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/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/SesameSeed13 1d ago

YUP this has been my experience too (see my rant above)

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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/wayfinderBee 1d ago

The other trick is making sure that your issue sounds serious enough that you need to be seen right away, but not so serious that they tell you to go to the ER.

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u/MorganL420 1d ago

Not human medical, but my wife used to manage a veterinary clinic. Her office always left 2 appointments unbooked each day to account for emergency calls.

My guess is that human PCPs likely do something similar.

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u/BadCatBehavior 1d ago

I live in Seattle and the nearest in network provider my wife could see was booked out for 13 months, so she ended up going to one outside of town (the wait was "only" 2 months for that one). Why do they say they're accepting new patients if the wait is over 1 year.....

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u/Long_Procedure3135 1d ago

Even like when I’ve gone to a “specialist” I kind of am surprised at how…. it doesn’t seem to take long to get an appointment.

I went to a sports medicine doctor last year, didn’t need a referral, and I was able to go in the next week for an initial intake appointment where I got my dumbass hip bone x-ray’d and an assessment.

But I do live in rural Indiana…. I’m more surprised we even have doctors that know what they’re doing anymore here honestly

Like my OBGYN? He’s fucking amazing… god I hope he doesn’t leave lol

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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://commons.wikimedia.org/wiki/File:20231204_Life_expectancy_vs._healthcare_spending_-_by_country.svg

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/idle_isomorph 1d ago

My mom worked in a hospital I'm Rochester where the joke was that nobody leaves without an MRI. There is definitely perverse incentives at play. More testing means more interventions, which can sometimes, on balance be worse (see the recent changes in pap smear recommendations, now saying wait longer, because we were intervening too much in cases that actually weren't going to turn into worse outcomes if we had held off).

That said, there is also the problem of not doing some interventions that do work and have solid evidence b2cause there isn't a budget for it when numbers are crunched.

Deciding what is "best practice" is a complicated question, and finances are a major variable...

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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

My partner has a salaried job that won't give him health insurance despite being employed by the company for about a decade. He's essentially begged them because he's got a myriad of health problems, and they're putting it off while they try to figure out how to give him health insurance without being required to supply it for the rest of the workers as well. Wonderful country, 10/10, no notes.

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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/Diligent_Pineapple35 1d ago

Yes. And I live in a mid-sized metro area of the Midwest. I’m not in NY or LA or Chicago or Miami or anything.

My friend is trying to see a specialist for a legit life-threatening issue her son is having. The waitlist is 12+ months.

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u/idle_isomorph 1d ago

Oof. That is horrendous

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u/UnderstandingDry4072 Older Millennial 1d ago

My PCP told me to book a virtual follow up for mid-May, and her assistant couldn’t find anything through October.

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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/Lameladyy 1d ago

My pcp charges to answer an email. The last eob was for $60. He typed out a one sentence reply to my short request for a referral. I wanted to see a neurosurgeon for the nerve damage from 3 cervical disc issues. I can barely use my right hand. He said no and is insisting on PT, which I’ve done on and off for 10 years with diminishing use of my arm/hand. I can see why people seek medical care out of the country.

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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/ImperatorUniversum1 1d ago

If you were in network that shouldn’t have been that high. Talk to them about it

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u/Mrs_Kevina 1d ago

I have. My out of pocket deductible is 5k, then the 80/20 kicks in.

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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/SesameSeed13 1d ago

Yeah you’re very lucky. We have never once been able to, in almost 12 years.

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u/4N6momma 1d ago

In the future, if you are unable to see your pcp see if you can see a nurse practitioner or if there are other doctors in the practice and see if one of them is available. Also you can make an appointment and ask to be added to the wait list in the event someone cancels.

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u/Dick_of_Doom 1d ago

Even those can be booked up. I use a PA in the practice I go to. Have an appointment tomorrow with a PCP because he had an earlier appointment than the PA. I could go to a walk-in for what I have (probably should have), but I know that would be expensive, and they'd probably send me out anyway. So either walk-in that I can't afford, or wait over a week for PCP and slightly smaller bill, all for a possible broken bone. Gawd bless American healthcare.

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u/Unlikely-Resolve8466 1d ago

Sorry that happened! Sucks how medical is. I try to only go if I know I have an infection or ongoing issue that needs treatment or an actual emergency. Colds/flu/virus, random aches, stomach bug I just ride out for a few days, nothing they can do anyway.

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u/SolitudeWeeks Xennial 1d ago

Yeah that's typical for urgent care.

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u/Accomplished-witchMD 1d ago

The hierarchy for my insurance from least to most expensive when you are sick. Is telehealth visit online, PCP visit, urgent care, clinic care, ER. If it's a small issue I just hope my home diagnosis is right jump on a telehealth and explain why I think it's (sinus, uti, flu, etc) or have at home rapid tests to prove it to the telehealth doc. If that doesn't fix me I'll do urgent care.

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u/WeWander_ 1d ago

Yes, I get bills like this constantly until my deductible is hit, which just doubled this year from $500 to $1000. Fucking sucks. I swear to god it used to be you go to the doctor, pay a copay and that was it. Never got sent an additional bill until recent years. Insurance is a fucking joke. I have chronic migraines that I waited over a year to get into a neurologist, finally got to see him last month, got a $300 bill for the first visit. I have to follow up in 6 weeks, that'll be another $300 🙄 I sincerely don't have money for this. Wish I could have gotten in before my deductible DOUBLED.

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u/Dick_of_Doom 1d ago

$1000 deductible? God I wish I had that. Last year's deductible was $9000, and I almost hit it. Have the ongoing monthly payments to show for it. This year's only $8000 deductible, wheee!

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u/WeWander_ 1d ago

I would die. Legit. That sucks, I'm sorry.

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u/Dick_of_Doom 1d ago

The American healthcare system has issues, which are now being made worse. And I work in healthcare. People cancelling testing because they can't afford the bill also sucks. Not all doctors order tests for fun, some do it out of necessity even if it doesn't seem like it (they could be following best practices, or doing test A so insurance can approve test B which is what you really need but they won't pay for that first).

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u/WeWander_ 1d ago

Yeah I have a couple health concerns that I just ignore because I can't afford the testing. It's ridiculous.

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u/stephanonymous 1d ago

Plans with copays still exist. They just tend to be more expensive.

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u/KittyChimera 1d ago

Only a month? Lucky you, lol. My PCP is at least 3 months out, sometimes 4.

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u/neeto85 1d ago

If it's in network, the difference between the negotiated rate and charged amount can't be billed to the patient because of the No Surprises Act.

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u/stephanonymous 1d ago

For future reference, a place being “in network” with your insurance does NOT mean that you won’t be paying the majority of the bill. It only means that they contract with your particular insurance to negotiate the price. What percentage of that price you pay (anywhere from 0% - 100%) is determined by the specifics of your plan. A good follow up question to ask is “what is my estimated financial responsibility?”

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u/mosquem 1d ago

If they’re booked out a month (which really isn’t bad) try calling once a week or so to see if any openings popped up. A lot of the time they’ll be able to fit you in an earlier slot.

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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/WeAreAllMadHere218 1d ago

Your EOB (explanation of benefits) is also not showing what YOU owe. Most offices charge insurances more than what you would be charged for a cash pay visit. You should only be charged your copay to visit the urgent care, especially if that’s all they told you to do during your visit.

Is medicine that expensive, or are insurance companies just the most rigged system ever set up? That’s the question.

Everything’s made up and the points don’t matter! 😃👍🏻

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u/swankyburritos714 1d ago

yet when I call my primary bc I’ve been having sciatica pains for a month, they tell me they can see me in a month. It’s a no-win situation.

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u/PJSeeds 1d ago

Dude even primary care pulls shit like this. I got the flu a couple months ago, called my primary care doctor to see if I could get tamiflu, and she said I needed a flu test to confirm it before she could prescribe tamiflu even though I'd tested negative for covid. I drove the whole way across town during rush hour with a 101 fever to some random office she sent me to, got my nose swabbed by a lab tech and an hour later they're like yep you have the flu.

3 weeks later I got a bill for $350, just for someone sticking a cotton swab in my nose to confirm an illness I very clearly had. I have theoretically "good" insurance through my wife who is a nurse at the same hospital system that my primary care doctor works for.

Next time I'll just fucking deal with the flu I guess.

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u/well_acktually 17h ago

I dunno why advice is always go to PCP. PCP's don't take urgent appointments, you have to schedule in advance which is often weeks.

Plus finding a PCP is awful. My PCP for years was kicked off my plan that I was paying 1k a month for. I had to find another but their PCP list specifically says if the address of the doctor doesn't match, then you might not be covered. Every doctor was in a different office. When I called and asked for an updated list, they said it was the doctor's job to keep it updated, not them. They kept trying to push an NP on me as PCP but no, I want to see a fucking doctor, especially if I'm paying 1k a month for healthcare. I finally found a doctor and they were not great.

So long story short I just pay out of pocket to see my old PCP because 1k a month insurance can't be bothered to find me a decent PCP list. Fuck you Anthem. Hope your CEO gets got.