Hey all, I’m British so I don’t really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.
So I’m just asking… How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
My wife recently had to get an array of bloodwork done. It was ~$700 after all of the office visits and lab stuff had been completed. And that’s all out-of-pocket, because our deductible (how much we have to pay per calendar year before insurance kicks in) is several thousand dollars. And we pay them ~$600 per month out of my paycheck for coverage, for just myself and my wife; If we ever have kids, the full family coverage (as opposed to just two people being covered) spikes up to nearly $1600 per month.
The monthly premium being $600, plus the deductible means we end up paying ~$10k per year before insurance even begins covering things. And even after the deductible, they only cover 80% of the bill, and we’re responsible for the remaining 20%. So if one of us has an extended stay in a hospital with a $150k bill, we’ll end up paying the $3k deductible, plus $29,400 (that’s 20% of the remaining $147k.)
And all of that is assuming everything is “in network”. Insurance companies have networked doctors, who have contracts with the company. If you see an out-of-network doctor, the insurance will often refuse to cover it, or cover it at a vastly reduced rate. Not-so-fun fact: Nearly all anesthesiologists are out of network, because they have a separate labor union that refuses to sign network contracts with insurance companies. So if you go into a surgery, even if you insist that every single doctor, nurse, aid, etc is in network, you’ll still always get an out-of-network bill from the anesthesiologist.
Oh, also, dental and vision are entirely separate plans. Because somewhere along the lines, insurance companies decided that you need to pay for a totally separate plan to have functioning teeth or eyes.
There’s a reason medical debt has historically been the #1 cause of bankruptcy in the US.