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?

  • shikitohno@lemm.ee
    2·
    3 months ago

    For people with insurance, there’s pretty much always a maximum yearly out of pocket amount, after which things are basically all paid for by insurance.

    With a few caveats, yes. At least with the insurance I had last year when I hit the max for the first time, it has to be both deemed medically necessary to do, and be in network. Just because you hit your annual out-of-pocket max doesn’t mean you can get free cosmetic surgery, for example. Out of network treatment also had a separate annual max, so if I saw the wrong specialist or went to the wrong hospital during an emergency, I could still have gotten hit with another $10,000 in bills before that kicked in. And finally, I learned that there are actually annual maximums for certain types of treatment. In my case, I have an autoimmune condition and my doctor wanted me to get blood work done for it every 3 months. In their boundless wisdom, my insurance decided I shouldn’t need blood work more than three times a year, and I got a $1,700 bill for going over the annual limit for such care.

    The limitlessness of their wisdom and beneficence is matched only by my pettiness, so I had the pleasure of having my first colonoscopy and an endoscopy the day after Christmas because my gastro said there was a tiny possibility of me having a problem more serious than hemorrhoids and I knew those assholes would have to pay for it, since they pre-authorized it, which added a few grand to what they had to pay for the year.