Hey all, I’m British so I don’t really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.
So I’m just asking… How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
I have (what I believe) is considered “very good” insurance. I pay $100 a month for premiums.
When my child was born, there were some complications and we needed to move to another hospital for emergency surgery.
The birth: ~$2500 deductible/copay/whatever you want to call it. I think this is all I would’ve had to pay if there weren’t more complications.
Surgery and aftercare for baby: ~$5600
Care for momma: ~$2000
But here’s a crazy twist. When moving hospitals, we rode in an ambulance. But this was an “out of network ambulance”. What the hell is even that? Under what circumstances do you have a say in which ambulance you ride?
Out of network ambulance ride: $4500
Basically it’s all just bullshit.
Yea ambulance companies fucking suck. they never contract with insurance so they’re free to bill whatever the fuck they want. Buncha predatory assholes charging thousands for a ride and paying EMTs barely minimum wage.
So did you have to pay all of this? (~$14600 if i did the maths right) Or can you negotiate?
You can negotiate, demand itemized bills, request a payment plan, etc., but there’s no actual guarantee that those will be useful, and it can be a bit of effort. Sometimes your insurance also should cover something that they won’t pay for, but getting the money from them is like pulling teeth.
TL;DR: You can fight the system, but no guarantees.
I called the insurance company about the bullshit “out of network ambulance” and they said they would “negotiate on our behalf”, apparently. In the end we paid about $2200 for the ambulance if I remember right.
Everything else we paid sticker price. Fortunately I had some money in an HSA from a previous job so that helped.
(For people reading this who live in more civilized countries: an HSA is a special type of account where you can put money and not pay taxes on it, with the caveat that it can only be used for health expenses. It’s similar to the much more common FSA, but with an FSA the account balance is reset to zero at the end of the year (not sure if the money goes to the government or the brokerage or what). This has led to a new absurd “FSA store” industry, where places sell only FSA-eligible items at a very high markup, with the idea being come December you’d rather buy their overpriced shit than just lose all the money outright. An HSA does not suffer from this nonsense (you keep the money indefinitely, because it’s your money), but it seems like it’s becoming more rare for an HSA to be offered on employer plans.)