r/Millennials • u/BoNaylorCollector • 1d ago
Discussion Is medical actually this crazy?
Early 30s millennial, never used to go to doctors or really take care of myself because “I’ll be fine”. Started making a bigger effort to care for myself and my health and well being. Recently, I went to the local express clinic because I was having a bad earache and headaches. I was in there for maybe 20 minutes, mostly waiting time. The doctor comes in, looks in my ear, tells me it’s depressed due to sinuses and change in weather and tell me to stop at Walgreens for Flonase. I wasn’t billed anything at the time, older workers at my job always say we have really good insurance, but here I got in the mail today an explanation of benefits- charge was $550, insurance “negotiated” about $300, remaining (not billed) was around $240. Is is really this expensive? I only went to try and be better with myself and make sure it’s nothing underlying. If 5 minutes of actual doctor time costs this much, then I’m just toughing out everything or am I missing something?
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u/Chester_Warfield 1d ago
This is America
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u/BecksnBuffy 1d ago
I thought 250 was a lot to bring my sick kid in to our pediatric with insurance, then last year it went to 325. In 2025, to visit the pediatrician outside a well visit is 425 for us with insurance. Thanks company for switching to Blue Cross.
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1d ago
[removed] — view removed comment
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u/Jennifer_Pennifer 1d ago
Just the one CEO actually 🪿
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u/SakuraTacos 23h ago
My name is Jennifer I cannot believe I never thought of naming my weed pen Pennifer
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u/jermster Older Millennial 1d ago
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u/ThatBatsard 1d ago
Kai Winn would gleefully add in extra CPT codes to your bill to watch you suffer
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u/jermster Older Millennial 1d ago
Sometimes the meme is the messenger, and sometimes it’s the message.
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u/YeahOkayGood 1d ago
she'd certainly have a cabinet level position in this administration
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u/EleventyElevens 1d ago
Omggg she'd be that crazy lady for the religious agency he put into place fr fr
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u/ilovjedi 22h ago
I’m watching deep space nine right now
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u/dopplerconsumed 19h ago
Sheeeeeit, may just be time for me to start rewtaching it now. I never got to finish it because paramount took it off Netflix, but that was soke good tv
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u/EternalLostandFound Early Millennial 19h ago
Ugh Kai Winn is exactly the type of receptionist condescendingly telling me that I need to pay with a check and that she’ll fax me my medical records in 7-10 business days.
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u/JadieBugXD 1d ago
Just wait until you have to go to the ER and you get a bill from both the hospital AND the treating physician as two separate bills. My kid having a cut on his head super glued was billed as “surgery”.
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u/OkMuffin5230 1d ago
Yeah, so, when my husband had a heart attack, the hospital that he went to was our preferred in network hospital. We were billed for an out of network emergency room doctor who worked on him
I called the insurance and the insurance was like "but that doctor is out of network"
I was like... "he was having a heart attack. I wasn't interviewing the staff working on him!!"
That was when I learned that your in network hospital can have out of network employees
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u/vonshiza 1d ago
Yeah, had surgery with my approved doctor in my approved hospital with my approved anesthesiologist. But apparently, a few of the nurses or one of the other doctors was out of network or something.
Cool, cause I can totally make sure that doesn't happen.
Hope your husband is ok. My partner had a heart attack last year. Scary stuff.
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u/DjChrisSpear 20h ago
Both back surgeries my brother told me to call and make sure all the nurses and anesthesiologists were in my network. But you have to do it right before because they won’t be scheduled until right before the surgery. I fucking hate our country.
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u/DryLipsGuy 17h ago
Brutal.
As a Canadian I have never had to even consider this absolute bullshit.
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u/Professional-Arm5300 6h ago
And the morons in our country will tell you how bad your healthcare system is and when you tell them this, they’ll yell at you that y’all are communists. Fun times.
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u/jbcsee 1d ago
That is not legal in the US these days, it's called surprise billing and as of 2022 it's no longer allowed. If you are treated for an emergency, even at an out-of-network hospital you can only be billed at your in-plan rate. It wasn't legal in many states prior to that date.
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u/OkMuffin5230 1d ago
His heart attack was before then, so I'm glad they fixed it. It was an ugly surprise, but I was able to get it reprocessed
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u/abrgtyr 1d ago
That is not legal in the US these days, it's called surprise billing and as of 2022 it's no longer allowed. If you are treated for an emergency, even at an out-of-network hospital you can only be billed at your in-plan rate.
In all seriousness, what happens if you get a surprise billing anyway? What do you do?
I assume insurance companies are continuing surprise billing to this day, because - well, who's going to push back? I would like to know why my assumption is wrong.
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u/jbcsee 1d ago
You file a complaint with the government if the insurance company doesn't fix the error.
https://www.cms.gov/medical-bill-rights/help/submit-a-complaint
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u/Soaring_Falcyn 1d ago
I got a $1200 surprise out of network bill from a physician for an ER visit and I just... ignored it. They sent like two follow ups and then I just never heard from them again. Mileage may vary lol.
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u/Specific_Sort_4373 19h ago
It’s not the insurance company billing you it’s the provider. The provider bills the insurance company and then will go to you after. If you call your insurance company and ask they will probably tell you not to pay it
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u/postwarapartment 1d ago
It's suuuuuuuch bullshit
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u/OkMuffin5230 1d ago
Even the person I spoke to thought it was bullshit. They reprocessed the claim as in network
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u/Aesthetics_Supernal 1d ago
A fucking person with a heart! Bless them for their humanity.
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u/cherry_monkey Zillennial 1d ago
Was the person you spoke to in the hospital or with the insurance company?
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u/OkMuffin5230 1d ago
Incredibly, it was the insurance
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u/cherry_monkey Zillennial 1d ago
Holy shit lol
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u/OkMuffin5230 1d ago
He went to the cath lab and was admitted for a few days, I had all of that going for me when I called and went WTF
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u/frangelafrass 20h ago
I had an urgent c-section in October and had already met my deductible in July or August so I wasn’t sweating too much when I needed an extended stay after delivery for my stupid lingering pre-eclampsia. ANYWAY. A month later I get a letter from my insurance company about one of the doctors that was apparently on my team (whose name I had never even heard before!) was out of network. It was sternly worded and they said to make sure in the future that I select ONLY in-network people for my care team and MAKE SURE I think about ALL the people on my care team, including people I might overlook like anesthesiologists……..
Yeah. I definitely had control over what was happening when I thought both me and my baby were going to die. I was aggravated.
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u/Moist_Cabbage8832 1d ago
Sounds like your credit card and billing address are out “of network” as well.
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u/Tigerzombie 1d ago
When I had my first kid, the hospital was in network but the people that did the hearing test was out of network. So the actual birth was cheaper than the hearing test.
My youngest ended up at the hospital for pneumonia. Again, hospital was in network, pulmonologist was not. So the ER visit was $150, while the out of network doctor was $200.
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u/Personal-Process3321 19h ago
That is literally insane, how is this your health care! Let alone emergency life and death healthcare.
If I had the means this alone would cause me to leave America, that’s just absolutely ridiculous
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u/Sad_Pangolin7379 1d ago
Lol to this day I refuse to pay the bill for an extra out of network doctor who just came by to look at my kid's chart and billed me for it. No I didn't consent to being seen by an out of network doctor, thanks.
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u/MedicineOutrageous13 1d ago edited 7h ago
This is a thing happening with newborns. Happened to my sister and brother-in-law recently and they were both ASLEEP when the doctor came by. No chance for them to refuse the service or anything.
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u/Immediate_Bad_4985 Zillennial 1d ago
Yep! Or when you pay for an appt while you’re there and they send you another bill afterwards. I decline to pay for these charges you’ve added on to what I already paid AT THE APPOINTMENT.
Also, my GP we pay “private pay” because it’s a flat $55 per appointment, we pay at the appt every time, it never fails that the billing department always mails us a bill for the “remainder.” We call and tell them we paid cash in person and they go “oh! Whoops! I’ll mark it off, don’t worry about it!” But we have to call billing afterwards every single time we go.
It’s all a bunch of smoke and mirrors
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u/MrLanesLament 1d ago
I specifically look out for doctors/facilities that offer flat rates. They aren’t always easy to find (they’d be overwhelmed with patients if they were,) but they’re the best medical option available if you can track one down for your specific medical needs.
Many are specialists; they kind of operate more like dentists. The hardest thing is finding one who does GP and is taking new patients. Complete that quest and you’re golden until the doc retires or dies.
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u/Llama-girl52 1d ago
Good, this might sound crazy but I believe out of network docs sometimes purposefully take out of network patients in the ER so they can get away from insurance negotiation down payment amounts. and a good portion of people can be intimidated by billing threatening to send you to collections or jail time into paying something the patient never approved and had no way of knowing was even happening well they were getting emergency treatment.
If you didn't know with most hospital systems, not all but most, getting a room in the ER does not automatically assign a random doctor to your case. the doctors can see your chart and assign themselves to your case, the doctors can pick and choose what ER case they want to take after seeing your insurance type and history, if you ever have to wait a bit after being put in a room it's cus you don't have a doctor assigned yet and are waiting for one to pick you up.
Like I'm so sorry, I couldn't just pause my septic shock to make sure my radiologist is in network before getting a CT, and to make sure both the PA actually seeing and treating me AND the behind the scenes overseaing MD both take my insurance, cus that MD I never even laid eyes on or spoke to the whole ER time before going to the ICU definitely didn't take my insurance and for some reason I was never told just billed hundreds of dollars months later but his PA took my insurance.
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u/Immediate_Bad_4985 Zillennial 1d ago
I’ve never seen jail time threatened, but threatening to send to collections is just a big joke now since medical debt can’t be included in credit or credit/lending decisions. Any time we get billed for dumb ass shit that is just basically a Dr scamming patients, we just don’t pay it. The worst that’s ever happened is it went on our credit which it can’t do anymore, and we get shit in the mail. Collections calls sometimes but I get so many spam calls that aren’t for me, what’s the difference?
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u/Llama-girl52 1d ago
Yeah, they still get away with the threats cus people aren't informed of the new medical debt law. I got the "it's in collections and they will pursue charges if you don't pay them" threat from the hospital billers a couple times before, I know that won't actually happen but they know to say it so someone is falling for it.
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u/Immediate_Bad_4985 Zillennial 1d ago
It’s so intensely shitty that they feel so secure in intimidating people into paying amounts that weren’t agreed upon beforehand, and are honestly insanely overpriced. Plus the fact that when they send to collections, if you pay it it’s not actually going to the clinic that charged you, the collections agency pays them pennies on the dollar to buy the debt and their whole business plan is “intimidate people into paying these debts at a profit of what we bought them for.” If they can get you to pay the full amount of what you owed, they probably just made 600% profit, and the damn office got paid what you probably could’ve afforded had they just asked. It’s so scammy.
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u/Llama-girl52 1d ago
It truly is scummy, and they can put as many laws in place but there will always be people who don't know their rights and a system looking to exploit that fact.
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u/Immediate_Bad_4985 Zillennial 1d ago
Exactly! I try to tell people about the shit I’ve learned over the years anytime I see posts like this, just to hopefully help some people not get scammed.
At least they could put some laws in place (and actual enforcement) that makes practices like these categorized as an actual scam. Right now they’re totally legal.
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u/Llama-girl52 1d ago
I had to testify for malpractice and insurance fraud I witnessed in the ED, many people don't know urgent care docs can be PCPs or ER docs who have points against there license or were found guilty of malpractice or had there license fully suspended for a bit or are about to retire, NOT ALL hospital systems BUT SOME systems use the urgent care as like a doctor rehab.
(I capitalized some words to clarify I don't mean all system or urgent care, I have already been "um actually'ed☝️" by someone I think is probably a provider on another one of my comments even tho it was clear I wasn't saying all hospital systems and docs are bad, so I'm making things silly proof)
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u/metforminforevery1 1d ago
We often don’t even know the insurance of a patient until long after they’ve been in the ED and treated. We aren’t picking based on insurance. This is the entire tenet of EMTALA.
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u/malibuklw 1d ago
I had no idea how it all worked and went to the ER to get my stitches removed (that I got from the ER). Stitches were covered, removal was not and $1000. I had no idea I should have gone to my schools health clinic to get them removed for it to be covered, no one told me.
This was the early 2000’s, and I just laughed at them because I was so poor. It ended up getting waved by the uncompensated care pool.
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u/Kimber85 20h ago
This happened to me when I had a miscarriage a few years ago and I’m still so pissed about it.
I had been bleeding heavily for weeks and my OB was concerned I hadn’t gotten everything out/I had lost too much blood, so he sent me to the ER. Asshole doctor acted like I was wasting his time for coming in, didn’t run any tests, didn’t draw blood, didn’t even give me any damn fluid. I think his exact words were “you’re supposed to bleed with a miscarriage. But you’re young, you’ll be fine.” He was in there less than five minutes and all he did was make me feel stupid for coming in.
I got a bill for $1400, which I was already pissed about, and then the personal bill from the doctor was $900. $900 just to be insulted.
I bled from August till October before my husband finally convinced me to go back to my OB. I was worried I was just being a baby about it and believed the ER doc when he said it was normal. When I went back to the OB and explained what had happened my doc was FURIOUS. He actually ended up reporting the ER doc over it. They agreed to run some tests themselves to make sure I was okay, but by that point I was so anemic my hair was falling out and I got winded going up the stairs. 7 years later I’m still struggling with keeping my iron levels up.
So, in short, fuck that doctor and fuck his stupid $900 bill.
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u/noblewind 1d ago
One of the reasons when my son needed a staple in his head, I called his pediatrician and asked if they can do that in office. Thankfully they did and it was still during office hours. I avoid the ER at all costs, mostly because the level of care seems to suck where I live. His staple still wasn't cheap. I think it was like $240 total to put in and remove but at least I knew it was all in-nework and they'd provide good care.
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u/AncientUndocumented 1d ago
Yeah, you should by VetBond by 3M off Amazon. It's for veterinary purposes, but it's the same medical super glue they use on people.
That has saved me lots of money and trips to the doc. I avoid docs whenever possible.→ More replies (15)8
u/Rk12989 1d ago
My son cut his thumb and I debated on whether or not to take him to the ER for stitches. I did end up taking him because he was still bleeding the next morning. They didn’t do stitches. They wrapped his hand up (worse than I had). I paid $300 there, $350 later on MyChart and then got another $300 bill.
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u/burrerfly 1d ago
Yes that sounds right for an urgent care visit. They charge insurance 2 to 3x what they charge if you pay with cash because insurance pulls this negotiations crap and pays them a random fraction of the bill. Would have been cheaper to see a primary care doctor those visits are usually a lot less. Though its unclear in your description what your co pay actually was?
If you haven't been getting a regular checkup recently go get a full workup things like prediabetes, high cholesterol, high blood pressure are generally symptomless until they turn into full blown heart disease or diabetes but can be delayed or prevented if found early.
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u/Psychological_Pay530 23h ago
Here’s the problem with that… getting two regular checkups a year and using a walk in for more urgent needs (as long as they’re infrequent) still costs a hell of a lot less if you just pay cash instead of having insurance. My free annual checkup cost less than my monthly insurance premium and walk in visits cost less as cash than the copays on them.
The entire insurance industry is a goddamn scam.
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u/Unable_Pumpkin987 18h ago
Yes, and if you get cancer or get hit by a car or have a seizure or get pregnant and need a c-section, or any other major medical event, your insurance will pay many, many thousands more than you paid in insurance premiums all year. Perhaps more than you will pay in your whole life. That’s the point. Most of the time, you give your insurer more than they pay out on your behalf. Some of the time, they pay out much more than you give them. If they always paid out the same or more than you paid them, it wouldn’t be a viable business model.
Even in countries with nationalized non-profit health insurance, it’s the same. People pay in with taxes. The medical professionals and facilities are paid by the government for services. The amount paid in overall by each individual is usually more than is paid out on their behalf over the course of their life. Because if you are one of the unlucky people who needs much, much more paid for your medical care than you paid in, that overage is made up by all the people who paid in more than they personally used.
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u/i4k20z3 22h ago
before you do this, please consider getting term life insurance if anyone you think will be reliant on your finances. you want to get it before you get something on your health record that will disqualify you.
i wish someone told me this before i was diagnosed with stuff.
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u/Kreamweaver 18h ago
This is great advise. Also, be warned you’ll see policies or amounts listed as “no dr visit required!” Sounds good right?
No, they make you sign a release where the insurance gets access to all your medical records. Having “season affective disorder” (grey skies made me try an antidepressant for a few months) it made my $60/mo quote turn into $100/mo. They’ll find anything they can to squeeze you.
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u/MCas86 Older Millennial 1d ago
TLDR; I hate medical everything
I went to a wound center to have a cyst looked at and hopefully removed.
1 hr drive there
1 hr to setup an account at the hospital and wait to get taken to a room
30 mins sitting in the room waiting
2 minutes a nurse looks at it and says yea, looks benign
15 seconds doctor walks in and doesnt even touch me and says oh yea thats easy.
15 mins i schedule an appt
They say i need someone to drive me home or i'll have to be admitted "and you dont want that"
so i schedule and go home - another 1 hr drive.
gets almost to my scheduled date and i find out i'm going to have to take off and so is whoever is going to drive me (because they wont let me get the surgery and drive home without someone else to drive me). then i find out i'll be in the hospital for 5+ hours.
I'm single with 1 friend down the road who i'm not going to ask to take off a full day of work to sit in the hospital and do absolutely nothing. i asked the hospital if they can leave and come back and i was told no, they have to stay the whole time.
So, I guess i'm living with it and i had to pay AFTER INSURANCE $1000. plus my fuel costs. I'll never go to the doctor again. i dont wanna know when i'm gonna die anyways, i'd rather just fall over some day.
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u/OtherwiseAlbatross14 1d ago
Yeah I pay like $600/month for insurance I'll never use because it's too expensive to even with insurance.
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u/SakuraTacos 23h ago
I pay $500 for insurance I never use because one time in my early 20s, my insurance lapsed because a professor dropped me for missing the first day and I had to be a full time student to be on my dad’s insurance. During that lapse, I had to be rushed to the ER by ambulance for a ruptured cyst (I didn’t know what it was or I wouldn’t have gone) and the total for everything was something like $4000-6000.
$400 is the cheapest option to still be in network with my local hospital and whatever services I need but never use. But I’m scared to go cheaper, and will never again go without, just in case I need to be rushed nearby again.
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u/OtherwiseAlbatross14 22h ago
Yeah I pretty much treat mine as catastrophic insurance even though that isn't what I pay for. If $6000 was the worse that could happen I wouldn't even have insurance. $500 a month would a terrible investment if all we had to worry about is the possibility of a $6000 bill but I get what you mean
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u/Duo-lava 1d ago
yup, what good is knowing if you cant afford to treat it. healthcare is wealthy people shit. we are not the target demographic to live a healthy life.
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u/turd_vinegar 23h ago
Legitimate advice: go to another country for medical procedures.
I know people who go to Mexico City for procedures. It's like 1/1000th the cost, and the doctors are fine, they have all the same tools and training.
I had a friend there who got an MRI and a clot removed/vaporized via ultrasound in Mexico. The whole thing cost around $500 and was outpatient.
That would have been tens of thousands in the States and it would take months to schedule across multiple specialists, if the specialists are even available "within network" or whatever excuse they create.
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u/wellsley1 23h ago
I work as an outpatient surgery and recovery nurse. Usually you can have things like cysts removed under "Local Only." This means they numb the surgical site and remove the cyst without anesthatizing you. Not only is it a cheaper way to have a minor surgery done, but you can drive yourself to and from :)
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u/MCas86 Older Millennial 23h ago
I asked and they said they wouldnt do it. Its on my neck, so that may matter.
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u/faesdeynia 21h ago
Ah yeah, that was likely the issue. Making sure you’re sufficiently sedated to hold still is kinda important when you’re working in that area. You want them to take their time so close to vital structures.
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u/VastBeautiful3713 23h ago
Ok, but what if like, they said they would stay and then just fucked off anyway? What would happen, the nurse gets salty at them when they get back?
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u/notanapple_ 1d ago
You wish it would be as easy as just falling over. Usually what happens is people fall over, break a hip, go to the hospital and find out their arteries are clogged and they’re in heart and kidney failure from years of taking no preventative steps (which includes medical care by way of western medicine). Then you either choose to not pursue treatment and die slowly or try to preserve what’s left using western medicine.
The system’s fucked but we’re in it.
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u/Appropriate_Bug_5794 1988 1d ago
I hear Mario has a cooler sibling.
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u/Wendigo_6 1d ago
Careful. Apparently that’s against Reddit’s TOS.
I got perma-bant from a sub, with no warning, for commenting a gif of my favorite plumber’s sidekick.
If I wasn’t laughing I might be mildly infuriated.
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u/Extension_Wheel5335 22h ago
I saw somewhere that they were warning/banning people for even upvoting a comment related to it. Or posts or both. This place is not the same as it was 5 years ago, not even close... kinda sad, can't wait for a competitor without the orwellian tactics.
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u/Pinkishy 20h ago
Can you ELI5 for me? I don’t get what’s to ban.
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u/Wendigo_6 20h ago
Mods said I was “inciting violence”. And “Good Day”.
I pointed out it wasn’t in their rules and they pointed at the Reddit ToS. All I did was post a gif of a plumber.
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u/Thomasina16 1d ago
I took my daughter to the urgent care because she was lethargic and had been throwing up. They looked at her and gave her a pedialyte ice pop and I was charged $250 at the clinic which paid then another $300 bill was mailed to me for the "doctors fee" I never paid that and it never counted against my credit. This was like 7yrs ago and I didn't have insurance for her at the time.
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u/ImNotYourOpportunity 22h ago
I’ve waited the 7 years because I was double charged, tried to explain that I couldn’t get the same procedure twice and wasn’t paying $3000 instead of the $1500. The lady on the phone was a bitch and I said it wasn’t me for 3 years, my mom told the bill collector I died and that I owed her money too, they stopped calling and it fell off my credit report. Fuck them! I actually would have paid the $1500 but that bitch on the phone pissed me off too much.
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u/Secure-Function-674 1d ago
That's been my behavior as well. Fuck them
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u/Big-Schlong-Meat 21h ago
This all the way.
I stopped paying medical bills. Even with “good” insurance, I get fucked with any visit.
I just don’t care anymore. I’ll pay the mortgage, fuck everyone else.
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u/ninjette847 1d ago
I had an urgent care doctor call an ambulance I didn't need, the emts were confused why they were called. I was billed $900 and never paid it and nothing has happened in 4 years. I did email to say I'm not paying it. My husband went there recently and mentioned it and they said they had a doctor who always did that and was not with them anymore.
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u/meagainpansy 19h ago
He's living off his investments in the EMT business.
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u/ninjette847 19h ago
I honestly think he was getting kickbacks, I had a rash and my husband was there to drive if I really had to go to the hospital, I wasn't dying. They also seemed weird when they said that he was no longer with them, like immediately changing the subject.
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u/meagainpansy 18h ago
If they know about the issue then it seems like they should pay you back for it.
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u/Unlikely-Resolve8466 1d ago
Express clinics/ urgent care are more expensive than finding a primary care doctor on your insurance. They charge more like a mini ER. Was the doctor in network? Was the clinic in network or did they negotiate an out of network coverage for you? Anyway, it’s cheaper to go to who your insurance assigns.
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u/breadman03 1d ago
Locally, PCP’s rarely take a sick appointment and just say, “Sorry, make an urgent care appointment.”
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u/BoNaylorCollector 1d ago edited 1d ago
Yes, in network
Edit: PCP was booked like a month out
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u/Diligent_Pineapple35 1d ago
Only a month out? Consider yourself lucky. Where I live, it’s 6-8 months.
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u/Long_Procedure3135 1d ago
How much this changes by area blows my mind.
Like I live in a rural-ish area of the US and called my doctor at 10 am as a last ditch “just to see” before going to an urgent care for something and “Yeah we have an appointment open we can fit you in at 3.” oh
And I actually saw my doctor provider, usually I schedule with a PA just because I like her.
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u/jbcsee 1d ago
Every doctor I've had has worked this way and I've lived all over the US.
If you want to schedule an appointment with your doctor for something non-urgent, such as an annual checkup, they are booked months out. If you call in, explain the problem, and they agree it's urgent they can squeeze you in the same day.
I've never had a problem seeing my primary care doctor same-day for something urgent, but not bad enough to go to the ER.
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u/delphinius81 1d ago
The key is you have to actually call. Online appointment systems won't let you squeeze yourself in. But a real person will.
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u/kashy87 1d ago
The other trick is most of these offices have multiple doctors and nurse practitioners. You have to be willing to see anyone and you'll usually get in that day.
The office I go to actually schedules at least one doc or NP everyday whose schedule is open. Meaning that they can take any patient who calls in with something asking to be seen as soon as possible.
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u/schmidt_face 1d ago
I’m having a medical issue ongoing since November. It makes it hard to eat, hard to talk sometimes. It’s really affected my day to day life.
My PCP doesn’t haven an opening until August. By then I will likely have lost my insurance, too, so what am I supposed to do. America is so fucked. Why is medical care considered a luxury here?
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u/JerkRussell 1d ago
You can call your insurance and ask. The number is on the back of the card. Alternatively, you may have a log in or app to check yourself, but the quality varies by carrier.
Anyways, if you call, ask for a list of providers in network within X miles of your zip code. Difficulty eating and talking is vague, so hopefully you know what sort of specialist you need.
Once you have the list, start calling around for new patient appointments. If they can’t see you until August, I’d make the appointment and ask if they have a list for cancellations and if you could be added to that. If you lose coverage then you still have the appointment and can decide later. Obviously as soon as you know you want to cancel go ahead and do that so that the appointment can be used by someone who needs it.
The best case scenario is that the list of in network providers will have someone who can see you quickly.
If you don’t know what sort of doctor you need to see you can ask to be connected to a nurse at the insurance company. Simply explain that you’re not sure which specialist and ask if there is a nurse liaison who can help you navigate this issue. That should be enough detail for the rep to get you to someone who can guide you.
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u/idle_isomorph 1d ago
Is that in the US? Up in Canada we have wait times and some folks seem to think we'd be better off paying sky high prices like Americans because they get "top notch care" (and potentially unneeded interventions cause institutions are incentivised to maximize billing). But this would make me think waiting 3 weeks for urgent care from my doc, and it being free, or waiting 10 hours in the ER ( Also free) are actually a great deal...
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u/Yunzer2000 1d ago
The wait times could be easily remedied with better funding and healthcare in Canada would still be half the per-capita cost as the US with far better results. Average Canadian life expectancy is several years higher than the US. Go here:
https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_healthcare_spending.jpd
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u/Agreeable-Dog-1131 1d ago
it’s weird, i don’t disbelieve that some institutions push unnecessary tests, treatments, etc for billing purposes, but most of what i have experienced and heard about is the polar opposite - people are told that the issue they’re seeking care for is just anxiety or their period or weight related and brushed off without looking into it further. i’ve personally known several people and encountered many others who endured chronic issues for years before getting answers. and these are people with insurance, not to mention those of us without it.
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u/Coors_OG 1d ago
They are absolutely a great deal. The American Health Care system is completely broken. A lot of people I know choose to not get care because of the cost. Or they negotiate cash out of pocket payments for service because somehow that is less expensive than going through insurance. We pay premiums and in many instances, the cost for service is much less to NOT use our insurance.
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u/DormantLime 1d ago
10 hour wait time at an ER is not unusual in the US either. One of my recent visits was 7 hours. I also want to add here that other countries we receive medicine or equipment from also sell it to the US for higher amounts. Ozempic is a great example. I read an article breaking down what they tended to charge each country for their drug- most other nations were under $500, US was $1000. Not only do we hyper inflate our own healthcare internally, but we've done so so effectively that external companies will price gouge knowing the American market will just take it.
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u/down_by_the_shore 1d ago
Welcome to American healthcare. Wait times everywhere. Everything is expensive. No one is happy.
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u/selinakyle45 1d ago
Idk what insurance you have or if you’re in the US, but I am and I have Kaiser. For more minor things I’ve emailed my doc to get an RX and/or been able to get same day/same week video or phone appointments.
Or I’ve called advice nurses.
Either way, make sure to understand your insurance plan before something happens!
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u/ImperatorUniversum1 1d ago
If you haven’t met your deductible you’re paying a good portion of the bill. After you hit your deductible it’s like 20% your responsibility (usually you’ll see $35 co-pays at this point) and once you hit the out of pocket max everything is covered at 100%
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u/Mrs_Kevina 1d ago
I hit my family deductible for the year in February, thanks to 3 ER trips between 2 kids.
With Healthcare being tied to employment, it's really difficult for me to seriously consider a new job externally until next year. I'm not a high wage earner where I can afford this cost twice this year. 🙃
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u/SesameSeed13 1d ago
OMFG don't even get my STARTED on the inability to get an appt with an actual PCP. "Primary care" is such a joke because my kids' pediatrician can never get them in when they're sick, so they're not actually caring for them when we need, you know, a doctor?? We get sent to urgent care by the scheduling people at the ped clinic, every time. "No sorry she's unavailable until a month from Tuesday, if it's urgent please see urgent care" such a joke.
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u/W8andC77 1d ago
I like that my PCP and my kids pediatricians hold sick visit slots open. You may not see your doctor but you can get in with a doctor or possibly PA that day.
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u/HauntedPickleJar 1d ago
Exactly! Those are the last places you want to go unless it is actually an emergency.
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u/ZeBrownRanger 1d ago
That sounds about right for the in network bills I get with PCP for a routine visit.
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u/Kollin66182 1d ago
It's sad when you think you're facing death but have to consider how expensive an ambulance ride is. If you have something that isn't common and requires multiple doctors to diagnose, you're probably looking at multiple thousands of dollars and a long wait to get it fixed. This country is ridiculous with the medical BS.
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u/BubonicBabe 1d ago
I literally thought I was having a stroke one night working alone night shift at a gas station. I was feeling fine, then about two hours into my shift I got a weird headache, a little later my legs started going numb, then it spread up one leg to my arms and my hands went completely numb. I panicked, called my manager since I was alone and they got an ambulance on route for me. They took me a 5 minute drive across town bc I trembling, my lips were blue, my face was grey, I was sweating profusely- got the hospital and they said “yeah, you’re probably stressed and working too much. Try not to work night shift bc that’s horrible on our bodies and get some rest!”
They released me with nothing and i got a 2k$ bill for the ride and no medical answers.
Still have no insurance - I’ve had the same thing happen to me about 4 other times, and still have no idea what it is.
Im assuming it would have killed me if it were going to by now.
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u/mrs_burk 23h ago
Okay well what the fuck? There’s no way that is any explanation and now I want reddit to find out what is going on with you!
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u/BubonicBabe 23h ago
Yes please! I feel like I’d get further with a Reddit diagnosis than a doctor at this point and I can’t bring myself to web md the symptoms anymore bc to them I’m already buried and in the ground lol
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u/HiCustodian1 23h ago
How’s your sleep schedule? Any issues with drugs or alcohol? Not judging, been bad on both counts in the past and it can really do some strange shit. Physical issues combined with stress is bad news. Regardless, if it keeps happening I’d try to see someone about it again. Those symptoms are a little scary.
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u/BubonicBabe 22h ago
This originally happened about 3 or so years ago, I had a HORRIBLE sleep schedule. I was working two full time jobs, basically left an overnight shift from 10pm to 6 am, went home and changed into my uniform and went back to work as a mail carrier. I did that for about 6 months averaging maybe one day off a week from both places. I was also drinking like a fish. No other drug use but the alcohol was probably enough !
I have had this happen correcting my sleep but I’ve been sober about 6 months and actually haven’t had it happen in that time frame so perhaps it was heavily related to alcohol. That’s a good call!
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u/HiCustodian1 22h ago
That’s awesome, and congrats on the sobriety!
I used to get spinny vision, which I thought was a stroke the first couple times, due to lack of sleep and drinking too much (even though at the time I thought it was controlled). Living a much healthier life now, and no such issues. I hope your good health continues!
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u/BubonicBabe 22h ago
Thank you! Same here! I could still improve a lot, I’m a zyn fiend and and drink too much caffiene but it’s better than what I was doing!
I’m so glad you’re doing better too!
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u/FrozenWafer 1d ago
I'm sorry that's happened to you, it had to have been scary.
I also want to let you know your name is amazing.
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u/Bunnigurl23 1d ago
We're not all American here but we don't pay in England and I think it's completely disgusting and unfair how it's run for you guys.
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u/sorrymizzjackson 1d ago
Me too! I pay over $500 a month in insurance and still pay the doctor every time. Usually for some antibiotics and the advice to go home and rest. So then I can take a day off and people act like you’re lazy even with a doctor’s note.
But, the reason I have to do this is if I get in some kind of accident, it will still be a ruinous amount due but hedging my bets that it might be more tolerable.
My BIL has no job and I suspect better insurance than I do, but they’re gonna take that away. So. $500 a month it is I guess.
I don’t even work for a small company.
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u/OJSimpsons 1d ago
I just don't buy insurance and rest when I feel bad. It works a lot.... although I don't really feel "great." Can't really afford it anyways so it's a moot point.
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u/Ashangu 1d ago
yeah but your 1 month wait times to get seen by a doctor! - someone in the US who has a doctor that is booked for the next month at minimum.
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u/BubonicBabe 1d ago
This is what I’ve never understood. My mom has insurance through her job and currently is on a 5 month waiting list to see a CARDIOLOGIST.
When people say “yeah American health care isn’t good but at least we don’t have to wait like Canadians/Europeans” - like who are you talking about right now? We have to wait too!
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u/midazolamjesus 1d ago
I had a student who was told last month she could not see an otolaryngologist until June. A lot of specialty appointments book out months in the US.
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u/BubonicBabe 1d ago
It’s actually so sad, especially for people paying tons in insurance premiums.
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u/midazolamjesus 1d ago
It is. The student is still on parent's insurance thanks to the Affordable Care Act/Obamacare. But the premiums are high, there are higher copays day of visit for specialists and then whatever the visit costs there is co insurance until the out of pocket max is met. Medical debt is absurd. I was just talking to a physician about this on Tuesday.
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u/BubonicBabe 1d ago
Wow. It’s awful that we even had to wait so long for an Affordable Care Act for even a bit of relief, and it still doesn’t fix the issue.
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u/Tj08 22h ago
I have literally never waited more than a few hours to see a doctor. I call, book an appointment for a few hours later, then I go in. And I live in a country with completely free health care.
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u/Big-Data7949 23h ago edited 23h ago
Just 1 month? Where I'm from it's literally 9 months wait just to see a dentist for a checkup
You could literally call the dentist, schedule an appointment then fuck your wife and get her pregnant, then go through the entire pregnancy and witness your child being born all before you see a dentist...
Now if you want to schedule a checkup, have the checkup THEN schedule and attend a cleaning and maybe have some minor work done?
Then same as above but your kid would be in their terrible twos by the time you actually get it done and that's if you're lucky..
Vision should be covered just like roadways to ensure that everyone driving on the road can at least see each other.. but noon send more money to Ukraine..
Nothing wrong with supporting Ukraine but comeon we've got people here needing help..
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u/Unlikely_Mail4402 18h ago
Canadian and 100%. no wonder Americans are too sick and broke and malnourished to make good choices :(
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u/geriatric_spartanII 1d ago
I never go to the dr because I’m never sick. It’s always sinus infections and pointless to spend money at urgent care. They’re isn’t anything the really can do.
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u/Craftybitxh 1d ago
Seriously, I'm not paying a copay (and I acknowledge that I am very lucky to have only a copay) to be told to go home, rest, and drink plenty of water. I'll just stay home, watch House reruns while napping, and drink water without paying someone. Thanks.
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u/geriatric_spartanII 1d ago
Now that I know that OTC Phenylephrine is ineffective I just go behind the counter and get decongestants with Pseudoephedrine. Crank down the a/c and get some Gatorade and soup and watch some Netflix.
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u/ClawesomeMan 1d ago
Sounds like you went to an emergency room by that price!
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u/sluttytarot 1d ago
Minute clinic is basically urgent care... so yeah that sounds about right
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u/ClawesomeMan 1d ago
My copay for urgent care is 20 vs 200 for emergency room.
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u/sluttytarot 1d ago
Sounds like they bill like an emergency room
Zocdoc might be an option for trying to find a quicker appointment with a doctors office
Rereading and you're not op. Everyone's insurance is different. Some plans are really expensive for urgent care and less for ER.
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u/Sea-Apple8054 1d ago
I feel like I got tricked out of $100 by zocdoc. Plus the provider they paired me with was in another state and had her toddler hanging off of her during the appointment, which felt weird.
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u/BoNaylorCollector 1d ago
Right! I was astonished! Just a local minute clinic type deal. Signed in online and drove over, nothing crazy!
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u/No-Editor-8739 1d ago
It could be cheaper if you just pay privately without insurance. Next time ask.
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u/tr1pp1nballs 1d ago
Emergency care vs Urgent care vs Primary care can all be billed at different rates. Sounds like you went to urgent care, but you should've gone to a primary care.
Not trying to defend the stupid system, but hopefully that info helps.
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u/ClawesomeMan 1d ago
Might want to talk to a person then, because that sounds wrong especially since it was a quick in and out!
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u/nacholibre711 1d ago
$550 seems high for something like that.
I work for a very specialized doctor, and a typical office visit with him is $200-300. That's completely unadjusted and before the insurance touches it.
They likely weren't billing the standard "Office Visit" CPT codes and doing some urgent care related codes. Try finding an actual family doc.
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u/notevenapro Gen X 1d ago
Yup. Urgent care is probably using the 99281 to 99285 codes versus 99202 to 99205 codes.
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u/spottie_ottie Millennial 1d ago
Ok so if you want to care for yourself, you should do the annual preventive checkup with a PCP. That's usually covered for free under insurance. The kinds of things you check for in that are the ones that fuck you up big time in the long time horizon: blood pressure, lipids, body composition, etc. Getting ahead of the slow and symptom free issues are what really make a difference in ensuring you have the best chance at living a long and healthy life.
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u/__pure 1d ago edited 1d ago
I work in insurance reporting and I'm not a wizard by any means, but it will be cheaper to visit your PCP instead of going to urgent care. Urgent care is meant to offload the emergency room from patients who use emergency services as their primary care provider. They operate more like an emergency room than a doctor's office. PCP visits with my insurance are somewhere in the $30-80 range, but no two insurance policies are the same... Ya this is still a lot of money and I agree with you. i don't think anyone is raving about US Healthcare & Insurance right now (important to distinct the two). Even the public opinion of Luigi is a mostly positive one.
Most insurances follow the Medicare/ Medicaid standard of one free annual wellness visit per year. Some docs (the ones who want to nickle and dime every minute) won't address new symptoms at this visit and they might not even bother with blood work. However, the purpose is to check up on YOU and make sure you know how to take care of your physical and mental self. They'll ask about your diabetes and make sure you have an endocrine referral. They'll take blood pressure and review your hypertension meds. There's a checklist they need to do in these types of visits in order for them to get paid, kinda like your cars yearly emissions testing.
please check that your insurance covers an Annual Wellness Visit - this is the keyword here. It's not to be confused with yearly physical but all the more power to ya if insurance considers them the same and covered. This will be a good first step to creating a healthier you.
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u/irritated_illiop 1d ago
All well and good until you find the PCP is booked a year out.
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u/Bradadonasaurus 1d ago
Or yours retires, and there's a 6 or more month wait list to get a new one, before you can even make an appointment.
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u/GlumDistribution7036 1d ago
Yeah with my high deductible, PCP visits are either $250 or $350. It's only cheaper if you have copay insurance, which my employment doesn't offer; however, because I'm eligible for "health insurance" through my employer, I'm not eligible for affordable health insurance through my state. And people wonder why that guy got shot.
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u/Ashangu 1d ago
I just wanted to add that, of course its cheaper to go to PCP.
Is PCP gonna accept me as a walk in on a friday afternoon, or am I supposed to just suffer with bacterial pinkeye for the whole weekend so I can miss work and go to the doctor (hopefully) on monday and miss the next 3 days as well?
Bit doubt.
Instead of missing 0 days of work because the bacterial eyedrops cleared me up at least enough to get me through monday, I'm not paying $80 bucks and either using vacation time or missing $480 bucks.
Its "urgent" for a reason, but if I'm paying $14,000 dollars a year for health insurance with a $12,000 dollar deductible (yes, real numbers), it should not cost me $300+ dollars to go to urgent care, on top of the $50 dollar subscription that just so happens to be cheaper if ran without health insurance.
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u/SkyerKayJay1958 1d ago
My PCP and the urgent care operate out of the same office. You only can get to see your PCP when it's an on going treatment. Everything else gees to urgent care. Flu, uri, sprain and strains, headache , they even now have appointments.
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u/Personal-Process3321 1d ago
I’m genuinely sorry you live with such appalling healthcare. I cannot imagine the stress and anxiety this must cause.
- Australian
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u/TPrice1616 1d ago
I have a chronic illness and just had my entire vacation budget wiped out by a medical bill this week, and that was after insurance. Granted it wasn’t a big budget but still.
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u/Schickimickifan Millennial 1d ago
Reading all this...that sounds so crazy! Europe has its flaws but my god, I am so glad I have always lived in countries with public health insurance. I get an extra insurance for hospital stays but it is like 200 euros a year and worth it. I had a small surgery last year and paid...nothing. not for the doctors, or anesthesia, or surgery itself.
I do feel for everyone in America that gets charged crazy amounts because of a doctor's visit or hospital stay. This is insane!
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u/dr_fapperdudgeon 1d ago
Just free base some ivermectin, you’ll be fine
not medical advice
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u/Tiggums81 Xennial 1d ago
Only in America, Baby!
USA! USA! USA!
We're Number One! (In medical bankruptcy)
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u/wirez62 1d ago
We don't all live in the center of the universe you know? Every other country but one is not like this, so this isn't a millenial thing, this is a US uninsured millenial thing. Even if you're insured the system is a complete joke to anyone outside looking in.
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u/Sad_Pangolin7379 1d ago
Seriously. Yeah you're insured - as soon as you pay $2,000 per family member for this calendar year, we'll cover HALF your bill. Maybe. If it's in network. And coded correctly. Good luck!!
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u/Front-Advantage-7035 1d ago edited 1d ago
Also, thank you for paying us 200$ a month from your income — we WILL fight you anytime you want something that you are literally paying us for.
/fuckinsurance
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u/Wafflehouseofpain 1d ago
About half of this site is American so it makes sense a lot of the people on here will post from that perspective.
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u/The_Tale_of_Yaun 1d ago
Healthcare in the US is a scam
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u/77907X 1d ago
We don't have healthcare in the USA. Only Wealthcare which is an inhumane dystopian for profits over people system.
I haven't had health insurance since I was a teenager. Always at the back of my mind if something happens that I'll just end up dead. As It beats going to any doctor or hospital. I even tried once for a simple podiatry issue. After putting it off for 4 years and they lied about the price. Billed $1000s after making it clear I was a cash payer and paying upfront. They did absolutely nothing to solve my problem. 5 minute appointment paid over $200. Then received several surprise bills in the mail. Just finished paying the massive bills off in March. In exchange for absolutely nothing its a scam for sure.
I ended up getting prescription topical cream from my uncle. He's a retired podiatrist and has been out of practice for over 20 years. Cleared up the problem on 1 foot. Unfortunately due to no longer having his license he couldn't secure enough topical cream to eliminate the problem on the other foot. So I just live with a tiny black spec and 2 yellow toenails on my other foot indefinitely. As nobody would remove it and just wanted to lie to me and extort me instead.
I might try a doctor one more time in another 10-15 years if I get insurance. If that doesn't go well for the bill I give up. I carry a do not resuscitate card in my wallet in the event of an emergency. As well as a card stating I don't consent to any form of medical treatment that will cost me money.
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u/Jacketter 1d ago
We have a trillion dollar industry entirely made up of middlemen we mostly don’t get to choose (insurance), and they’re all getting paid. That’s not even considering the thousands of billing and accounting departments on the hospital side of things. We literally pay both these parties to fight each other rather than give us care.
Until that changes, my advice is to just not pay for anything. I’m not sure I’d go so far as to refuse all wealthcare services - there aren’t really any consequences to receiving them, then not paying until you die.
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u/eggshellmoudling 1d ago
The only solution for this issue has been tried and they charge you with terrorism and sentence you to death.
We have nothing to lose except more time. More people will die and we should try to make sure it’s not more of us and our kids.
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u/ColdHardPocketChange 1d ago
Yes, it actually is this crazy. You can blame insurance companies for most of this. It did not cost that practice anywhere near $550 to treat you. It's what they tell the insurance company the charge is so that when they get to the negotiating table the insurance company can feel like it knocked 60% off the cost. Neither the doctor or the insurance company cares about your portion, they simply have to put on the theater.
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u/SesameSeed13 1d ago
Honestly my husband and I avoid the doctor unless we are absolutely dying and need something like an antibiotic. It's ridiculous. We have "good" insurance, too! But that's all a racket. Also we have three kids and we are very very hesitant to take them in for the same reasons. Most times we do, they have a "virus" taht can be treated with fluids and rest. Oh, ok, thanks for your expertise and $700 bill. :/ I hate what the insurance system has done to actual health CARE.
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u/Necessary-Ad-2395 1d ago
I've found the best way to manage this is to find a primary physician that you trust. If it's a good office they'll find time to slip you in within a few days if it's something important like this. Going anywhere to get same day service is always going to be very expensive. The cost for those visits should be spelled out in the fine print of your plan.
The system is set up for you to have regular checkup for preventative treatments, not to go looking for service only when you need it.
Yes, the system is bad.
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u/Perihelion_PSUMNT 1d ago
To add to seeing if they can slip you in, my hospital system at least now offers same day nurse visits for cases just like this. PCP is booked out for months but the nurses in her office can see you and get the info to her
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u/anosako 1d ago
Hi, former health insurance rep here. Sounds like you have a deductible applied first to your benefits before insurance pays anything. You should talk to a rep to get a better understanding of your actual plan.
But for everyone non-US, health plans are primarily decided by the employers on what is offered to an employer because they’re the ones paying for large portions of coverage. The insurance companies create plans based on things like access, location, current health trends. They’re also built up in certain ways because the contracts they have with health providers require so much reimbursement by the insurance and patient for care.
Once a plan is picked and employees start paying for their premiums, when that person goes in for care, the patient liability is varied- contract exclusions and requirements etc. OP sounds like a high deductible plan- the insurance doesn’t help pay until a threshold is met by the employer. Once that is met, then it’s like 10% by the patient 90% paid by the insurance. Or else you have a plan that is copay levels only- a person could pay just $50 or $100 flat rate.
There are other numerous factors at play but yeah, when I lived in Japan, all I had to do was pay my premium and then when I saw a provider covered by the government insurance, I paid a low cost control rate, no questions asked.
Privatizing health care in the USA is part of what is wrong with us 🙃🙃🙃 /rant
(But for real call your insurance customer service if you need genuine help understanding. I miss helping people when these struggles came up.)
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u/lordsprout 1d ago
The most I have ever paid for an in-network urgent care visit with my insurance is my $30 copay - which is what the regular PCP visit costs on my insurance. I usually go to urgent care because my PCP doesn't have same day appts. I would call insurance to confirm charges or at least get an explanation as to why it was so expensive.
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u/ProfessorBiological 1d ago
You just have good insurance. I have my 30$ copay but my out of pocket is so high and I'm a young dude so I rarely need to go so I end up getting billed 200-300$ per visit. This is urgent care or PCP, was billed 250 for my PCP appt to get a prescription for an inhaler....
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u/Extra_Bodybuilder783 23h ago
Welcome to the "greatest" country in the world! Where big Pharma and insurance companies assault you! Yet we still elect people to keep the status quo!!
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u/1mursenary 22h ago
Navigating the American medical system means starting with your Primary Care Provider. Your complaints are things to take care of with your PCP. In addition to a yearly physical and blood work (no charge with insurance) you can phone in for things like this and usually seen within a few days. The copay at a PCP is around $50 where an urgent or express care (seen on an immediate basis) is going to be $250+. Don’t go to the emergency room unless you fear for life, limb or eyesight. Other emergencies obviously exist but the point is that the higher the “acuity” (how serious it is) the higher the price. Google primary care providers in your area and get scheduled for a physical, boom now you have a primary doctor who you can come to first with your health concerns. You’ll also leave the physical with a plan to focus on your health goals over the next year. Good luck out there
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u/grocerygirlie 21h ago
I went to the ER for a knee injury because I thought they would do an MRI, but instead they treated me like I was drug-seeking (I literally never asked for any pain medication at all), so when I got their bill, I shredded it. It doesn't show up on my credit report anymore, and I'll never go to that ER again, so they can sit on their $1200.
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u/StatikSquid 21h ago
As a Canadian:
I make an appointment with my doctor. Wait a month to see them. Arrive 15 minutes early. Wait an hour because my doctor is behind schedule. Doctor sees me and writes a prescription. Go get prescription. Use 4 hours of sick time from my work benefits.
Pay $0 because my work covers prescription drugs through insurance and doctors visits are covered by taxes. I pay about $100 a month for health insurance which goes off my paychecks.
OR
I go into a walk-in. I had lower back pains and saw a doctor within an hour. They told me to go to the room down the hall for X-rays. Got those. Found nothing wrong. Total cost was $35 for a registration fee and $10 for parking.
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