Hey all, I’m British so I don’t really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.
So I’m just asking… How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
“However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.”
Partial Truth.
Healthcare providers have negotiated prices for services. These prices are negotiated per insurer.
Blue Cross and Blue shield will pay them X dollars for Deep Sleep anesthesia. United Healthe care will pay them a different amount. Medicare will pay them yet a different amount. Bob’s backyard healthcare will pay more because they don’t have buying power.
If you walk in without coverage, the provider “can” charge you a reduced rate. They are not required to. They do NOT universally offer that.
If you get the procedure done anyway, agree to pay and cannot pay your health bill, the provider “can” just let you off the hook or reduce your rate. They do NOT usually do that. That’s the exception.
If you go to a provider that accepts your insurance (they all do not) and book a procedure, the provider has to get the procedure covered by the insurer. If the insurer decides not to cover the procedure, you can call the provider and try to create a grievance. The back-and-forth is maddening.
My local doctor said I needed a colonoscopy (it’s just that time, no emergent issues)
My insurer authorized the procedure but not the anesthesia.
The office offered to pay out of pocket for the anesthesia ($1200), but I declined because I couldn’t afford it. They also offered to set up payments if I paid 50% upfront, but I declined because that didn’t help me. I can’t take on another $100 / month for 12 months.
I spoke with the GI doctor, a second GI doctor, and my General Practitioner. They all said that people here really don’t get the procedure without anesthesia, and it was a bad idea for both the doctor performing the procedure and for me.
I contacted the insurer, but they refused. Another GI doctor contacted the insurer, but they refused.
My insurer decided in January that they will not cover anesthesia for a colonoscopy unless someone can prove you’re frail enough it might kill you.
We have federal laws that mandate insurers to cover the anesthesia for this procedure, but state-level insurers (hint: they’re all state now) don’t have to follow their rules.
So here I am, two years late for a colonoscopy, wondering if I have pre-cancer or cancer brewing down there, but can’t manage to pay for what is considered by all providers here a necessary part of the procedure.
It’s not great here.
Plus all of that negotiating is baked into the end costs which is why in the US on average we spend twice as much on medical care with worse outcomes and not everyone is covered.
The insurance companies having more say than doctors about what procedures you can and can’t get is peak insanity, and yet here we are.
You need to consider your health first and only. You get the anesthesia and then you either ignore the bills or pay a little bit what you can. Either way eventually you’ll be able to close it out by paying maybe half.
Alternatively, you can tell the doc to either give you the anesthesia for free or go with the insurance attitude and have the procedure without it and - should something go wrong because it is not what you are supposed to do - then you have yourself a juicy malpractice suit for them.
The investors who make money from this bullshit write our laws. That’s the problem. We allowed it to happen by having such dumb fucking morons for citizenry who vote for these monsters who then turn around and rape them. And then they vote for them again. Our people are mostly absolute morons who can’t think for themselves and so they follow the shiniest trinket they obey the loudest voice with the bleached smile and the most promises.
And yes, conservatives are to blame and yes, there are awful liberals as well but the simple truth is republicans need to fucking die. They are a deadly cancer to our society because all they do is ruin everything except their own pockets.
Doc will not provide anesthesia for free. The insurance company will not budge.
I’m not in a situation where I can just keep hopping over doctors while they all send me to collections, even though $600 is too much to swallow at the moment.
If I do end up with any form of GI cancer, a lawsuit against the insurer seems pretty reasonable.
The people here already spoke of the option of medical tourism, can’t you look up that ? A colonoscopy is not some advanced tech, any decent hospital in latin america will be able to do that. Since you earn US dollars, you could research about making a trip to Mexico (possibly the cheapest option, because it can be done by bus or car), Cuba (possibly the cheapest too, because of the conversion rate and short plane distance), Brazil, etc for the travel, lodging and procedure (and even a little tourism too if you have the time and will XD ).
I’m mid-atlantic. Procedure + flight + basic accommodation is still around 2/3 of the anesthesia. Medical tourism works well when you’re uninsured or when the whole procedure isn’t covered. Sadly, I’m already paying a fortune for the insurance. It’s a mid-high plan Blue Cross. F’ing insane they’re taking this line.
I’m really sorry for your situation. I would personally just get it done, commit to paying them and then just stretch it out maybe a few bucks at a time. Your health is more important. But I do wish you the best of health.
I was on Medicaid for many years but I’m really lucky now my wife is in the teachers union and we have very decent insurance. But the entire system is a big stinking chaotic farce to which the terms “broken” and “mayhem” are even too light to apply.
But as long as our government is in the employ of the 1% nothing is gonna change. We seriously need to start stringing up some billionaires and take their money for everyone.
I have Blue Cross and Blue Shield. a mid-upper tier plan. They just decided to stop covering this.
WTF? I have to say this makes no sense to me. I think you need to double and triple check, try another facility perhaps? Something. To cover a colonoscopy but not anesthesia is unheard of, and even freakin Medicaid would pay for it.
https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_a050126.html
Anthem BCBS classifies it as not medically necessary so they will not pay for it since April of this year.
Jesus. That’s disgusting.
Edit: Hang on I just skimmed that document it seems to indicate it IS considered medically necessary.
Edit edit:
* Prolonged or therapeutic endoscopic procedure requiring deep sedation such as endoscopic retrograde cholangiopancreatography (ERCP) or repeat colonoscopy due to tortuous colon; **or** * A history of or anticipated poor response due to cross tolerance or paradoxical reaction to standard sedatives used during moderate (conscious) sedation specifically due to narcotics or benzodiazepines; **or** * Increased risk for complication due to severe comorbidity (American Society of Anesthesiologists \[ASA] class III physical status or greater. See Appendix for physical status classifications); **or** * Individuals over 70; **or** * Individuals under the age of 18; **or** * Pregnancy; **or** * History of drug or alcohol abuse; **or** * Uncooperative or acutely agitated individuals (for example, delirium, organic brain disease, senile dementia); **or**Uncooperative or acutely agitated individuals. Tell the doc to tell the insurance that it makes you crazy without it and you can’t tolerate it. Jeez is your doctor new at doing these things? That’s what they do they submit whatever criteria is accepted that they don’t have to prove with charts.
When Boston BCBS did it they put their clause in to include fear of the procedure. Aetna is apparently in the running for biggest piece of s***.