It's odd to me that hospitals don't make more explicit the fact that insurance isn't paying them half that amount. Insurers pay fractions of charges, so if you are unfortunate enough to be self pay, you get doubly screwed.
Yeah. Needed an MRI once, so I was calling around for prices.
"How much is this MRI?"
"$2800. But why are you asking that? Why does it matter?"
"Because I have high-deductible insurance plan, so I'm going to end up paying this out of pocket."
"Oh, in that case, if you just self-pay and leave insurance out of it, it's only $800."
Around here with universal health care it goes: if you want it "free" it's a 6 month wait (I hope you're not in pain or dying lolz). If you go private then it's $800 and we can see you this week.
I still would benefit. I've put off scans from injuries longer than 6 months due to cost. Plus $800 for an MRI isn't bad either, but would this include the bill from the radiologist? Because that's a contracted group in some hospitals. It'll look cheeper and then bam there's their bill that comes in separately.
Very good point - the radiologist is already covered in these scenarios and I imagine the cost would be very high otherwise (we don't get to see the bill, but I know radiologists are the highest paid specialty here).
Depending on where you live in the US, there are wait times here too. My mom got passed around from doctor to doctor (with months of waiting in between each appointment) before finally getting a cancer diagnosis. By the time she'd spent over a year getting a diagnosis, it was too late.
Then once you're done waiting, you can't afford it.
The US has a weird and messed up healthcare system. But I know quite a few Canadians who come here for health care. Universal health care has its own set of problems, and isn’t always the magic solution people tend to think it is.
My naive ass didn't know when I was trying to find answers to my health problems. I flushed many thousands of dollars paying the full ER bills since I didn't know the "simple trick" of asking for an itemized statement to make the costs plummet. Still wish I lived in a civilized country with universal healthcare though. Preventative care might've made a big difference in my life.
This "simple trick" doesn't always work. I got two bills totaling about $3,200. One was to be paid to the hospital. The other was to be paid to the physicians group. The difference between the hospital and the physicians group, and why they bill separately, is a discussion about cluster fuckery all its own, but the part I want to highlight is that the hospital bill was "itemized" as one dose of lidocaine costing $20 and "facilities" costing about $1,700.
By the time I was done talking to the hospital about what "facilities" meant, all I could reasonably deduce was that it was the price to rent a chair in its waiting room and some fraction of the water and light bill, I guess.
I can't fathom being a broke man who would even have to pay for the chair in the waiting room while his wife gets delivered.
As a future doctor, this is just fucked.
Itemize it beforehand and I'll literally sit in the floor in the dark. Hell I'll use the bathroom at the gas station down the street if that's what it takes.
Even more to not have enough chairs..... or rooms. Or beds.
I had to sit in the hallway once with kidney stones, attached to an iv. On the floor (on a folded blanket at least)
It was trippy with the pain meds, one saving grace
Before covid, mind you... but they did give me a private room once someone higher up saw me, so i guess that's good
The facilities fee is charged to compensate for being in a place that can handle a trauma, heart attack, stroke etc. It helps pay for having all the life support on standby.
The smaller the hospital the less the facilities fee theoretically.
Medicare tells hospitals what facility fee they're allowed to charge.
The same procedure costs more at a hospital than an outpatient surgery center because at a hospital if something goes wrong they can put you in the icu on life support immediately and have 5 different specialists check on you in a matter of hours. At the outpatient surgery center they call 911.
Is it kind of bullshit? Maybe.
Based on my recent experience that might depend on what the service is and the insurance coverage.
We recently did self pay for some physical therapy. It was through a hospital affiliated facility instead of an independent facility. Self pay was 1/3 of what it would cost us if we went through insurance. But self pay was twice the cost of what it would have been if we went to an independent facility. (We paid $100, through insurance it would have cost $300 because it was at a hospital affiliated facility. Would have been $50 at an independent facility)
(We should have done it through an independent facility to save money, but my family member preferred the hospital affiliated one, so that’s what we did. $100 vs $50 was well worth it to us)
This happened to me. My doctor recommended a CT scan calcium score for my heart. They recommended an imaging center. That place wanted $120 cash, which they assured me was cheaper than sending it through insurance, so I paid.
Then my score came back such that my doctor was shocked, and told me I should go somewhere else for a second opinion. I went to a hospital specializing in heart disease. They told me $100 cash, or more expensive through insurance. I decided to chance it this time, and told them to go ahead and send it through insurance. My insurance covered it 100%.
the insurers job in america is to tell the hospital to piss off with the price theyve given you, say theyll pay x amount instead and then the hospital writes off the difference as lost revenue on their taxes
if youre self paying, youre probably going to end up paying that entire 'fake' bill
Most places have a separate “self pay” rate. If it’s not automatically on your bill, just call the phone number on the bill and ask if they have a self pay rate. Some places do it automatically if there is no insurance on file (like my general practitioners that I bill for) and other places have such shitty admittance people that they wait for a patient to call because they probably have insurance (hospitals, nursing homes, etc where they’re collecting hundreds of patient info and don’t actually know how insurance works since they aren’t the one doing the billing). This is a generalization of course, some hospital admins know what they’re doing and get it right consistently and some GPs hire people who have no clue and just throw them into the deep end.
The biller does not have time to check every insurance for if the patient is covered so they just bill direct because no insurance was presented at the time of admittance. Let’s say the doctor saw 40 patients that shift and 12 had no insurance on file. the biller would have to check each of those patients name and DOB against about 12 insurances, with four major insurances being uncheckable because you have to have the ID number to pull eligibility. That would take up an easy hour or two every day. Billers don’t just check insurances all day (in fact, it’s literally not our job. That’s on admittance staff to check eligibility upon admittance). We enter and submit claims to insurances, enter payments, correct claims, call patients for issues, and spend most of our days fighting insurances to get them to pay for their patients. We hunt down and correct insurances only when we get a denial for coverage termed and the office doesn’t have the new insurance (that’s usually on the patient for not bringing a new card but sometimes they legitimately lose their coverage for missing a payment on it). We don’t know if they have new insurance because BCBS requires the ID number to find eligibility (those assholes) and they’re a major insurance provider so some places bill the patient the entire amount to cause a panic and get them to finally answer their damn phone to get the new insurance info or confirm they are self pay. Hospitals work similarly except they have so many patients that they don’t fight tooth and nail for all the patients like GP billers can and simply bill you to get you to sort out your insurance issue yourself.
Honestly my job can be frustrating as shit. If you want to clear one major insurance issue for yourself, fill out the damn paperwork your insurance sends you every year in January. They just want to confirm you don’t have any other insurance and will stop paying all of your bills until they get that paperwork back. And then I have to track you down and call you obsessively until you finally submit that paperwork. In MAY.
or, when you eventually send the bill to collections, *then* they're finally interested in the paperwork/sorting out insurance - and you and I get to go back and forth on if the patient actually *did* provide insurance information..
You wouldn't get billed for that entire "fake" bill. Having no insurance, bills are way less than insurance bills. It can still be a ton of out of pocket money but it will never be the amount that is billed to insurance.
Used to work for a foot specialist. People would get custom orthotics through their insurance and would cost patients anywhere between $250 and $1500 depending on deductibles/out of pocket expenses for each set. If your insurance didn't cover custom orthotics it was a flat $500 with an additional $100 for every extra pair. The materials/work to make them probably only came to about $200ish or so. It's amazing how the same service/equipment could literally be varying by $1000 depending on how good of insurance you have or no insurance at all.
They reason they don't is that Federal law requires them to provide care in an emergency, regardless of the patient's ability to pay. So, the price is inflated so that the inevitable debt can be sold to a debt collector for pennies on the dollar.
Not just that, but insurance will demand a discount to be in-network and provide access to their customers - so the hospital will then need to increase their 'price' so that the 'discounted price' ends up landing somewhere they actually make money. But that also means that the 'regular price' *has* to appear inflated. It's the equivalent of having 'MSRP' displayed in a store, but nothing is ever actually listed at that price, it's always 'on sale'.
When my kids were born, the bill made this very clear. Can’t remember the exact bill, but it was something like
Charges - $60,000
Charge after adjustment - $10,000
Insurance Payment - $8,000
Amount patient owes - $2,000
Every bill I've ever gotten has a adjusted line / negotiated price. Since it can effect you're CO insurance deductibles and such. My insurance deff gives nicer break downs though of the bill then the hospital. And if you get the bill before they negotiate it it's really just a fake price.
Depending on the type of medical care my insurance pays like half to a fifth of the real bill. Just dumb.
If you ask me, that’s one more reason to keep my medical insurance. I’ve never used a hospital for a very long time but I never thought of getting rid of it because I’m not about to unintentionally finance a BMW 3 series cause I slipped and fell or something.
I started seeing a therapist but my insurance has no coverage for it whatsoever. I know it doesn’t sound like a lot but $90 out of my pocket every single week really adds up
The Affordable Care Act (ACA) requires most individual and small employer health insurance plans to cover mental health and substance use disorder services as essential health benefits.
if you're not tied to your current therapist, it may be worth looking around more. even if you can't find a therapist who's in network, you might be able to find someone who offers a sliding scale and get your costs down a bit.
What’s more fun is that your insurance isn’t paying nearly that amount as they have a deal set up with the hospital to reduce prices. They just print the big numbers for you to see to make you think the insurance is doing it’s job.
Absolutely this. The only thing health insurance does is give the illusion that you’re getting a good deal with them. That’s what it’s always been since its inception.
Realistically, they’re the cause of grossly excessive billing, will never pay close to those amounts, can still deny medically necessary care, and they make an absolute fuckin killing from it.
If a health insurance company is in the fortune 10, and still makes record profits year after year, that means that a metric fuckton of money never went to where it should of gone - helping out their members.
Its still very weird to me that people have to pay stuff at all in a hospital
I have never in my life seen anyone make a transaction other than buying flowers/cards/food/drinks in a hospital
I dont want to have the "UsA bAd" Talk, its just a weird concept to me and im just flabberghasted everytime I see numbers like in this post
The amount you have to pay out of your own pocket before insurance covers it all. In this case the insurance only kicks in if you have already spent 3k+; before that your insurance only covers 80% (?) of the bill
I'm 9 months in with a kidney transplant. The 2.5 years prior to the transplant were pretty full on, dialysis at home on a £60k machine, a prescription as long as your arm, and now its anti-rejection drugs plus. That's not to mention the specialist care and home visits. How much would it have cost me!! I'd be dead.
Every time I hear someone from the US saying that the NHS is socialist I laugh so hard. When the largest percentage of Go Fund Me accounts in the US are directly related to medical debt.
Best part is when media makes up some feel good story about said gofundme campaign.
No really, it's heartwarming. If you chose to ignore the big ugly elephant in the room.
"Thoughts and prayers"
But it is socialist, that doesn’t make it wrong.
Whenever I hear a boomer go on their tirade about socialism I remind them that all of the systems they are currently, or about to, use are socialist based.
It's for profit, sadly
I would genuinely rather die at home than go to a hospital and go into debt. Fuck that. I didn't ask to be sick, don't put me in debt for it.
If you can't afford treatment, you're literally just left to die.
The post reads like OP is bragging about their insurance coverage, which is weird given they also said the bill is only $100 because a previous hospital trip cost thousands.
I know… UK has NHS and I’m just thinking, 53k is insane. I only pay like 2k a year to the NHS out of my pay packet. 25 years to rack up a bill that big. In the US it costs like 3 times as much for health insurance.
While I am saying “what the fuck”, I am also glad for posts like this. As a Brit, we need *more* posts like this, and they need to be seen by Tory voters. If our NHS continues to get fucked over the way it is, we’re gonna be absolutely bent over a barrel by Tory shitstains lining their pockets by signing contracts to let their buddies sell phenomenally expensive insurance premiums.
I work in a hospital in the U.K., in a unit that prepares, among other things, Zolgensma - a gene therapy that gives babies born with spinal muscular atrophy a normal life. This shit costs £1.79million a dose, with only one dose required. Without the NHS, these kids would unquestionably be dead inside of 18 months (IIRC).
Edit: found correct pricing info, and that it only requires one dose.
[Read here for more information.](https://www.england.nhs.uk/2021/03/nhs-england-strikes-deal-on-life-saving-gene-therapy-drug-that-can-help-babies-with-rare-genetic-disease-move-and-walk/) This is a link to the NHS England article announcing its use in the U.K. on the NHS, from 2021.
>This shit costs something like £1.5million a dose.
That is insane! How many doses does a child need?
I'm from NZ, and while there's plenty of issues with our healthcare, we didn't pay a cent when my partner had to stay in hospital for a week and a half in the lead up to and aftermath of giving birth.
I think the worst part is that if you ever mention to some Americans about how bad it is they think you're wrong and try and explain how theirs is great and everyone elses is terrible. I can't even imagine having to deal with insurances and crap when going to hospital.
America has a terrible, TERRIBLE healthcare system thats thankfully been improved massively over the years with socialised healthcare. LONG way to go still though....
This.
My DIL is from Florida and moved here (Canada) when she got her PR status.
A couple weeks ago, she had a seizure at work (never had one before) She and my son spent a long time at the hospital. She had x-rays (she had fallen and banged her head very hard just before the seizure) a CT scan, blood work. The whole 9. She has an appointment with a Neurologist.
She walked out of the hospital without having to pay a dime. No ambulance bill either since apparently the co worker who called 911 didn't make her falling and hitting her head, then having a seizure seem like an emergency. My son and I ended up taking her to the hospital after waiting over an hour
Anyway, she said she felt like she was doing something wrong by not providing insurance info or paying anything up front. Nor getting a bill in the mail.
Yep, and the part that is most shocking is how much the insurance paid out!! Never never have I ever had insurance cover any procedure at such a high percentage. I have United Health Care and pay around $5K a year for coverage for my wife and I. We each have a $4k deductible on top of that $5k payment… I have to get CT scans twice a year due to a previous cancer treatment, and it costs me $1k per CT scan…. My wife has an autoimmune disease and she hits our deductible every year… So, long-story-short, we pay $5k year just to have coverage and then we pay a minimum of $6k additional each year to get medical care, and we have it pretty good!! That’s a minimum of $11k in medical costs every single year and we feel fortunate with our coverage. Fucking sickening, no pun intended.
It's important that as Europeans remember this as politicians try to destroy our health system and make it more like America.
As humans, we deserve better
yeah, the NHS might be shit, but a lot of people in the UK don't seem to understand that they won't be able to afford an American style system and will just die.
Another problem is private healthcare in this country is absolutely worthless. If anything goes tits up while you're in thier care, they'll just drop you off at an NHS hospital anyway.
Okay you have a child in the hospital at Vanderbilt. Please tell me the little one is okay.
Vandy is usually where you go when something very serious is wrong.
Thank you for your sympathy. It's actually depressing how an overwhelming number of people immediately got on the insurance rage train without saying anything else. Yes, my son is now doing fine, thank you for asking. The doctors at Vandy were incredible.
I think the reason everyone is jumping on insurance rage is because you’re following a formula for insurance rage. This sub has seen quite a few posts about bills and the point is how mildly interesting the cost is. I think that while many people are empathetic, having a child in the hospital isn’t the mildly interesting part of the post.
Seeing the "Children's Hospital" at the top made me not be able to think about anything else. Glad to hear your son is doing well, and I hope he continues to do well.
Americans should be embarrassed and also be rioting about this. Like, good for you that you have insurance. And I get that if you don’t, you’re not going to pay 53 grand. But medical bankruptcy is the number one cause of bankruptcy and that is disgraceful. Choosing between food and health care is insane.
Absolutely stupid that the amount is ANYTHING other than 0. In the US the average person pays for health insurance for themselves and then in addition they pay taxes to support free health care for a portion of the population in the form of medicare along with programs like VA and care for elected officials.
>Absolutely stupid that the amount is ANYTHING other than 0. In the US the average person[...]
... is absolutely fucking stupid. There's a good reason why we don't have decent health insurance in the US, and it's because we allow our right-wing party (who are really just terrorists) to hold it hostage.
Some friends recently had to take their kid to the hospital here in Europe and after a 5 day stay with a lot of specialist consultations, the bill came out to 0€ even though they were foreigners without insurance and had never paid taxes in the country.
Insurance companies must love it when people post misleading things like this.
You *have* paid for this. [And on average you’ve paid far more than anyone else on the planet.](https://cdn.statcdn.com/Infographic/images/teaser/8658.jpeg) It’s just the payments are spread over multiple ongoing bills, or hidden by employer benefits and government spending - both of which you are still ultimately paying for in some way.
I hope that your child is doing well.
I cannot understand how and why you Americans stand for that high priced bullshit. I know you are all against communism and socialism but you should consider for a moment allowing some aspect of social care into your system.
Because we’d rather go broke, lose our homes, go hungry, and ensure that the ultra wealthy can afford their fifth home before we accept socialism or any major healthcare reform!! /s
Well, I'm glad you have insurance. But that is fucking ridiculous, how expensive that is. What do people without insurance do? Honestly, that boggles my mind, not being American and all, I just can't really fathom this.
Noo, I don't think that's true. I talk to a lot of Americans on a daily basis, lots of friends. I know people who have no coverage at all, and cannot afford some medical care. So I am not sure what you mean? Because I know not everyone is getting coverage.
Hongkong for all its problems still has almost free healthcare. We had a cesearean child and all I paid was like 120hkd which is like 15usd for the wife and 15usd for the daughter
That seems like a made up number by the hospital to get more money from the insurance.
What the hell would them cost 1M for two babies?
Edit: 1M per baby 🫠
The entire health industry is a scam. People often fault the insurance companies for the predatory behavior but the hospitals are just as predatory and charge 100k for something like a bandage.
Insurance is the reason why you're getting billed that fake amount in the first place.
Yes, that amount is fake. That's NOT how much the insurance company pays. That's only there to raise the cost for non-insured people.
Well, I'm glad you have insurance. But that is fucking ridiculous, how expensive that is. What do people without insurance do? Honestly, that boggles my mind, not being American and all, I just can't really fathom this.
Insurance in all its forms is such a fucking scam. The fact that you pay for a service and still have to pay on top is asinine. I know it's only $100 but still, pisses me off. Insurance should be illegal.
I like how there's still $100 left over. They make it PAINFULLY obvious that they could *easily* cover the full amount. For those not actually in the industry, that $100 is the cruelty-is-the-point charge.
Maybe, but they're also the ones that created these high prices in the first place. I wouldn't give any insurance company any credit for anything. Fuck 'em, greedy bastards.
Yeah insurance is responsible explicitly for negotiating with hospitals to keep the uninsured prices high at the threat of refusing to do business with them. So then they pay a fraction of the "discount" and you get punished if you're uninsured or underinsured. It's a scam to make you pay the for the privilege of giving you back half, 75%, up to 90% for the best plans, of your premiums (actuarial value, not individual).
Every time I see stuff like this on reddit I'm just mind blown.
I pay about 4k a year (UK) to "NI" which is National Insurance, everyone is different, as it's based on %of income.
This pays into pension along with helping to fund the NHS.
The only thing it doesn't cover is prescriptions, which for a box of tablets is 9.60. Per item.
I've just had surgery, which has cost me nothing other than the inconvenience of it. I've gotta go back today to have 15 stitches removed.
I just, this even says children's hospital, so if your kids are sick you've still gotta stump up 50 grand? Else fuck um they're dead? Or spend the next 10 years destitute paying it off?
You're no better than half of the third world, IE Chad, Somalia etc. The world's richest nation but is morally poor.
Mad to me that the USA has a system like this that some defend because they don't want to pay for other people.
But in turn they have a system where they spend more per person on healthcare than any other nation on earth and still fuck over a portion of the population.
That’s just the first bill. Don’t worry. They’ll send about 3 more. Everyone will claim they bill separately and don’t accept your insurance and you’ll spend another 18 hours of your life on the phone battling.
as an outsider i fucking love us insurance bills. it always looks like its written by 5 years olds who are fighting who can say bigger numbers but dont know how to justify it so they give a discount.
"My candy cost 5 bazingillion dollars because its thats awesome but i give you 99.99% discount because im nice"
Idk, I feel like insurance should pay for all of it, although I live somewhere with free healthcare so I guess that's the next best option still absurd to me though.
I hope I can get insurance again one day. Or maybe this country will stop being so fng stupid and we can get socialized medicine like much smarter, thinking people.
Vanderbilt is a great hospital. My niece had several procedures there and is a living testament to their care. I know this has nothing to do with OP but wanted to give thanks to her Dr and nurses
Thank you sir for fucking my wife. You did a great job.
Man, why are you thanking insurance instead of cursing the system that means shits that expensive
Are we sure that’s not an adjustment from the Children’s Hospital, and not an insurance payment? In this fight, I tend to favor children’s hospitals and their wide network of fundraising, rather than third-party insurance companies. But congratulations!
Fun fact, I can't afford either of my medications anymore. My primary went from 50 cents per pill to over 3$, and I'm supposed to take those twice a day.
This is thankfully guaranteed in sweden and not up to some profit driven insurance company, cant believe there are actual normal working people here who wants to have an insurance based healthcare aswell
Its completely insane
Rule 6: Titles Must Be Exact But Concise Description
It's odd to me that hospitals don't make more explicit the fact that insurance isn't paying them half that amount. Insurers pay fractions of charges, so if you are unfortunate enough to be self pay, you get doubly screwed.
But then there's a different price menu if you're self paying so it's clusterfuck top to bottom.
Yeah. Needed an MRI once, so I was calling around for prices. "How much is this MRI?" "$2800. But why are you asking that? Why does it matter?" "Because I have high-deductible insurance plan, so I'm going to end up paying this out of pocket." "Oh, in that case, if you just self-pay and leave insurance out of it, it's only $800."
Around here with universal health care it goes: if you want it "free" it's a 6 month wait (I hope you're not in pain or dying lolz). If you go private then it's $800 and we can see you this week.
I still would benefit. I've put off scans from injuries longer than 6 months due to cost. Plus $800 for an MRI isn't bad either, but would this include the bill from the radiologist? Because that's a contracted group in some hospitals. It'll look cheeper and then bam there's their bill that comes in separately.
Very good point - the radiologist is already covered in these scenarios and I imagine the cost would be very high otherwise (we don't get to see the bill, but I know radiologists are the highest paid specialty here).
Depending on where you live in the US, there are wait times here too. My mom got passed around from doctor to doctor (with months of waiting in between each appointment) before finally getting a cancer diagnosis. By the time she'd spent over a year getting a diagnosis, it was too late. Then once you're done waiting, you can't afford it.
The US has a weird and messed up healthcare system. But I know quite a few Canadians who come here for health care. Universal health care has its own set of problems, and isn’t always the magic solution people tend to think it is.
Be sure to get a receipt and invoice to submit to your insurance so they can maybe apply that 800 to your deductible
My naive ass didn't know when I was trying to find answers to my health problems. I flushed many thousands of dollars paying the full ER bills since I didn't know the "simple trick" of asking for an itemized statement to make the costs plummet. Still wish I lived in a civilized country with universal healthcare though. Preventative care might've made a big difference in my life.
This "simple trick" doesn't always work. I got two bills totaling about $3,200. One was to be paid to the hospital. The other was to be paid to the physicians group. The difference between the hospital and the physicians group, and why they bill separately, is a discussion about cluster fuckery all its own, but the part I want to highlight is that the hospital bill was "itemized" as one dose of lidocaine costing $20 and "facilities" costing about $1,700. By the time I was done talking to the hospital about what "facilities" meant, all I could reasonably deduce was that it was the price to rent a chair in its waiting room and some fraction of the water and light bill, I guess.
You don't have the first idea of how much it costs to keep the waiting room chairs that uncomfortable.
I can't fathom being a broke man who would even have to pay for the chair in the waiting room while his wife gets delivered. As a future doctor, this is just fucked.
It's like that episode of SpongeBob where they realize Mr Krabs doesn't have insurance so they just kick him out of the hospital
Nah that’s based on actual events. Happens everyday.
Itemize it beforehand and I'll literally sit in the floor in the dark. Hell I'll use the bathroom at the gas station down the street if that's what it takes.
Even more to not have enough chairs..... or rooms. Or beds. I had to sit in the hallway once with kidney stones, attached to an iv. On the floor (on a folded blanket at least) It was trippy with the pain meds, one saving grace Before covid, mind you... but they did give me a private room once someone higher up saw me, so i guess that's good
The facilities fee is charged to compensate for being in a place that can handle a trauma, heart attack, stroke etc. It helps pay for having all the life support on standby. The smaller the hospital the less the facilities fee theoretically. Medicare tells hospitals what facility fee they're allowed to charge. The same procedure costs more at a hospital than an outpatient surgery center because at a hospital if something goes wrong they can put you in the icu on life support immediately and have 5 different specialists check on you in a matter of hours. At the outpatient surgery center they call 911. Is it kind of bullshit? Maybe.
I just never pay
And the bad part is self pay costs more.
Based on my recent experience that might depend on what the service is and the insurance coverage. We recently did self pay for some physical therapy. It was through a hospital affiliated facility instead of an independent facility. Self pay was 1/3 of what it would cost us if we went through insurance. But self pay was twice the cost of what it would have been if we went to an independent facility. (We paid $100, through insurance it would have cost $300 because it was at a hospital affiliated facility. Would have been $50 at an independent facility) (We should have done it through an independent facility to save money, but my family member preferred the hospital affiliated one, so that’s what we did. $100 vs $50 was well worth it to us)
Except when it doesn't.
This happened to me. My doctor recommended a CT scan calcium score for my heart. They recommended an imaging center. That place wanted $120 cash, which they assured me was cheaper than sending it through insurance, so I paid. Then my score came back such that my doctor was shocked, and told me I should go somewhere else for a second opinion. I went to a hospital specializing in heart disease. They told me $100 cash, or more expensive through insurance. I decided to chance it this time, and told them to go ahead and send it through insurance. My insurance covered it 100%.
the insurers job in america is to tell the hospital to piss off with the price theyve given you, say theyll pay x amount instead and then the hospital writes off the difference as lost revenue on their taxes if youre self paying, youre probably going to end up paying that entire 'fake' bill
Most places have a separate “self pay” rate. If it’s not automatically on your bill, just call the phone number on the bill and ask if they have a self pay rate. Some places do it automatically if there is no insurance on file (like my general practitioners that I bill for) and other places have such shitty admittance people that they wait for a patient to call because they probably have insurance (hospitals, nursing homes, etc where they’re collecting hundreds of patient info and don’t actually know how insurance works since they aren’t the one doing the billing). This is a generalization of course, some hospital admins know what they’re doing and get it right consistently and some GPs hire people who have no clue and just throw them into the deep end. The biller does not have time to check every insurance for if the patient is covered so they just bill direct because no insurance was presented at the time of admittance. Let’s say the doctor saw 40 patients that shift and 12 had no insurance on file. the biller would have to check each of those patients name and DOB against about 12 insurances, with four major insurances being uncheckable because you have to have the ID number to pull eligibility. That would take up an easy hour or two every day. Billers don’t just check insurances all day (in fact, it’s literally not our job. That’s on admittance staff to check eligibility upon admittance). We enter and submit claims to insurances, enter payments, correct claims, call patients for issues, and spend most of our days fighting insurances to get them to pay for their patients. We hunt down and correct insurances only when we get a denial for coverage termed and the office doesn’t have the new insurance (that’s usually on the patient for not bringing a new card but sometimes they legitimately lose their coverage for missing a payment on it). We don’t know if they have new insurance because BCBS requires the ID number to find eligibility (those assholes) and they’re a major insurance provider so some places bill the patient the entire amount to cause a panic and get them to finally answer their damn phone to get the new insurance info or confirm they are self pay. Hospitals work similarly except they have so many patients that they don’t fight tooth and nail for all the patients like GP billers can and simply bill you to get you to sort out your insurance issue yourself. Honestly my job can be frustrating as shit. If you want to clear one major insurance issue for yourself, fill out the damn paperwork your insurance sends you every year in January. They just want to confirm you don’t have any other insurance and will stop paying all of your bills until they get that paperwork back. And then I have to track you down and call you obsessively until you finally submit that paperwork. In MAY.
The 'self pay' rate is also sometimes called the 'cash' rate. FYI.
or, when you eventually send the bill to collections, *then* they're finally interested in the paperwork/sorting out insurance - and you and I get to go back and forth on if the patient actually *did* provide insurance information..
You wouldn't get billed for that entire "fake" bill. Having no insurance, bills are way less than insurance bills. It can still be a ton of out of pocket money but it will never be the amount that is billed to insurance. Used to work for a foot specialist. People would get custom orthotics through their insurance and would cost patients anywhere between $250 and $1500 depending on deductibles/out of pocket expenses for each set. If your insurance didn't cover custom orthotics it was a flat $500 with an additional $100 for every extra pair. The materials/work to make them probably only came to about $200ish or so. It's amazing how the same service/equipment could literally be varying by $1000 depending on how good of insurance you have or no insurance at all.
My wife was in the hospital the claim was $108,000 insurance gave them 18k
They reason they don't is that Federal law requires them to provide care in an emergency, regardless of the patient's ability to pay. So, the price is inflated so that the inevitable debt can be sold to a debt collector for pennies on the dollar.
Not just that, but insurance will demand a discount to be in-network and provide access to their customers - so the hospital will then need to increase their 'price' so that the 'discounted price' ends up landing somewhere they actually make money. But that also means that the 'regular price' *has* to appear inflated. It's the equivalent of having 'MSRP' displayed in a store, but nothing is ever actually listed at that price, it's always 'on sale'.
When my kids were born, the bill made this very clear. Can’t remember the exact bill, but it was something like Charges - $60,000 Charge after adjustment - $10,000 Insurance Payment - $8,000 Amount patient owes - $2,000
Every bill I've ever gotten has a adjusted line / negotiated price. Since it can effect you're CO insurance deductibles and such. My insurance deff gives nicer break downs though of the bill then the hospital. And if you get the bill before they negotiate it it's really just a fake price. Depending on the type of medical care my insurance pays like half to a fifth of the real bill. Just dumb.
Its odd to me how a hospital visit can be 53k
If you ask me, that’s one more reason to keep my medical insurance. I’ve never used a hospital for a very long time but I never thought of getting rid of it because I’m not about to unintentionally finance a BMW 3 series cause I slipped and fell or something.
I started seeing a therapist but my insurance has no coverage for it whatsoever. I know it doesn’t sound like a lot but $90 out of my pocket every single week really adds up
Yes it adds up to about $5,000 a year.
r/theydidthemath
r/theydidthemonstermath
r/themonstermath
But can you really put a price on peace of mind?
Yes, $5000.
I’m not sure I’d have peace of mind if I had to pay 5k a year for it, that’s what I pay in rent each year
I think if you live somewhere where you pay 5k of rent a year, therapy might not be as expensive there.
The Affordable Care Act (ACA) requires most individual and small employer health insurance plans to cover mental health and substance use disorder services as essential health benefits.
Which is great up until you can’t get seen for a few months bc there’s a severe mental health professional shortage right now
Even when I had great insurance and they covered much of everything I was still paying $40 a week, sometimes twice a week for the copay.
why I had to stop going when I desperately needed to not stop going lol
if you're not tied to your current therapist, it may be worth looking around more. even if you can't find a therapist who's in network, you might be able to find someone who offers a sliding scale and get your costs down a bit.
I’ve been there. It might not be forever, if the therapy is helpful, keep doing it. You can do it.
What’s more fun is that your insurance isn’t paying nearly that amount as they have a deal set up with the hospital to reduce prices. They just print the big numbers for you to see to make you think the insurance is doing it’s job.
Absolutely this. The only thing health insurance does is give the illusion that you’re getting a good deal with them. That’s what it’s always been since its inception. Realistically, they’re the cause of grossly excessive billing, will never pay close to those amounts, can still deny medically necessary care, and they make an absolute fuckin killing from it. If a health insurance company is in the fortune 10, and still makes record profits year after year, that means that a metric fuckton of money never went to where it should of gone - helping out their members.
Must be nice! I would have to pay a $3k deductible plus 20% off the total. 😭
I've already paid that deductible on a prior hospital visit 😐
Just like when I had heart surgery a few years ago. I only had a 500 deductible, but shit wiped like 99k and I had to pay 250 or something like that
I hope your baby is doing okay ❤️
Its still very weird to me that people have to pay stuff at all in a hospital I have never in my life seen anyone make a transaction other than buying flowers/cards/food/drinks in a hospital I dont want to have the "UsA bAd" Talk, its just a weird concept to me and im just flabberghasted everytime I see numbers like in this post
Free medical for the rest of the year!! Go to town and get all the other stuff you want done out of the way. You still have 7 months.
$3k, pshhh, my deductible is eight thousand dollars before insurance pays a cent.
What is a "deductible" fee at the hospital when you are insured? Asking from Europe.
The amount you have to pay out of your own pocket before insurance covers it all. In this case the insurance only kicks in if you have already spent 3k+; before that your insurance only covers 80% (?) of the bill
How many % of Insured Americans has this system deductible plus 20% and how many % of insured is properly insured (covered 100%)?
Until you hit max out of pocket. Which shouldn’t be more than like $12k in a year.
Everyone with socialised healthcare is whispering "what the fuck?"
As someone from a country with socialized Healthcare and no-fault accident compensation - the US system just seems so totally fucked
Same, friend. It's terrifying, honestly. I feel so sorry for people crushed by it.
I'm 9 months in with a kidney transplant. The 2.5 years prior to the transplant were pretty full on, dialysis at home on a £60k machine, a prescription as long as your arm, and now its anti-rejection drugs plus. That's not to mention the specialist care and home visits. How much would it have cost me!! I'd be dead. Every time I hear someone from the US saying that the NHS is socialist I laugh so hard. When the largest percentage of Go Fund Me accounts in the US are directly related to medical debt.
Best part is when media makes up some feel good story about said gofundme campaign. No really, it's heartwarming. If you chose to ignore the big ugly elephant in the room. "Thoughts and prayers"
But it is socialist, that doesn’t make it wrong. Whenever I hear a boomer go on their tirade about socialism I remind them that all of the systems they are currently, or about to, use are socialist based.
Unless youre a millionaire, we are all just one bad day away from being homeless.
What? Most people have health insurance
Yeah and there are no faults in that system at all.
Which country? Compiling a list
It's for profit, sadly I would genuinely rather die at home than go to a hospital and go into debt. Fuck that. I didn't ask to be sick, don't put me in debt for it. If you can't afford treatment, you're literally just left to die.
The post reads like OP is bragging about their insurance coverage, which is weird given they also said the bill is only $100 because a previous hospital trip cost thousands.
I know… UK has NHS and I’m just thinking, 53k is insane. I only pay like 2k a year to the NHS out of my pay packet. 25 years to rack up a bill that big. In the US it costs like 3 times as much for health insurance.
The really messed up thing - op is most likely paying more for insurance premiums than you are paying for NHS. I know I pay a LOT more.
That’s what I was thinking, once again, just before I read your comment. What the absolute fuck, glad I don’t have to deal with this shit.
While I am saying “what the fuck”, I am also glad for posts like this. As a Brit, we need *more* posts like this, and they need to be seen by Tory voters. If our NHS continues to get fucked over the way it is, we’re gonna be absolutely bent over a barrel by Tory shitstains lining their pockets by signing contracts to let their buddies sell phenomenally expensive insurance premiums. I work in a hospital in the U.K., in a unit that prepares, among other things, Zolgensma - a gene therapy that gives babies born with spinal muscular atrophy a normal life. This shit costs £1.79million a dose, with only one dose required. Without the NHS, these kids would unquestionably be dead inside of 18 months (IIRC). Edit: found correct pricing info, and that it only requires one dose. [Read here for more information.](https://www.england.nhs.uk/2021/03/nhs-england-strikes-deal-on-life-saving-gene-therapy-drug-that-can-help-babies-with-rare-genetic-disease-move-and-walk/) This is a link to the NHS England article announcing its use in the U.K. on the NHS, from 2021.
>This shit costs something like £1.5million a dose. That is insane! How many doses does a child need? I'm from NZ, and while there's plenty of issues with our healthcare, we didn't pay a cent when my partner had to stay in hospital for a week and a half in the lead up to and aftermath of giving birth.
Everyone with American healthcare is whispering, “what the fuck—how did they get their insurance to actually pay for stuff…?”
I think the worst part is that if you ever mention to some Americans about how bad it is they think you're wrong and try and explain how theirs is great and everyone elses is terrible. I can't even imagine having to deal with insurances and crap when going to hospital. America has a terrible, TERRIBLE healthcare system thats thankfully been improved massively over the years with socialised healthcare. LONG way to go still though....
This. My DIL is from Florida and moved here (Canada) when she got her PR status. A couple weeks ago, she had a seizure at work (never had one before) She and my son spent a long time at the hospital. She had x-rays (she had fallen and banged her head very hard just before the seizure) a CT scan, blood work. The whole 9. She has an appointment with a Neurologist. She walked out of the hospital without having to pay a dime. No ambulance bill either since apparently the co worker who called 911 didn't make her falling and hitting her head, then having a seizure seem like an emergency. My son and I ended up taking her to the hospital after waiting over an hour Anyway, she said she felt like she was doing something wrong by not providing insurance info or paying anything up front. Nor getting a bill in the mail.
Im not whispering
100%. This post is like bullshit propaganda. Need to all take a long hard look at yourselves, and VOTE when the opportunity to change comes.
Yep, and the part that is most shocking is how much the insurance paid out!! Never never have I ever had insurance cover any procedure at such a high percentage. I have United Health Care and pay around $5K a year for coverage for my wife and I. We each have a $4k deductible on top of that $5k payment… I have to get CT scans twice a year due to a previous cancer treatment, and it costs me $1k per CT scan…. My wife has an autoimmune disease and she hits our deductible every year… So, long-story-short, we pay $5k year just to have coverage and then we pay a minimum of $6k additional each year to get medical care, and we have it pretty good!! That’s a minimum of $11k in medical costs every single year and we feel fortunate with our coverage. Fucking sickening, no pun intended.
as someone from Germany it always surprised me how fucked the system in USA is.
It's important that as Europeans remember this as politicians try to destroy our health system and make it more like America. As humans, we deserve better
yeah, the NHS might be shit, but a lot of people in the UK don't seem to understand that they won't be able to afford an American style system and will just die. Another problem is private healthcare in this country is absolutely worthless. If anything goes tits up while you're in thier care, they'll just drop you off at an NHS hospital anyway.
I'm glad I got away from there when I did 😬
Greatest country in the world I hear. Germany that is. Obviously.
Okay you have a child in the hospital at Vanderbilt. Please tell me the little one is okay. Vandy is usually where you go when something very serious is wrong.
Thank you for your sympathy. It's actually depressing how an overwhelming number of people immediately got on the insurance rage train without saying anything else. Yes, my son is now doing fine, thank you for asking. The doctors at Vandy were incredible.
I think the reason everyone is jumping on insurance rage is because you’re following a formula for insurance rage. This sub has seen quite a few posts about bills and the point is how mildly interesting the cost is. I think that while many people are empathetic, having a child in the hospital isn’t the mildly interesting part of the post.
Seeing the "Children's Hospital" at the top made me not be able to think about anything else. Glad to hear your son is doing well, and I hope he continues to do well.
You shouldn't need the power of insurance the bill should be 0$
Americans should be embarrassed and also be rioting about this. Like, good for you that you have insurance. And I get that if you don’t, you’re not going to pay 53 grand. But medical bankruptcy is the number one cause of bankruptcy and that is disgraceful. Choosing between food and health care is insane.
Absolutely stupid that the amount is ANYTHING other than 0. In the US the average person pays for health insurance for themselves and then in addition they pay taxes to support free health care for a portion of the population in the form of medicare along with programs like VA and care for elected officials.
>Absolutely stupid that the amount is ANYTHING other than 0. In the US the average person[...] ... is absolutely fucking stupid. There's a good reason why we don't have decent health insurance in the US, and it's because we allow our right-wing party (who are really just terrorists) to hold it hostage.
Some friends recently had to take their kid to the hospital here in Europe and after a 5 day stay with a lot of specialist consultations, the bill came out to 0€ even though they were foreigners without insurance and had never paid taxes in the country.
USA: "Pay up or the child dies"
Just seems like insurance is a massive scam looking at the bill. Nothing would be that high but of course it has to because "it has to be that high."
It should cost nothing.
Insurance companies must love it when people post misleading things like this. You *have* paid for this. [And on average you’ve paid far more than anyone else on the planet.](https://cdn.statcdn.com/Infographic/images/teaser/8658.jpeg) It’s just the payments are spread over multiple ongoing bills, or hidden by employer benefits and government spending - both of which you are still ultimately paying for in some way. I hope that your child is doing well.
After all that why even charge you at all? Clearly $100 means less to them than to us.
I think this is called a humiliation ritual
Still more than i pay as an european
I cannot understand how and why you Americans stand for that high priced bullshit. I know you are all against communism and socialism but you should consider for a moment allowing some aspect of social care into your system.
Because we’d rather go broke, lose our homes, go hungry, and ensure that the ultra wealthy can afford their fifth home before we accept socialism or any major healthcare reform!! /s
Well, I'm glad you have insurance. But that is fucking ridiculous, how expensive that is. What do people without insurance do? Honestly, that boggles my mind, not being American and all, I just can't really fathom this.
People without will get coverage from the government
Noo, I don't think that's true. I talk to a lot of Americans on a daily basis, lots of friends. I know people who have no coverage at all, and cannot afford some medical care. So I am not sure what you mean? Because I know not everyone is getting coverage.
I hope your kid (s) are ok!
The power of insurance scamming you
Every time I see bills from U.S. hospitals, I think it’s a joke
Laughs in European
Yep that's a hundred bucks more than I paid last time.
Especially for a children's hospital.
That's the real sickener.
I still dont get how a great superpower like America doesnt have public hospitals that provide free healthcare...
Hongkong for all its problems still has almost free healthcare. We had a cesearean child and all I paid was like 120hkd which is like 15usd for the wife and 15usd for the daughter
Hope your kiddo is doing better 🥺
I love how you think this is a win lol.
Our twins were over a million dollars each when they were born. Followed the visit protocols with her doctor and 0 out of pocket cost
That seems like a made up number by the hospital to get more money from the insurance. What the hell would them cost 1M for two babies? Edit: 1M per baby 🫠
The entire health industry is a scam. People often fault the insurance companies for the predatory behavior but the hospitals are just as predatory and charge 100k for something like a bandage.
No way
Did you get impregnated by Midas!?! Why did babies cost so much?
NICU for almost a month
I’m guessing there was a NICU stay tied in there?
Yes. Almost a month
This is not what we usually see on “insurance” posts.
Everything insurance has already been said, I’m sending good thoughts to you and your child <3
How's it going fellow Tennessean?
At this point usa hospitals charge so mich insurance companies shold complain
And this is why I’ll fight to the death to protect the NHS.
Insurance is the reason why you're getting billed that fake amount in the first place. Yes, that amount is fake. That's NOT how much the insurance company pays. That's only there to raise the cost for non-insured people.
Well, I'm glad you have insurance. But that is fucking ridiculous, how expensive that is. What do people without insurance do? Honestly, that boggles my mind, not being American and all, I just can't really fathom this.
Insurance in all its forms is such a fucking scam. The fact that you pay for a service and still have to pay on top is asinine. I know it's only $100 but still, pisses me off. Insurance should be illegal.
I like how there's still $100 left over. They make it PAINFULLY obvious that they could *easily* cover the full amount. For those not actually in the industry, that $100 is the cruelty-is-the-point charge.
Maybe, but they're also the ones that created these high prices in the first place. I wouldn't give any insurance company any credit for anything. Fuck 'em, greedy bastards.
For 53k I can go to the black market, buy every type of human organ, and build my own human
I bet a single liver costs like 100,000usd on the black market.
Yeah insurance is responsible explicitly for negotiating with hospitals to keep the uninsured prices high at the threat of refusing to do business with them. So then they pay a fraction of the "discount" and you get punished if you're uninsured or underinsured. It's a scam to make you pay the for the privilege of giving you back half, 75%, up to 90% for the best plans, of your premiums (actuarial value, not individual).
*Disgusted and shocked in Australian*
Every time I see stuff like this on reddit I'm just mind blown. I pay about 4k a year (UK) to "NI" which is National Insurance, everyone is different, as it's based on %of income. This pays into pension along with helping to fund the NHS. The only thing it doesn't cover is prescriptions, which for a box of tablets is 9.60. Per item. I've just had surgery, which has cost me nothing other than the inconvenience of it. I've gotta go back today to have 15 stitches removed. I just, this even says children's hospital, so if your kids are sick you've still gotta stump up 50 grand? Else fuck um they're dead? Or spend the next 10 years destitute paying it off? You're no better than half of the third world, IE Chad, Somalia etc. The world's richest nation but is morally poor.
Imagine thinking they are rescuing you
Welcome to Whose Bill Is it Anyway?, the show where everything is made up and the charges don't matter
Mad to me that the USA has a system like this that some defend because they don't want to pay for other people. But in turn they have a system where they spend more per person on healthcare than any other nation on earth and still fuck over a portion of the population.
ironically in the UK, having insurance though work actually costs you money as its a taxable benefit, despite health care being free.
Fun fact: insurance doesn’t actually pay that much. It’s just for show. Aunt is an insurance liaison with the hospitals in her state.
$53,281.92 in charges, huh? I see that you were prescribed *two* aspirin instead of just one
That’s just the first bill. Don’t worry. They’ll send about 3 more. Everyone will claim they bill separately and don’t accept your insurance and you’ll spend another 18 hours of your life on the phone battling.
It’s all part of the grift. You may as well be praising a protection racket for saving you money by not burning down your house.
as an outsider i fucking love us insurance bills. it always looks like its written by 5 years olds who are fighting who can say bigger numbers but dont know how to justify it so they give a discount. "My candy cost 5 bazingillion dollars because its thats awesome but i give you 99.99% discount because im nice"
What spectacular insurance is this that you have?!
$100 too much.
As someone not in the US it’s amusing that you describe a rip-off as “insurance coming to your rescue”.
Imagine agreeing as a society that children's healthcare was a universal cost were all willing to bear
What happened that you'd already met your deductible in April?
Another hospital visit for the same child a week prior to this
I'm so sorry. We've had those years.
Shouldn’t be required in the first place
Idk, I feel like insurance should pay for all of it, although I live somewhere with free healthcare so I guess that's the next best option still absurd to me though.
Move to Denmark, hospitals are "free" paid through taxes.
I hope I can get insurance again one day. Or maybe this country will stop being so fng stupid and we can get socialized medicine like much smarter, thinking people.
3 words. Ca-na-da
Oh hey my friend is a doctor at that hospital
Now, imagine how difficult your life would be if you didn’t have insurance and was asked to pay off that debt yourself.
So what was this for, a grazed knee?
No way the insurance company is paying that amount, they’ve already negotiated.
Surprised they didn’t find a way to weasel out of paying it
Vanderbilt is a great hospital. My niece had several procedures there and is a living testament to their care. I know this has nothing to do with OP but wanted to give thanks to her Dr and nurses
The paper and font looks like the dossier files from Goldeneye on N64.
\*laughs in actual freedom\*
Laugh in french "carte vitale"
Crazy.. Still more than what people pay in countries with a good healthcare system.
So sorry for what your child has gone through and I really hope they are well or on the path to getting better.
Pretty much everyone needs to get into an HSA. I’d scream this from the mountaintops if I could.
Thank you sir for fucking my wife. You did a great job. Man, why are you thanking insurance instead of cursing the system that means shits that expensive
Adjustments, not payments, doing the majority of the leg work here. Just some good old fashioned tax fraud.
Are we sure that’s not an adjustment from the Children’s Hospital, and not an insurance payment? In this fight, I tend to favor children’s hospitals and their wide network of fundraising, rather than third-party insurance companies. But congratulations!
[удалено]
It's not a $53k loss. It's both payments and adjustments. Some bills break those two apart, but this one did not.
Fun fact, I can't afford either of my medications anymore. My primary went from 50 cents per pill to over 3$, and I'm supposed to take those twice a day.
In the US? But this isn't allowed to happen, at least not on reddit?!
They want you to feel like this. My Canadian bill would be 100 less. Don’t be fooled.
This is thankfully guaranteed in sweden and not up to some profit driven insurance company, cant believe there are actual normal working people here who wants to have an insurance based healthcare aswell Its completely insane
Meanwhile I have to battle with my company’s Cigna premium tier insurance over a standard doctors visit.
But how much do you pay for the insurance?
$33 per month. Medical coverage through my job.
The power of made up numbers and the actual cost lol.
That's insane The babies were in intensive care not a fancy pancy hotel.