A tale of American healthcare as told through one Doctor visit

[Figbash]

Follow me on my journey:

- Meet pediatrician, explain issue, refers us to another doctor, pay $30 co-pay for 10 minute visit
- Call Insurance company to get referral (HMO)
- Call Doctor's office to check on referral, told there is a 6 month wait list
- Finally show up to specialist, Pay $60 co-pay
- Meet with doctor for 30 minutes, get blood drawn
- Receive $600 bill a month later because Doctor-ordered bloodwork is not covered by insurance
- Call Insurance company and fight charges
- Call hospital and ask for further breakdown of charges
- Call back insurance company and get new person - explain yourself all over again
- Call different insurance number only to be told the blood work is NOT covered. 
- Write check to hospital for $600. 

$690 OOP total

Merry Christmas!

---

And all of this after paying 1,000+ a month for "coverage"

[Brian37]

Follow me on my journey:

- Meet pediatrician, explain issue, refers us to another doctor, pay $30 co-pay for 10 minute visit
- Call Insurance company to get referral (HMO)
- Call Doctor's office to check on referral, told there is a 6 month wait list
- Finally show up to specialist, Pay $60 co-pay
- Meet with doctor for 30 minutes, get blood drawn
- Receive $600 bill a month later because Doctor-ordered bloodwork is not covered by insurance
- Call Insurance company and fight charges
- Call hospital and ask for further breakdown of charges
- Call back insurance company and get new person - explain yourself all over again
- Call different insurance number only to be told the blood work is NOT covered. 
- Write check to hospital for $600. 

$690 OOP total

Merry Christmas!

---

And all of this after paying 1,000+ a month for "coverage"

Welcome to corporate health care.

Sad thing is, that it used to not be this way. I know growing up having had kid injuries and teen illness, insurance back then and medical care for that matter was far cheaper that my mom always had the option of paying out of pocket or using her insurance but neither were a anchor on her ability to pay.

[brewer]

Follow me on my journey:

- Meet pediatrician, explain issue, refers us to another doctor, pay $30 co-pay for 10 minute visit
- Call Insurance company to get referral (HMO)
- Call Doctor's office to check on referral, told there is a 6 month wait list
- Finally show up to specialist, Pay $60 co-pay
- Meet with doctor for 30 minutes, get blood drawn
- Receive $600 bill a month later because Doctor-ordered bloodwork is not covered by insurance
- Call Insurance company and fight charges
- Call hospital and ask for further breakdown of charges
- Call back insurance company and get new person - explain yourself all over again
- Call different insurance number only to be told the blood work is NOT covered. 
- Write check to hospital for $600. 

$690 OOP total

Merry Christmas!

---

And all of this after paying 1,000+ a month for "coverage"

Try more steps.
-Call insurance company and ask for written appeal procedures. They must comply.
-Take (or have sent) to physicians office and have doctor complete blood work justification of medical necessity.
-Call insurance company and pester them regarding status of appeal. (repeat as often as you can stand it)

Change insurance coverage prior to 12-15-2018?

[Jackalope]

Was the lab who did the work out of network? If so, you're a victim of back billing - where an in-network sends labs or XRay/CT/etc to a radiologist who is out of network for interpretation and you get billed whatever they feel like billing, even if the doctor who ordered it or performed it is at the same facility.

You probably have little recourse now since you've paid the bill, but I have had luck complaining to the facility who performed the work in question. In most cases, they've reduced the billed amount to near the in-network rate.

Back billing is evil, but that's healthcare in the USA.

[BrianSoddingBoru4]

My wife cut her foot pretty severely a little more than four years ago. Here’s that journey:

-Ambulance transport from Kerikeri to Whangerai Hospital. Cost: nil

-X-rays. Cost: nil

-A total of eight staples to close two cuts. Cost: nil

-Perscriptions for antibiotics and pain meds: Cost: nil

-Ambulance service from the hospital back to our house: Cost: nil

-Loan of a pair of crutches from ambulance service: Cost: nil

-Two home visits by a nurse from the local GP: Cost: nil

-Removal of staples. Cost: nil

It can be done.

Hope your kid’s ok, Fig.

Boru

[Tiberius]

Also if you have done everything you can and are still faced with paying the bill, call the billing department and ask if they can reduce the amount in any way, or set up a monthly payment plan. Payment plans are usually interest free, but on several occasions I've had bills reduced by thousands.

[zebo-the-fat]

In the UK the NHS is far from perfect, but I have never paid a penny to any doctor... ever. (yes I know I pay through my tax, but it makes no difference if I see a doctor once a week or once a decade)

[BrianSoddingBoru4]

In the UK the NHS is far from perfect, but I have never paid a penny to any doctor... ever. (yes I know I pay through my tax, but it makes no difference if I see a doctor once a week or once a decade)

Much like here. We also carry some private health insurance, not sure if we’be ever used it - She Who Must Be Obeyed handles all such matters.

Boru

[Jackalope]

It's insane that insurance here is tied to your employment.

You might get no insurance at all.

You might have the shit insurance my employer offers due to being in a tiny risk pool (high premiums, 6500/13000 in network individual/family deductible, 100% coverage of covered services after deductible is met.  Out of network?  Forget it.

You might have insurance like my wife's.  Far lower premiums than mine, 1150/2300 in-network individual/family deductible.  Preventative care and mental health covered 100% regardless of deductible.  Most covered services are 80% covered after deductible, and the maximum out of pocket is half what my employers is.  Guess which plan we chose?

Or, you might have a chronic condition that's no longer covered when you change employers or your employer changes health plans.

Lose your job and need a bridge plan to carry you to the next job?  Good luck paying the premiums if you're like many and have to live pay check to pay check.

[BrianSoddingBoru4]

By law, no one who is legally in NZ can be denied health care.  If you're here on a tourist visa and you break your arm, you're covered and there's no out-of-pocket.

Boru