795
What I'm paying to find out I don't have breast cancer. I have insurance. (Ultrasound and mammogram in the USA)
(lemmy.world)
this post was submitted on 03 Feb 2024
795 points (97.8% liked)
Mildly Infuriating
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So if I had insurance like that and I actually had cancer I'd pay the first $2,000 and then literally all treatment after that would be free regardless of cost and then I just pay like the standard insurance price?
Presumably your insurance would then go up after that or does it only go up for other cancer related stuff?
well it depends.
for major surgeries, no. after you satisfy your deductible, you're likely to pay a co-insurance on your procedure.
co-insurance is the percentage you're personally responsible.
so lets say your procedure is billed by hospital for 50,000. and your co-insurance is 20%.
you would be paying 20% of the 48000, so 9600.
up to your "out of pocket maximum", which can be like 15000 to 30000 or whatever.
if you've already paid like 10k already this year then you would just be paying up to 5k for ur cancer treatment.
confusing? yes. fuck health insurance so much.
No the treatment would not be free, most plans will also only cover a certain percentage of the overall procedure so on top of your annual deductible which mine for example is 7,500, there's also certain procedures that are not covered at all and the rest of the procedures are at a 70-85% coverage, which is still better than them not covering anything I guess but still pretty dog shit for an insurance that you're paying over $100 a month that's tied to your employer
It's pretty confusing, but basically your insurance won't cover much until you meet your deductible for the year. After that, your coverage depends on the policies of your insurance company. Some stuff may be totally covered, some partially, some not at all. And there's really no way to know what costs what until you get it done.
This is the part that drives me bats. For any other service in any other industry you can get a quote first, but for some fucked up reason healthcare in America doesn't work that way. The hospitals and insurance companies just do whatever the fuck they want, and you get to find out afterwards if you could have afforded it, i.e. after it's too late. It's such bullshit.
Indeed, I hate it when people are like "you shouldn't pay that much, you need to shop around". Assuming you even have multiple hospitals to choose from, tell me you don't get "I don't know" 9/10 times when you ask about the cost of a procedure.
you can absolutely ask the hospital for a good faith estimation.