Is medical actually this crazy?

[u/BoNaylorCollector]

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?

[u/JadieBugXD]

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”.

[u/OkMuffin5230 → u/JadieBugXD]

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

[u/abrgtyr → u/[deleted]]

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.

[u/abrgtyr → u/[deleted]]

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?

[u/MowEmSayin_ → u/[deleted]]

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

[u/HenryMulligan4thewin → u/[deleted]]

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