Ask Lemmy

nobody actually pays those bills. They're just some elaborate dance between insurance companies and hospitals.

Sometimes there is an elaborate dance between the two on pricing. Sometimes the insurance company dances on its own to determine why the service is not covered.

If you don't have insurance, the cost is lower

Depends what you mean by cost. insurance is always out to make money, that means paying less, and negotiating lower prices with providers. However, there are some situations where it benefits both the service provider and the insurance provider to inflate the initial price, and negotiate a steep “discount” to a final price (a portion of which the patient pays) that is higher than the non-insurance price. But I don’t remember the exact details, and I may be conflating this with some other healthcare industry scheme.

or removed entirely. Supposedly.

If a hospital is nonprofit, I believe they are required to have a (self determined) charity care policy that they must follow. If you make below a certain amount, you can apply for relief, but that also applies for to after-insurance costs, not just no-insurance costs. For-profit hospitals will rake you over the coals and send collections after you. Part of the problem with charity care, is that you may have to ask for it, and few people know enough about it to do so. And you may have to ask for it in the right way. If you aren’t specific enough, they may offer you “financial assistance” which is just a payment plan. Then they’ll treat you the same as a for-profit hospital would.

If you’re interested in a deeper dive, the Arm and a Leg podcast is a great show about healthcare costs in the US.

It varies a lot for people, and the bills you actually pay depend on a lot of things. It’s complicated here.

I would say I’m the average “I have healthcare through work” person. But that’s not average for the population (many people have no healthcare).

I pay about $600 a month for a plan that lets me go to any doctor (called a ppo). If I wanted a cheaper monthly bill, I could get on board with the plan where you have to go to the doctors and facilities that are “in the insurers network”. I’ve had problems with these plans as they’ve become more and more run by the insurers than actual doctors - leading to shoddy care. So $600 a month for my family it is.

I did require major surgery about 10 years ago. I was in the hospital for a month and had a million office visits. The grand total “bill” was just over a half million dollars. My portion of that was about $10,000. It was crazy to look at the itemized bill though. Two Advils cost like $50. An X-ray? Like $1000. But that’s like this this fucky-fuck game insurers and providers play with each other. Sometimes people are flat broke, and the hospitals still have to care for them if they wander into the ER - and they get paid nothing. It’s a weird system.

If you don’t have health insurance-you’re kind of in trouble. Interestingly, those $1000 X-rays become $200 if you’re uninsured. Definitely more manageable-but you’d be screwed if you required major surgery. You’d be bankrupt.

Basically it’s very American-it works great for people doing well in life - screw everyone else less fortunate- get a job…

You essentially gamble a little bit. Most people get insurance through work (or they are part of a family plan). Generally, you'll have a few plans to choose from. If you are older, or have recurring issues, you might pick a plan that's a little more expensive, but covers more costs. If you are young and healthy, you might pick a cheap plan, essentially betting that you won't really need healthcare other than your yearly checkup and some vaccines.

The biggest thing with healthcare in the US is that it's very complex. Even if you have insurance that should cover something, it can be hard to find a doctor that's part of your insurance, so people often put off going to the doctor, which is part of the reason why costs are high. Teeth and eyes have separate insurance cause they are optional, apparently.

You basically have "premiums" that are your monthly payment. If you get your insurance through work, they cover a percentage of that; generally a pretty hefty amount of it. They usually don't outright tell you what percentage, though, so many people think insurance is cheap, and get a rude awakening when they lose a job, and suddenly can't afford $1000 a month when they used to be paying $100. Those premiums are taken out of your paycheck pre-tax, too, which gives you even more of a benefit if you have a job.

Depending on the "style" of the plans, they cover things differently. They all (I think) cover "preventative care" completely, which includes your yearly checkup, vaccines, and birth control for women. After that, some plans have "co-pays", which are set costs for a few things, like $25 for a normal doctors visit, $50 for a specialist, $100 for an emergency room visit. Some just cover a percentage of those costs, and some don't pay anything until you hit a limit (the deductible). Finally, there's an "out of pocket" limit. That's most you'll have to pay in a year, after which point the insurance covers everything.

All together, I pay less than $1000 a year for healthcare, but if I got really sick, and needed a bunch of expensive healthcare, I would quickly hit my out of pocket maximum, which I think is like $6,000. I could cover that, but many people cannot cover an expense like that on short notice.

The number on bills is very misleading. The hospitals know that insurance will negotiate down, so they start high, and then after the negotiations, insurance will pay some or all of the remainder. If you don't have insurance, you typically don't pay that whole number on the bill, either, cause the hospitals recognize that they dont have to adjust it up for the negotiation. You can still negotiate on your own, though.

Your friend should let all the Americans going into bankruptcy each year due to medical debt that they imagined it all along.

I pay 9.79$/month for medical only, pre-tax, myself only on the plan, working for a mental healthcare nonprofit. My medical copays have been free lately for routine office visits. I have to get labs done 4 times a year for the meds I take and those have all been free so far. Because they’re classed as “preventative” to make sure nothing goes wrong with the meds, it’s free 🤷🏽‍♂️. Non preventative things have a 2000$ deductible, so I have to pay that much before medical care for the calendar year becomes free to me. That means that if I get sick in December, I have to pay 2000$to cover for December and again in January to cover for the next year.

Dental coverage is free. I pay 40$/visit as a copay for cleanings and all else (if I’m not in perfect health) I pay 30% of that bill. Recently I had periodontitis and my bill after treatment was 600$.

I forget what count is taken out of my check every 2 weeks, I think it's like 50 bucks for vision/dental and my work actually fully covers medical?

Went to the ER 2 months ago due to severe dehydration because I was puking and having diarrhea everywhere almost as badly as when I was e. Coli poisoned. 2 hours in a chair getting a saline drip cost 2750ish, plus the ambulance ride of something like 3200? Wife got the special pass thing they sell for $100 that comes with 3 rides a year if you're in our county, so we only had to pay 100 for the ride but still.

Just shy of 6k to be rehydrated and told "lol no idea what caused it buddy come back during normal hours and we'll scan you" as my wife had been in earlier that day for the same issues, gotten an MRI (cat or whatever scan it is) and got told "lol idk", but her insurance covered it completely

We could do it cheaper if we did it like any other civilized country but nope, it makes someone money

mine is decently inexpensive through Obamacare, and I'm in a low enough income bracket. but it still isn't ideal, I needed a sleep study. with or without my insurance it was going to cost $1,000 so I just never had it

I pay $50/mo and then $25 for appts and $50 for ER visits.