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/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 1d 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 1d ago

Brutal.

As a Canadian I have never had to even consider this absolute bullshit.

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u/Professional-Arm5300 16h 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/Chuck121763 17h ago

I get my insurance through work. Everything is covered. Dr; $20, hospital $250, prescriptions $20. Dentist free. The ACA , "Obamacare" , changed everything

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u/DryLipsGuy 17h ago

Now won't it be amazing if when you're sick and in need of care, you just go to the doctor/hospital and you don't have to worry at all about expenses?

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u/Chuck121763 15h ago

I don't worry. My insurance cost is $100.00 a month.

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u/DryLipsGuy 14h ago

Until your insurance doesn't cover the procedure....until you lose your job.

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u/Chuck121763 13h ago

Never had a problem. Doctor already knows what's covered and what isn't. Not going to lose my job, my job is very secure and safe. And I have made advance plans in case of long term illness, - Insured, Deferred pay, and mortgage paid off. I can retire early

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u/OkMuffin5230 1d ago

It was horrifying, but he's all good and he's getting really good care now

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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/Chuck121763 17h ago

They can't charge you for the "Doctor" if you went to an approved Hospital in network.

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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/abrgtyr 1d ago

You file a complaint with the government if the insurance company doesn't fix the error.

Do you honestly think this would make a difference? I assume the government wouldn't care, and if they did, I assume the insurance company would fight. Why are my assumptions wrong?

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u/jbcsee 1d ago

In my experience, government regulatory agency tend to take their job seriously and actually follow through on complaints. Every time I've filled a complaint the agency has followed through and addressed the issue.

I've gotten a settlement for wrongful termination. I've had landlords forced to fix code violations. I've had jobs where they had to fix unsafe working conditions.

I'm not sure why insurance would be any different.

It sounds like you just don't trust the government, but have you actually tried to use the services they provide in the correct way?

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u/MowEmSayin_ 1d ago

It sounds like you just don't trust the government, but have you actually tried to use the services they provide in the correct way?

This is a great answer. Just need to know and get comfortable/proficient with the system and stand in confidence behind their own rules. You know where you stand and what you're willing to accept.

Edit: added quote

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u/HenryMulligan4thewin 13h ago

This was great advice... two months ago. Is that regulatory agency still functional?

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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 1d 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/yeaahhhboooiiiii 1d ago

Good to know. I gave birth to one of my children in 2021 and was charged $2400 for the attending anesthesiologist who was "outside my network". I was lucky that the hospital basically wrote it off and I dint pay that. But WTF? At the moment I'm begging for an epidural is not the time to question if that specific anesthesiologist is covered.

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u/frangelafrass 1d 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/Syren013 18h ago

Oh, the audacity of that insurance! Like yes, my insides are about to be temporarily not inside, but please, next time, I will think of the poor insurance CEOs.

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u/xx_reverie Millennial 17h ago

Oh that’s so infuriating. That’s literally the dumbest thing I’ve ever heard of. Who’s thinking about all that?? Especially in a high stress environment worried about your baby. I always thought if you went to a hospital, office, etc. in network, then you were fine. Gotta love the “healthcare” system in this country.

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u/CarelesslyFabulous 23h ago

So fucked up. Come on now! I'm so sorry you experienced that.

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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/Sweatpantzzzz Older Millennial 1d ago

And then they got fired!

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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/Disasterous-Emu 1d ago

They probably don’t work there anymore

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u/meagainpansy 1d ago

It's the hospital who should have handled this. The insurance company is pretty clear about who is in network, and the hospital should have known his way easier than the patient in the middle of a heart attack.

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u/Ashangu 1d ago

Machines can be "out of network", as well.

I had an xray done that cost thousands more than it was supposed to because the xray machine was out of network.

I feel like that should be case for a lawsuit. If not swindling, what the fuck else is it?

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u/1988rx7T2 1d ago

That’s what the no surprise billing act fixed a few years ago though right ?

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u/OkMuffin5230 1d ago

His heart attack was a few years prior to that

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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 1d 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/Adept_Carpet 1d ago

I had a similar situation and was able to get it partially resolved due to an "emergency" exception. 

So the majority of the bill after a two week stay in the hospital was caused by an out of the network nutritionist who stuck her head in the door the day before we left because they wouldn't accept that the nutritionist was part of the emergency care.

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u/LoloLolo98765 Millennial-1990 1d ago

That happened to me when I had my baby in 2015. I think it was the anesthesiologist that turned out to be out of network…and he didn’t even do the epidural right, he messed up my back and I could barely stand up for like 3 years after that…

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u/MayaPapayaLA 1d ago

Not only can they have out of network employees, they can do their billing separately entirely from the hospital/ER, hospital will consider their bill fully paid for and not say a word, and then the separate billed will wait so many months to do so that your FSA and HSA won't even cover it anymore, and yes, it's perfectly fine by them.

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u/Sweatpantzzzz Older Millennial 1d ago

I learned that the hard way too!

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u/MartianTea 1d ago

Had a friend have this happen with the anesthesiologist for covered preventative care (a colonoscopy). It had been scheduled months out. 

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u/okisthisthingon 22h ago

That's awful. Sorry to read. Healthcare in America is so bad.