up having a heart valve repaired and a triple bypass when he went into the ER back in October. He knew his flu-like symptom seemed overly terrible, but there you have it. His insurance paid what it did and he was left with a $40K after the hospital wrote off $165K. I can only wonder what the insurance actually paid for.

I guess Obamacare considered his situation elective surgery.

 

[Engineer]

Wife just had surgery. Hope the bills don't go above the out of pocket of $3,500 (shouldn't but you never know with this stuff. We tried for weeks to get an estimate of the costs and not a single group involved in this could provide any information).

 

[tcsenter]

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.

My sister went to the ER for migraine and vomiting. They started an IV and some meds, monitored her vitals, no scans, just had her in an exam/treatment room for about seven hours. She was feeling better, they told her she could wait another however many hours it would take to get CT and neuro consult, they didn't know how long it would be just said at least another 4 hours but might be the next morning, she would have to wait there the entire time in the ER. She said I'll just go back home.

$8700 bill. She tried to work with them but they would NOT budge since she had a job and made decent money ($43K per year). She let it go into collections, who eventually accepted a lesser settlement.

 

[Fanatical Meat]

Wife just had surgery. Hope the bills don't go above the out of pocket of $3,500 (shouldn't but you never know with this stuff. We tried for weeks to get an estimate of the costs and not a single group involved in this could provide any information).

This irritates the crap out of me it shows what a mess billing is. Would you have a garage repair your car without having any clue what the cost would be. I'll say it again I am amazed we all tolerate this crap.

 

[master_shake_]

wow.

every one of your guys stories.

wow.

 

[Imp]

Friend unexpected wound up having a heart valve repaired and a triple bypass when he went into the ER back in October. He knew his flu-like symptom seemed overly terrible, but there you have it. His insurance paid what it did and he was left with a $40K after the hospital wrote off $165K. I can only wonder what the insurance actually paid for.

I guess Obamacare considered his situation elective surgery.

So insurance helped him not go into bankruptcy. Now he's just severely financially affected... and might go bankrupt later.

 

[feralkid]

lol.

i could have easily said rabbit.

but who would punch a rabbit in the face?

 

[DCal430]

Friend unexpected wound up having a heart valve repaired and a triple bypass when he went into the ER back in October. He knew his flu-like symptom seemed overly terrible, but there you have it. His insurance paid what it did and he was left with a $40K after the hospital wrote off $165K. I can only wonder what the insurance actually paid for.

I guess Obamacare considered his situation elective surgery.

Nothing in ACA deals with what insurance is required to cover except a handful of screenings for children and preventative things. For the most part ACA does not deal with what medical conditions need to be covered. It is mostly the responsibility of state laws to dictate what health insurance need to cover.

It really is a problem because the ACA only requires screening for Autism in those under 3, so people over 2 who are not diagnosed are excluded form screening coverage in many states. This can be a problem for parents of older children who are suspected of having autism, but are over 2 years old, as they often have to pay hundreds if not thousands of dollars for screening out of pocket. It is worst for adults who are not diagnosed and need help; because only California and 1 or 2 other states require coverage for adults over 21 to screen for autism and therapy treatment.

 

[IntoxicatedPuma]

My sister went to the ER for migraine and vomiting. They started an IV and some meds, monitored her vitals, no scans, just had her in an exam/treatment room for about seven hours. She was feeling better, they told her she could wait another however many hours it would take to get CT and neuro consult, they didn't know how long it would be just said at least another 4 hours but might be the next morning, she would have to wait there the entire time in the ER. She said I'll just go back home.

$8700 bill. She tried to work with them but they would NOT budge since she had a job and made decent money ($43K per year). She let it go into collections, who eventually accepted a lesser settlement.

If they found out she had insurance that's probably why. Insurance companies are a bit ridiculous when it comes to ER visits.

 

[Strk]

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.

And at $245/mo, that is around 6-7% the average household income in this country, so I'm guessing it is a bit higher % for an individual. That doesn't seem like a very good deal for an individual for what is probably crappy insurance.

I still can't figure out how anyone really defends our system.

 

[TXHokie]

I have HSA high deductible plan. First time I took my daughter into ER because she felt some sharp stomach pain (tried the local clinic first but they didn't have an Xray machine). Probably was in ER for 1.5 hrs and they took an Xray and then the doctor looked at it and spent 10 min telling us it was all ok.
Couple weeks later got a bunch of bills from technician fees to facility fees to doctors fees totaling about $3000.

 

[Homerboy]

The saddest thing here (and in all the similar "Health Care Horror Stories" threads we've had) is that NONE of the stories shock me. We've all been fucked over by this system at some point. It's just ridiculous and completely saddening.

 

[Rebel44]

US Healthcare is IMO completely insane.

I prefer our single payer system - me and my employer (combined) pay around 10% of my gross salary as "healthcare tax" and after that my copayments are limited to around $200 per year. children, elderly, unemployed etc are insured by state. State insurance company also have a huge leverage, when negotiating for payments for drugs etc.

 

[Slew Foot]

Had a kid at the university, never saw a bill. Kid needed a neonatal transport and an overnight stay in the nicu, never saw a bill. kid needed an er visit, never saw a bill. second kid born at kaiser, $200 copay and never saw another bill. its not all bad.

 

[z1ggy]

With out reading any other replies, in short the answer is "yes". Without knowing what "huge" is to the OP makes it hard to answer completely though. With my plan, I have to meet a deductible of $350. After that point, I pay 10% of all costs going forward, up until $10,000 out of pocket.

So I could receive treatment worth ~$100,000 and pay roughly $10,000 for it. To me, that is a fairly "huge" bill.

 

[Engineer]

My sister went to the ER for migraine and vomiting. They started an IV and some meds, monitored her vitals, no scans, just had her in an exam/treatment room for about seven hours. She was feeling better, they told her she could wait another however many hours it would take to get CT and neuro consult, they didn't know how long it would be just said at least another 4 hours but might be the next morning, she would have to wait there the entire time in the ER. She said I'll just go back home.

$8700 bill. She tried to work with them but they would NOT budge since she had a job and made decent money ($43K per year). She let it go into collections, who eventually accepted a lesser settlement.

I hate to see this. My daughter just spent 7 hours in the ER because her neck locked up and arm went numb. They did a CT scan and eventually relieved her with some sort of arthritis medication. I now dread that bill on top of my wife's Friday surgery bill. Thinking of bending over now to save the trouble.

Edit: Oh goodie, the first bill of $3,000 from the ER has been denied by insurance. No reason given. Guess she will have to call (won't talk to my wife - the policy holder - because my daughter is 18 or older). *sigh*

 

[Engineer]

US Healthcare is IMO completely insane.

I prefer our single payer system - me and my employer (combined) pay around 10% of my gross salary as "healthcare tax" and after that my copayments are limited to around $200 per year. children, elderly, unemployed etc are insured by state. State insurance company also have a huge leverage, when negotiating for payments for drugs etc.

Yes, it is insane.

 

[tcsenter]

If they found out she had insurance that's probably why. Insurance companies are a bit ridiculous when it comes to ER visits.

None insurance. She opted-out for whatever reason (the premium was getting too high).