PhantomCrayon
99720
1458
60
Finally got insurance with my new job, first time having actual insurance that a company. I've never had issues before with doctors because I've self paid and haven't been in often, not something I can normally afford. When I'm sick I typically tough it out and wait, because a trip to the doctor is a multi hundred dollar thing and I can't afford sudden costs. Heaven forbid I break something.
So you can see that this would be great. I'm super excited to be able to get basic medical care without having to worry too much that bills will eat me alive. My new insurance gives me a free annual visit, so I decided to go and have the check up. I developed tendinitis a few years ago and I was put on muscle relaxers to compensate, but I don't really need the high doses anymore. While I was in, I asked if they could switch me to a lightweight brand, since I don't really need the strong pills. My doctor says sure and switches me over to a new pill that works better and will help me with anxiety. This is something I could have called and requested instead of bringing it up, but I figured I'd kill two birds with one stone while I was already in for the day. This is where I fucked up.
Bill comes in for the visit this morning, insurance has denied the coverage saying they don't cover diagnostic visits and I'm on the hook for $220, the base price of an office visit. Lets keep in mind this was a 15 minute visit where I pretty much said hi to my doctor, stepped on a scale, and talked about how my medicine was working for me. I'm thinking its a mistake, I didn't get diagnosed with anything new, I'll call the insurance company.
Three phone calls later, the woman in claims informs me that if I have any other service besides having my blood pressure taken, my weight recorded, and my heart or lungs listened to, it's considered diagnostic. This includes talking to my doctor about my options. Which they won't cover.
"So if I need to go to the doctor because of an injury, or I've become ill, that isn't covered?"
"Yes ma'am that's correct."
"And I have to pay the full amount?"
"Yes ma'am, up to your deductible, and then 50% after."
This makes me frustrated. If I need simple, basic care, I cant afford it, despite having medical insurance. Just. Why? Why is it this bad?
Thank you for reading imgur, Im not here for your internet points, Im just here to vent because Im flabbergasted at not being able to afford to be sick.
FP Edit: holy, I did not think this would make it all the way to FP. Thank you to everyone for your help, I'm gonna try to respond to all the messages, my inbox is flooded. As for questions, I have a PPO plan and it was the only one offered by my job when I started. I am going to look at other options for coverage and my doctor is helping me out with a payment plan since I explained the situation to them. Thank you again everyone for your support!
anonanonsnake
Health insurance is such a scam here even after the ACA. Pisses me off to no end that Congress has their own premium care. And takes bribes
GreaterDog
50% coinsurance??? What is your deductible and out-of-pocket max?
InsertCleverNickname
I have the best insurance my employer offers and I still have a $2500 deductible and zero coverage until the deductible is paid. It's a joke
chibimermaid6
I have so much to say on this but 140 characters is not enough
HowardMoonsHotpants
Thank fuck for the NHS (and sorry for your hassles, @op)
MerToo
May et al will fuck the NHS but while you watch her do that the rich will get richer & the poor poorer & Hey look a kitten in a waistcoat!
slack3rdav3
Welcome to New America!
DrKillebrew
america is the stupidest fucking developed country on earth. if you hadn't got nukes first...
Bonesy84
I cut my finger a few months back, needed 5 stitches. Went to clinic, they were closing so they sent me to the ER. Zero cost. I love Canada
MerToo
wife, week in hospital with pneumonia, free, two premmies, 7wks+6wks NICU, free, now wait for some asstard to say "oh but it's not free!!!"
slack3rdav3
My mom tried to pull this type of shit with me for cost of living diff vs taxes. Said Cali was taxed so much higher than Ohio, did calc 1/2
slack3rdav3
2/2 ....ulations and showed her the % tax in Ohio was about 5% higher than Cali.
Bonesy84
Technically it's not free, I pay taxes, but I would rather pay taxes than hear about people going bankrupt to stay alive.
MerToo
called it!
gr8snd
Everyone, please read about how we got here. It's starts with Ronnie Reagan and deregulating the health insurance industry.
PirateFroglet
I thought Nixon had a hand in it before that?
gr8snd
There were all non profit before Regan.
Locolarue
Nope. The AMA before anybody, then FDR during WW2, Medicare, Medicaid.
gr8snd
They were all non profit before Regan.
Locolarue
Every doctor, every hospital, everything was non profit? Prove it.
gr8snd
The insurance companies were non profit. So profits did not come into their negotiations with doctors etc.
TonawandaBlue
It's always cheaper to let people suffer & die.
WristDeepInaBook
https://imgur.com/0SskLq2
MethelyneBlue
Insurance in the US is a fucking scam. You pay to say you have insurance, not to actually have it. It pisses me the fuck off.
WokeGhettoSpiritualist
omenofstorms
As someone living in australia. Wtf? A doctors visit is free with medicare. Why in the fuck are you paying 220$ for a 15 minute visit
LuxFalx
Our Medicare is slowly being gutted, and they're paying for less and less.
SolusEmsu
USA Medicare is typically an 80%/20% split, with a deductible. This year's dedu is $183. If this was OP's first service this year, not much.
Zeefox
That's not the point. The point is how does a Dr charge $220 for a 15 minute visit? Same visit (no subsidy) costs $90 tops in Aus.
SolusEmsu
Because they can. There is no regulation on what the visit costs. Actually though, Medicare does negotiate down. On Medicare, this visit--
SolusEmsu
would likely be charged at a rate of around $100 instead. Which would help, even during the deductible. People forget about negotiated rates
SolusEmsu
So it sounds like OP's insurance also does a terrible job at negotiating, as the member rate applies even during the dedu.
jrhawk42
health insurance is a scam, plain and simple.
BayazTheBenevolent
Literally only in the US. The rest of the civilized world is doing quite fine in terms of health care.
tooomanysteves
Only in the USA
wtftomdelonge29
Your visit crossed from preventive to diagnostic. It's as simple as asking about a rash on your arm - Dr codes as something else. :(
wtftomdelonge29
... works in claims at BCBS and it happens all the time.
SolusEmsu
As another BCBS applications/customer service agent, yeap. The littlest things still count as diagnostic. I work on the Medicare division.
Kowalski154
#lovetheNHS
ukenagashi
American Healthcare....you are being screwed buy hey, have a gun....
emkev
At least then we can blow our fucking brains out when we have a terminal illness before it bankrupts our families.
nobodylikesmyname
without life insurance, then they get to pay that $10,000+ med examiner, mortuary, cemetery, and headstone company fees. yay more expenses
emkev
Most life insurances don't cover suicides anyway.
ukenagashi
I had a full ankle reconstruction last year. 3 procedures, private hospital for 2 nights......AU$4500. I even had a beer the second night
emkev
I don't want to think about how much that would cost in the US.
ukenagashi
One single Achilles surgery my friend had was $35K
EdwardWongHauPepuluTivruskiIV
It's the deductible that got you. If you have an HSA or FSA you can use that money to pay your out of pocket costs. Message me if you 1/2
EdwardWongHauPepuluTivruskiIV
Have questions. I'm by no means an expert but I deal with insurance stuff on a daily basis. Happy to try to help. 2/2
N0ledge
Wording, that's how rich people screw over poor people and there's nothing you can do about it. Unless you start some riots and a revolution
WhatSayYouCitizen
You don't have medical insurance. You have "money deducted from your paycheck so you don't get hit with ACA fee" .
tooomanysteves
I can't help, I can only sympathise. Your system sucks. :(
[deleted]
[deleted]
tooomanysteves
Did you even read the post? The guy got charged $220 for a basic 15min GP visit.
[deleted]
[deleted]
GiantRobotsRule
Not if it's the only plan his employer offers.
tooomanysteves
See, that's what's fucked-up. You shouldn't have to rely on private insurance for a basic GP appointment, and it def shouldn't cost $220!
anakhasilver
If you read, he has the ONLY plan his company offers. That's NOT on him, he HAS no options.
UmmonPrime
I went for son's wellness check, which is free.. asked for new script on his reoccurring meds. get a bill. Not part of wellness check.
wtftomdelonge29
Yep, you cross from preventive to diagnostic when you consult about anything outside the scope of preventive services.
PhantomCrayon
This! 100% what happened to me
tinytinkingdom
And me! 300 bucks I wasnt planning on spending
questionableotp
Drs fault he coded it as med visit. Rather than a well visit
ThaWaySheGoes
GiantRobotsRule
USA:You pay huge premiums, then you pay huge costs when you need care. Civilized countries: you pay taxes, but then care is affordable/free.
slack3rdav3
But I aint payin fer no lazy sacks a shit to get no free care on my dime. I'd much rather pay far more and not raise them taxes. taxes = bad
Vaanhalen
As someone who is old enough to have had insurance for many years, the non-welfare insurance got dramatically worse under Obamacare.
imgurdemocratcirclejerk
Much worse. Plans keep getting shittier, and the premiums keep going up.
Vaanhalen
Which turns every plan into a catastrophic plan. Which is the real solution: everyone just has to buy a catastrophic plan. That's it.
Vaanhalen
As for preexisting cs, they can seperately buy a defined benefit plan.
Vaanhalen
Every year a new adventure!
1414145691
In England you'd have been charged £8 for a month of your new pills and that's it... come over but bring a tent we haven't enough houses
CityYeti
Yu guys don't want more foreigners though
1414145691
To be fair we'd be happy with Americans just not other types of foreigner... I still think we should have free movement within NATO
1414145691
I should add it's legal to camp anywhere that isn't fenced off with opaque 6 foot fencing as long as it isn't in the road
Lysergian
We all know the system here is a disgrace, the problem is people seem to think it was fine before Obama, I'd have what you're having.
Urgalicity
We have 2.3 houses pwe person here, and people are still homeless.
GodzillaHarddiskson
In Sweden you'd have been charged $20 for the doctor and like $10 per 100 pills. If you don't need a lot of meds,
GodzillaHarddiskson
then the cap would be $270. After that, the välfärd pays for it all
1414145691
Not being Swedish, not speaking Swedish, "the välfärd" read like a person, and yes I imagined a giant norse God... sue me
His4Harold
Since when do you pay 8 quid? never paid for meds in Wales
His4Harold
or a Dr. for that matter
1414145691
See now that's weird, because I was a student in Wales but mine were free then cos I was a student
MrKibbs
Do you have plenty of trees? Maybe I'll build my own.
AuntieNelle
That's not allowed. The oaks belong to the queen don't they? Or is it just the swans?
1414145691
Under orders of the queen all new builds must be of brick construction
PolarHailStorm
They're building more where I am. But charging 850+ a month for rent. A mortgage is out of the question unless you're loaded.
1414145691
They build very few houses JUST so they can keep the prices high, it's not like we lack builders ironically the builders are out of work
1414145691
because of regulations meant to limit how much they can build/develop
PolarHailStorm
And they wonder why people still live at home with their parents into their 30s. My mothers house is huge, and cost £40k.
1414145691
It's ridiculous, the government admits it is a problem and has comitted to building 350,000 homes per year...they've yet to hit half of that
RandomVoiceFromTheInternet
We have loads of unused houses that have been bought up by property developers for financial gain. The UK is fucked in so many ways.
1414145691
Doesn't help that we don't even meet half the quota for new houses built each year, it's a manufactured problem to keep rent/lending high
RandomVoiceFromTheInternet
Manufactured problems are capitalism's specialty!
1414145691
'Capitalism' ... free capitalism homes would meet demand, but racketeering etc seems to invade on our fake capitalism and be allowed
RandomVoiceFromTheInternet
Just like no plan survives contact with the enemy, no political system survives contact with people.
anominousbeef
Very seriously thinking about a campaign to boycott the entire industry. Just stop buying insurance completely. If enough people did it...
gifsaregifsnotgifs
...we'd all get hit with fees come tax time
anominousbeef
I feel ya but if we don't do something it's gonna keep getting worse.
SolusEmsu
To be fair, a lot of people qualify for an exemption from the Annual Shared Responsibility Payment (yes, that is the name), based on income.
AbyssusPuella
crapy health insurance, they refused to pay for my c-section and birth control, cause it "wasn't medically necessary", owe 35k hospital bill
nobodylikesmyname
they won't pay for my BA or SRS for the same reason :( mental health has declined severely
TheOlsenTwins
As a Canadian that's fucked up
tooomanysteves
How the fuck is US$220 your base price? In Aus it's AU$40, of which you get $30 refunded by Medicare (public health insurance).
tooomanysteves
And that's only if the clinic doesn't "bulk-bill" Medicare. I haven't paid for a GP visit in 6 years, and that's without private insurance!
emkev
Hey, $220 is cheap, OP got off easy. More like $320 where I am.
tooomanysteves
Damn! No wonder you Americans are suffering.
anonanonsnake
$220 is one of the lowest subsidized plan prices available in this state unless you qualify for Medicare.
anonanonsnake
Actually I think the lowest rose to about $400 this year, no health problems, young etc.
tooomanysteves
I believe you, but I don't understand why your subsidised price is AU$280 when our UNsubsidised price is AU$40-$70 (US$32-55) ?
anonanonsnake
I think it has to do with having politicians bought by lobbyists and high hospital fees. Some states also rejected Obamacare subsidies.
tooomanysteves
Well that sucks.
Zeefox
$90 where I am (Canberra), but still fuckloads cheaper than these prices.
gr8snd
Never buy the cheapest plan OP. Always get at least the middle option. Seriously. When open season comes in November upgrade.
VoguePoseSnipSip
Agreed! Also read what the plan entails, usually a lot of fine print reading.
Tatelina
Or... just live in a country that has healthcare.
DiegoGarcia12
That’s not the point though. Health are is so fucking broken even with health insurance you can’t afford healthcare! It’s bullshit to have -
DiegoGarcia12
- Pay a larger amount of money monthly just to afford to talk to a doctor. Not even talking about invasive procedures here
DinglyDanglyDingDongDiddly
People. Cant. Afford. That.
gr8snd
Can't afford what?
DinglyDanglyDingDongDiddly
The middle option. Sometimes even the cheapest one is too expensive.
Shoelebubba
Never understood why the fuck health insurance has open seasons
nigglemaster
I have IHS. Free healthcare!
gr8snd
And any American who has lived in Europe, me being one, hates you. lol
nigglemaster
I told my white friend about it and he was pretty irritated.
ARatEar
The cheapest family plans are about 900 a month. $1,500 to $2,000 a month for better plans.
BondSpaceBond
Or ya could just move to canada and get it free...
dohcohv
The cheapest plan is $500/mo less than the more expensive plans. That is $6000/yr. My maximum out of pocket is 5000.
gr8snd
Under the circumstances....
dohcohv
If I was single I would get the better plan(it's only 70/mo more than the cheap one.)
Pusilanimous
We have a Gold plan and since we hit our family deductible & out of pocket we have $19,000 in medical bills this year to pay WITH insurance
ARatEar
I have medical procedure coming up... so I dropped my HD insurance plan to save up and pay for it. 7k!
gr8snd
Single payer now.
TOOLfan303
I have the top plan, and I work for the gov. The insurance decided this year to drop copay and go deductible. Canada bound.
WarOnMouse
Really? Mom works for SSA and still has copays.
gr8snd
You're fucking kidding me? I grew up on BC/BS Dad was VA. Diabetic brother. It saved my parents. Oh fuck, really?
TOOLfan303
I meant I'm working on leaving the US for Canada. Have family already there. Sorry for confusion.
gr8snd
If you work in a field they need you can get landed quick. I meant BC/BS insurance was gold in the day. It saved my parents.
PhantomCrayon
We only have one plan through my job sadly. Should I try the healthcare market place?
bubdub
Sounds like your plan doesn't meet the Minimum Essential Coverage requirement of the ACA https://www.healthcare.gov/glossary/minimum-value/
bubdub
job-based insurance is required to meet the MEC. Might want to bring that up to your employer.
wantsthefunnystuff
As a health ins. agent, just know if you shop for a plan on the marketplace and have access to credible coverage through your employer, you
wantsthefunnystuff
will not qualify for a subsidy from the government to help with the premiums or other cost sharing reductions.
thdudedude
Where do you work?
gr8snd
I was forced to learn a lot of HR. Yes, check the market place but DO NOT cancel your current plan UNTIL you find a new one.
PhantomCrayon
Thank you, our enrollment is up in November so I'll start researching now.
gr8snd
Good luck,
Kushita
Supposedly they got rid of the penalty for tax season... assuming this is in the US.
LibrarianCatLady
I hope so. I'm getting married in Oct. And my plan is up Sept 30th. I'm hoping I can get on his plan quick enough to not get a penalty.
Kushita
MrPredator
Check your area before going through the market place. Many companies have pulled out. It's HORRIBLE for some people, trust me.
MrPredator
Relative lost her policy cause the a-holes were pulling out. Only policy around was one with a $900 a month fee.
MrPredator
Was just lucky she only needed it for 2 months before medicare kicked in, but still, $1800 was a hard pill to swallow for 2 months.
monsto
Dbl chk the rules, but I think a big part is that you CANNOT get marketplace insurance if your employer provides. I looked into it a cpl >>
specificstatistics
Doesn't the plan have to have the same or better benefits as a "silver"plan?
merbaby
You can be barred from getting a subsidy, but anyone is allowed on the open market.
monsto
years ago for my family of 7 and that was the case then. Double check the rules, tho.
ChaoticJen
I was doing some HR to sign my company up. In FL at least, if the company premium would be ~ >9.5% of your annual income you HAVE to use 1/2
ChaoticJen
the company plan. If it is higher, you have the option to go to the marketplace. But might depend on company size so check per state.
Obsidian3
A lot of the rules vary from State to State.
Ineedtochangemyname
I seem to remember that in the state of Georgia. If your employer offered anything, you paid a higher monthly premium. I could be mistaken.
hploeg1
It sounds like you have an HSA plan. If so, KEEP IT! You would have a lower premium which means the money you would spend on a more 1/
illegalacorn
It sounds like OP has a plan that doesn't cover jack shit, dump the fuck out of that plan because you're paying money and getting nothing
hploeg1
Premium plan you can instead save pretax for life (you can even invest that money if you're really aggressive). If you're generally a 2/
hploeg1
Healthy person this gives you the ability to save up a nest egg that can be used on future medical expenses (regardless what happens to 3/
hploeg1
Health insurance in the future). I HIGHLY recommend keeping an HSA type insurance and putting as much money in your HSA account as possible
Tinman2022
You might also try to see if there are any direct care physicians in your area. Direct care physicians are a relatively new trend (1)
Tinman2022
in medicine wherein the clinic doesn't take insurance and only charges a flat monthly subscription fee for unlimited visits.
Tinman2022
They also don't upcharge lab fees, so you pay what they pay. Just saying there might be another option.
PhantomCrayon
Take all the updoots, had no idea this was a thing. Apparently we have one, it's $60 a month and the visits are free. I'm going to >>
agustusgloop
Interesting ......
mephiston
I'm probably gonna cop hell for this, but... people rail against universal healthcare.. why, again?
SolusEmsu
Because they are misinformed and/or evil.
BayazTheBenevolent
Because politicians make them. There are few sane people that are truly, by themselves, against Universal Healthcare.
TheLastGunslinger
*need, dammit.
Locolarue
Because economic calculation problem.
frostybook
ask vermont or california, they ran the numbers and realized it was too expensive
BayazTheBenevolent
Shit yeah, there's probably no way you guys could, I dunno, change the government budget to accomodate a good universal health plan
BayazTheBenevolent
Or you could just increase defense spending again. Yeah, let's do that.
MerToo
Tuuuuurxes! Too manny tuuurxes!
gr8snd
No you won't. Single payer now.
GiantRobotsRule
"you're not entitled to doctors' &nurses' labor" is the typical reply from sociopathic libertarians who've always been privileged w coverage
DrMcTouchy
We wouldn't be entitled, we would all be paying for it. Every taxpayer. This isn't highway robbery here.
gr8snd
And this is sad, isn't it? You don't get to choose if you get leukemia.
GiantRobotsRule
Because how are drug & insurance companies going to make crazy profits if we empower Medicare to cover everyone &negotiate reasonable prices
RecurringNightmare
because there is something better than universal healthcare: universal social healthcare! not only is everyone insured and the healthy pay >
RecurringNightmare
> for the ill and old, also the rich are paying for the poor, superawesome! <<<
The1579
Mmmm, my premiums were raised by $2,200 as a result of ACA. That’s money I’m on the hook for. What’s fair or affordable about that?
WarmCigarette
Your insurance comp raised the premiums because they had to stop cherry picking who they covered and can't bargain as well as a single payer
The1579
Well it ain't helping me any as a public employee. We don't make shit as it is. ACA fucked me right out of a few grand.
WarmCigarette
The ACA didn't mandate increased prices- insurance comps are just refusing to take a profit hit to cover more people, so they increase prems
The1579
Which happened as a direct result of ACA. Either way, I had 2 grand more for my kid before ACA than after.
WarmCigarette
Your insurance company fucked you out of a few grand. The ACA just made it possible for previously uninsurable people to get covered at all.
The1579
Apparently at mine and other's expense. Either way, the screwing just went on down the line...just like a lot of other social programs.
alwaysupvoteprincessbride
because the europeans did it before us so it must be bad?
Gandalfsuglybrother
Has absolutely nothing to do with it at all.
Ironbunny
Because the idea/mental picture of how it will/should work is different by far from how our fucked up government will implement it.
TheLastGunslinger
It's unamerican. We don't that Commie shit.
gr8snd
You're unAmerican. You don't think your neighbor should be able to get healthcare.
TheLastGunslinger
I never said that. What we've got here is a clear example of Poe's law.
gr8snd
If you were being facetious I apologize.
mephiston
It takes a mature person to admit they were wrong, I commend you.
mephiston
Don't worry, I recognised this as a joke.
TheLastGunslinger
I'm much obliged.