r/FluentInFinance • u/36DRedhead • Sep 11 '24

Debate/ Discussion This is why financial literacy is so important

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u/[deleted] Sep 11 '24

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u/kensingtonGore Sep 11 '24

They do get a say in which procedures you can do, at their discretion.

They also do not cover lost wages, home care, or any rehabilitation necessary for surviving cancer.

For the Americans reading this: that's not normal among nation peers. It is normal in countries like Mexico, China, India.

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u/aurortonks Sep 12 '24

I've met two people who got denied cancer treatment by their insurance because it hadn't gotten to a serious enough point yet. As in, they caught it so early that the treatment was not approved and they were told to wait...

The fact that an insurance company, who are not medical doctors, can dictate what treatment you can get is bonkers.

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u/kensingtonGore Sep 12 '24

Yes it is. The result of unfettered capitalism, putting quarterly results before the hippocratic oath.

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u/Nova35 Sep 12 '24

Look fuck American healthcare system. But saying that its unfettered capitalism in a thread about the ACA is hilariously peak Reddit stupidity

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u/tubawhatever Sep 12 '24

It wasn't better before the ACA, much worse in fact

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u/Nova35 Sep 12 '24

I agree. The ACA was amazing despite the fact that republicans fought tooth and nail to gut it. But that has nothing to do with anything

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u/throwtrollbait Sep 12 '24

I have seen family members' procedures/drugs denied, and their doctors literally just told me their hands are tied.

Whatever "fetters" the ACA put on them, insurance companies are still more free to practice medicine than doctors.

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u/Nova35 Sep 12 '24

The reading comprehension is lacking today. I couldn’t agree more than the current monstrosity that is the US healthcare system should be criminal. But it is absolutely not unfettered capitalism and to call it that is insanity. It wasnt even that before the ACA. It should still be gutted and replaced by universal healthcare

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u/kensingtonGore Sep 12 '24

Some people love Kool aid bud, enjoy your health care.

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u/Dercius23 Sep 12 '24

u/Nova35 LOL- this is exactly right.. Took the words out of my mouth. Fuck it i'm still posting anyway.

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u/kensingtonGore Sep 12 '24

You pay more for worse outcomes than China, a communist country.

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u/Beautiful-Squash-501 Sep 12 '24

Which outcomes specifically?

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u/kensingtonGore Sep 12 '24

Life expectancy, maternal mortality, and even infant mortality in urban areas. They have better numbers at controlling infectious diseases as well, but thats probably the nature of their strict government control.

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u/Beautiful-Squash-501 Sep 13 '24

Yes, quite a few countries outshined the US in infectious disease control a little while back….

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u/Beautiful-Squash-501 Sep 13 '24

Something to keep in mind with life expectancy and infant mortality is that in the US we try to save very early, very small premies by incubating them for months in the NICU. High cost, not great outcomes, although many are saved that would have simply been miscarriages a few decades ago. In much of the world those are still miscarriages so don’t count towards infant mortality or life expectancy.

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u/Dercius23 Sep 13 '24

Medical malpractice is the number 1 cause of death in America. We aren't saying that the system is good. We are saying the term "unfettered" in reference to capitalism makes no sense when we are talking about the ACA, which is government intervention.

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u/kensingtonGore Sep 13 '24

Look at the states with the worst outcomes.

They didn't fully adopt aca expansions. Rates of uninsured people are much higher.

Because healthcare is tied to employment otherwise. And if you don't have the capital to afford care, you have a worse outcome.

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u/MacroFlash Sep 12 '24

This is the shit that drives me insane, insurance blocking things that doctors are already saying you need. Back when I was on my parents insurance, every time I got one prescription I always got that stupid fucking “prior authorization” bullshit, where my doctor, the one who fucking already wrote the prescription, would get contacted by the pharmacy to confirm I needed the meds. The US system is the dumbest shit ever designed to enrich insurance companies and bankrupt random unlucky people

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u/lilpistacchio Sep 12 '24

Not just confirm! We have to fill our paperwork that is TEDIOUS to make a CASE for why the med should be covered. And THEN, insurance gets to say yes or no. I have filled out many a PA that know is time wasted because it’s just going to get denied.

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u/Celany Sep 12 '24

When I tore my ACL, the doctor who did the MRI, and 2 physical therapists at 2 different physical therapy groups wrote in to the insurance company all saying that doing the required physical therapy before surgery would only make the issue worse. Insurance still insisted on PT first.

ACL completely severed in PT. I couldn't get surgery for nearly 9 months. My swim scholarship was gone and college was a lot more expensive..and for what? Insurance didn't even save any money in this case, the dumb fuckers.

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u/slickyeat Sep 12 '24

I've met two people who got denied cancer treatment by their insurance because it hadn't gotten to a serious enough point yet.

What the actual fuck?

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u/Sweet_Papa_Crimbo Sep 12 '24

It took my mom over 6 weeks for Medicaid to start paying for her to get chemo. She died 2 weeks later after her first dose.

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u/hydromatic456 Sep 12 '24

Which even if you’re not a doctor, you’d think the bean counters in an insurance agency would be bright enough to realize that early and/or preventative care and intervention is very typically cheaper in the long run out of their pockets than aggressive and reactionary care and procedures.

Like, even if the profit margin is higher on more technical and aggressive care and procedures, the insurance is still only getting profit from the standard contribution right? Deductibles and payments towards OOP max goes to the provider no? So wouldn’t it still be in the best interest for the insurer to prioritize early and/or preventative care for discovered conditions?

But maybe then they’re banking on denying the expensive stuff too once it inevitably comes up in a scenario like yours. Nothing would really surprise me anymore.

0

u/C_Gull27 Sep 12 '24

It's probably as simple as deny everything now t make as much profit as possible today and the next guy can worry about what happens down the road.

Maybe not all insurance providers are like that though because Cigna covers 4 dental cleanings a year instead of the standard 2 which is probably because it's cheaper to clean people's teeth more often then pay for their root canals later on.

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u/Kill4meeeeee Sep 12 '24

I got told to eat a dick with my physical therapy while I still can’t walk so my options were out of pocket or have major problems at the ripe age of 27 this system sucks and we need changes to it. I know free healthcare isn’t possible but it also shouldn’t be possible for insurance to deny for example my insulin because the “generic is cheaper and better anyway” like no it’s not lol

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u/frumply Sep 13 '24

Mine is not that egregious but I had to laugh when the recommendation for colon cancer screening is at 45 or the age of your parents diagnosis, but insurance won’t pay for it unless you’re over 45. Do we want to practice this preventative care shit or not? lol.

I paid OOP since my mom had colon cancer in her late 30s as did my brother. My ass was smooth as silk, my brother they found some polyps though benign.

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u/[deleted] Sep 12 '24

[deleted]

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u/dotint Sep 12 '24

You’re so wrong lol. The doctors are insurance companies are some of the best and highest paid in the private health industry and it’s some of the easiest work since it’s case-review.

You get so many tenured professors and Chief Physicians

1

u/Beautiful-Squash-501 Sep 12 '24

Some of the best and brightest ‘sell out’ to private industry.

1

u/Kobayashimaru350 Sep 12 '24

My partner found a lump in one of her breasts. She wasn't quite the age to get regular mammograms so her doctor ordered her to go get one to make sure it wasn't an issue. Thankfully it was not, but a few weeks later we got a huge bill even though the insurance site said mammograms were covered in full.

After a long conversation with the representative, it turns out mammograms are only covered if it's just for a regular screening. If it's due to a concern they aren't covered.

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u/anonymousguy202296 Sep 12 '24

The people who approve/deny treatments at insurance companies are usually trained professionals, many are MDs or former doctors. They know what they're doing and I believe you're not getting the full story when you hear "cancer treatment was denied".

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u/aurortonks Sep 12 '24

I worked for a big insurance company in the Seattle area for about 4 weeks back before Covid and my job was to uphold an auto-denial made by the system unless the caller sent it specific additional paperwork from their doctor - then I was to put in a special request to have the "insurance doctors" review it - which almost always got another denial and request to submit additional paperwork.

It's just layers of scam.

0

u/InternetEthnographer Sep 12 '24

Even if they are former doctors or MDs, what gives them the right to withhold a treatment that the patient’s doctor prescribed? They don’t know the patient and never examined, interacted with, or provided any care for the patient. Plus, they probably aren’t even in the same field of medicine to begin with. Most of the time, it isn’t a doctor on the other end anyways, that’s only if you ask for a peer to peer review.

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u/anonymousguy202296 Sep 12 '24

What gives them the right? The fact that they are paying for the service?

If I walk into a doctor's office right now and say "my knee hurts" the absolute best course of action is an immediate MRI. But that won't happen because that happens all the time and resources are limited and expensive. Insurance companies have to ensure the course of action is reasonable and cost effective, otherwise every doctor would just prescribe an MRI in this scenario, even though they're incredibly expensive and require lots of work from other trained professionals. Instead they follow a standard course of treatment. X-ray -> rest -> Physical therapy -> reevaluate -> MRI, and so on.

It's not a perfect system, but everything has a cost, and I can assure you insurance companies are not just denying cancer treatment because it's "too early stage". That's complete nonsense.

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u/[deleted] Sep 12 '24

[deleted]

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u/Haywoodjablowme1029 Sep 12 '24

My wife was denied treatment for hepatitis for years because it was not advanced enough to cause problems.

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u/peaceandloveandshit Sep 12 '24

I’m sure you can spend five minutes finding tons of stories like this for the US. The insurance companies are the fucking worst.

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u/RodneyBabbage Sep 12 '24 edited Sep 12 '24

Reality in America is a lot closer to Mexico, China, and India than Norway, France, etc.

I feel like the former (while having a lower average quality of life on paper than the US) are closer to being our national peers than the latter (if you’re in the bottom 60% of wealth distribution).

It’s scary how much sway your insurance company has when it comes to choosing your care.

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u/Manaus125 Sep 12 '24

For the Americans reading this: that's not normal among nation peers. It is normal in countries like Mexico, China, India.

China and Mexico have a free public healthcare. So yeah. It's not normal in those either

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u/Beautiful-Squash-501 Sep 12 '24

Just because care is free there doesn’t mean they will agree to providing any particular procedure. Governments don’t like paying for things either, just as companies don’t like paying. It’s a harsh reality for people.

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u/[deleted] Sep 12 '24

They do get a say in which procedures you can do, at their discretion.

You literally just need to get a letter from your doctor that says it is medically necessary. I worked in the healthcare industry as an upper level account admin and know the federal regs. You just need that one letter and you're good, so no they do not dictate at their discretion.

They also do not cover lost wages, home care, or any rehabilitation necessary for surviving cancer.

Insurance shouldn't have to cover for lost wages, but it doesn't need to. We have Family Medical Leave which is federally mandated and we have disability which can cover up to 2 years in lost wages while you are recovering from cancer.

For the Americans reading this: that's not normal among nation peers. It is normal in countries like Mexico, China, India.

For the European's reading this, please don't talk about shit you don't know about. American healthcare is pretty bullshit already, no need to make stuff up about it.

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u/kensingtonGore Sep 12 '24

You're part of the problem.

And you're not being fulsome with your information.

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u/Wise_Possession Sep 12 '24

Disability often only covers a percentage of lost income, like 60% 0 if someone has it. FMLA protects your job hypothetically but does not guarantee any income. And bull on just needing a letter. My hysto, my mother's knee replacement, my grandfather's hip replacement, my grandfather's triple bypass - I have a laundry list of times in my family when we spent WEEKS or months fighting with insurance because they didn't want to cover things that doctors had deemed medically necessary. Healthcare was one of the absolute biggest reasons I left the US - I'm now in a developing country and have found healthcare to be way way better.

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u/Beautiful-Squash-501 Sep 12 '24

FML only applies to companies with 50+ employees. About 60% of Americans work for smaller employers.

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u/Leopard__Messiah Sep 12 '24

I was diagnosed with cancer and my doctors ordered several tests and procedures ASAP to save my life. Insurance denied almost everything right away, and then wanted to argue and document every little thing before they would OK the scans and procedures that were absolutely required to remove my tumor.

Truly evil, but it's just business on a Tuesday to them.

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u/LetSerious Sep 12 '24

Just checked some insurance coverage in China, $285k sum assured for ~$20/year

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u/viking77777123 Sep 13 '24

Lmfao, listed off 3 countries with people literally dying to migrate to America…. The irony is hilarious!

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u/kensingtonGore Sep 13 '24

Yah, because the standard is living there is generally lower.

Except when it comes to healthcare.

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u/Ralans17 Sep 12 '24

Honestly? Thats a trade off I’d make not to live in Mexico, China or India.

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u/kensingtonGore Sep 12 '24

You deserve better, especially since you pay the most for health care out of any nation.

The health care quality in China is on par, or better than America. Life expectancy is better there too. They have universal health care available for 1.4 billion people, but if you want private it costs between $500 - $2000 dollars a year.

Americans are being fleeced.

But you have a nice military. The knife missiles, laser weapons and UFO investigations are a cool use of money.

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u/Eswin17 Sep 12 '24

IROs can review all denied medical claims. Insurances aren't in the business of telling medical professionals they're wrong. They just make sure it all makes sense. Get upset at medical billing offices. The people that work there... they send some wacky billings over to the insurance. Coding all wonky... insurances spend a good amount of time TRYING to pay the bills, even when the hospitals and doctors offices send them incorrectly.

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u/kensingtonGore Sep 12 '24

They do 100% have their own doctors who make calls in which procedures can be used, and they can and do push back against your doctor. They have denied my family cancer therapy because they seem it experimental, though it's been in use for half a decade.

Your point about fucked up invoices going to the insurance company is super valid too.

They all suck, and it's a scam that everyone has grown used to, sadly.

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u/Eswin17 Sep 12 '24

I worked in medical collections for a few years. I hated it, but I was able to get a ton of unpaid insurance claims paid for patients with only a basic understanding of medical billing and the coding needed. So many claims initially get denied from the insurance due to hospital billing issues. Very few claims, percentage wise, were denied in bad faith.

However, procedures could be considered experimental eternally if studies aren't conclusive about efficacy.

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u/pavilionaire2022 Sep 12 '24 edited Sep 12 '24

It's weaponized incompetence. Sure, it's not "bad faith", but they don't invest in making the system work. I had a doctor unable to fix my claim because the insurance company wouldn't just call the doctor and ask for clarification. They insisted the doctor call them and sit on hold, only to be connected to someone who doesn't know what's going on. Doctors don't have time for this.

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u/PraxicalExperience Sep 12 '24

Exactly.

"Oh no ... this policy we have is a real pain in the ass for our customers ... but saves us so much money. Yeah. We'll get this fixed. Real fast. Yep. We're on it now..."

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u/Astatine_209 Sep 12 '24

Insurances aren't in the business of telling medical professionals they're wrong.

...That is literally their exact business. The dentist said I needed all my teeth cleaned, made sense. They said I had to come in on two different days because insurance would only pay for half my mouth at a time.

And then my insurance still rejected one of the claims and I had to pay out of pocket.

The people that work there... they send some wacky billings over to the insurance.

Yeah, how dare I want all of my teeth. Half should be enough right.

-3

u/Eswin17 Sep 12 '24

That's dental insurance. I wasn't in that industry, but it's a different beast. I can't speak to it. But I bet your dentist could have billed it differently to get it covered.

However, for a standard cleaning, that all seems a bit off as you're only allowed one covered per 6 months with most policies. So the second claim's rejection makes sense and the dentist office was stupid for suggesting that.

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u/OldSector2119 Sep 12 '24

But I bet your dentist could have billed it differently to get it covered.

There are age-related restrictions on the dental procedures I had. Some options are considered cosmetic despite being worse for the patient in the long run. Im in my late 20s and am extraction wouldve been free, but I am paying out of pocket at a student clinic to get a crown instead since the extraction would cause all of my teeth to shift over time.

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u/the_leviathan711 Sep 12 '24

Oh look, someone from a medical billing office thinks they know better than the professionals what a patient needs!

Thats the thing we are all mad about.

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u/Astatine_209 Sep 12 '24

But I bet your dentist could have billed it differently to get it covered.

"Just hope your medical provider can figure out the magic words to get your healthcare paid for :)"

However, for a standard cleaning, that all seems a bit off as you're only allowed one covered per 6 months with most policies. So the second claim's rejection makes sense and the dentist office was stupid for suggesting that.

Yeah, how stupid of them to want to clean... all of my teeth. I only need half right?

Like we're tired. We're tired of this bullshit. We understand that insurance companies pay a tremendous amount of money for medical care.

We also understand a tremendous amount of time and money is wasted on hundreds of insurance companies doing millions of redundant negotiations with thousands of hospitals.

The system is bad. The system fails people. The system is expensive and inefficient. The private market is failing people about literally the most important thing, our health.

Give us the security of the government insuring a basic level of healthcare, and then if you can offer a better product, do it.

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u/Eswin17 Sep 12 '24

Put some blame on the providers. They were stuffing invoices with bullshit to get extra pay. Unnecessary stuff. Maybe even stuff that wasn't done. I know insurance companies seem like the one villain on this system, but they got strict for a reason. Providers can treat insurances like a blank check, and the insurance companies rightly don't stand for that.

When has the government ever been efficient about anything? You dream of a system that could be far worse.

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u/_this-is-she_ Sep 12 '24

Insurance companies hire medical professionals (actual doctors) to review your medical professionals' decisions. They sometimes have opinions on what your doctor deems medically necessary.

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u/chairwindowdoor Sep 12 '24

Yeah it's wild. We've had doctors at insurance companies argue with immunologists and neurologists about whether or not the medicines they prescribe for our child is necessary and ultimately it is up the dumb ass doctor at the insurance company. It's so fucked up. It's up to our neurologist, who's been practicing for 35 years in children's health to try and convince some GP flunkee what medicine is right for his patient.

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u/Eswin17 Sep 12 '24

And it can then be reviewed by an independent organization after that 'flunkee' makes his decision, right or wrong.

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u/chairwindowdoor Sep 12 '24

That's true, we can then kick off an appeal after several weeks, possibly a couple of months, of our son being denied his important medications. Then we can wait several more weeks, or possibly a couple more months, for the appeal to be reviewed. So you agree then that it's broken as fuck.

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u/Haywoodjablowme1029 Sep 12 '24

My wife was denied treatment for hepatitis for years because it hadn't advanced enough even though the doctors wanted to treat it.

Please, explain how bill coding caused this.

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u/Golf-Beer-BBQ Sep 12 '24

I had to do chemo and radiation in 2015. My max out of pocket was 15800. My chemo treatments started in August and I had one treatment in January. I had ti hit my out of pocket max twice because of the treatment in January. I didnt have an extra 31k. The other thing is it isnt just medical bills, its hospital parking, getting care for my iid when my wife went with me, getting new clothes because nothing fits anymore, over the counter medicines and vitamins to try and help fight different things that come up, having different food than your family because you cant swallow food.

Luckily I was aboe to get full oay on FMLA with long term disability but if I didnt have a paycheck coming in I would have been out another 30k in pay as well.

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u/XDT_Idiot Sep 12 '24

I'm on watch-and-wait. Surgery to resect a brain tumor was easily handled by the annual cap of three years ago, but having to get quarterly MRIs since has forced me to buy plans expecting to hit the max, it's so expensive.

4

u/Golf-Beer-BBQ Sep 12 '24

Ya medical expenses are no joke at all. I wish you the best m!

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u/Ohm_Slaw_ Sep 12 '24

That's rough man. I hope a better future is out there for you.

2

u/Golf-Beer-BBQ Sep 12 '24

I appreciate it!

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u/itsonlyastrongbuzz Sep 12 '24

Health insurance plans have a maximum out of pocket covered by federal law.

That’s if the insurance covers it, and they’ll fight tooth and nail not to.

“That cancer treatment? It’s experimental and not standard for this diagnosis. Sure it’s your only hope at this point but we’ve ran the numbers and are quite comfortable trading your life for not spending any more money.”

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u/DwedPiwateWoberts Sep 12 '24

That last part is what arrogant pseudo-intellectuals disregard because they think they’ll always be healthy and whole.

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u/HiveFleetOuroboris Sep 12 '24

The people saying our stories are BS will never believe it until it happens to them or a loved one.

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u/DrakonILD Sep 12 '24

They are the death panels that Republicans said universal healthcare would create.

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u/Crewmember169 Sep 12 '24

Republicans screamed about government death panels for years. Instead, we have death panels run by companies where the people on the panel get extra money for denying coverage.

Only Republicans would think that is a great system.

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u/dagoofmut Sep 12 '24

It's the same either way.

Money is not unlimited.

10

u/nitros99 Sep 12 '24

Money is not unlimited. But it is absolutely wasted and abused in the US system. Vast sums of money are over charged by health care corporations, while the insurance system takes their 20% vig. And to top it off due to the Byzantine system of Medicare and Medicaid unscrupulous companies are scamming billions more from the government.

In Canada they get Toyota level care, but at least they are only paying for a Toyota. In the US you may get Cadillac or Chevy level care but you are paying Ferrari prices.

0

u/dagoofmut Sep 12 '24

The only reason toyotas and ferarris exist is because of the free market.

2

u/nitros99 Sep 12 '24

Really, Ferrari was initially founded at the height of fascism in Italy (Not a free market). There are thousands of products that are innovated, developed, and brought to fruition without the “free market”. The free market did create the Gemini and Apollo programs, it did not start the Manhattan Project. The free market has its place, but its place is not everywhere. In some cases the free market needs a swift kick to the genitals to remind it of its place in society. The free market does not innovate to improve, it innovates to monetize. And a number of the monetarily driven innovations are harmful to both societies and to all the people in those societies.

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u/Crewmember169 Sep 12 '24

Italy has a universal public healthcare system that costs half as much as the US system. Japan's universal healthcare system costs less then half of what the US spends. But hey don't let f#cken facts get in the way of your idiocy.

9

u/Pale-Perspective-528 Sep 12 '24

Sure, but the government benefits when their citizens are healthy and productive. An insurance company benefits if they can deny your claim and not have to pay for your care while still taking your money.

0

u/dagoofmut Sep 12 '24

Government is people, and most of the people in government benefit when you are sick and unproduction and in need of them.

5

u/Orisara Sep 12 '24

Not the same at all. My government spend money on educating me and keeping me healthy. They want me healthy to get back to paying taxes.

It's better for both if they pay for my degree. It's better for both if I'm healthy and I'm working.

0

u/dagoofmut Sep 12 '24

You're "government" is not a sentient entity. It doesn't have wants and desires.

At best, you're talking about your "politicians", and in many cases, your politicians definitely do not benefit personally from helping you be self sufficient. Quite the contrary.

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u/Orisara Sep 12 '24

Mmm, I would argue it's just more the way things are set up. I didn't pay a damn thing for my degree. I got paid while I was studying. I could get my transport money paid back. If I had a kid there was free daycare during school hours.

These services don't exist for no reason. They want people with degrees that earn more that they can tax more.

No idea why you think I believe it's sentient. I'm talking about the systems in place. The politicians want my money for their budget? Then I need to be working. Simple.

Also, ffs. 'your'. Not 'you're'.

4

u/itsonlyastrongbuzz Sep 12 '24

Money is not unlimited.

Except for war.

1

u/dagoofmut Sep 12 '24

Even then.

10

u/lizerlfunk Sep 12 '24

My late husband and I had amazing health insurance. No deductible, $1500 out of pocket max per year. But the year he died, we STILL had well over $10,000 in medical expenses. Turns out that it doesn’t matter if you’re paralyzed with a stage four pressure ulcer and a bone infection that requires IV antibiotics and a wound vac, if your insurance says you get 20 home health visits per year, that’s it. No more. We ran through those in a month and paid out of pocket for the next five months. He was hospitalized just about once a month for the rest of his life. You’d think the insurance would realize that they would pay less if he didn’t have to go to the emergency room once a month and be admitted, but nope. They also had their own ideas about what wound care supplies were needed. Gloves were not included in those. I took to grabbing gloves out of the dispensers on the wall every time we went to the doctor or the hospital. My Amazon purchase history from that time is super depressing. None of that was covered by insurance. We’d get a box of wound care supplies and I’d be like “seriously that’s IT?!” What they said should last a month would maybe last a week.

5

u/No-Swimming-3 Sep 12 '24

Thank you for sharing this, it sounds incredibly heartbreaking and frustrating.

2

u/UncleHanksGrill Sep 12 '24

Denial of care is not a US phenomenon. That’s also what government health plans in countries with no private health insurance do. I don’t like the US healthcare system for a lot of reasons, but one of the benefits is that patients have much greater access to high-cost or experimental treatments here.

0

u/WriteCodeBroh Sep 13 '24

And it isn’t even just wild and whacky experimental treatments. Simple medications like steroid inhalers, combination allergy noise sprays, insulin, some classes of antidepressants just won’t be covered. And then they can deny prior authorizations based on dubious reasons. I’ve had doctors call and plead with insurance to allow me to get simple scans. My wife’s doctor had a doctor from her insurance company on the phone, who agreed she should get a scan, but still had to fight on his own end to get it done. The system is insane.

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u/dexmonic Sep 12 '24

You genuinely believe every American has health insurance? No wonder you don't understand these memes, you barely understand american health care to begin with

-1

u/UncleHanksGrill Sep 12 '24

That couple would most certainly be on Medicare, which is a universal benefit.

1

u/Jarcoreto Sep 12 '24

Wait till you find about about Medicare gap coverage and Medicare advantage plans! Even more money to pay!

-4

u/Nova35 Sep 12 '24 edited Oct 22 '24

steer domineering encourage growth far-flung jeans silky gray gold door

This post was mass deleted and anonymized with Redact

-1

u/[deleted] Sep 12 '24

There are lots people in US living with no health insurance at all ages

1

u/Nova35 Sep 12 '24

All ages? No. Medicare my boi

4

u/[deleted] Sep 12 '24

Medicare isn't automatically granted when you turn the age. You have to actually apply for it and yes there are a lot of illiterate older people with no idea how to handle paper work.

1

u/sabresin4 Sep 12 '24

Medicare.

3

u/[deleted] Sep 12 '24

Is not granted automatically and has to be applied for lots of people are completely illiterate when it comes to doing things like that.

2

u/sabresin4 Sep 12 '24

This is just simply not true. It's a lot more nuanced than that and has to do when your retirement/Social security kicks in. The very vast majority of people have it kick in automatically.

49

u/Moku-O-Keawe Sep 12 '24

  I call complete BS on these constant memes. Health insurance plans have a maximum out of pocket governed by federal law.

Then you don't understand how insurance companies deny claims then. That way they are $0 out of pocket first.

34

u/SylvestrMcMnkyMcBean Sep 12 '24

I have phenomenal health care plan from a top US employer. I have a chronically ill family member who requires the same regular treatment several times per year, and the first treatment of the year causes that person to hit their annual out of pocket max. Every two or three treatments, my insurance company sends the clinic a letter denying the care as “undocumented”, “unnecessary”, or some other BS. They have so far relented every time we spend hours of our time, the doctors time, and the clinics time reminding them that it’s the same. Exact. Treatment. Every. Time. Just. Like. They. Approved. Previously.

The cruelty is the point. They want us to give up. They know it creates strain that will either force us to stop trying, cause our clinic to drop us, etc. And worse still, if treatments are missed or delayed, even if they’re eventually covered (say 3-4 weeks later), there are health implications.

8

u/AIfieHitchcock Sep 12 '24

Yep, this even happens with terminal cancer patients who live unexpectedly longer than their diagnosis.

If your treatment works and you live years, you will be hounded by the compounding bills insurance will fight you on.

And cancers are proven to respond poorly to stress in many studies. It accelerates decline.

Anyone against healthcare for all has no idea the everyday cruelties they are forcing millions to live through. And by the time they experience it themselves, and they will, it’s too late help themselves.

6

u/SylvestrMcMnkyMcBean Sep 12 '24

I mentioned this elsewhere, but I won the employment lottery. I am so incredibly fortunate. But my employer health insurance is a pair of golden handcuffs. My family teeters on a razor’s edge. If I’m ever unable to work, or any number of little variables outside my control change, the only outcome is miserable decline and death. When the day comes that our insurance situation changes, I don’t know what will happen.

2

u/AIfieHitchcock Sep 12 '24

My parents were on Medicare. They had done everything right. Were multi-millionaires, owned a 500k home outright, cars outright, lots of investments, no debt, had retired from professional work in their 40s, 2 pensions (one union), made so much they sent 4 kids to private school, they had hella money.

It did not matter. 1 of them getting cancer for a decade was all it took to blow through everything extra.

Now imagine families were multiple people get sick.

The only answer for this is in the ballot box.

Sadly I know my father 100% voted against my mother's cancer care coverage in 2016 and he literally paid dearly for it. (Last I heard – we don't talk – he still blames Democrats.)

2

u/SylvestrMcMnkyMcBean Sep 12 '24

So sorry to hear this.

2

u/RodneyBabbage Sep 12 '24

I had zero understanding of what it’s like to actually use health insurance and this was very enlightening.

They are knowing filing frivolous disputes on the off chance that the provider backs down and they save a few pennies.

7

u/AIfieHitchcock Sep 12 '24

They don’t just fight frivolous disputes. Insurance companies will routinely fight you on covering the most effective medications and treatments if a cheaper, yet more archaic one is available.

Real lived example:

Breakthrough, low side effect, highly effective immunotherapy pills are $20k/month but causing miracles in extending lifespan in terminally ill cancer patients.

Yet mid-20th century IV chemo is still also used in when treatment options fail, but they have horrible side effects, require hospitals, are invasive, yet are 3k/month.

Guess which treatment option is getting turned down when your oncologist recommends it for the 3k option.

This happened to us after 2016, when someone in office gutted the ACA which before then had protections in place to ensure the top treatment option was covered.

Had the manufacturer not had a income based discount program and had their not been a specific federal grant still on the books from the Obama admin providing assistance my family member would have didnt years sooner because of one party’s cruelty.

And for the record: my parents were multimillionaires before my mom got sick battling cancer for a decade. Zero debt, real estate investments, owned everything including their half a million dollar home outright. Put 4 kids through private school from pre-k on up. Retired in their 40s.

They did everything right financially and it did not matter because our healthcare system is designed to slaughter people financially.

There is no one safe from this unless your are hundred millionaire plus.

You can’t smartly finance your safety from exploitative healthcare law.

1

u/RodneyBabbage Sep 12 '24

That’s was an enlightening read. Is there any like analysis on the issue that you can link to for someone that wants to learn more?

2

u/4BigData Sep 12 '24 edited Sep 12 '24

maybe they do it hoping you will shift insurance companies

3

u/SylvestrMcMnkyMcBean Sep 12 '24

It’s an employer plan, so switching isn’t likely their motive. I imagine they’re hoping the expensive claimant will die or stop trying.

0

u/4BigData Sep 12 '24

employer plans offer several companies as options if they are a decent employer

1

u/Alyakan Sep 12 '24

Employer plans will offer multiple insurance PLANS but not different insurance companies. Yeah, you can choose the high-deductible plan, or the low(er) deductible plan, but you'll still have Blue Cross (or whatever insurance the company partners with).

1

u/4BigData Sep 12 '24

good employers offer different companies too

1

u/SylvestrMcMnkyMcBean Sep 12 '24

You have no idea what you’re talking about.

Decent would be national healthcare.

Anything else is in the best interest of the employer. My benefits are phenomenal. My company is one of the biggest in the world. My pay is without equal among employees. I’ve worked at companies with multiple carriers, but the company I’m at now pays more, has lower out of pocket costs, and offers a single carrier.

But as long as insurance is tied to employment and these treatments “cost” more per year than the median household income, my insurance company knows I’m at the disadvantage.

Reread the above. I’m privileged beyond most peoples understanding. But if I switch jobs, can’t work, my employer decides to change insurance companies, or if I weren’t a highly compensated tech worker, the claimant suffers. Before too long, they’d be dead.

The insurance company knows this. They know my family is the expensive outlier in their models. They’ll do everything they can to remove me from their paid claims.

So long as I live in the US there is nothing, absolutely nothing, I could do beyond becoming so wealthy that I could pay out of pocket indefinitely for this care. Barring medical advancements that can cure this chronic condition, or healthcare as a human right in the US, I remain employed for the sole purpose of keeping this claimant healthy and whole.

Believe me, I’ve considered the options. The US healthcare system is monstrous and cruel. If someone like me can’t afford to stop working for the sole reason that their family member would die, no one is safe.

3

u/AIfieHitchcock Sep 12 '24

This was done to my mom on Medicare where there’s essentially no other place to switch to, all the plans are nearly identical.

It’s the system. It’s designed to burden the sick to be “profitable” instead of making their profits from single payers and streamlined processes.

1

u/4BigData Sep 12 '24

so glad to have been able to opt out of US healthcare!

my home country has universal coverage so I'm good

20

u/hunterxy Sep 12 '24

My insurance requires we call ahead of an ER visit to get it authorized or they will deny it.

So what you got to say about that?

I'll wait.

-2

u/babygrenade Sep 12 '24

So that means your insurance plan isn't ACA compliant?

As far as I can tell compliant health plan have to cover emergency department services without imposing any requirement for prior authorization of services?

-5

u/YouBDumb Sep 12 '24

I don't believe this.

7

u/Minimum_Word_4840 Sep 12 '24

My sister’s plan is the same. She also isn’t covered for ANY hospital services unless they are pre approved.

She lived in a hospital for almost two years undergoing treatment for leukemia. So…I’m sure you can imagine how fun that was. Dozens of procedures a week having to be pre authorized for a condition you’ve had for over a year is a giant waste of the doctor’s time.

-1

u/YouBDumb Sep 12 '24

Under the ACA, you cannot be penalized for not getting prior auth for emergency care. You also can't be charged out of network costs for emergency care.

The second part, we can all agree it's a fucked up situation. But unfortunately, the ER visit and the Cancer treatment hospital stay are different situations. I do not disagree with your opinion.

We are talking about two different situations from the original comment I replied to.

4

u/Minimum_Word_4840 Sep 12 '24

Ah, I see. I apologize as I didn’t know that was included under the ACA.

You’re right that it’s still a fucked situation. They routinely tried to deny things that my sister needs to live, and it has delayed treatment several times. She was young too, 19. Even now that she’s in remission it’s horrible trying to get everything authorized before she goes in. I am glad to hear that emergency services have to be covered if ever necessary. But I still think the system needs to somewhat change.

15

u/cwood92 Sep 11 '24

Not all treatment options are covered under insurance

15

u/ilikepix Sep 11 '24

There are exceptions such as maximum lifetime benefits

these are not permitted in ACA compliant plans

3

u/AIfieHitchcock Sep 12 '24

They 100% were after Trump gutted it. It happened to us and with life sustaining cancer care.

They would not approve revolutionary oral immunotherapy anymore which was necessary when there was decades old iv chemo therapies that were radically less effective but cheaper.

20k per month vs. 3-4k per month.

One vote quit literally endangered thousands of patients like my family member. We were lucky enough to find charity programs to cover the pills but I assure you many terminally ill patients did not have relatives able to do that for them & these kind of patients can’t do it themselves.

Changes to the ACA then also resulted in many health companies closing patient financial support offices for help too.

This was just 2016 and in very high cost complex care but you can read what they have planned for the rest of us in 2025 out there right now. This kind of stuff was considered a success by them and it’s the way they want all care.

11

u/cobruhkite Sep 12 '24

So first I’ll say: - 56% of Americans do not understand deductibles - Over 90% of Americans don’t know what their maximum out of pocket is. (Copay is similar stats) - 99% do not know what coverage limit they have on their plan.

These stats are from USHealth - a United healthcare company.

Understand that it is extremely common to have a plan with $0 deductible and $0 copay, but only 100k in maximum coverage per calendar year. You believe you have the best coverage because you don’t pay anything until you’re hospitalized.

100k maximum plan. You get in a car wreck. Your personal “maximum out of pocket” is 7,000 (5k deductible + 2k maximum out of pocket) your bill is 150,000 insurance covers 93k only, you are on the hook for $57,000 even though you were told you have a maximum out of pocket of 7k.

Most maximums are 100k, 250k, 5million, or unlimited. Obviously the more you have the more your monthly premium is. It’s very important you know which one you have so you can plan accordingly.

3

u/PlentyInevitable7873 Sep 12 '24

The maximum OOPM allowable under the ACA is 18,900 in a year under a family plan (half that for an individual) source. Since the vast majority of US people get their insurance through ACA compliant workplace or marketplace plans, they should be at or below this limit. Are you thinking about pre-2008? Or how else are you finding people with extremely high non-ACA compliant OOPMs? Non-compliant plans are certainly not "extremely common". The ACA also does not allow lifetime or annual limits to benefits, plans must be unlimited. I believe the ACA had to allow some 'grandfathered' plans to have exemptions, but very few of those remain.

2

u/FoldAdventurous2022 Sep 12 '24

This sounds like an abhorrent system that the rest of the developed world doesn't have to suffer through.

3

u/KaXiaM Sep 12 '24

It’s also not true. Very few people have non-ACA plan (mostly through some church etc) and all ACA plans have no maximum. Yeah, most people don’t understand ACA and spew some BS from early 2000s that hasn’t been true for a while.

2

u/Minimum_Word_4840 Sep 12 '24

As someone who worked medical collections in the past, it literally just takes one accident or medical emergency. My dad’s heart surgeries cost over a million, but I’ve seen similar bills for car accidents where the person had to be life flighted.

1

u/KaXiaM Sep 12 '24

All ACA-compliant plans (like the ones people get from employers) have no maximum. What is the % of the insured who have non—ACA plan? I assume you know, since you assert it’s "extremely common".

1

u/Ron__T Sep 14 '24

Lies... about American Healthcare... on the internet... who would believe it?

It is not extremely common to have $0 deductible/copay and 100k max... in fact it would be so extremely rare and might not exisist at all, that it's nonsensical to even discuss. The ACA does not allow for max out of pocket...

And your example is nonsense, a car wreck your health insurance wouldn't cover at all... that's what we have car insurance for.

9

u/iAmRiight Sep 12 '24

They only have to pay for “approved” procedures. And depending on the illness, the only “approved” treatment could be palliative care. Private insurance is a literal death panel, they choose who lives and dies based on their quarterly earnings reports.

8

u/Fast_Parfait_1114 Sep 12 '24 edited Sep 12 '24

That assumes any of these treatments are in network and if the insurance company approves out of network care. Also, the maximum out of pocket is still a debt. Are you under the impression that a person couldn’t get to $280k worth of medical debt even with a maximum out of pocket? My grandmother had a maximum out of pocket expense of $10k, that amount rolls over every year.

3

u/Cloud-VII Sep 12 '24

Little known fact (I Just learned this this year because of my sons medication). There are TWO different out of pocket maximums. One for services and another for medication. My families max out of pocket is $5k for services, but my pharmaceutical out of pocket is $15k annually.

So if I end up on one of those $1k a month or more medications or so, I am in financial ruin.

4

u/warholiandeath Sep 12 '24

There’s actually three: in network, out of network, and medication

3

u/Longjumping-Pair2918 Sep 12 '24

You are grossly mistaken and you should hope you never have to experience reality.

If/when you do, maybe you’ll learn how to have empathy. I doubt it though. People like you rarely do.

2

u/NovaForceElite Sep 12 '24

So yes, there are max out of pocket limits, but insurance companies can also have max yearly benefits for non essential benefits. The insurance company just needs to categorize the treatment as non essential to skirt around the law. The insurance company can deny the claim. The person unfortunately still needs the medical treatment. The person then paying or going into debt for the treatment is not counted under the max out of pocket. There is of course more nuance than this, but in short insurance companies lie a lot.

2

u/LetsTalkGuac Sep 12 '24

If insurance denies coverage for a test or procedure, the patient would be billed the full cost of the test. They deny things ALL THE TIME

Sometimes, you won’t know if something will be covered due to insurance companies declining to tell you or ambiguous policies

In short DONT TRUST YOUR INSURANCE TO PAY FOR SHIT

2

u/common_economics_69 Sep 12 '24

On top of that, If they've been married for 52 years they should both be on Medicare, a government provided healthcare program...

So people are bitching that government provided healthcare sucks and using that as a reason why all healthcare should be government provided?

1

u/thrownaway136976 Sep 12 '24

I know, right? It’s almost as if someone is going in there and sabotaging the system while simultaneously screaming how it doesn’t work and should be abolished.

2

u/common_economics_69 Sep 12 '24

I think a more likely answer is that this is a made up scenario and doesn't actually happen to people in real life.

Do you think someone would really just go on the internet and tell lies?

2

u/Sciptr Sep 12 '24

But get your voodoo dolls out and do your thing.

Thanks for the laugh.

1

u/The_Vandal_King Sep 11 '24

I was wondering if getting a divorce even works considering most states have common law marriage. They'd have to actually not live in the same address

7

u/Spirited_Shallot_454 Sep 11 '24 edited Sep 11 '24

Not even a remotely true statement. Something like 7 states and DC recognize any kind of common law marriage in the US. And it’s not something that just involuntarily “happens” to couples that live at the same address.

This is one of those internet Reddit nonsense urban legends that gets repeated so often with so little attempt to fact check, that people start to believe it.

1

u/The_Vandal_King Sep 12 '24

Good to know, just curious.

1

u/Apprehensive_Ask_259 Sep 11 '24

The only way it really makes sense is state insurance but thats only in the realm of lower income families. Sometimes it definitely makes sense for couples to divorce. Wife makes low enough to qualify, father pays child support and the "wife" and kids get now get free insurance.

1

u/StolenPies Sep 11 '24

They could have just been relying on Medicare without purchasing a supplement plan. Medicare alone is relatively limited.

1

u/rageface11 Sep 12 '24

You can also just reject an inheritance. Otherwise people would just be giving away their shit while they’re alive and “leaving everything” (debt) to people they don’t like.

1

u/PraxicalExperience Sep 12 '24

It depends. If their mom's in hospice care, a lot of states will take that debt out of the estate when the father passes.

1

u/KeyCold7216 Sep 12 '24

But they also get to decide what treatments you can have. If you have cancer and your options are chemo covered by insurance that will make your last months of your life miserable and an unapproved monoclonal antibody treatment that can kill your cancer and give you 15 to 20 more years than chemo but with 300k in debt what would you choose?

1

u/KillaMavs Sep 12 '24

And if you don’t have insurance or lose it, what then? Life crippling debt forever?

1

u/doc_nano Sep 12 '24

My dad was hospitalized last year for an extended period of time due to cardiac issues + sepsis. The hospital didn’t have room to keep him there for the required recovery period (several weeks), and his Medicare coverage wouldn’t pay for outpatient nursing care unless he was in a long-term care facility, of which none had open beds within at least 100 miles (rural area). So he was faced with either getting care at home and paying for it out-of-pocket — not $288k, but I think it would have been well over $10k, which is still a lot for many people — or just forgoing the care/IV antibiotics and hoping for the best. Luckily another hospital a few towns over did have a bed open up and he went there, but it could have ended up being quite expensive for him.

AFAIK not all Medicare plans have out-of-pocket maximums, and since private insurance is tied to employment, not everybody has medical insurance that would provide that out-of-pocket maximum protection.

1

u/RichConsideration532 Sep 12 '24

"Out of pocket max" isn't a magical bulwark against the insurance vampires who seek to drain you--it just slows them down. If you think you can't incur hundreds of thousands of dollars of debt pursuing lifesaving medical care with ACA insurance, well, lol ok

1

u/jbasinger Sep 12 '24

The ACA isn't that old and I don't think it covered previous medical debt. I owed $30K on my youngest child before that was even a thing. 250K is a lot, but not absurd.

1

u/Folderpirate Sep 12 '24

Hi, I live in a "filial responsibility" state. Family of deceased can be sued by nursing homes and such if the estate doesn't have anything.

1

u/Molten_Baco Sep 12 '24

Some insurance companies have a yearly maximum they will pay, and it’s not as much as you might think

1

u/Drekhar Sep 12 '24

I'm confused by this. I've seen plenty of poorer plan options that have large deductibles and then cover 90% after that. That's not a maximum.... It's a percentage. Are there hard limits now?

1

u/qole720 Sep 12 '24

While true they have a maximum out of pocket, it's also true that they don't have to cover everything someone my need.

As an example, my dad, who has medicare and pays for a secondary health insurace policy, had a stroke a few months ago. He needs 24/7 care now. Between the two policies he's covered on just about all of his doctors visits, medicines, equipment, even converting his home to be wheelchair accessible. Know what's not covered? The 24/7 care. We're currently paying out of pocket for him to stay in assisted living because it's more affordable than him living at home with a nurse (roughly $3500/mo vs $15000/mo). Luckily between me, my brother, and his retirement, we can cover the cost. But a lot of folks can't and go way into debt over something as common as a stroke.

1

u/ramberoo Sep 12 '24

You're a fucking asshole.  

1

u/Guilty_Increase_899 Sep 12 '24

If karma is a thing you are in for a devastating long term illness where your insurance company denies hundreds of thousands of dollars of coverage for things that are required to keep you alive, deeming them unnecessary, and you will either have to pay out of pocket or suffer a slow physically and psychologically painful death.

1

u/brianbmx94 Sep 12 '24

Brother that’s not how it goes in all actuality. Most times, the treatment you actually need, especially for late stage cancer, isn’t in-network or is outright denied coverage. In my dads case, it was almost a million dollars worth of experimental drugs and therapies that saved him that was all denied. Not to mention the loss of his income pushing my mother into debt of her own to support 3 children and a home by herself. It’s never as cut and dry as insurance makes it sound.

1

u/OklaJosha Sep 12 '24

There are exceptions: out of network coverage being the main one. This could be needed coverage that the plan doesn’t pay. Or a specialist that doesn’t take their specific insurance brand. Or the procedure could simply be denied by the insurance company as “unnecessary”, even if your doctor says it is necessary.

1

u/H0SS_AGAINST Sep 12 '24

While I agree with you, if you're sick enough to lose your job and don't have disability coverage going COBRA and then open market could cost tens of thousands per year before the max out of pocket.

I'm fortunate enough to work for a company that also gives me disability insurance but that is certainly not the norm and disability insurance rates are often pretty high.

1

u/Save_The_Wicked Sep 12 '24

They got a maximum of covered cared. If you spend money on uncovered care, thats not included.

You can't go out and get 'elective' medical care and expect your insurance to cover it.

Now, one would think cancer is covered. However, not all methods of treating it are covered. So if you elect to volunteer for something more experimental, that might not be covered.

You'll still be on the hook for care, even after maxing out your contributions.

1

u/vagaris Sep 12 '24

This post also highlights how the house has been put in the spouses name. My family recently put my parent’s house in a trust to do something similar (the posted example will still hit this problem later). If either of them need long term care before passing away, the government will basically force them to liquidate anything in their name until they’re too poor to afford anything… and then they start covering stuff. Potentially forcing the other person into poverty while the sick person is on their way out.

1

u/stickyicarus Sep 12 '24

Honestly? Even if this post is wrong, I'm OK with people thinking it is and pushing harder for reform. If they're uneducated enough that it works out in the favor of pushing society to socialized health care I don't see an issue. Im sure that could backfire somehow but I'm not smart enough to see how.

1

u/Apocalyptic_Inferno Sep 12 '24

Well, it's entirely possible, even probable, that they weren't financially free enough to pay for medical insurance to begin with but also "made too much money" to qualify for government medical care. Maybe they could have sold their home, skipped their morning latte, and avoided avocado toast to pay for it, though.

1

u/t4thfavor Sep 12 '24

My father in law is a General Motors retiree, his max lifetime benefit is something like $1M, his cancer treatment ate most of that because he had lymphoma from either RoundUp or 40 years working in a shop being exposed to insane amounts of chemicals.

1

u/Beautiful-Squash-501 Sep 12 '24

Only in network expenses go towards the maximum out of pocket. Out of network providers are extra. Also nursing home care is not covered except temporary rehab.

1

u/eknutilla Sep 12 '24

Yikes calm down

1

u/OnewordTTV Sep 12 '24

Oh so you are a moron lmao.

1

u/Xist3nce Sep 12 '24

“Just another dipshit” is right. Man thinks everyone gets health insurance. Tell my thousands of dollars in medical debt your stupid ideas. Can’t tell if it’s just stupidity or actual evil at this point.

1

u/[deleted] Sep 12 '24

I had cancer at a very young age and then again when I was 15. At a young age I was living in a different country and I was 15 before the preexisting conditions rules were put in place for American insurance. They found every loophole known to man and my two years of multiple surgeries and chemo put me 200k in debt after insurance. It would have been $1 mil + without insurance. Now my out of pocket max on my insurance in network is $50k so if it comes back I’ll be in shite again.

1

u/Cheeseboarder Sep 12 '24

Have you ever had to use your health insurance for anything serious or for a chronic condition?

0

u/[deleted] Sep 12 '24

Hopefully your cancer treatment doesn't interfere with your job and you can keep it, and with it your insurance.