Can anyone please explain how this would have worked in the USA, please?

Armoured · Feb 10, 2017

So a little over a week ago, my wife noticed a new mole on my back that looked suspicious. I made an appointment to see my GP the next morning, he didn't like the look of it either, and referred me to a specialist for an appointment that afternoon, who agreed it looked worrying, took a biopsy and sent it off for pathology. The pathology result was back in 3 days, confirmed displastic nevi, which can become melanoma if left untreated. This morning before work, the specialist performed an excission under local and I'm booked in for a follow up scan in 6 months.

Total time from first concern raised to clinical excission; 10 days

Total out of pocket expense to me for GP consult, Specialist consult, pathology, surgery, and clinical follow up; $0

Had there been a significant cost involved at any point in there, the process may have been significantly delayed, even stopped, which, worst case scenario, could have lead to cancer and death. Instead, with the Australian system, it took 10 days start to finish for best practice standard treatment. I'm genuinely curious to know what the personal costs, time lengths, and flow chart would have been like under the American system, and also what it would be like in the American system without insurance.

Anyone?

Wolfe · Feb 10, 2017

Without insurance, it woulda been a pain.

Though usually they do things pretty quick, and there are plenty of free hospitals, and urgent cares.

probably woulda taken around the same amount of time for you to get your mole removed.
Give or take, hospitals in the US are crazy packed all the time.

Wolfe · Feb 10, 2017

Probably with a good insurance company, the out of pocket would have been no more than 100. And that's being extremely generous.

My sister had a mole removed, and got out the same day, and had a followup in a month.
And it costed us like 40 dollars I think?
The mole was quite large.

Wolfe · Feb 10, 2017

Even with the removal of the mole, you're still at risk though. (fairly certain, not doctor of any sorts though, only going off what I've heard).

I pray that it doesn't end up developing into cancer.
My uncle had skin cancer, though it wasn't what killed him, it was a pretty ghastly affliction.

Aryeh Jay · Feb 10, 2017

stanria · Feb 10, 2017

I can give a comparison for South Africa. (All numbers USD)

With insurance (so private medical care) probably a couple of hundred usd, maybe $300 max in total for everything (GP + specialist + outpatient procedure) and no waiting in queues. All paid by the insurance. Monthly insurance for an adult is $150/month and it covers everything, including hospital stays, emergencies, gp visits, dentists, optometry, etc. I suspect the difference is that you pay for the insurance in your taxes and I pay for it separately.

I had a miscarriage in Dec and it came to $200 and the insurance paid for it all.

Without insurance (so public medical care offered by the state) works on a sliding scale paywise. If you have no income it's $0, if you have max income on the scale it would be like $50 or something in total. But lots of waiting in queues and at clinics. It's very cheap if you go through the state, but takes a lot of waiting time. The without insurance care has older, busier facilities but they're not really that bad.

(Another note: even though I have insurance, I often use the state facilities because they're a lot cheaper. I used to get free family planning from the state, but private family planning is like $30. There's a state clinic around the corner where I live which does like flu shots for $1, etc)

Aryeh Jay · Feb 10, 2017

iluvatar5150 · Feb 10, 2017

As @Wolfe said, with good insurance (and I'd add, an existing relationship with a doctor), it probably would've been similar - maybe even faster. Out-of-pocket would have been somewhat higher, but probably not a ton. My memory's a bit foggy, but IIRC, when they found my dad's kidney cancer, the turnaround time between first concern and lopping out his entire kidney was about the same as it was for your mole. I was in college at the time and didn't even realize what was going on until it was over.

wing2000 · Feb 10, 2017

Armoured said:
So a little over a week ago, my wife noticed a new mole on my back that looked suspicious. I made an appointment to see my GP the next morning, he didn't like the look of it either, and referred me to a specialist for an appointment that afternoon, who agreed it looked worrying, took a biopsy and sent it off for pathology. The pathology result was back in 3 days, confirmed displastic nevi, which can become melanoma if left untreated. This morning before work, the specialist performed an excission under local and I'm booked in for a follow up scan in 6 months.

Total time from first concern raised to clinical excission; 10 days

In the U.S. with employer provided insurance:
One would be fortunate to see the GP by the next morning. Doctors, particularly those employed by large medical companies, are incentivised by the number of patients seen leading to high patient loads and overbooking.
To see a specialist:
-First review if the desired specialists is "in network" or out (cost implications); this step may require two inquiries- minimum - to both the insurance company and the specialist.
-Schedule appointment with the specialist - very unlikely to be seen the same day. 1-2 weeks is more likely (depending on the local supply / demand of course)
- biopsy/pathology - same
- Procedure to remove the mole - same

Total time: 2 - 4 weeks

Cost estimate - varies wildly....add additional time if one attempts to "shop" the specialists; Factor in lost productivity at work for conducting the above steps and the procedure itself.

Faster options: Urgent Care - for same day GP advice....but still subject to the remaining delays; ER - everything the same day at 10x the price.

trunks2k · Feb 10, 2017

It depends on your particular situation. If you were insured and followed all the rules (in network practices and referrals if required), it would probably cost you pretty much a co-pay if you had good insurance. Not so good insurance and you're looking at an unknown cost.* No insurance and you probably weren't even at the doctor's in the first place. In terms of wait time, it depends really. Dermatologists are notoriously hard to schedule with, and can be a long wait time depending on your insurance network and where you live. I've had moles removed after being referred to a dermatologist by a GP both the same day, and having to wait a few weeks before an appointment was available.

*Things can get wonky.... my company provides pretty good insurance (which I don't use, I'm on my wife's). My coworker went to her GP and they noticed something that they thought needed an ultra sound. So they referred her to a place to do the ultra sound but, couldn't figure out if it was in network for her - it should be, and it should be covered, but it's not coming up in the computer. So she calls her insurance company, and they say yes it's in-network. So she asks what her out of pocket cost is going to be. And they say, it could be up to something like $400. She freaks out and calls her GP who says they can't tell her how much it will cost because they aren't the ones doing any of the billing. So she calls the lab, and they tell her they don't know, and won't know until after the ultra sound is done. She says that's not acceptable, and demands to know how much it is going to cost. Someone calls her back later and says it will be on the order of $300. She freaks out again, but coworkers tell her that it doesn't make any sense, they've never been charged for an ultra sound before. So she decided to suck it up and risk having to pay $300 out of pocket. Ultimately, the ultrasound was fully covered, but it took her HOURS to get an out of pocket cost, and it wasn't even correct. And that's with good insurance.

FireDragon76 · Feb 10, 2017

The Affordable Care Act is a misnomer. I go to the doctor and routinely have a 120 dollar co-payment- just for the visit. Then it costs $400 a month just to have some mediocre insurance.

A recent endoscopy had a $700 dollar copayment, and it took a month from the time I saw my GP and jumped through the hoops until a specialist ordered the procedure. With the amount of pain I was in, I was worried I had an ulcer. I took steps to treat it myself, but if it had been serious it would have been a really long wait.

The in-network/out-of-network stuff is frustrating and adds time and energy to just trying to get medical stuff done. I've had appointments with my cardiologist turned down just because I had problems with the HMO's computers (you must get approval from an HMO to get a procedure done, the doctor alone can't approve it).

wing2000 · Feb 10, 2017

trunks2k said:
*Things can get wonky.... my company provides pretty good insurance (which I don't use, I'm on my wife's). My coworker went to her GP and they noticed something that they thought needed an ultra sound. So they referred her to a place to do the ultra sound but, couldn't figure out if it was in network for her - it should be, and it should be covered, but it's not coming up in the computer. So she calls her insurance company, and they say yes it's in-network. So she asks what her out of pocket cost is going to be. And they say, it could be up to something like $400. She freaks out and calls her GP who says they can't tell her how much it will cost because they aren't the ones doing any of the billing. So she calls the lab, and they tell her they don't know, and won't know until after the ultra sound is done. She says that's not acceptable, and demands to know how much it is going to cost. Someone calls her back later and says it will be on the order of $300. She freaks out again, but coworkers tell her that it doesn't make any sense, they've never been charged for an ultra sound before. So she decided to suck it up and risk having to pay $300 out of pocket. Ultimately, the ultrasound was fully covered, but it took her HOURS to get an out of pocket cost, and it wasn't even correct. And that's with good insurance.

I often hear similar discussions at work....and employees spending hours of company time dealing with insurance companies, providers etc. The cost in lost productivity time must be huge....

FireDragon76 · Feb 10, 2017

I'm going to start going back to my Chinese doctor in the future. In the state of Florida they have to have as much academic training in western medicine as any other doctor. And it only costs about $110 per visit (which includes herbs and acupuncture). I've had good results with herbs and acupuncture in the past treating things like malaise, sleep problems, and even hormone imbalances (some of the things I've had, didn't even have a western diagnosis- about 5 years ago I would be cold all the time, in the middle of summer. I just felt like I was in a state of shock all the time).

Rion · Feb 10, 2017

Timing would probably have been the same, since something like that is very situational in the States and in Oz. Cost would've depended on your insurance. Your total costs aren't so easily comparable, however, as you are still paying for the medical services, but it is being covered in the form of a tax instead of individual insurance. I have no idea what the total cost per person is in Australia for the single-payer system.

Armoured · Feb 10, 2017

Wolfe said:
Even with the removal of the mole, you're still at risk though. (fairly certain, not doctor of any sorts though, only going off what I've heard).

I pray that it doesn't end up developing into cancer.
My uncle had skin cancer, though it wasn't what killed him, it was a pretty ghastly affliction.

I have a family history, so I'm familiar with the surrounding literature. Concern of further instances is why I'll probably be having 6 monthly checks for life. Thank you for any prayers and sharing information.

Armoured · Feb 10, 2017

Aryeh Jay said:
My wife had a mole removed last year, after the insurance paid all they would, my bill was $1793.70 USD.

Your joking, right?

Armoured · Feb 10, 2017

FireDragon76 said:
The Affordable Care Act is a misnomer. I go to the doctor and routinely have a 120 dollar co-payment- just for the visit. Then it costs $400 a month just to have some mediocre insurance.

A recent endoscopy had a $700 dollar copayment, and it took a month from the time I saw my GP and jumped through the hoops until a specialist ordered the procedure. With the amount of pain I was in, I was worried I had an ulcer. I took steps to treat it myself, but if it had been serious it would have been a really long wait.

The in-network/out-of-network stuff is frustrating and adds time and energy to just trying to get medical stuff done. I've had appointments with my cardiologist turned down just because I had problems with the HMO's computers (you must get approval from an HMO to get a procedure done, the doctor alone can't approve it).

I don't think we have anything like that network business here. Frankly, I'm not entirely sure I know what you're talking about. Sounds sort of like the "preferred tradesmen" car insurers use, would that be close?

Armoured · Feb 10, 2017

wing2000 said:
I often hear similar discussions at work....and employees spending hours of company time dealing with insurance companies, providers etc. The cost in lost productivity time must be huge....

Collectively, all told I lost half a day's work over this, and it could have been less if I'd really pushed things around.

Armoured · Feb 10, 2017

Rion said:
Timing would probably have been the same, since something like that is very situational in the States and in Oz. Cost would've depended on your insurance. Your total costs aren't so easily comparable, however, as you are still paying for the medical services, but it is being covered in the form of a tax instead of individual insurance. I have no idea what the total cost per person is in Australia for the single-payer system.

We pay what's called the "medicare levy" but my point was that I didn't have to personally come up with a large amount of cash on short notice while operating on a budget. I know healthcare isn't free, per se, but it was immediately accessible without going into financial stress, which I appreciated.

Rion · Feb 10, 2017

Armoured said:
We pay what's called the "medicare levy" but my point was that I didn't have to personally come up with a large amount of cash on short notice while operating on a budget. I know healthcare isn't free, per se, but it was immediately accessible without going into financial stress, which I appreciated.

Hospitals in the U.S. cannot refuse you due to an inability to pay. They develop payment plans for large amounts.

Can anyone please explain how this would have worked in the USA, please?

So is America great again yet?

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So is America great again yet?

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