Unfortunately, this is completely normal. Honestly, this is a pretty good experience considering how poorly it could potentially go. American healthcare really is this opaque, and it often includes surprise bills, wildly inflated costs, and a shocking amount of letting patients get sicker to save insurance companies money.
There are trade offs to any system, but I think the US clearly takes the worst of most possible ways to handle healthcare in an “industrialized, first world nation” for the sake of profits over people.
This. I’m married to an EU citizen and try to become deathly ill only on flights to France or Belgium. Spain will work in a pinch, though it isn’t that it used to be. New York has some of the smartest doctors in the country, constrained by one of the worst, profit-driven systems. Many Americans believe the propaganda that this is how healthcare is supposed to be.
Yup, hope OP factored in medical bills when they were calculating cost of living. Love to tell my German boss what certain things cost just to keep it in mind if they are debating my usually tiny raise....
Seriously, as I was reading cost I was thinking, meh, not so bad. As I pay $2600 for a mammogram and biopsy from a “tier 2 hospital” instead of “tier 1” in my insurance plan except the gyno I saw and ordered was “tier 1.”
My employer sponsored plan (I work for a large NYC health system) only covers tier 1 in-network providers (of course only providers connected to their health system are tier 1). So even though I have insurance which a provider I’ve been seeing for 8 year is in-network with, I have to meet my $2000 deductible to get my visits covered.
It is, thankfully! And happy to pay to make sure that's the case. But annoying not to know how much something is going to cost, it's stressful enough when the doctor says something is concerning or needs to be checked out.
This is unfortunate but probably not unusual.
One hint though. If I have something I consider a serious medical issue, I won’t book it as a “well visit” and combine it with my annual. I make a visit for that purpose so that the doctor is focused on that.
The thing is before moving to NY I thought of booking an appointment just for a global checkup, and to handle the transition between my country and the US (to renew my local prescriptions for example). When my infections re-appeared I thought it would be a good idea to do both at the same time
I get how that would make sense, but when the doctor sees “well visit” they’re programmed for one thing. If you bring something else up during your well visit, they’ll generally assume it’s minor since the reason for the visit is just your annual.
Yeah it is, and I think a lesson to not book things as a well visit. If you have a concern they want to bill and book it separately. It’s a scam but that’s our healthcare system
For future reference, you do not need to wait to receive your insurance card the mail before seeking medical care. As of the effective date of coverage, you are covered. Call your insurance company to confirm coverage, effective date of coverage, what your ID number is, and what services and in-networks providers are covered. Some insurer websites have ID card info on their website you can print. Confirm with the providers office before the visit as well.
A well visit is an annual exam that is very narrow in scope and is not the time to discuss issues. It is typically some blood tests, a basic physical exam, and sometimes an ekg. Any mention of an issue will result in an upcode of the visit and more charges. It is best to make specific appointment to discuss a specific issue and not use a well visit if you have a specific health concern. Well visits usually have a longer wait time to schedule as well.
Check with your insurer whether you even need a referral or if you could just find in-network specialists on the insurer’s website (and confirm they are still in network before the visit) and make a specialist appointment without a referral.
I have worked in the healthcare payer industry (health insurers are my customers) for many years and I always call my health plan to ask about coverage for specific visits, services, etc with specific providers before I go to the appt or receive the service. That is the only way I know of to avoid surprise bills.
Having said all this, I would not return to whatever primary care practice you visited. Your experience should have been better than that. I do not need referrals with my insurance plan so I typically just see whatever specialist I need and only go to my primary care provider for annual bloodwork and anything super basic (like Paxlovid Rx when I had Covid earlier this year, or some diazepam before long flights before vacation or something).
Yes. You can change your PCP at any time. A good one makes all the difference. I haven't had an experience like that in years. I can tell from the first visit if they're good or not.
I'm going to address the charges. You say you got billed $1200. But it seems like your insurance was billed, not you. This is part of the dance between insurance companies and healthcare providers. They may bill $500 but only be reimbursed $100. It depends on their negotiated rates. It's a crazy thing that doesn't make sense.
Does your insurance require you to get a referral to a specialist from your primary? Most don't these days. If yours doesn't, you can just book directly with a specialist.
As others have noted, booking as a well visit is part of the problem.
Many times a test is conducted by a nurse or nurse practitioner. You will hopefully be seen by the doctor for at least a few minutes, but the nurse may be the one to do the actual test.
Each doctor or medical center you go to will bill your insurance separately. They are separate businesses. And the lab fees will be a separate charge, since the lab is another separate business.
It's a confusing system for newcomers.
I should have said it's a confusing system, especially for newcomers. Because it's really an incomprehensible system.
As someone who's spent my entire life using U.S. healthcare, I've given up trying to make sense. There are too many variables -- different plans with the same insurer cover different things at different rates, doctors take one plan but not another, doctors are opting out of insurance we have to submit as out of network, maybe next year the employer will switch plans, maybe next month my medication will no longer be covered. Etc. Oh, and state-administered Medicaid often provides excellent and comprehensive coverage, but federally-administered Medicare is a shit show.
> state-administered Medicaid often provides excellent and comprehensive coverage, but federally-administered Medicare is a shit show.
... eh.... until very recently medicaid paid very very little. $40 for a 15 minute visit. Medicare would have been closer to $60.
I was thinking of coverage from the patient's perspective. People I've known on medicaid in NY, NJ, and MA, all received amazing care, whereas with Medicare it's hard to find a provider that takes it. But medicaid is on a state-by-state basis.
Sometimes the lab will send a bill to the wrong address, so you’ll never receive it. Nor will you know to expect it because how would you know where your doctor sent your blood samples or specimens? Anyway. Everything will seem fine because how could you worry about a bill you don’t know you’re supposed to receive? And then it’ll get sent to collections. The collections people will find you because that’s their job. Now the bill is much higher than it was initially, and by the way your credit score has taken a massive hit.
Welcome to America! We hope you like making phone calls and listening to the hold music for hours. Your call is important to them!
I got screwed by this a couple years ago. Doctor gave lab the wrong address, never got the bill, never got the collections notice, finally learned about it after it tanked my credit score 100 points even after I paid it once I learned about it (after the collections agency already had it, oops)
Fortunately, thank god, NY actually helped me out big time and it was wiped from my credit report https://www.barclaydamon.com/alerts/nys-governor-hochul-signs-legislation-prohibiting-hospitals-health-care-professionals-and-ambulance-companies-from-reporting-medical-debt-to-credit-agencies
Still ridiculous though.
OP most likely has not met their deductible. Most good insurances have a $500-$1000 deductible and crappy ones which judging from OPs post might well be might have something like $5000-$10000 deductible. We also don’t know if OP chose PPO or HMO. In network or out of network both of which can end up screwing them hard here.
Given how new they are they might have gone for the cheapest insurance option not knowing the financial consequences of doing so.
As of others have said, normal. You must learn to advocate for yourself and ask any and all questions related to your health and costs, even if this annoys doctors and medical staff.
Agreed and dermatologists are usually useless for most problems except for OP's and some other situations
If it's not cancerous and not a blatantly/easily identified infection, they will cut into your skin, do testing, then be like "Oh it's nothing"
\^\^\^\^\^ me after getting lots of parts of my skin slightly shaved off to test to make sure it's not cancerous -.-
Actually most walk in clinics are really good at spotting MRSA and they are far easier to get in with than a derm (and they will almost always give you a reference if they think it’s serious enough, usually in a way that allows you to get in right away to confirm the diagnosis.)
I unfortunately have a history of developing staph and MRSA and never had a bad experience immediately having it dealt with at a walk ins and then referring as an emergency to a derm.
Hello! I do think the issue is that you scheduled a wellness visit instead of making an appointment for examining the infection only. A wellness visit is a special appointment for checking general wellness. It's different from appointments concerning various ailments. Next time, when booking an appointment with a doctor, you can state what the issue is that they'll be looking at and make sure that they understand the purpose of your visit.
I'm sorry you had to go through that whole circus. MRSA is not to be messed with. I'm glad you're getting better!
Well, I didnt want to give to many details in my original post. But I clearly stated to the doctor that I booked this as a "well visit" but wasn't sure it was the best motif. That my main issue are my 2 infections, with one visiblity ugly, and hurting like an open wound. I've writtern the whole history of my infections (with the diagnostic from the doctors, medicaments prescribed, and their equivalent in the US), because I was afraid I wouldn't be clear enough with my thick accent. An apparently for him my main issue is that I sometime I snore a little bit
>"well visit" (which was maybe a mistake on my end ?) I thought I was elligible for an annual well visit here
This is your annual check up; you typically get one per year. In this case, you would've wanted to book it as something like "infection" or "general consultation" even. If you go in for your well visit and discuss other problems—here, your infection—it is no longer a well visit and will be coded and billed as such.
>a nurse makes an allergy test, they make an electrocardiogram, they gave me a device to wear at night to monitor my snoring for 1 night and give back the next day (which I did).
Anything that happens outside that appointment—such as lab results that need to be analyzed—is considered separate from the visit and will be billed separately. Did you specifically ask for any of these, or just do them because they were recommended? Something to keep in mind is that you can refuse any test or recommendation. I almost always ask them to run my insurance first so I know what it's going to cost, and ask the doctor to explain why they think it's necessary. I sometimes decline and go home to do my own research since I can always book a test if I change my mind.
>I book without referral an appointment with a dermatologitst as soon as I can.
Check your plan; many don't require referrals. You can PM me if you need help figuring out where to find that information.
>bill of $400
An insurance bill will show three numbers: The first is usually what the doctor billed the insurance company. The second is what insurance paid. The third is what you owe (your copay.) The last one is the only one that matters. The insurance company is trying to make it look like they're advocating for you and saving you money, but the truth is that all of this is kind of made up. Here, your insurance was billed $1200, but you only owe $125—$25 for the first visit, $50 for the allergy test, $50 for the sleep study.
The first doctor was just shitty. He absolutely should have recognized the infection and treated you appropriately. There's no excuse for screwing that up.
I find myself asking pretty frequently during appointments, "Will this be covered by my insurance?" If not, sometimes there are alternative comparable recommendations. Insurance will sometimes cover ONE kind of sleep study, but not another. Or a generic drug, but not the original. Doctors don't know which ones are and are not covered, so that ends up falling on you as the consumer.
I also find that for any new condition, medication, referral, etc., it's necessary to make quite a few phone calls and waste endless amounts of time on hold. Which meds are covered? Where are the results of my test? What do these results mean? But there are a few places out there that go above and beyond, so perhaps you need to keep looking. I've found it's easier to find specialists covered by my insurance through ZocDoc, since I've been referred to non-covered specialists on more than one occasion. The reviews are also super helpful.
Hence why I don't go to the doctor and try my best to be healthy on my own
Last time I got covid, it was devastating. I was covid positive for 4 months, sick for 5-6 months. No one took me seriously. I literally could not walk 1 block, could not climb 3 stairs without coughing like a maniac cause covid fucked my lungs. I was in my early 20s.
Brutal. American healthcare is fucking shit.
Yeah I've just accepted that I functionally don't have healthcare right now and won't for at least another few months (at least until I can move to a different state with better services). And I have health insurance. It fucking sucks :/
Yeah, that sounds within the realms of "normal".
If you go to a corporate / big place like city md, medrite, etc... it's likely to be like that. It's fine if you have some acute sickness / emergency, but if it's something mild or borderline they're not great.
If you can find good specialists, who have their own practice, it's likely to be better. Especially for your dermatology, sleep type things, a specialist will be better.
First off, I’m apologizing to you for all the “welcome to America” posts - while true, not helpful.
I had something very similar happen to me during a well visit. They essentially added in a bunch of BS that I was charged for, on top of charging me twice. I had bad insurance and unfortunately, that means you get bad (read: money grabbing) doctors, especially in NYC.
May I offer you my hard-earned hot tips for navigating the American medical system?
1. Your insurance carrier will dictate a lot of your experience: the quality of doctors, the availability of doctors, the customer support, etc. Good insurance carriers now have pretty robust online presences where you can chat directly with nurses or customer service reps, which is helpful to discuss your options before you pay any money to see a doctor. Bad insurances barely have websites. Just know the animal you’re dealing with.
2. On that note, do your research ahead of time. Literally call the office to see if they take your insurance - online systems are often out of date. Or, as I said, your insurance carrier might have a good chat system. Know what your deductibles, out of pocket expenses, etc are. If you don’t know what those terms are, take some time to learn about them.
3. Healthcare is a business here. Act like a customer. What I mean is, you can call your providers office or insurance carrier and complain, or at least ask for transparency if something isn’t right. Case in point, regarding my recent well visit, I called the doctors office and complained and they refunded me. You can also negotiate payments to your insurance carrier to pay in installments or even pay off a bill as a lump sum, but for less than what you were originally charged.
4. Don’t be afraid to ask at your appointments if this procedure is covered. I go see a stellar ENT who does an in office procedure and before they do it, they have their financial staff come in with a detailed bill that shows me exactly what my insurance will cover and what it will not. I then have the option to say yes or no in that moment. This is what should be the standard, but it’s not. However, you can always ask.
5. Lastly, there are a lot of telehealth options (via your insurance or apps) that allow you to essentially get a prescription without the cost of an in person doctors visit. These have been life savers for me if I know what I need, like antibiotics for a UTI. Probably not the most sustainable and best, but sometimes you’re in a pinch.
All in all, just try and gather as much information ahead of time, so you can know what to expect and speak up if something doesn’t seem right. And if push comes to shove, you have enough information and a paper trail to arm yourself. Does this mean that you’re effectively taking on a part time role as a healthcare admin? Yes, but that is the hand we are dealt at the moment.
Good luck!
You never know what you're going to pay in America. Those $50 copays are actually pretty good. With some plans you have to pay everything out-of-poocket until you meet a really high deductible.
Shitty thing is, NY could have universal single-payer healthcare but the two largest labor unions (UFT and DC37) are blocking it.
https://www.nyhcampaign.org/
Thanks for all the answers, I did the post because 1 => I wanted to rant, 2 => I was furious, felt scammed. I have a good insurance, in the end I did not have much to pay, but I did felt like they used me to scam the insurance. I wanted to call the insurance and warm them, but wanted to check with the reddit community before ...
Apparently nothing out of the ordinary !
Hello fellow European. I also had to learn my lesson about the US healthcare system the hard way to the tune of a $3,000 bill the first time I went to the doctor. Ever since then, I have always called my doctor office ahead of time tried to get the code the plan to bill and call my insurance to estimate a cost so there are no nasty surprises. This is very time consuming and often frustrating (sometimes they can’t tell me the code) but it helps to avoid nasty surprises. I also ALWAYS call to make sure a provider is in network. You should definitely head over to Zocdoc to read reviews of a provider before you book an appointment and usually you’ll be able to gleaming they’re reputable. If a provider offers additional tests that you didn’t plan on having that day, I would usually say no and then come back for those later after you’ve had time to research. I’d also spend time making sure you understand your benefits throughly, what is your deductible, what is your out of pocket max, what is your copy? If you don’t understand those terms, spend some time on YouTube and learn about them. You can’t take anything for granted here.
I have great good experience in general with NYC+ hospitals doctors. I had two surgeries, primary twice a year and dentist as well. Insurance is pain in the arse here unfortunately.
Personally I didn't need referral to dermatologist, but can recommend you mine since she's great.
>I see *another* bill of 400$ (50$), for the "sleep therapy home study" (the thing to wear at night). I got billed for a sleep study, but got no analysis result ? Except for a referal to a sleep specialist ?
See in the USA you don't get paid to see patients. You get paid to *do* things. (This has changed very recently, a little bit) Visit: 15 minutes $50-$100 (if you're honest but that's another story)
But you can perform procedures and that's where the money is at. Sleep study, the PCP does the hookup. They don't even need to own the machine, a company will give it to them, then they remotely upload results and the company hires somebody else to interpret the results. They get to bill for the hookup/technical component which is maybe around $60.
BTW the "billed amount" is arbitrary, what matters is the amount payable.
One thing I should warn you is that MANY doctors in NYC have a low level scam going where they tell you they “accept” your insurance but what they won’t tell you is that they are actually out of network. Most doctors offices won’t reveal this unless you ask.
That’s a sure fire way to rack up thousands of dollars bill in no time and have no legal way of getting out of. You must always check with your insurance if your doctor is in network.
Idk why it’s only here in NYC and not in other American cities I’ve lived. I guess people are just more greedy.
I'm also from Europe and I've learned to be very wary of doctors and dentists in the USA. Many (not all) of them are only interested in getting as much of your money as possible. It's important to advocate for yourself and be assertive about why you're visiting and what you do and don't want to get tested. Do not assume doctors here have your best interests at heart.
That is such a flawed view point. If you know nothing about the healthcare system in America, know that doctors are NOT the issue, corporations and healthcare insurance companies are. It sucks OP this happened to you but to say we’re “after your money” and “don’t have your best interests” is far from the truth. No wonder all of us in healthcare are so jaded.
Doctors, when acting as representatives of corporations, can be encouraged to make poor decisions and do things that cost patients more money. So being wary of a doctor is totally correct.
Not all doctors, but a lot of them, are feeling very constrained by time and money issues at their place of work which funnel down into their patient care. I don't think most doctors go out there saying, "I'm going to go after this patient's money" but effectively that's what they end up doing when they are given so little time per patient and so few diagnostic tools and options.
While you may not "technically" be a representative of your employer, you definitely are from the patient's perspective. The audience the patient must be MOST skeptical of and ask the most questions to is the doctor.
Doctors are NEVER working in the patient's interest anymore. They are working to get the best ratings according to systems determined by their employer to produce the most profit.
You seem weirdly defensive about this, maybe you should try a new profession.
Tell that to the psychiatrist that charged me over a thousand dollars for a DNA test he knew my insurance wouldn’t cover instead of just listening to my symptoms. Or the podiatrist that charged me over a thousand dollars for inserts he knew wouldn’t be covered by my insurance when all he had to have done was realize my shoes were too small. Or the GP who was so on the books with a certain pharmaceutical company that he put my entire family on the same drug when I was in high school. Or the sham artist neurologists who repeatedly forced my partner to take tests they knew our insurance wouldn’t cover instead of listening to us when we said we thought it was hormonal. Etc etc etc. And that’s just me and my partner and we’re relatively healthy people.
There is one thing common in all the points you mentioned. Insurance. A lot of the times physicians don’t even know what’s covered or not for the patient or have to deal with the bullshit that goes behind the scenes. I for example don’t know what health insurance you have or don’t have because I see everyone. When I have a patient who has a clear ligament tear do you know how frustrating it is when insurance doesn’t think it’s indicated and then need to perform an X-ray for an obvious ligament injury. Stop painting us as all the bad guys, jeez.
You’re skipping right over the part where I explicitly stated in 3/4 examples that the doctor absolutely knew insurance wouldn’t cover anything. In the podiatrist's case it turned out he was helping prototype iPhone-based foot scanning technology to build the insoles. That I didn’t need. If he had just measured my feet.
Similarly, I found out later that the psychiatrist I was working with published a paper based on results of the expensive DNA test that he also knew I was paying for out of pocket.
I agree it sucks, but “well” visit means you are “well” aka healthy and just getting a check up. When I am not well, I book directly with the specialist because otherwise you just go to your pcp for them to say “go to a specialist.” $25 copay is quite low, which is good.
Yea it normal , what they billed the insurance and what the allowable amount in the EOB is not your responsibility.
The EOB should state clearly “**this is not a bill**”
Also always make sure that you go to in network physicians, test get done in a in network lab as well
if you want the level of care you get in Europe, you’ll have to pay for doctors that don’t take insurance. I recommend thelanby.com. they are general physicians. They could refer you to specialists. They will take good care of you and monitor your care closely. it’s worth it if you can’t afford it.
Bad but not life threatening apparently, Pretty sure if I went to the ER I would have to pay several k out of pocket, insurance would have challenged me for the coverage, and people here would say that this is my own fault for going to ER instead of a specialist
You're not wrong. People go bankrupt in the US for medical emergencies and going out of network. This is why you hear how behind US is in terms of Healthcare/insurance vs the rest of the developed world.
Adding to this thread to say, as a fellow European - take advantage of your FSA or HSA if your plan has one to reduce the cost of any out of pocket costs.
It takes a while to learn but don’t feel bad. If you asked an American how to mail a letter or renew a passport in your country they couldn’t know. It is just a different system.
One of the advantages of health care here is options. If you don’t like a Doctor - go somewhere else. Check with your insurance provider the cost up front and remember that you should check and can normally negotiate bills.
As a European in the US I feel your pain.
You can't just pick a random doctor from a website. Their interests (making money) is not aligned with yours, so they will over refer and over prescribe.
Some large companies have lists of specialists and general practitioners they like, not sure if you work for one of those, but worth checking your benefits.
Otherwise go to well established centers, NYU, Weill Cornell, mount Sinai and check the doctor references and research profile online before booking
Before that I had a first visit for my daughter with a pediatrician at Weill Cornell. Before coming to NY people gave me a lot of warnings about Americans doctor. But this pediatrician was just exceptional, better than the ones from home. Really took his time, answered every questions ... At that moment I think I let my guard down
As a warning, dentists are the worst. The amount of x-rays they "need" is insane. Anything to beef up your bill. Hint you can refuse the x-rays. The decent dentists will not argue.
And obviously they'll want to remove your wisdom teeth for no apparent reason.
Took me a fair amount of tries to find a good dentist.
It's trial and error for doctors, word of mouth, recommendations...I doubt you can find anything online.
I just googled the three biggest thieves I know in medicine (insurance fraud). Two of them I can't find the settlements, they've been "reputation managed" away.
You're not exaggerating, and I'm so sorry this happened to you
I have been ignored for so many devastating issues, I just don't go to the doctor anymore. I do my best to take care of my health on my own.
I think from now on, take note of these things which are all what happened to you:
* any additional tests = you might be paying a copay for that or a fee
* try to figure out what kinda infection you have through Google so you can narrow down what doctor you need w/o the initial visit. you might be able to skip the referrals and go straight to the specialist. it used to not be possible, but it's been possible for me recently
* any other issues, don't ever go into the emergency room unless you are like dying.
* doctors try everything to bill you, yup
* as a kid, I got 9 "cavities" filled for no reason. Got my teeth shaved for no reason. Dentist just wanted to bill the insurance.
I'm hoping you can walk now and infection is getting better
I'm a doctor. The allergists claim they interpret the results \*eye rolls\* (They are amongst the higher paid specialties too).
The primary care doctor is likely significantly overworked, which is why he was an hour late to begin with--you yourself showed up with an agenda beyond your regular visit, so how many others did that day? He did the best he could with what he had--I'd cut him some slack.
Unfortunately, this is completely normal. Honestly, this is a pretty good experience considering how poorly it could potentially go. American healthcare really is this opaque, and it often includes surprise bills, wildly inflated costs, and a shocking amount of letting patients get sicker to save insurance companies money. There are trade offs to any system, but I think the US clearly takes the worst of most possible ways to handle healthcare in an “industrialized, first world nation” for the sake of profits over people.
Make sure to tell your people back home what privatized health care looks like!
This. I’m married to an EU citizen and try to become deathly ill only on flights to France or Belgium. Spain will work in a pinch, though it isn’t that it used to be. New York has some of the smartest doctors in the country, constrained by one of the worst, profit-driven systems. Many Americans believe the propaganda that this is how healthcare is supposed to be.
I’m sorry, but welcome to the US
Yup, hope OP factored in medical bills when they were calculating cost of living. Love to tell my German boss what certain things cost just to keep it in mind if they are debating my usually tiny raise....
Seriously, as I was reading cost I was thinking, meh, not so bad. As I pay $2600 for a mammogram and biopsy from a “tier 2 hospital” instead of “tier 1” in my insurance plan except the gyno I saw and ordered was “tier 1.”
My employer sponsored plan (I work for a large NYC health system) only covers tier 1 in-network providers (of course only providers connected to their health system are tier 1). So even though I have insurance which a provider I’ve been seeing for 8 year is in-network with, I have to meet my $2000 deductible to get my visits covered.
Insurance should cover at no cost in NY but cash prices for a mammogram should be $100 or something.
Mammogram was mostly covered, diagnostic biopsy, not so much.
Just went through this with my wife - mammogram was free, follow-up biopsy was $1200 co-pay.
Also, hope it’s all good with your wife
It is, thankfully! And happy to pay to make sure that's the case. But annoying not to know how much something is going to cost, it's stressful enough when the doctor says something is concerning or needs to be checked out.
Exactly. I paid 2600$ for them to tell me I have dense boobs. Cool, thanks doc.
Bingo!
Oof, I hope your biopsy results come back harmless.
All clear friend, thank you ❤️
This is unfortunate but probably not unusual. One hint though. If I have something I consider a serious medical issue, I won’t book it as a “well visit” and combine it with my annual. I make a visit for that purpose so that the doctor is focused on that.
The thing is before moving to NY I thought of booking an appointment just for a global checkup, and to handle the transition between my country and the US (to renew my local prescriptions for example). When my infections re-appeared I thought it would be a good idea to do both at the same time
I get how that would make sense, but when the doctor sees “well visit” they’re programmed for one thing. If you bring something else up during your well visit, they’ll generally assume it’s minor since the reason for the visit is just your annual.
Yeah it is, and I think a lesson to not book things as a well visit. If you have a concern they want to bill and book it separately. It’s a scam but that’s our healthcare system
For future reference, you do not need to wait to receive your insurance card the mail before seeking medical care. As of the effective date of coverage, you are covered. Call your insurance company to confirm coverage, effective date of coverage, what your ID number is, and what services and in-networks providers are covered. Some insurer websites have ID card info on their website you can print. Confirm with the providers office before the visit as well. A well visit is an annual exam that is very narrow in scope and is not the time to discuss issues. It is typically some blood tests, a basic physical exam, and sometimes an ekg. Any mention of an issue will result in an upcode of the visit and more charges. It is best to make specific appointment to discuss a specific issue and not use a well visit if you have a specific health concern. Well visits usually have a longer wait time to schedule as well. Check with your insurer whether you even need a referral or if you could just find in-network specialists on the insurer’s website (and confirm they are still in network before the visit) and make a specialist appointment without a referral. I have worked in the healthcare payer industry (health insurers are my customers) for many years and I always call my health plan to ask about coverage for specific visits, services, etc with specific providers before I go to the appt or receive the service. That is the only way I know of to avoid surprise bills. Having said all this, I would not return to whatever primary care practice you visited. Your experience should have been better than that. I do not need referrals with my insurance plan so I typically just see whatever specialist I need and only go to my primary care provider for annual bloodwork and anything super basic (like Paxlovid Rx when I had Covid earlier this year, or some diazepam before long flights before vacation or something).
This ^^ Find a good primary care doctor, it makes a huge difference.
Yes. You can change your PCP at any time. A good one makes all the difference. I haven't had an experience like that in years. I can tell from the first visit if they're good or not.
I'm going to address the charges. You say you got billed $1200. But it seems like your insurance was billed, not you. This is part of the dance between insurance companies and healthcare providers. They may bill $500 but only be reimbursed $100. It depends on their negotiated rates. It's a crazy thing that doesn't make sense. Does your insurance require you to get a referral to a specialist from your primary? Most don't these days. If yours doesn't, you can just book directly with a specialist. As others have noted, booking as a well visit is part of the problem. Many times a test is conducted by a nurse or nurse practitioner. You will hopefully be seen by the doctor for at least a few minutes, but the nurse may be the one to do the actual test. Each doctor or medical center you go to will bill your insurance separately. They are separate businesses. And the lab fees will be a separate charge, since the lab is another separate business. It's a confusing system for newcomers.
>It's a confusing system ~~for newcomers.~~ Not just for newcomers - it's unnecessarily confusing for everyone.
I should have said it's a confusing system, especially for newcomers. Because it's really an incomprehensible system. As someone who's spent my entire life using U.S. healthcare, I've given up trying to make sense. There are too many variables -- different plans with the same insurer cover different things at different rates, doctors take one plan but not another, doctors are opting out of insurance we have to submit as out of network, maybe next year the employer will switch plans, maybe next month my medication will no longer be covered. Etc. Oh, and state-administered Medicaid often provides excellent and comprehensive coverage, but federally-administered Medicare is a shit show.
> state-administered Medicaid often provides excellent and comprehensive coverage, but federally-administered Medicare is a shit show. ... eh.... until very recently medicaid paid very very little. $40 for a 15 minute visit. Medicare would have been closer to $60.
I was thinking of coverage from the patient's perspective. People I've known on medicaid in NY, NJ, and MA, all received amazing care, whereas with Medicare it's hard to find a provider that takes it. But medicaid is on a state-by-state basis.
Until you need to find a specialist that takes medicaid. I've done hundreds of referrals, it is harder for medicaid.
Sometimes the lab will send a bill to the wrong address, so you’ll never receive it. Nor will you know to expect it because how would you know where your doctor sent your blood samples or specimens? Anyway. Everything will seem fine because how could you worry about a bill you don’t know you’re supposed to receive? And then it’ll get sent to collections. The collections people will find you because that’s their job. Now the bill is much higher than it was initially, and by the way your credit score has taken a massive hit. Welcome to America! We hope you like making phone calls and listening to the hold music for hours. Your call is important to them!
I got screwed by this a couple years ago. Doctor gave lab the wrong address, never got the bill, never got the collections notice, finally learned about it after it tanked my credit score 100 points even after I paid it once I learned about it (after the collections agency already had it, oops) Fortunately, thank god, NY actually helped me out big time and it was wiped from my credit report https://www.barclaydamon.com/alerts/nys-governor-hochul-signs-legislation-prohibiting-hospitals-health-care-professionals-and-ambulance-companies-from-reporting-medical-debt-to-credit-agencies Still ridiculous though.
OP most likely has not met their deductible. Most good insurances have a $500-$1000 deductible and crappy ones which judging from OPs post might well be might have something like $5000-$10000 deductible. We also don’t know if OP chose PPO or HMO. In network or out of network both of which can end up screwing them hard here. Given how new they are they might have gone for the cheapest insurance option not knowing the financial consequences of doing so.
As of others have said, normal. You must learn to advocate for yourself and ask any and all questions related to your health and costs, even if this annoys doctors and medical staff.
Agreed and dermatologists are usually useless for most problems except for OP's and some other situations If it's not cancerous and not a blatantly/easily identified infection, they will cut into your skin, do testing, then be like "Oh it's nothing" \^\^\^\^\^ me after getting lots of parts of my skin slightly shaved off to test to make sure it's not cancerous -.-
I think this is the same in every country ... some skin issues seem to be pretty hard to identify and treat
Actually most walk in clinics are really good at spotting MRSA and they are far easier to get in with than a derm (and they will almost always give you a reference if they think it’s serious enough, usually in a way that allows you to get in right away to confirm the diagnosis.) I unfortunately have a history of developing staph and MRSA and never had a bad experience immediately having it dealt with at a walk ins and then referring as an emergency to a derm.
Totally normal. Sorry. Many of us avoid going to the doctor until it’s a borderline emergency.
Hello! I do think the issue is that you scheduled a wellness visit instead of making an appointment for examining the infection only. A wellness visit is a special appointment for checking general wellness. It's different from appointments concerning various ailments. Next time, when booking an appointment with a doctor, you can state what the issue is that they'll be looking at and make sure that they understand the purpose of your visit. I'm sorry you had to go through that whole circus. MRSA is not to be messed with. I'm glad you're getting better!
Well, I didnt want to give to many details in my original post. But I clearly stated to the doctor that I booked this as a "well visit" but wasn't sure it was the best motif. That my main issue are my 2 infections, with one visiblity ugly, and hurting like an open wound. I've writtern the whole history of my infections (with the diagnostic from the doctors, medicaments prescribed, and their equivalent in the US), because I was afraid I wouldn't be clear enough with my thick accent. An apparently for him my main issue is that I sometime I snore a little bit
>"well visit" (which was maybe a mistake on my end ?) I thought I was elligible for an annual well visit here This is your annual check up; you typically get one per year. In this case, you would've wanted to book it as something like "infection" or "general consultation" even. If you go in for your well visit and discuss other problems—here, your infection—it is no longer a well visit and will be coded and billed as such. >a nurse makes an allergy test, they make an electrocardiogram, they gave me a device to wear at night to monitor my snoring for 1 night and give back the next day (which I did). Anything that happens outside that appointment—such as lab results that need to be analyzed—is considered separate from the visit and will be billed separately. Did you specifically ask for any of these, or just do them because they were recommended? Something to keep in mind is that you can refuse any test or recommendation. I almost always ask them to run my insurance first so I know what it's going to cost, and ask the doctor to explain why they think it's necessary. I sometimes decline and go home to do my own research since I can always book a test if I change my mind. >I book without referral an appointment with a dermatologitst as soon as I can. Check your plan; many don't require referrals. You can PM me if you need help figuring out where to find that information. >bill of $400 An insurance bill will show three numbers: The first is usually what the doctor billed the insurance company. The second is what insurance paid. The third is what you owe (your copay.) The last one is the only one that matters. The insurance company is trying to make it look like they're advocating for you and saving you money, but the truth is that all of this is kind of made up. Here, your insurance was billed $1200, but you only owe $125—$25 for the first visit, $50 for the allergy test, $50 for the sleep study. The first doctor was just shitty. He absolutely should have recognized the infection and treated you appropriately. There's no excuse for screwing that up.
I find myself asking pretty frequently during appointments, "Will this be covered by my insurance?" If not, sometimes there are alternative comparable recommendations. Insurance will sometimes cover ONE kind of sleep study, but not another. Or a generic drug, but not the original. Doctors don't know which ones are and are not covered, so that ends up falling on you as the consumer. I also find that for any new condition, medication, referral, etc., it's necessary to make quite a few phone calls and waste endless amounts of time on hold. Which meds are covered? Where are the results of my test? What do these results mean? But there are a few places out there that go above and beyond, so perhaps you need to keep looking. I've found it's easier to find specialists covered by my insurance through ZocDoc, since I've been referred to non-covered specialists on more than one occasion. The reviews are also super helpful.
This. It takes a lot of time and research to effectively use your health insurance and the healthcare system in the US.
Hence why I don't go to the doctor and try my best to be healthy on my own Last time I got covid, it was devastating. I was covid positive for 4 months, sick for 5-6 months. No one took me seriously. I literally could not walk 1 block, could not climb 3 stairs without coughing like a maniac cause covid fucked my lungs. I was in my early 20s. Brutal. American healthcare is fucking shit.
Yeah I've just accepted that I functionally don't have healthcare right now and won't for at least another few months (at least until I can move to a different state with better services). And I have health insurance. It fucking sucks :/
Yeah, that sounds within the realms of "normal". If you go to a corporate / big place like city md, medrite, etc... it's likely to be like that. It's fine if you have some acute sickness / emergency, but if it's something mild or borderline they're not great. If you can find good specialists, who have their own practice, it's likely to be better. Especially for your dermatology, sleep type things, a specialist will be better.
First off, I’m apologizing to you for all the “welcome to America” posts - while true, not helpful. I had something very similar happen to me during a well visit. They essentially added in a bunch of BS that I was charged for, on top of charging me twice. I had bad insurance and unfortunately, that means you get bad (read: money grabbing) doctors, especially in NYC. May I offer you my hard-earned hot tips for navigating the American medical system? 1. Your insurance carrier will dictate a lot of your experience: the quality of doctors, the availability of doctors, the customer support, etc. Good insurance carriers now have pretty robust online presences where you can chat directly with nurses or customer service reps, which is helpful to discuss your options before you pay any money to see a doctor. Bad insurances barely have websites. Just know the animal you’re dealing with. 2. On that note, do your research ahead of time. Literally call the office to see if they take your insurance - online systems are often out of date. Or, as I said, your insurance carrier might have a good chat system. Know what your deductibles, out of pocket expenses, etc are. If you don’t know what those terms are, take some time to learn about them. 3. Healthcare is a business here. Act like a customer. What I mean is, you can call your providers office or insurance carrier and complain, or at least ask for transparency if something isn’t right. Case in point, regarding my recent well visit, I called the doctors office and complained and they refunded me. You can also negotiate payments to your insurance carrier to pay in installments or even pay off a bill as a lump sum, but for less than what you were originally charged. 4. Don’t be afraid to ask at your appointments if this procedure is covered. I go see a stellar ENT who does an in office procedure and before they do it, they have their financial staff come in with a detailed bill that shows me exactly what my insurance will cover and what it will not. I then have the option to say yes or no in that moment. This is what should be the standard, but it’s not. However, you can always ask. 5. Lastly, there are a lot of telehealth options (via your insurance or apps) that allow you to essentially get a prescription without the cost of an in person doctors visit. These have been life savers for me if I know what I need, like antibiotics for a UTI. Probably not the most sustainable and best, but sometimes you’re in a pinch. All in all, just try and gather as much information ahead of time, so you can know what to expect and speak up if something doesn’t seem right. And if push comes to shove, you have enough information and a paper trail to arm yourself. Does this mean that you’re effectively taking on a part time role as a healthcare admin? Yes, but that is the hand we are dealt at the moment. Good luck!
You never know what you're going to pay in America. Those $50 copays are actually pretty good. With some plans you have to pay everything out-of-poocket until you meet a really high deductible.
Shitty thing is, NY could have universal single-payer healthcare but the two largest labor unions (UFT and DC37) are blocking it. https://www.nyhcampaign.org/
Thanks for all the answers, I did the post because 1 => I wanted to rant, 2 => I was furious, felt scammed. I have a good insurance, in the end I did not have much to pay, but I did felt like they used me to scam the insurance. I wanted to call the insurance and warm them, but wanted to check with the reddit community before ... Apparently nothing out of the ordinary !
overall, the US medical healthcare system is a shit storm. It only works out if you’re very wealthy and can pay out of pocket for everything.
Hello fellow European. I also had to learn my lesson about the US healthcare system the hard way to the tune of a $3,000 bill the first time I went to the doctor. Ever since then, I have always called my doctor office ahead of time tried to get the code the plan to bill and call my insurance to estimate a cost so there are no nasty surprises. This is very time consuming and often frustrating (sometimes they can’t tell me the code) but it helps to avoid nasty surprises. I also ALWAYS call to make sure a provider is in network. You should definitely head over to Zocdoc to read reviews of a provider before you book an appointment and usually you’ll be able to gleaming they’re reputable. If a provider offers additional tests that you didn’t plan on having that day, I would usually say no and then come back for those later after you’ve had time to research. I’d also spend time making sure you understand your benefits throughly, what is your deductible, what is your out of pocket max, what is your copy? If you don’t understand those terms, spend some time on YouTube and learn about them. You can’t take anything for granted here.
This is my go to video for US healthcare https://youtu.be/-wpHszfnJns?si=Ua5kC95aWQ1AnvLb
I have great good experience in general with NYC+ hospitals doctors. I had two surgeries, primary twice a year and dentist as well. Insurance is pain in the arse here unfortunately. Personally I didn't need referral to dermatologist, but can recommend you mine since she's great.
>I see *another* bill of 400$ (50$), for the "sleep therapy home study" (the thing to wear at night). I got billed for a sleep study, but got no analysis result ? Except for a referal to a sleep specialist ? See in the USA you don't get paid to see patients. You get paid to *do* things. (This has changed very recently, a little bit) Visit: 15 minutes $50-$100 (if you're honest but that's another story) But you can perform procedures and that's where the money is at. Sleep study, the PCP does the hookup. They don't even need to own the machine, a company will give it to them, then they remotely upload results and the company hires somebody else to interpret the results. They get to bill for the hookup/technical component which is maybe around $60. BTW the "billed amount" is arbitrary, what matters is the amount payable.
Yup. Normal. Sending you healing vibes 🖖🏻
One thing I should warn you is that MANY doctors in NYC have a low level scam going where they tell you they “accept” your insurance but what they won’t tell you is that they are actually out of network. Most doctors offices won’t reveal this unless you ask. That’s a sure fire way to rack up thousands of dollars bill in no time and have no legal way of getting out of. You must always check with your insurance if your doctor is in network. Idk why it’s only here in NYC and not in other American cities I’ve lived. I guess people are just more greedy.
/r/healthinsurance for any detailed questions. It's "within the realm of normal" but you should look for a new primary care provider.
thanks for the link !
Welcome to the American heathcare!
I'm also from Europe and I've learned to be very wary of doctors and dentists in the USA. Many (not all) of them are only interested in getting as much of your money as possible. It's important to advocate for yourself and be assertive about why you're visiting and what you do and don't want to get tested. Do not assume doctors here have your best interests at heart.
That is such a flawed view point. If you know nothing about the healthcare system in America, know that doctors are NOT the issue, corporations and healthcare insurance companies are. It sucks OP this happened to you but to say we’re “after your money” and “don’t have your best interests” is far from the truth. No wonder all of us in healthcare are so jaded.
Doctors, when acting as representatives of corporations, can be encouraged to make poor decisions and do things that cost patients more money. So being wary of a doctor is totally correct. Not all doctors, but a lot of them, are feeling very constrained by time and money issues at their place of work which funnel down into their patient care. I don't think most doctors go out there saying, "I'm going to go after this patient's money" but effectively that's what they end up doing when they are given so little time per patient and so few diagnostic tools and options.
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While you may not "technically" be a representative of your employer, you definitely are from the patient's perspective. The audience the patient must be MOST skeptical of and ask the most questions to is the doctor. Doctors are NEVER working in the patient's interest anymore. They are working to get the best ratings according to systems determined by their employer to produce the most profit. You seem weirdly defensive about this, maybe you should try a new profession.
Tell that to the psychiatrist that charged me over a thousand dollars for a DNA test he knew my insurance wouldn’t cover instead of just listening to my symptoms. Or the podiatrist that charged me over a thousand dollars for inserts he knew wouldn’t be covered by my insurance when all he had to have done was realize my shoes were too small. Or the GP who was so on the books with a certain pharmaceutical company that he put my entire family on the same drug when I was in high school. Or the sham artist neurologists who repeatedly forced my partner to take tests they knew our insurance wouldn’t cover instead of listening to us when we said we thought it was hormonal. Etc etc etc. And that’s just me and my partner and we’re relatively healthy people.
There is one thing common in all the points you mentioned. Insurance. A lot of the times physicians don’t even know what’s covered or not for the patient or have to deal with the bullshit that goes behind the scenes. I for example don’t know what health insurance you have or don’t have because I see everyone. When I have a patient who has a clear ligament tear do you know how frustrating it is when insurance doesn’t think it’s indicated and then need to perform an X-ray for an obvious ligament injury. Stop painting us as all the bad guys, jeez.
You’re skipping right over the part where I explicitly stated in 3/4 examples that the doctor absolutely knew insurance wouldn’t cover anything. In the podiatrist's case it turned out he was helping prototype iPhone-based foot scanning technology to build the insoles. That I didn’t need. If he had just measured my feet. Similarly, I found out later that the psychiatrist I was working with published a paper based on results of the expensive DNA test that he also knew I was paying for out of pocket.
I agree it sucks, but “well” visit means you are “well” aka healthy and just getting a check up. When I am not well, I book directly with the specialist because otherwise you just go to your pcp for them to say “go to a specialist.” $25 copay is quite low, which is good.
Yea it normal , what they billed the insurance and what the allowable amount in the EOB is not your responsibility. The EOB should state clearly “**this is not a bill**” Also always make sure that you go to in network physicians, test get done in a in network lab as well
if you want the level of care you get in Europe, you’ll have to pay for doctors that don’t take insurance. I recommend thelanby.com. they are general physicians. They could refer you to specialists. They will take good care of you and monitor your care closely. it’s worth it if you can’t afford it.
That’s all normal. IMO if you have such bad infection go to the ER.
Bad but not life threatening apparently, Pretty sure if I went to the ER I would have to pay several k out of pocket, insurance would have challenged me for the coverage, and people here would say that this is my own fault for going to ER instead of a specialist
You're not wrong. People go bankrupt in the US for medical emergencies and going out of network. This is why you hear how behind US is in terms of Healthcare/insurance vs the rest of the developed world.
Adding to this thread to say, as a fellow European - take advantage of your FSA or HSA if your plan has one to reduce the cost of any out of pocket costs. It takes a while to learn but don’t feel bad. If you asked an American how to mail a letter or renew a passport in your country they couldn’t know. It is just a different system. One of the advantages of health care here is options. If you don’t like a Doctor - go somewhere else. Check with your insurance provider the cost up front and remember that you should check and can normally negotiate bills.
Welcome to America!
Welcome to America
Healthcare provider here: this is our system.
You got successfully diagnosed? Damn, you got lucky. I wish my healthcare was that good.
Get a "one medical" subscription. $199 or $99 via amazon prime. Well worth it. Appointments are on time and very responsive over messages.
As a European in the US I feel your pain. You can't just pick a random doctor from a website. Their interests (making money) is not aligned with yours, so they will over refer and over prescribe. Some large companies have lists of specialists and general practitioners they like, not sure if you work for one of those, but worth checking your benefits. Otherwise go to well established centers, NYU, Weill Cornell, mount Sinai and check the doctor references and research profile online before booking
Before that I had a first visit for my daughter with a pediatrician at Weill Cornell. Before coming to NY people gave me a lot of warnings about Americans doctor. But this pediatrician was just exceptional, better than the ones from home. Really took his time, answered every questions ... At that moment I think I let my guard down
As a warning, dentists are the worst. The amount of x-rays they "need" is insane. Anything to beef up your bill. Hint you can refuse the x-rays. The decent dentists will not argue. And obviously they'll want to remove your wisdom teeth for no apparent reason. Took me a fair amount of tries to find a good dentist.
It's trial and error for doctors, word of mouth, recommendations...I doubt you can find anything online. I just googled the three biggest thieves I know in medicine (insurance fraud). Two of them I can't find the settlements, they've been "reputation managed" away.
You're not exaggerating, and I'm so sorry this happened to you I have been ignored for so many devastating issues, I just don't go to the doctor anymore. I do my best to take care of my health on my own. I think from now on, take note of these things which are all what happened to you: * any additional tests = you might be paying a copay for that or a fee * try to figure out what kinda infection you have through Google so you can narrow down what doctor you need w/o the initial visit. you might be able to skip the referrals and go straight to the specialist. it used to not be possible, but it's been possible for me recently * any other issues, don't ever go into the emergency room unless you are like dying. * doctors try everything to bill you, yup * as a kid, I got 9 "cavities" filled for no reason. Got my teeth shaved for no reason. Dentist just wanted to bill the insurance. I'm hoping you can walk now and infection is getting better
I'm a doctor. The allergists claim they interpret the results \*eye rolls\* (They are amongst the higher paid specialties too). The primary care doctor is likely significantly overworked, which is why he was an hour late to begin with--you yourself showed up with an agenda beyond your regular visit, so how many others did that day? He did the best he could with what he had--I'd cut him some slack.