this post was submitted on 13 Aug 2024

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240

How much do Americans actually pay for healthcare? (pawb.social)

submitted 3 months ago by savvywolf@pawb.social to c/asklemmy@lemmy.world

220 comments fedilink hide all child comments

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?

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[–] linearchaos@lemmy.world 7 points 3 months ago (2 children)

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.

[–] AndrewZabar@lemmy.world 2 points 3 months ago (1 children)

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.

[–] linearchaos@lemmy.world 1 points 3 months ago (1 children)

I have Blue Cross and Blue Shield. a mid-upper tier plan. They just decided to stop covering this.

[–] AndrewZabar@lemmy.world 1 points 3 months ago (1 children)

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.

[–] linearchaos@lemmy.world 1 points 3 months ago (1 children)

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.

[–] AndrewZabar@lemmy.world 1 points 3 months ago* (last edited 3 months ago) (1 children)

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.

[–] linearchaos@lemmy.world 1 points 3 months ago (1 children)

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***.

[–] AndrewZabar@lemmy.world 1 points 3 months ago (1 children)

Well I sincerely wish you the best. But I would put up a fight and keep fighting.

[–] linearchaos@lemmy.world 1 points 3 months ago (1 children)

It's not big enough on the news yet when everybody finds out this is what's going on they'll raise a big enough stink to get it reversed.

[–] AndrewZabar@lemmy.world 1 points 3 months ago

Yeah I hope so. This is not the place to cut corners. Fucking downright indecent.

So you should contact news stations ask them to run something on it.

[–] Teils13 2 points 3 months ago (1 children)

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 ).

[–] linearchaos@lemmy.world 1 points 3 months ago

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.