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Possible to get huge healthcare bills even with insurance?

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Ferzerp said:
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.
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Of course everything has cost, the question is since you pointed out that there are charity hospitals. Assuming one went to one of these mystical places in the US you'd get free care without any requirements? Your insurance company only exists because they like being there they aren't out for profit, your Dr. office that is affiliated (invested) in a lab where your test results go isn't making a profit. Come on we both know the US system generates the highest bills in the world and we see very little life benefit from it.
 
Fanatical Meat said:
Of course everything has cost, the question is since you pointed out that there are charity hospitals. Assuming one went to one of these mystical places in the US you'd get free care without any requirements? Your insurance company only exists because they like being there they aren't out for profit, your Dr. office that is affiliated (invested) in a lab where your test results go isn't making a profit. Come on we both know the US system generates the highest bills in the world and we see very little life benefit from it.
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Non-profit does not mean free....
 
tortillasoup said:
$75k is NOT $10k. The bill was $10k, well within a oop limit for out of network coverage.
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That's very true and I, too, never saw a $75K figure quoted in the linked article.

On the other hand, it was just the surgeon's bill, not the hospital's bill.


But can you end up with huge bills even with insurance? Sure. Happens to millions every year.
 
Of course you can, not only that but insurance companies can deny claims still too.

The only people who will defend ACA are hacks and bafhhhoonnnsss.

This place needs a single payer system or bust.
 
Fanatical Meat said:
Of course everything has cost, the question is since you pointed out that there are charity hospitals. Assuming one went to one of these mystical places in the US you'd get free care without any requirements? Your insurance company only exists because they like being there they aren't out for profit, your Dr. office that is affiliated (invested) in a lab where your test results go isn't making a profit. Come on we both know the US system generates the highest bills in the world and we see very little life benefit from it.
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Really? Little Benefit? Tell that to my teenage son who received a kidney from me. $250K plus total cost and we paid $3K, roughly. I think we benefited just fine.

I know the popular thing is to bash our medical system, but that profit motive you are slamming provides some of the greatest hospital systems in the world. And believe it or not, hundreds of thousands of people annually come to America for treatment because they can't get it in their own country's, usually government provided, healthcare system, including Danny Williams, the Premier of Newfoundland (that's in Canada).
 
I'm glad it worked well for you CPA that is a good thing to do and say. I'm questioning the 250k figure. Chart is a few years old but I'd bet its gotten worse.

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waggy said:
did you read and understand the article?
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I agree with fuzzy, I'm pretty sure it's possible.

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

It doesn’t have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits.
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Most plans would have a separate / higher out-of-pocket maximum for out-of-network care, but I don't think it's a requirement.
 
fuzzybabybunny said:
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?
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Yes, you have a particular coverage area which is why you need travel health insurance if you take a cruise or something like that.

HOWEVER in a true emergency its common for the insurance company to work with the hospital, and a heart attack definitely qualifies. I would say if he contacts the hospital billing department and his health insurance he might get his bill greatly reduced.

Edit: Oh thats probably the reason it was $10k and not $75k.
 
purbeast0 said:
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.
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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.
 
Don't worry. I'm sure if he buckles down and negotiates hard with the hospital he can get the bill knocked down to oh, 60k? 50 thousand? All he has to do is scrounge up fifty grand out of the couch cushions and he's good. :colbert:
 
MSCoder610 said:
I agree with fuzzy, I'm pretty sure it's possible.

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



Most plans would have a separate / higher out-of-pocket maximum for out-of-network care, but I don't think it's a requirement.
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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.
 
I don't think that these types of things are all that common for the vast, vast majority of people.

In 2015 my wife and I got medically evac'd in Costa Rica to San Jose, spent days in the hospital there (My sincerest gratitude to CIMA Hospital!) including a laprascopic surgery while there. We also had a baby and visited the ER no less than 4 times for various problems. Even given that we spent under $4,000 for the year.

Now we did not have the worst year, medically. There are probably hundreds of thousands of people who experienced MUCH worse medical emergencies than we did, but I was pretty happy with how it all came out for us, monetarily.

Like all insurance, this is a gamble. Low monthly premiums and terrible coverage, or a bit more and more coverage in case you need it. You have to balance what you are willing to lose versus what you can afford to lose.
 
fuzzybabybunny said:
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.
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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
 
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