Any of you self pay for doctor/hospital visits

[rfuerst911sc]

My wife and I are retired , she is 62 and I am 61 . We have health insurance through an online broker and the insurance is $1400 per month with a 1K deductible . It covers health/dental/vision . Sounds good if you say it fast but there is more to the story .

My wife had a kidney stone about 6 months ago . It appeared it was not going to pass on it's own so urologist scheduled " surgery " . When the " surgery " took place they realized the stone had passed . Ok sounds good . Fast forward 6 months and on Friday we got the bill for the portion the insurance is not going to cover ........ 18K !!! WTF ??? We are paying almost 17K a year for insurance and then get hit with a bill like this .

I know many doctors and hospitals give substantial discounts for cash paying customers . So have any of you said screw it and dropped your insurance and went cash pay ? In our scenario we would take that 17K we would have paid to insurance and put it into a health care savings account and write checks as needed. Am I crazy for considering this ?

[rwest]

Yes, it doesn’t take much to get huge hospital and surgical bills, so going without insurance could get very expensive or you could just take your chances and then file bankruptcy if you ended up with a massive bill.

[rfuerst911sc]

My concern is our insurance probably won't pay out much on a " massive " bill so why pay them all that money ? I am not going to make any rash decisions I need to check out other insurance options if there are any . Lot of smart folks on here I want to see what others have to say .

[wayner]

For this reason alone, this is why I appreciate our government run healthcare in Canada.

There is no fine print, and they have no incentive to deny coverage.

I don't feel qualified to chose a long distance telephone savings plan let alone health care insurance.

I really don't want this to turn political so please, I hope nobody turns this into an "our system is better than you system" discussion. Instead what I want to focus this on is how can buying insurance yet getting hit with something like this be ok, or in any way rationalized?

You payed good money, yet they dodged your claim.
I know new regulations came in in the US to prevent some of the more devious avoidance by insurance companies, yet it still seems to happen, so why isn't this a significant talking point whenever health care in the US is brought up?

[rfuerst911sc]

Wayner very well said , I want this to be a discussion about health insurance options vs self pay as an individual . Having said that I am a fan of a well run and funded socialized medicine . Again I said well run and funded .

[Tobra]

It is not a significant talking point because the insurance companies have excellent lobbyists

oh yeah

they have no incentive to deny coverage

[Dantilla]

The USA has the best medical system, tied to the most screwed-up medical billing system.

After a minor Dr visit a couple years ago, I went to the check-out window, got out my checkbook and asked: "What do I owe you for today?"
Complete befuddlement. She had no idea, no idea how to find out. She just wanted my insurance card.

[rfuerst911sc]

Originally Posted by Tobra

It is not a significant talking point because the insurance companies have excellent lobbyists

Bingo !

[rfuerst911sc]

Dantilla that is crazy but I am not surprised . Unfortunately I don't see this getting any better in my lifetime .

[pavulon]

Originally Posted by rwest

Yes, it doesn’t take much to get huge hospital and surgical bills, so going without insurance could get very expensive or you could just take your chances and then file bankruptcy if you ended up with a massive bill.

This. The medical system is FUBAR'd...the rules, the billing, the egos, the turf wars, the BS marketing...did we cover the egos? Omg, the egos.

[Sooner or later]

The system is loaded with layer apon layer of bureaucracy. And each layer has to take their cut.

Imagine the cost of groceries if no store posted pricing in advance. Imagine the only way you could know your bill was after you check out. Imagine that there was no return policy and once you checked out you had to pay the bill. Imagine how little concern of the overall cost if you had a food insurance policy that picked up most of the tab.

Hospitals know to the Q tip the average cost of procedures.

[drkshdw]

I haven't had insurance since I was on my parents insurance when I was in college. Since then (over 20 years now), I have been to one doctor, once, to get some moles taken care of. It cost me $200 out of pocket including the office visit, the procedures, the lab tests and a follow up phone call. Paid for on the day of the visit.

With that said I have sprained an ankle, broken a bone, torn muscles and had a nail go through the bottom of my foot and back out the top and all of it was taken care of at home because of the costs of seeing a doc. I'm no worse off for it. Everything has healed fine. Perhaps I've been lucky.

But I don't think insurance is the problem in our country. I think the problem is the cost of healthcare. There is no reason for simple things costing so much and until we do something about the COST of it, nothing is going to change.

[Sooner or later]

Originally Posted by drkshdw

I haven't had insurance since I was on my parents insurance when I was in college. Since then (over 20 years now), I have been to one doctor, once, to get some moles taken care of. It cost me $200 out of pocket including the office visit, the procedures, the lab tests and a follow up phone call. Paid for on the day of the visit.

With that said I have sprained an ankle, broken a bone, torn muscles and had a nail go through the bottom of my foot and back out the top and all of it was taken care of at home because of the costs of seeing a doc. I'm no worse off for it. Everything has healed fine. Perhaps I've been lucky.

But I don't think insurance is the problem in our country. I think the problem is the cost of healthcare. There is no reason for simple things costing so much and until we do something about the COST of it, nothing is going to change.

Part of that cost is due to how much we value our life. We would/will "spend " millions to extend life a year. We demand the latest and greatest technology gizmo to diagnose our disease. We expect the latest and greatest pill to cure our ills. Each of those new technologies /pills cost billions to develop and test. And every hospital must install that new tech to keep up with the Joneses.

As we extended life a disease such as mac degen or Alzhiemers became far more prevalent. At one time a heart attack dropped you dead. Today after a transplant or quad bypass you are forever on a costly drug regiment.

Our sucess has driven the costs into the stratosphere.

[Bugsinrugs]

What was the Insurance companies reason for denying coverage? That’s complete bulls..t in my book. When my daughter broke her hand and need surgery our insurance had a $5000 deductible. Out of nowhere they raised it to $7500 saying that it was in their rights to do that. That was Blue Cross. We switched to Kaiser soon after. Insurance companies should not be profiting off people’s misfortunes in my opinion.

[rwest]

Slightly off topic, I do self insure for dental. The monthly premiums for a year are more than one standard visit+ and the max payout is only $1,500 and lots of 20% co pays, so not much risk on my part. Luckily I have had good teeth; two cavities in my life.

[rfuerst911sc]

Bugs at this point we don't know , didn't have a chance to call them on Friday . We will be calling them on Tuesday to see if this really is what we have to pay. I am going to fight as hard as I can with the insurance company and the doctors office to get this to be more reasonable . We will see how it goes .

[VincentVega]

I'm pretty happy with high deductible plans. Max out the hsa and save some premium every month. I use the hsa as a tax free investment and pay out of pocket but you can use the hsa funds for tons of qualified expenses.

[rwest]

In December I had a tumor removed from inside my head, I have high deductible insurance, so I pay the first $4,500 and then 20% up until I hit $6,000 out of pocket.

Even though I pay for everything until that limit, having the insurance gets me the “bargained” for prices.

MRI was listed at a no insurance street price of $3,000, my cost $600. Hospital stay of 4 days street price $50,000, my cost $10,000. Don’t get me started, somehow it is worth $50,000, but they can sell it for $10,000 and still be profitable? Crazy.

[Bugsinrugs]

Originally Posted by rfuerst911sc

Bugs at this point we don't know , didn't have a chance to call them on Friday . We will be calling them on Tuesday to see if this really is what we have to pay. I am going to fight as hard as I can with the insurance company and the doctors office to get this to be more reasonable . We will see how it goes .

Fight like hell! Insurance companies hope you just accept their decision and just go away. Can you take this to arbitration?

[Chocaholic]

Didnt read all of this but your opening post said you had a $1k deductible. No copay beyond that? Do you have a lawyer?