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Thread: Healthcare stories

  1. #1
    Hasta Siempre Madrigal's Avatar
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    Healthcare stories

    Okay, no, seriously, I don't get it. I just read in the other thread that someone gets insane emergency room bills they have no hope of paying. What does that even mean? You just don't pay and go on with your regular life? What consequences are there for someone who doesn't pay their medical bills in the US?

    Anyway, this thread is so I (and maybe others) can understand what it's like to have healthcare (or not) in the US. However, for comparison's sake, people outside the US are also encouraged to reply. I realize some of these questions are absolutely indiscreet, so answer the ones you like.

    If you have healthcare, where do you get it from? How much do you pay for healthcare monthly? If in the US, how has that changed since the ACA? What does your health plan cover? What does that not cover and how much do you pay for what's not in the plan? What are some extraordinary expenses you have had to incur for minor or serious medical problems? What are some expenses you have incurred for check-ups or routine visits? Do you have a medical debt? Do you plan to pay it? What happens when you don't pay, how does it affect your regular life? Is healthcare among one of your bigger concerns or do you just think about it when you have to? Have you ever considered living in another country because of its health care system?

    Thank you for your participation.
    Everything under heaven is in utter chaos; the situation is excellent. - Mao

  2. #2
    malarkey oxyjen's Avatar
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    If you have healthcare, where do you get it from?
    I have had four different insurance plans in the last four years, due to moving/employment changes, income changes, etc.
    How much do you pay for healthcare monthly?
    This varies so, so much.
    In 2013--I had an employer who had decent rates/coverage for an individual plan. $150/month I think? I was there for a few years and then realized I was fucked when planning for our baby. We worked at the same place and our family insurance rate was $832/month. We had no choice really so we had to go with that (And I tried. I looked into keeping both our individual coverage and buying an ACA plan for the baby on the day he was born but nobody knew if that was possible, lol.)
    2014-mid 2015Then had an ACA plan that was six hundred something per month, because we did not have insurance through employer and made too much for subsidies.
    2015-late 2016 Had a lower cost plan, 200-something per month when my husband's self-employment income fluctuated
    late 2016-now Have an employer provided plan through mr oxy, three hundred some per month

    If in the US, how has that changed since the ACA?
    You are not allowed subsidies if you are provided a health plan deemed as "affordable" from your employer. However, they only consider individual insurance into that equation, *not* if you need to buy health insurance for your kids. So shortly after my son was born and my health insurance paid my bills, I went from full-time to "on call" status to drop benefits because the plan cost more money than what I could buy on the exchange even without subsidies.

    What does your health plan cover?
    It comes with an EOB sheet, with is an explanation of benefits. The ACA requires certain preventative to be provided, entirely free of cost to the patient. They are to cover the bulk of doctors' visits, but almost all plans require a small fee for that service (called a copay). Routine visits nowadays should not cost a lot of money unless you make the mistake of going to an out-of-network provider, whose explanation of benefits sheet has an entirely different fee/benefits chart. There are also things called coinsurance, deductibles, and copays for medication too.

    deductible--you pay all of it until you hit a certain dollar point, then your insurance kicks in
    coinsurance--some things your plan might pay 90% of the cost, and you only pay 10% of the cost
    copay--straight fee for a dr. visit, or a medication
    out of pocket maximum--the maximum amount you can pay out of your own pocket towards your health costs in a calendar year

    ^this is all confusing as fuck, but you need to know it because I have caught providers overcharging me more than a couple of times. I have never had problem getting charges removed when I point out why they're erroneous.

    What are some extraordinary expenses you have had to incur for minor or serious medical problems?
    With my first kid, I hit the out-of-pocket maximum for all the prenatal testing, ultrasounds, and hospital bills surrounding his delivery-- $5,750. Luckily my pregnancy and delivery fell in one calendar year so my deductible didn't reset again, otherwise the tab could have run past that. We used our anniversary vacation fund to help pay for it. I had a very long induction, had vaginal delivery, and baby was not in NICU. They did prep the OR in case I needed a c-section though. The cost for hospital stay billed to insurance was 30,000.

    What are some expenses you have incurred for check-ups or routine visits?
    Most of my care is preventative nowadays (immunizations and well-baby checks for the kids), they were both born since ACA passed. Formerly it would be a copay cost each office visit, cost of any bloodwork, cost of vaccines. The cost of that varies by not only each health plan, but whatever contracted rate the doctor you see has with that particular health plan. And very very few people can tell you how much you will pay out of pocket for something. My doc recommended a screening in my second pregnancy and I was wary of how much it would cost and I was on the phone for at least 45 minutes over a span of two days. The doc told me to call insurance and the insurance told me to call the doc. I decided I didn't need it so I cancelled it.

    In pregnancy, they can charge for certain labwork screenings, and any radiology/ultrasound. These are not preventative for whatever reason. My labwork was a middling two digit number, ultrasound low three digits.
    Do you have a medical debt? Do you plan to pay it? What happens when you don't pay, how does it affect your regular life?
    I don't have medical debt. I wholeheartedly believe in paying what you owe, even if you need to draw up a payment plan for a small amount every month. I think if you don't pay, it goes to collections and affects your credit. I'm not sure if it goes further than that, as I have no personal experience.

    Is healthcare among one of your bigger concerns or do you just think about it when you have to? Have you ever considered living in another country because of its health care system?
    Being pregnant twice in the past four years, and thus going to the doctor monthly/biweekly/weekly for 9 months (and then a hospital stay) made me very fucking aware of health care. Normally I'm pretty healthy and don't think about it too much otherwise.
    Last edited by oxyjen; 03-08-2017 at 04:17 PM.

  3. #3
    malarkey oxyjen's Avatar
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    I also liked the ACA because you are not just stuck with whatever your employer has. We selected a plan off the exchange that made sense to us due to the makeup of the prescription drug benefits/deductible/premium/out of pocket max when we were considering the costs involved of having a second baby.

    ETA: also fun quirk of the US medical system. If you are very poor, then you can qualify for Medicaid. There are mostly no costs for any visits, drugs, hospital stays. Some things might have a verrrry small fee though. This drives some people crazy, that poor people have "better" care than they do.
    Last edited by oxyjen; 03-08-2017 at 04:39 PM.

  4. #4
    Senior Member Starjots's Avatar
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    Quote Originally Posted by Madrigal View Post
    Okay, no, seriously, I don't get it. I just read in the other thread that someone gets insane emergency room bills they have no hope of paying. What does that even mean? You just don't pay and go on with your regular life? What consequences are there for someone who doesn't pay their medical bills in the US?
    In my experience many hospitals/doctors/whatever turn your account over to a collection agency pretty quick and the collection agency starts hounding the f*ck out of you.

    Our local hospital contracts out their billing department to someplace across the country. They seem to generate bills almost at random and you can't get an itemized statement to figure out what you are paying for. A few times I've discovered their random bills exist via collection agency.

    Long story short - I try never to go to the local hospital or doctor (they mostly work in hospital), which translates into avoiding medical care unless it's an emergency.

    If you have healthcare, where do you get it from?
    Have worked at the same place over 20 years and use their plan.

    How much do you pay for healthcare monthly?
    About $500/month, that covers family. The employer pays a lot more than that from what I can tell. Twenty years ago the number was $0 and the deductibles were lower. The general trend has been increased cost, deductibles etc. Interestingly, last year there was no increase in premiums.

    If in the US, how has that changed since the ACA?
    My older kids are covered by my plan until they hit 26 because of ACA. One has aged out, no idea how he's getting coverage now but I have two other grown kids (21) who are covered.

    My wife has a serious pre-existing condition/disease that may have limited my ability to change jobs. I'm not changing jobs, but ACA does away with the pre-existing conditions as an excuse not to cover.

    What does your health plan cover? What does that not cover and how much do you pay for what's not in the plan? What are some extraordinary expenses you have had to incur for minor or serious medical problems? What are some expenses you have incurred for check-ups or routine visits?
    So far our plans have covered most everything we've had to deal with. With my mate, that's a lot, with me not so much so far. We have to be careful to stay in the network. Typically if there is a serious medical issue that requires tests and specialists and minor procedures we are going to be out thousands of dollars. The most in one year was probably 10K. Routine visits and minor stuff are $40 a visit but bills for hundreds start coming in if you do anything beyond the doctor poking a finger up the rear.

    Do you have a medical debt? Do you plan to pay it? What happens when you don't pay, how does it affect your regular life? Is healthcare among one of your bigger concerns or do you just think about it when you have to? Have you ever considered living in another country because of its health care system?
    No - we're fortunate to have a good plan and make a pretty decent salary. Medical expenses can be a sizable expense and cause us to borrow from Peter to pay Paul, but we do that for lots of situations.

    Medical is a very large concern, most procedures cost thousands to tens of thousands and my wife's condition also requires expensive drugs (though she's gotten off many by switching to a natural alternative you are familiar with). I plan on retiring soon and that is only possible because company continues to pay their part of premium if I have X years of service and am Y years of age.

    Once you are old enough (65 I think) you get Medicare and buying enough supplemental plans are 'safe.' However, that's threatened by politics here IMO.

    EDIT: The paperwork associated with current insurance system can be insane. Most doctor's offices employ a small army of people to take care of records/billing. Statements vary widely in quality so sometimes it's hard to tell what you are paying for and why. Doctors are often specialized and time-limited so being an effective patient requires a lot of research and self-knowledge and advocacy if your situation is complicated. You must understand any meds you get put on because some doctors really like to push pills. If we are visiting a new doctor for something complicated, I usually go with my wife at her request so we have two sets of brains at initial consult. She's done the same for me a few times.
    Last edited by Starjots; 03-08-2017 at 05:22 PM.

  5. #5
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    For people who have employer-sponsored insurance, in a nutshell: You and your employer share the premiums (the monthly fee for insurance), on top of that you pay for some fraction of your care, the amount you have to spend each year is capped after which the insurance company covers all of it. The insurance company tells you what providers you can use and what procedures and pharmaceuticals are/aren't approved. If you go off the approved list, you have to pay more and sometimes all of the cost, but sometimes you or your doctor can convince the insurance company to cover it. This is what most working professionals get.

    One more thing I'll throw in here -- you never know when you walk into a hospital if the doctor you're seeing is on your insurance plan ("in network" is what we call it) or not. Even if the hospital is in network, the doctors bill and contract separately. You also don't know if the tests your doctor is ordering are covered until you get the bill (or don't get the bill). You know up front if a drug isn't covered, and oftentimes the pharmacist can contact the doctor to have them prescribe an alternative that is covered. It's kind of a clusterfuck in these respects, even for the well-insured.

    My premiums are about $300/month for me and rhinosaur, my company pays about $900/month. Copays are $10 for a general practitioner, $40 for a specialist (you almost always go to a specialist, there are about zero general practitioners these days). My deductible is $500 and my cap is $3500 for each of us, $7k for me an rhinosaur combined and I pay 20% coinsurance. What that means is I have to pay out of pocket for procedures and tests up to $500, then I have to pay for 20% of everything up until I have spent $3500. Once I've spent $3500, the insurance company pays for everything until the end of the year, then the cycle starts over. Copay for drugs is $10-$30, I think, and the deductible and cap do not apply. My old employer payed the whole premium, and my coverage was similar. That was nice.

    When you try to explain it to someone else, it sounds really complicated, but this is how insurance has always been so it more or less makes sense to me by now.

  6. #6
    non-canonical Light Leak's Avatar
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    Quote Originally Posted by Madrigal View Post
    If you have healthcare, where do you get it from? How much do you pay for healthcare monthly? If in the US, how has that changed since the ACA?
    I get mine through work, but it's an individual plan. Which means if I quit or get fired I can keep my healthcare plan as long as I pay for it. My work pays for half of my plan. My half is about $200 a month that they take out of my paycheck pre-tax. Before the ACA I had a group plan which meant if I quit or got fired I lost my health insurance. Group plans still exist, my husband still has one just pretty much every plan through an employer was a group plan before the ACA. There was a way to keep a group plan temporarily if you lost your job through something called COBRA - I dunno what that stands for, but the price was crazy if you had to do that. I had to do it once and it cost like $1800 a month to stay on my health insurance. It was my only option at the time because before the ACA I couldn't buy my own insurance because I would be denied for having pre-existing conditions. The only way I could get it was through an employer or being added to a spouse's plan gotten through an employer, but I was not married at the time.

    Premiums have gone up over the years. I remember paying under $100 (my half, employer still payed other half) at one point.


    What does your health plan cover? What does that not cover and how much do you pay for what's not in the plan?
    It covers most things that I've gone for to some degree or another. My medications are free as long as I get generic which is awesome. I have a gold plan though, so I pay a higher monthly premium and then get lower deductibles and out of pocket maximum, and a little bit lower costs for other things. For example I pay a little lower co-pays for things like labwork and specialist visits, which is good for me because I see my specialists more than my primary doctor. Acupuncture is covered. It does have a co-pay. Out of network doctors are not covered. I see a physical therapist that is out of network. I pay $100 a visit for that. I had to pay $250 for an MRI. I would have to pay more to go to the ER or hospital or something, but I haven't had to do that. Those are things that I think I have to pay my entire deductible first before they pay for anything, and then they only pay a certain percentage until I hit my out of pocket maximum.

    What are some extraordinary expenses you have had to incur for minor or serious medical problems? What are some expenses you have incurred for check-ups or routine visits?
    Recently I have not thought any were so extraordinary. I've hit my out of pocket maximum in the past - thousands of dollars over a year. Checkups and routine visits I just pay a co-pay. Mine is $30. If I see my primary doctor it's free. I rarely see her though. Before ACA I used to have major issues with my insurance company for getting treatment for my autoimmune illness covered. They liked to pick and choose how they would decide to classify it every time, so sometimes I would get a bill for thousands of dollars in the mail for that because they denied the claim for whatever reason they came up with even though they covered it the time before. It was a battle ever time. I have not had a problem since the ACA. I also don't have to fight them to cover my migraine medication, or pay hundreds of dollars for a few pills. I get those for free now... the generic ones at least. But even if I got brand name it would still only be $50 now vs. a couple hundred.

    Do you have a medical debt?
    No.

    What happens when you don't pay, how does it affect your regular life?
    You can take it up with your insurance company and fight the claim that you owe anything. But if that doesn't work and they say the claim is correct then the medical provider who sent the bill can send you to collections. If you don't pay at this point it messes up your credit.

    Is healthcare among one of your bigger concerns or do you just think about it when you have to?
    It has been a major concern in the past before the ACA. I used to have to worry about whether I would be able to get healthcare if I lost my job, and now I can just buy it because they can't deny me for having pre-existing conditions anymore. And also the hassle of just having to fight so many health insurance claims seems to have greatly improved. Basically things have been pretty good for me since the ACA so I haven't worried about it much recently. I do worry about what might happen with healthcare. Not that it couldn't be better... I just don't want it to get worse.

    Have you ever considered living in another country because of its health care system?
    Toyed with the idea? Yes. Seriously considered it? No.

    Edit: A little side note. My health insurance plan sent me a nice summary of charges from last year showing what my medical providers actually charged vs. what my insurance company paid after their 'discounts.' Also what I paid. What I found interesting was what was charged was more than my salary. What was actually paid overall between my insurance company and myself was like half that amount. I wonder if I would get those discounts if I didn't have insurance. I'm guessing not.
    Last edited by Light Leak; 03-08-2017 at 05:48 PM.

  7. #7
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    I tend to take my health insurance for granted until I read what others pay. My employer covers 100% of my premiums, and it's a pretty good plan. It covers anything necessary, including mental health. I have $0 deductible and a $20/$40 copay plan (that is, $20 fee for seeing general doctors, $40 for specialists). It was the same case with my previous employer, although I only had a $10 copay there. At the same time, I figure I'd be getting paid more if insurance wasn't so expensive. I don't have any medical debt. Never have, except for one time I went to the emergency room and didn't realize there was a $300 bill after what insurance paid (this was while I was in college). They never mailed it to me, and it went straight to collections, so I didn't find out about it until I checked my credit one day.

    I don't think insurance premiums are the real problem, the problem is the cost of healthcare. It's absurdly inflated. From my understanding, the industry has taken advantage of the incredibly severe health care regulations so that they can essentially charge what they want for things. It's extremely difficult for there to be any competition. But it's still handled by private industry, so that equals a racket. No matter if premiums were handled entirely by individuals, employers, or taxpayers, it'd still represent an enormous financial burden that needs to be addressed. We're ignoring the larger issue by focusing on who pays the premiums. Meanwhile, the health care industry is laughing all the way to the bank. I'm not sure how it got like this, but my guess is that our litigation-happy society helped. I see attorneys advertising to help you sue your doctor in the subway all the time.

    I've considered moving out of the country, but not specifically because of health care. It'd be more of an issue if/when I start a family. Personally, none of this affects me much. Even if I did move to a country with cheaper health care, I'd probably come out with less money due to the lower earning potentials in most countries I could realistically emigrate to (EU is pretty much out of the question). But if I had kids, I'd want them to grow up in a place with better public services in general.
    "Doesn't matter what a man has if he doesn't have purpose. You take that away from him, man usually goes with it." -Beau

  8. #8
    Senior Member Senseye's Avatar
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    It sounds as if the ACA is on balance an improvement, despite all the complaints I hear about it. As an outsider looking in, I have no clue.

    Is this true? Or would you all prefer to go back to pre-ACA days? If so, what was better back then? It's not clear to me why the Republicans are so anti-ACA (unless it is just politics, i.e. ACA bad 'cuz Democrats brought it in).

  9. #9
    Dr.Awkward Robcore's Avatar
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    In Canada, all provinces, except for BC where I live, fund public health care through taxes. Here in BC we pay monthly MSP premiums, which just go into general revenue anyway...and on top of that, revenue from MSP doesn't even cover the cost of providing health care...so it's mostly just a bureaucratic pain in the butt. I'm not sure what happens if you don't pay your premiums, actually. I think it was about $1800/year when I was working...split up into monthly payments.
    Anyhow, there's no cost to go to any doctor and to get a procedure recommended by the doctor...no out of pocket cost for surgeries, or gloves, gauzes, bandages, etc.

    I'm not super familiar with Fair Pharmacare, but they'll cover a lot of drug costs. They currently cover my drug treatment which would cost about $10-20,000/year if I was paying out of pocket.

    I also get sweet benefits through my union...$1200/yr for massage; $1200/yr for acupuncture; $1200/yr for Naturopath (I pay 15% of everything until the union pays their $1200, then I pay the full cost for everything after that), Union also reimburses 85% of any drugs not covered by medical/pharmacare, also covers 85% of flights and accommodations, and provides a per diem grant for food if I have to travel to see a specialist. Pretty sweet perk, seeing as it costs about $650 to get a return flight between here and where my specialist works(I'm an 8 hour drive from the nearest 'big' city...but more like a 20 hour drive from an actual major center). Unfortunately they only cover 8 flights per illness...which sucks if you have a chronic condition...but it's still a pretty great benefit.

    The union has changed insurers a few times over the last several years...and in some cases, I'd pay full cost for things up front, and then get my 85% reimbursed later...other times they've used insurance providers who are more integrated in the system so that I only pay my 15% at the point of purchase (that's how it is for our dental...which covers up to $5000/yr or something that i'll never use unless the kids end up needing braces or something)...so I paid $25 to have a wisdom tooth pulled, a few years ago.

    With all of that coverage, it's all pretty fluid...no worries about any medical care that we need. Through my union we also get free rehab for addiction, if needed.

    I would like to see Naturopathy covered better...especially because the preventative benefits of vitamins and supplements are far cheaper than medications and procedures...but at the end of the day, I'm glad to live here.
    ...the origin of emotional sickness lay in people’s belief that they were their personalities...
    "The pendulum of the mind alternates between sense and nonsense, not between right and wrong." ~Carl Jung

  10. #10
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    I met an American guy in a hostel in Istanbul. Went into the usual chat. "How long have you been travelling for?" He'd been travelling for years because of medical bills he couldn't ever pay. In the US he'd developed some illness that would kill him without treatment. It would have cost him $100,000 or more than that. The hospitals wouldn't treat him without payment. So they would actually let him die. He was able to arrange a down-payment of something like $10,000 for them to do it. He still couldn't even afford that. He was able to get his brother to help him pay that, and then they did the operation. He's got no chance of paying off that fee. He seems to be dirt poor. He was staying in only the Eastern European countries because they're cheaper. Working illegally in some places to get a little more cash. He sounded really bitter and depressed about everything. How the fuck do you have a system that works like that?

    In contrast, I've not really ever paid for medical things except medication, and that's only ever come to a maximum of $30 probably.

    I got an x-ray in the UK and that was completely free. I'm not a citizen of that country. But Australia and UK have some reciprocal agreements like that because we're pretty similar.

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