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How timely! American here who just received a bill for scoping my sinuses by an ENT specialist: insurance covered $28 out of the $415 procedure. This is on top of the $70 copay I owe for the $195 office visit. So all accounting factored in, I owe $450 for what I thought was going to be $70.
Because it was billed through insurance, the provider's hands are tied in terms of further negotiation. I would bet if I had gone in as a cash patient, I'd be much better off.
The icing on the cake is that the scoping procedure was non-conclusive.
The US healthcare insurance system is the ultimate way to make money fast, for little effort. As long as you're on the right side of it, that is.
copay is such a bullshit word, like i'm somehow equal partners with this trillion dollar corporation of ghouls
Try telling them you decline to pay the bill because it's outside network and see how much they value your partnership.
The worst is that insurance companies "cover" things and that's all they can say before anything is done. After, when billed, they can say "we cover 5% of the final bill. See? We covered it." And we have no idea how much we will need to pay for standard necessary procedures.
Fuck. Canadian here who is just aghast at the charge. Had a friend go through the same procedure but essentially never paid a dime. We don't even pay MSP any more but back when we did it was locked to your income bracket and while I had some bumpercrop years (my base rate is 33 bucks an hour and I work 12 hour days standard with time and a half applied for everything past 8 hours for 2019 I worked 11 months with routine 60 hour weeks) my payments never crested $250 for a quarterly payment. Heck I didn't even realize that they stopped charging for two years because I had the thing rigged to autopay.
Heck a friend of mine's Dad needed emergency hospital transfer from a small town and they used a helicopter ambulance and the family was never charged.
People want to complain that we're slower and that people have to actually wait in waiting rooms and sure, non life-threatening stuff needs to be put in a queue but from what I have heard from my US buddies wait times at least are pretty comparable.
I swear people who talk about waiting have never visited an ER for something mundane because it’s the only option opened after 6, or who never had to meet with a specialist, or get a procedure that requires one.
Story time. January 2019. I have a 6 month old baby with mysterious rash. Pediatrician has us cut out common allergens and he clears up. Tells us to book with a pediatric allergist.
Now, I don’t live in BFE. I live in Southeastern MA. By no means an area underserved by doctors. The doctor refers us to Boston Children’s Hospital. It’s an hour and a half away without traffic, or 2 hours and 3 transfers on public transit.
The first appointment available was in October. Kids 7 months old at this point and already getting appointments for longer than that out.
We get put on a cancellation list and around March we get a call for him to be seen and get a scratch test. We take it, we are going on vacation 3 days after that and we’d love to know exactly what to avoid.
Kid lights up like a damn Christmas tree, but only one food allergy (peanuts) and it comes in like 1.5x the diameter of positive control.
Next, because of his age, they want to get him into an exposure therapy study, but he needs a good challenge first and they would call us when we got back from vacation.
Well, we came back from vacation the first week of March, 2019. BCH was now not scheduling any challenges due to the pandemic. Try again after Easter when the whole thing blows over. Then a month later. And another month.
Eventually they are booking again and after getting through the backlog of people that were cancelled due to the pandemic , the next appointment is 14 months out. By that point he’s too old for the study and we neeed to wait till he’s 4.
Well, now he’s 4. We book an appointment for his food challenge. The old scratch test is no longer good. He needs another one. Next booking for that is 10 months out, again. As luck would have it, though, we called back over and over again and eventually got a booking for his scratch test.
That was back in August. We booked his food challenge while we were in the office. It will be next October, barring any more global catastrophes or blind luck on the cancellation list. He will be five.
It’s amazing to me that there’s a person who can beat me at Smash Bros who has been waiting for a doctors appointment for nearly his entire life. And people tell me healthcare in America is fine. Those motherfuckers don’t know about this. They don’t know how much it costs every time he’s out of school for a couple of days with a fever and the school wants a doctor’s note. They don’t know that after wages, the single biggest part of their compensation package is their employers portion of their health insurance. In fact, depending on their job, it may even be more than their wages.
That last bit is important. People don’t realize how much their healthcare actually costs. They see the pre-tax line item for their share of premiums, never their employers. They see that as separate from the Medicare pre-tax item, and the vision and dental, all of which they don’t see the employers portion. They might see the bills if they got the high deductible plan, but they’re somewhat expected because “they got the ‘cheap’ plan”.
See up here people go all "I had to wait six months for a specialist! Bloody socialized medicine!" lt's a blindness caused by not having anything to compare to and buying into the American political lies about our own system. That kind of wait time for a scratch test is insane even by our standards.
Yeah the ENT specialist I saw was three months after I was referred by my general physician, because that's the earliest they had available.
There's nothing admirable about US heathcare (at no fault of the healthcare workers, let me be clear).
I admit that I technically have a horse in the US healthcare system. The industry I work in contracts our labour vs the US market because they don't have to pay in to sponsor our medical insurance policy coverage. Technically speaking if the US fixed it's healthcare my job would be less competitive.
But fuck, my job ain't worth anybody suffering.
Get your jaw checked bro. TMJ can cause a lot of similar issues