As you mentioned there is a dance between insurance companies and care providers. You should never pay a bill on the spot or upon first receiving it. Always wait until it says final warning. Often by then the bill has been reduced significantly.

There are many ways for the system to suck. When my wife and I were working it was less expensive for me to be covered by my company’s insurance and her by hers because adding a spouse to one policy was more expensive. This is because when you are working for a company that has a plan (not all provide this) the company usually pitches in on the cost of the insurance. The amount the company pays relative to the employee has typically been shrinking over the years. Combined the two of us paid about $500/month. Now that we are retired it is about $1500/month and the deductible has doubled to about $700 (which as I understand it isn’t too bad). There is also something called a co-pay, which is a small amount you pay for normal office visits regardless of anything else. Ours was $25. Now it is $50.

Coverages were all over the place. For a while we paid more to both be in the same insurance because my wife’s insurance would not cover alternative forms of birth control. My wife could not take the pill because it caused her to get blood clots. Ironically they would have paid (way more) for the birth of a child.

When my wife had a major issue, we found that ambulance services do not negotiate prices with insurance the same way as doctors, if at all. She was airlifted for a cost of $55k. Insurance paid $11k for some reason. The hospital stay (approx. 5 days) was $120k. Her max out-of-pocket was $16k, which we paid. Despite this, the air ambulance service was insisting that we pay the $44k and the insurance company was not budging on this. We had the same problem with the ground ambulance for $1600. This went on for like 2 years while my wife acted as intermediary trying to get the ambulance service to lower their price and the insurance company to raise theirs, figuring that having hit our maximum out-of-pocket meant we were off the hook. Not so. We were expected to pay this. Ultimately we were saved in the end when my wife’s employer paid those bills.

After that, assuming that because we had hit our max, it would be good for me to get my colonoscopy, we wound up paying the whole co-pay and deductible because I was not considered family. Yup, I’m a spouse. Apparently family means children. Why didn’t they say this? Probably to get people to do what I did.

So one of the biggest problems I think is when people don’t have insurance or they do have insurance but no real savings to speak of, they avoid getting health care for fear of the high cost.

In New York a while back there was a viral video of a woman who had her leg trapped between the subway train and the platform and all of the people on the platform teamed up to tilt the entire train a bit to free her. It is an awesome video of humans being kind. What wasn’t as viral was the fact that the woman had just prior to that, pleaded with the people on the platform NOT to call for help because she couldn’t afford it. Very sad for a country with so many resources.

A lot of it depends on what insurance you have and what insurance you have depends on who you work for.

I had EXCELLENT coverage with Kaiser Permanente, and other than a couple of hundred dollars a pay check and an in-office co-pay for treatment, I never had a bill.

When I had my heart attack, the Emergency Room was $150. 8 days in the hospital and open heart surgery from the head of the department was $100. The prescriptions and all the oxygen bottles I could carry was $100.

4 weeks into recovery, my company got bought. :( The new company didn’t do Kaiser in Oregon. If I lived in California or Washington, I would have been fine, not Oregon.

So they switched my insurance to Aetna which meant I lost all of my doctors and had to start over at a new hospital. Kaiser is members only and I was no longer a member.

Naturally I started having complications, congestive heart failure. That was an ER visit followed by 7 days in the hospital.

Under the new insurance, they start by paying 80% and there is an out of pocket maximum of $6,500. Once you pay that, all other treatment is free the rest of the year. No co pays, nothing.

So I hit my $6,500 about 1/2 way through January. Goodbye signing bonus! But all the other complications I had the rest of the year were covered 100%.

Now… if I had NO insurance? 15 days in the hospital x 2 hospitals? Open heart surgery? All the tests and such? 24 oxygen bottles? A million dollars, maybe more?

I pay $30 per doctor’s visit and $40 if the visit is for a specialist. I also pay $0 for a yearly checkup and $0 for telehealth. For any hospital visits, I pay 20% of whatever the actual bill is after a $300 copay (basically a down payment), which came out to a total of $600 when I went to the ER. Lastly, my prescription drugs are capped at $10 per month for generics and $150 for some brand-name drugs.

I use a ton of healthcare and the costs have been super manageable, but affordability is going to vary wildly between people. A ton of insurance plans don’t start working until you hit an out-of-pocket minimum of several thousand dollars, and others work like mine except with way higher copays.

Lastly, insurance often doesn’t cover certain drugs or procedures. As someone with really good insurance with good customer service, it’s still an issue every so often, and the solution is either to find an alternative, try to find a manufacturer’s coupon and pay up, or suck it up and move on. There are insurance companies that use shady tactics to get them out of paying for certain expensive drugs that they’re supposed to cover.

In addition to the actual costs other people are talking about, the mental costs of dealing with the system are inmense.

You have to update your information whenever you change your job. It’s not like your social security number that’d given once and you memorize.

Every year you probably have to review your insurance options and pick one. This is essentially gambling- if you pick a low cost one you save money, unless you actually need to use it.

You probably need to find doctors that are “in network” or pay a lot more.

Sometimes bills are sent directly to you and that’s a mistake. But sometimes you’re supposed to pay and be reimbursed.

You typically don’t know what the costs will be up front, so you have to guess what the best option is. Take a nasty spill on a bike? Is it worth calling an ambulance? Does your insurance cover that? Maybe just walk into the emergency room. But does your insurance cover that? Maybe just call a regular doctor?

In short, there’s a lot of stuff you have to think about as the end user. I’d rather it was just “oh shit you’re hurt, let’s take you to the doctor. Don’t worry about money”

Okay, so the American system is an employer based model, meaning that your health plan, if you have one, is determined by your employer. This means a few key things:

• Your plan may (and probably does) vary wildly in nearly every regard from someone else’s despite both of you being with the same insurer.

• You are not the customer, but the user. Your boss is the customer. As such, the insurance company doesn’t really care if they piss you off, because you can’t just fire them and go with some other plan. They only care about not pissing off your boss. Well, you can technically, but individual insurance is so expensive and bad (and there’s only a few big players in the market anyway) that it’s an obviously better choice to just get jerked around by your employer’s plan.

• The entire healthcare payment process is so arcane, unintuitive, and complex that no lay person outside the system can be really expected to navigate it if someone says “whoops, we’re not paying because the florp code was misapplied during Venus Wednesdays, and though you flipped your florp last month, some businesspeople made a deal just last week to agree that florps will only be covered by approved Todds (the closest is a convenient 600 miles from you). This judgment is final, may God have mercy on your soul.” As an example, I’ve had insurance pre-approve something and then turn around and deny it once it got billed, and because I didn’t think to get physical proof of pre-approval first, the insurance basically just ended it with “nuh uh, we never said that, do you have a receipt?” Lesson learned. And a lot of times, the people inside of it don’t have the full picture. There are people whose entire profession is either arguing with insurance companies all day to force them to pay what’s due, or helping patients navigate the system. It makes it really, really easy to rip off both patients and health providers.

• Government insurance like Medicare also sucks. Their reimbursement rates are terrible, among other factors, and it’s caused more and more providers (those who can choose, anyway) to stop seeing these patients, meaning that you start ending up with a few Medicaid clinics whose soonest appointment is months from now and spend about 20 seconds per patient. This is largely a result of our conservatives trying to prove that government doesn’t work by making the government not work. Just so we’re clear, private insurance holders also have long wait times and doctors that are pressed for time, it just tends to be a little less bad.

• Since insurers have figured out that there’s money to be gouged in medication, they’ve gotten into the mail order pharmacy and pharmacy Benefit manager (if you want to get a tummy ache, read up on PBMs, they’re the biggest bastards in a field full of absolute bastards) game. Since then, they’ve managed to kill off most small business pharmacies and turn just getting your medication into the same bureaucratic, clown energy pain in the ass as trying to arrange an MRI. (YMMV by insurer, plan, medication, etc)

On top of all that, about a decade or two back, private equity figured out that healthcare in the US is practically a license to print money, so they’ve come in, taken all kinds of stuff over, made everything worse for everyone involved but the businesspeople, all while jacking up prices and cutting services. Yaaaaaaaaay

Dr. Glaucomflecken on YouTube provides a pretty good (and funny / simultaneously infuriating) insight into the mess of healthcare in the US from a providers perspective.

mine is decently inexpensive through Obamacare, and I’m in a low enough income bracket. but it still isn’t ideal, I needed a sleep study. with or without my insurance it was going to cost $1,000 so I just never had it

You essentially gamble a little bit. Most people get insurance through work (or they are part of a family plan). Generally, you’ll have a few plans to choose from. If you are older, or have recurring issues, you might pick a plan that’s a little more expensive, but covers more costs. If you are young and healthy, you might pick a cheap plan, essentially betting that you won’t really need healthcare other than your yearly checkup and some vaccines.

The biggest thing with healthcare in the US is that it’s very complex. Even if you have insurance that should cover something, it can be hard to find a doctor that’s part of your insurance, so people often put off going to the doctor, which is part of the reason why costs are high. Teeth and eyes have separate insurance cause they are optional, apparently.

You basically have “premiums” that are your monthly payment. If you get your insurance through work, they cover a percentage of that; generally a pretty hefty amount of it. They usually don’t outright tell you what percentage, though, so many people think insurance is cheap, and get a rude awakening when they lose a job, and suddenly can’t afford $1000 a month when they used to be paying $100. Those premiums are taken out of your paycheck pre-tax, too, which gives you even more of a benefit if you have a job.

Depending on the “style” of the plans, they cover things differently. They all (I think) cover “preventative care” completely, which includes your yearly checkup, vaccines, and birth control for women. After that, some plans have “co-pays”, which are set costs for a few things, like $25 for a normal doctors visit, $50 for a specialist, $100 for an emergency room visit. Some just cover a percentage of those costs, and some don’t pay anything until you hit a limit (the deductible). Finally, there’s an “out of pocket” limit. That’s most you’ll have to pay in a year, after which point the insurance covers everything.

All together, I pay less than $1000 a year for healthcare, but if I got really sick, and needed a bunch of expensive healthcare, I would quickly hit my out of pocket maximum, which I think is like $6,000. I could cover that, but many people cannot cover an expense like that on short notice.

The number on bills is very misleading. The hospitals know that insurance will negotiate down, so they start high, and then after the negotiations, insurance will pay some or all of the remainder. If you don’t have insurance, you typically don’t pay that whole number on the bill, either, cause the hospitals recognize that they dont have to adjust it up for the negotiation. You can still negotiate on your own, though.

I’m trans in the US. After insurance I pay about $300 to $400 every 3 months for blood tests and a follow up. My meds cost me an additional $90 for 3 months as well. They are my hormones and another medication unrelated to me being trans. I get my meds at a local independent pharmacy, so they are relatively cheap. I used to get them at a large chain pharmacy and they were about twice as much there.

I also used to work as a cashier at a pharmacy. I once had to ring someone up who was paying over $3,000 for some cancer medication. It also wasn’t uncommon to see people paying around $500 for medications that they need to be alive.

A lot.

I haven’t seen any other posters mention Medicare. I am about to lose Medicare (for good reasons) but I have used it in California, Washington and Oregon and overall it’s a lot better than nothing.

Medicare has covered full childbirth expenses, a ligament replacement surgery, years of mental health therapy, my HRT, dental care, glasses (in some states) and everything else pretty much.

The care is NOT as good as when I had $700/mo techbro insurance for instance i hurt my back (ruptured disc) and medicare doctors refused to even image it because i can walk and stand so they just say to eat ibuprofen. I’m really excited to get private insurance and actually get an MRI and treatment because the back part sucks.

But the country hasn’t left me to die in the streets. Medicare and SNAP have been feeding my family and taking care of our health care for a couple years now while we pivoted and my partner went to school (also paid for by the gov) and now we are back to the productive portion of society. Social safety nets work and the left coast at least has useful ones.

I paid about $1750 in insurance premiums last year and an additional $9,000 in deductibles. This year should be a little more in premiums and hopefully, just $7500 in deductibles. (Wife was treated for cancer last year and had reconstructive surgery this year. I had a routine colonoscopy for the higher expense that I won’t need again for a few years. )

My insurance is probably better than most since my employer is huge.

I work for one of the largest healthcare providers in the US. I pay $450/mo for health insurance. This is not including vision, dental, or money I set aside for FSA (a pre-tax savings account restricted for use for paying for healthcare) and for and HRA (similar to FSA, but intended for when you’re older, and our company partially matches our contributions). The FSA has been refusing to pay for legitimate doctor visits that insurance has sanctioned. I pay out of pocket for a lot of procedures that the insurance ducks, such as laser eye surgery, vasectomy or even for birth control pills prior to the vasectomy.

The laser eye surgery was ~$5,000 out of pocket, the vasectomy was ~$2,000.

I had a visit to the ER - I was driven by my partner to avoid ambulance costs, and with insurance, had to pay $450 only for the doctors to stay they couldn’t figure out what was wrong and I end back up there later that week for another $450.

I was in a car crash a few years ago and my medical costs (again, with insurance) came out to ~$250,000.

This is while making $85,000/yr working as a Senior IT Engineer, and paying $2,700/mo for rent.

Generally speaking, with insurance, we’re probably paying about twice as much for any given situation, but insurance itself is also expensive and likes to dodge paying for as much as possible.

Consider that most Americans are pay 2x to 5x more in insurance premiums each month than folks in the 32 other developed nations with national healthcare coverage pay monthly in taxes for health care. Consider that Americans still pay deductibles and copays. Consider that insurance won’t cover pre-existing conditions (which are many). Consider the insurance frequently denies claims and requests for further tests and specialists. Consider that most insurance only works within the limited network of the insurance companies designated healthcare providers.

I work a multinational company that has moved staff from Japan, Canada, and the UK to the USA for periods of work. All of these folks were shocked and horrified by the American insurance system.

I had an explosive migraine a couple years ago and went to the emergency room because I thought I was dying. I had to wait for about 3 hours before being seen. Once I was seen they did a brain x ray and gave me an IV migraine medication. I had a bad sinus infection and inflammation that was pressing on facial nerves and triggering the migraine. They told me to take Claritin and sent me home.

After about a month I got the bill, over $8000. I forgot what my “good” insurance paid to the hospital but my part of it was $8k. For an x ray and IV. They also charged $200 for IV hydration which I didn’t ask for or consent to, and didn’t need because I keep myself well hydrated always.

Also it turned out that this infection was bacterial because about a week after I went to the hospital I started getting 103-105°F fevers. I then went to an urgent care and had to pay $180 to get told that I need to wait at least 3 weeks with the infection before they will treat it with antibiotics. So I suffered like that for another 2 weeks and finally got antibiotics from a different place. The nerve pain I got from that infection was unlike anything I’ve ever felt before. I was literally screaming and thrashing around, completely delirious with fever and pain and my wife trying to keep me alive. I fucking hate this country.

Oh I just remembered, I also got sent an additional $300 bill for the specific doctor I saw at the hospital. Yeah that’s a thing in a America too. You sometimes have to pay both the hospital you went to and the individual doctor who saw you, separately.

It is true that nobody pays the cartoonishly high bills that you see posted online. It is also true that we spend way more on healthcare than basically anyone else.

My company offers very good insurance. Anything “in network” is free after the first $3000 every year, and the monthly premium is around ~$330. Note that this is a company that intentionally offers very good health insurance so they can be less competitive when it comes to salary and time off. I’d say in a given year, I spend around $7,000.

But really, one of the biggest practical issues with our healthcare system is its opacity. Most people are unable to figure out what most things will cost them before they consent to care.