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

[trunks2k]

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?

Insurance companies make deals with different medical practices - essentially they say "we'll reimburse you a negotiated reduced amount for their care and you get patients" they are considered "in network". Some practices may not like how a given insurance company reimburses them, so they won't agree to it. They'll be "out of network". Some insurance companies won't pay for any out of network care, others will reimburse their customers, but not as much as they would for in-network.

And you know what's really nuts, in some cases it's possible to be in a hospital that is in network, but some of the doctors are not actually part of the hospital's practice and are out of network. People have been in an in network hospital, needed immediate surgery and were operated on by an out of network surgeon and/or using an out of network anesthesiologist ended up getting stuck with a huge bill. IIRC, steps are being made to stop that sort of thing.

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

Hospitals have a legal responsibility to stabilize any patient. If it's not an emergency, they aren't under any obligation to treat you.

 

[Aryeh Jay]

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[JGG]

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

My sister-in-law had a mole removed a year or so ago, for her it was more like $600-700, not counting time off. However, I don't know the steps she had to take.

 

[trunks2k]

Your joking, right?

I'd believe it if it was bad insurance. When I was in college I sliced my finger. Not a hugely bad cut but fairly deep and in a spot where it'd be hard to keep closed so I figured it might need stitches. Went to the local ER and got three or four (poorly done) stitches. I didn't have my insurance card on me, so we had to wait for the bill and then submit it. Got the bill, it was over $2500. Did the whole insurance bit, and got a bill of between $600 and $1000 from the hospital. For a few stitches. AFTER insurance. My mom, who was an ER nurse for 20+ years got furious. She asked for an itemized bill ad got even angrier. They charged some outlandish amount per stitch pack they used. After a couple calls to the billing department and threats to call the state AG, they lowered the bill to $20.

 

[Greg J.]

There is no standard medical care in the U.S., and a lot depends on how much knowledge the patient has for taking advantage of services and reduced cost medical care. How long it takes to get help varies widely. For some medical issues in some locations it can be three months to see a doctor. For other things, you can get in the same day. The potential danger to life is a big factor. For a scary-looking mole, it probably would have been handled in roughly the same amount of time, or even faster, presumably because medical practitioners are aware of how fast some skin cancers can progress.

A visit to the emergency room—the fastest form of care available (very quick if you arrive by ambulance)—can make a person wait 4+ hours before someone will look at you, unless you are bleeding or are about to collapse. An hour wait is common.

Cost also varies widely. The cost of good insurance varies. $600/month is a typical amount for good, but not the best, insurance for a single adult. Poor insurance would be $200-$300/month (which, among other things, means you have to pay a higher % of actual medical costs). Insurance premiums typically go up 10%-15% per year. Sometimes it is hard to know the cost because what a medical institution charges is not necessarily what an insurance company pays. The difference is sometimes passed on to the patient and sometimes it is not, because the insurance company has worked out a deal with the provider.

An insurance deductible is an amount the patient must pay total for medical expenses that year before insurance starts covering costs. I've seen plans with $200 or less to $2500 or more. Typically, the higher your monthly premium, the lower the deductible for that plan. Also individual services may have separate deductibles and maximums that the insurance company will pay. While highly regulated, medical care is provided by businesses trying to make money.

Most 25+(?) person companies pay for their employees insurance premiums and often make it possible for the employee to pay for other family members. Larger companies often even offer employees several choices for insurance plans.

Quality of care is probably what you'd expect: it varies widely. The best option for quality vs. cost seems to be medical services provided by universities with medical schools whose doctors are both university medical school instructors and medical providers to the general population. These facilities often just carry the name of the university.

Also, this is just medical insurance. Separate insurance plans are often needed for non-emergency dental and eye care.

 

[trunks2k]

Quality of care is probably what you'd expect: it varies widely. The best option for quality vs. cost seems to be medical services provided by universities with medical schools whose doctors are both university medical school instructors and medical providers to the general population. These facilities often just carry the name of the university.

My wife works for a very large, one of the best in the country, hospital (oddly enough the one that tried to stick my parents with a huge bill for my stitches). We get really good insurance through them. Pretty much any service done through the hospital is free, outside of some small copays for office visits. We haven't even seen any bill for our daughter's birth there. They also give good insurance for other in-network providers but since the hospital is so big and is good quality, we don't bother.

 

[redleghunter]

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?

I'm glad you had this taken care of in such an expeditious manner. I was acquainted with several Australian officers over the years and a few have told me skin cancer is one of your #1 cancer killers.

Given I am retired military my answer would not be the norm.

If I went to a military treatment facility the time from exam and diagnosis to outpatient surgery would be from a few days to a few weeks depending on case load. Our military healthcare is a single payer universal type.

However, if I put up a stink and wanted to get the mole cut off faster, I could ask for a referral outside the military treatment facility and get it taken care of immediately. If the civilian provider is within the military healthcare network, I pay a $12 copay.

If I go out and find a doctor who will do same day service or a lot faster than both options above, and he/she is out of the military healthcare network? I pay 20% of the total cost, insurance pays 80% and I have a catastrophic cap (max paid by insured in one year) of $3000.


The Military TRICARE used to be the 'pariah' of all healthcare plans...Until AHA. Now Tricare is one of the best.

 

[Aryeh Jay]

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[HannahT]

The Military TRICARE used to be the 'pariah' of all healthcare plans...Until AHA. Now Tricare is one of the best.

Medicaid isn't anything to call home about either. The young lady that lives here with us? She has two wisdom teeth growing out of a bone, and so they instructed her to get a surgeon. The nearest one was three hours away, and I drove her this week. She got a consultation, and we wait up to 6 weeks to find out if they are going to cover it.

She is a cancer survivor, and they did pay for all of that. Yet, trying to find doctors willing to deal with Medicaid? It's a nightmare.

We are working on our retirement property currently, and our builder is on ACA. He found it was cheaper to tell the doctor/hospital he had no insurance, because it was cheaper than the out of pocket to use the insurance. I guess they have a $15,000 deductible before they pay anything. Since they never hit that point, and since the 'no insurance' route is cheaper? He does it that way. His monthly premium went up 40% this year. He was talking about going no insurance for real this time.

So the normal government system for health insurance, and the system (medicaid) that is for the low income? Neither are all that great it seems.

I'm glad you have at least Tricare!

Armoured I do hope the best for you, and I'll be praying.

 

[Always in His Presence]

I had a mole removed just a couple days ago. It was quick and easy.

A little bait at the opening, the squeeze of a trigger. And no more problems. Cost less than a dollar for the shotgun shell.

 

[High Fidelity]

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

Wow. I'd do it myself at that point!

 

[Always in His Presence]

Seriously though. Before the affordable care act it would've been a $20 co-pay for the office visit. A $100 co-pay for the procedure and I imagine 2 to 3 weeks time frame

With The affordable care act after a 130% increase in premiums. And my co-pay for the doctor's visit is $40 and the procedure would've been 100% out-of-pocket because I have not met my deductible.

 

[Armoured]

I wish I was but for some reason I am having trouble with uploading a picture of bill.

I'm sitting here open mouthed. That's, I'm just shocked.

 

[Greg J.]

Maybe I should have saved the paper that showed my insurance company paid $40,000 for my cancer treatment (27 years ago). It would be darkly amusing.

I'm sitting here open mouthed. That's, I'm just shocked.

$1800 is totally not unusual, but people have widely different insurance plans. Note that $1800 is, at a guess, equivalent to 4-5 months of premiums. A plan that would have lowered that $1800 to $200 could easily cost $1800 more per year for premiums.

 

[Armoured]

Maybe I should have saved the paper that showed my insurance company paid $40,000 for my cancer treatment (27 years ago). It would be darkly amusing.

$1800 is totally not unusual, but people have widely different insurance plans. Note that $1800 is, at a guess, equivalent to 4-5 months of premiums. A plan that would have lowered that $1800 to $200 could easily cost $1800 more per year for premiums.

I pay insurance, too. What I'm really interested in is costs outside of insurance.

 

[Aryeh Jay]

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[FenderTL5]

Given my current plan (employer provided) my out of pocket would have been anything up to 10K. After I spent 10K, then they began coverage.
So if the treatment is less than 10K, I would have had to pay ALL of it. Specialist and hospital stays could be excepted from coverage.
We (my household) had a 'catastrophic event' in 2010. My total out of pocket costs exceeded 17K. I emptied 401Ks in order to avoid bankruptcy.

 

[Armoured]

Given my current plan (employer provided) my out of pocket would have been anything up to 10K. After I spent 10K, then they began coverage.
So if the treatment is less than 10K, I would have had to pay ALL of it. Specialist and hospital stays could be excepted from coverage.
We (my household) had a 'catastrophic event' in 2010. My total out of pocket costs exceeded 17K. I emptied 401Ks in order to avoid bankruptcy.

That's terrible! So, in the situation I was in just now, I'd have to basically pay all costs up to 10K?

Do your doctors accept instalment plans at least? Or do you just have to forego treatment until you've raised enough money, or what?

 

[FenderTL5]

That's terrible! So, in the situation I was in just now, I'd have to basically pay all costs up to 10K?

Do your doctors accept instalment plans at least? Or do you just have to forego treatment until you've raised enough money, or what?

Yes, I (you'd) pay everything up to the deductible amount. My current plan has a 100~ a week premium and a 10K deductible. I pay them one hundred dollars a week in order for the insurance company to apply all expenses toward the deductible up to $10,000. So basically, it's $100 a week for no coverage outside of a major event.

Installment plans? depends on the doctors. Those that I dealt with, officially, did not accept installments BUT when they billed the full amount and I only paid a partial amount - the next month's bill came with a new balance.
This worked for 90 days, then the bill was turned over to a collections agency. I then emptied the retirement accounts to pay off the bills.

Now, medical bills are 'tax deductible' so a portion of the 17K was deducted from my income taxes the following year. However, the amount of taxes owed was actually less than the penalties for early withdrawel from the retirement accounts - so I ended up paying additional tax penalties on top of the medical costs.

It sucks to be 'working poor' in the USA.

 

[Armoured]

Yes, I (you'd) pay everything up to the deductible amount. My current plan has a 100~ a week premium and a 10K deductible. I pay them one hundred dollars a week in order for the insurance company to apply all expenses toward the deductible up to $10,000. So basically, it's $100 a week for no coverage outside of a major event.

Installment plans? depends on the doctors. Those that I dealt with, officially, did not accept installments BUT when they billed the full amount and I only paid a partial amount - the next month's bill came with a new balance.
This worked for 90 days, then the bill was turned over to a collections agency. I then emptied the retirement accounts to pay off the bills.

Now, medical bills are 'tax deductible' so a portion of the 17K was deducted from my income taxes the following year. However, the amount of taxes owed was actually less than the penalties for early withdrawel from the retirement accounts - so I ended up paying additional tax penalties on top of the medical costs.

It sucks to be 'working poor' in the USA.

I haven't the words. I'm shocked and appalled, and that doesn't describe it.