Health Insurance is EXPENSIVE!!

[sasywtch]

Thank you for explaining that. I was under the (false) impression that if you went to a hospital they would treat you for free..no questions asked. I didn’t realize that they would make you sign something saying you would pay out of pocket. That’s why I didn’t understand why people got insurance if they could just go to the hospital for free. I mistook the quote that they had to treat you no matter what.

When my daughter arrived by ambulance and then the triage nurse took her to the waiting room, we were called in (with dd) to the little financial window to provide proof of insurance or sign paperwork that we would pay cash. All this time, her aorta was ripped open and she was having her spinal stroke. My daughter did not have insurance as it would have been 80% of her paycheck. They do ask and if you don't have insurance, you sign promising to pay. Right now, when my daughter gets her settlement, I think she's at about a 2 million dollar bill from both the hospital and their long term care facility that she will reimburse the state. My other kids and I all have great insurance. I pay zero as a retiree with Kaiser, $15 office visits, $5-15 for prescriptions depending if they are generic for a 3 month supply, labs, xrays etc free. My other kids pay $250 a month for the same plan with kids included. I never realize how fortunate we are until I read these threads.

 

[DisneyHardin]

I am sorry for the people that are paying mortgage sized payments each month for their health insurance. It really makes me appreciate what I pay. DH has totally free insurance from his job and I pay $80 for a month for mine (that's because I chose the top plan, I could have had free if I chose the lesser plan).

 

[morgan98]

[This, I'm not sure about - having worked in a major urban ER and a major urban hospital. Caregivers have no idea what's going on with anyone's insurance, tbh; nor do we care much other than for what is best for the patient. What would happen is that, upon admission to the ER or hospital, a non-insured patient would have to sign a waiver saying they were responsible for paying out of pocket. I suppose it might come up when a treatment plan is being discussed, if only to say hey we recommend an MRI or whatever. The uninsured patient would then say, wait, do I really need it, because I am paying out of pocket. So, in other words, recommendations would be what they are, but the treatment plan might be limited unless one's willing to pay the full price for all the treatments recommended. When it comes to inpatient, what happens is if major treatment is necessary, that patient is hooked up with a social worker who then helps the patient apply for Medicaid or disability, whatever they can get. So if quality of care does go down, it is likely because things are so expensive and someone who's paying themselves might want to limit care to the bare minimum until they get some assistance. That's what I see, anyhow. Caregivers know very little about a patient's insurance issues. [/QUOTE]

I apologize for not being more thorough in my prior post. I do not mean that you would receive inferior care while at the hospital being treated as an uninsured patient, because you are right, the actual caregivers do not know what your payment situation is. However, being uninsured or under insured most definitely has an impact on say where you can be transferred for long term care, etc. I also meant that to say the when you lack good insurance coverage you are way less likely to get treatment early on, making health issues worse in many cases. I guess these are the types of things I mean when I talk about quality of care. I am in no way saying that doctors or nurses provide inferior care. Hope this makes sense.

 

[morgan98]

Exactly how things work in different areas of the country, or even in different hospitals in the same area or region, can vary greatly. I can only speak for what I've seen and experienced. I know where I work there is a certain percentage of the budget is put aside for care for the uninsured. The hospital does eat some costs. (And the rest is probably complex, like perhaps there are tax write offs or something, not really sure.) And I've also read in various places that if people have large bills, they may be able to negotiate what's owed, or at the very least, set up a payment plan. But I do believe that in most hospitals, people have to sign that waiver during the official admission process. It even happens now in doctor's offices when you sign in - you have to attest that if your insurance won't pay for services, that you'll be responsible for it.

Just to add to the discussion, a lot of people blame hospitals for a lot of the high costs of care, and I'm sure there's some truth to that. But everyone wants the best treatment and the best care with the least amount of aggravation, etc. I think many hospitals try to do that for people, but it isn't cheap to provide that. Hospitals know that if they don't pony up, people will go elsewhere, so as businesses, hospitals have to figure out a balance between surviving, staying profitable, and giving patients what they want. Very complex today, and no easy answers to solve the problems.

I will say that patients getting admitted to hospitals today often have complex medical needs, and hospitals are expected to perform to a certain high standard. With the onset of the ACA, Medicare (the government run insurance program for people over age 65 who paid into the system) started implementing very large fines for standards that were not met. Some of these fines are extremely high, like $30K per incident, per patient, say if someone develops a urinary tract infection from a urine catheter (who doesn't?) or a pressure ulcer/bed sore, or if they are readmitted to the hospital within 30 days for certain things, etc. This has been a huge strain on hospitals, because as you can imagine, problems do come up when care is very complex and someone, say, is unconscious for a week or otherwise very sick or debilitated. But very few are talking about that. In addition to fines, for many years, Medicare has lowered reimbursement rates to hospitals for many things, and elderly insured by Medicare comprise a large portion of patient populations, so more and, in essence, better care is being given, yet reimbursements to hospitals are lower and fines are larger and more prevalent.

https://khn.org/news/more-than-half-of-hospitals-to-be-penalized-for-excess-readmissions/

http://www.sandiegouniontribune.com...cquired-penalty-medicare-2015dec26-story.html

https://www.beckershospitalreview.c...o-know-about-medicare-reimbursement-2017.html

So bottom line, these are challenging times for hospitals, too.

I believe this is true is most cases for non life threatening situations. However, due to EMTALA laws, I do not think hospitals can ask during a life threatening situation about one's ability to pay. Hospitals have had to sign and pay out settlements when this has occurred. Now, once you are treated, they most definitely can ask payment status and can then negotiate payment, etc.

 

[crjack]

Another difficult issue for hospitals is observation vs admission status. Most people assume if you are in the hospital overnight you are admitted but that isn't necessarily true. Your status can impact reimbursements for both the hospital as well as the patient, particularly when it comes to rehab which is common for many elderly patients. (We found that out the hard way with my dad).

Often times patients in ER's can be waiting for a long time for a bed to open up elsewhere (maybe a rehab/nursing home/facility for mental health, etc) Hospitals and staff still devote resources and care to those patients but often times receive very limited reimbursement because of their "observation" status. It's quite a Catch 22 we've created.

 

[Veronique]

Really why? Salt in the wound ?

I'm sorry. I just meant to say that other systems exists in the world and works and the people in the US should fight for that.

Sickness can strike anyone and choosing, has a society, to left no one behind seems a no brainer.

I just can't imagine going through what we are right now (my husband is 30 years, never smoked, never drinks, we have to kids 7 and 2 yo and he only have 30% chance of being alive in 5 years) and adding financial stress and lifetime debts to that... it's crazy. I'm sorry.

 

[Gumbo4x4]

Really? No alternatives? We could try looking at any of European countries, Canada, Australia, most of Asia, etc, and see if maybe they have any ideas. I can tell you that our German exchange student is dumbfounded at the way our health care system works (or doesn't). Her mother is a pediatrician in Germany, so she's pretty well versed in how that system works.

The issue is that our government already spends more per capita on healthcare than any other nation on earth and that’s without universal healthcare. Until we are willing to get serious about cost containment and all the pain that could come with that, any notion of universal healthcare is really putting the cart before the horse.

Ironically, if we could just get serious about cost containment, we probably wouldn’t need universal healthcare.

 

[mi*vida*loca]

The issue is that our government already spends more per capita on healthcare than any other nation on earth and that’s without universal healthcare. Until we are willing to get serious about cost containment and all the pain that could come with that, any notion of universal healthcare is really putting the cart before the horse.

Ironically, if we could just get serious about cost containment, we probably wouldn’t need universal healthcare.

Or we could just eat better and exercise more. That would lower a lot of our health issues in this country. Not all but a big portion. Healthier lifestyles, healthier people, less doctor visits and less healthcare costs. Of course some things can't be fixed with just diet and exercise. I'm not talking about those issues.

 

[MIGrandma]

So do you mind if I ask, is the subsidy based on income? Do you happen to know what criteria is used? And when you say this is something new, do you know if this was in the original ACA guidelines? Or how did this make it in there? Thanks

Yes, it is based on income. DH handled it, but I think he had to submit 3 years' worth of our tax returns. We were told there were changes made in the ACA for THIS year, so I don't think we would have qualified for any subsidy until this year.

Farm prices have been down, so I'm sure that's why we qualified. And if, or when, farm prices go up to where they should be we probably wouldn't qualify then.

 

[Gumbo4x4]

Or we could just eat better and exercise more. That would lower a lot of our health issues in this country. Not all but a big portion. Healthier lifestyles, healthier people, less doctor visits and less healthcare costs. Of course some things can't be fixed with just diet and exercise. I'm not talking about those issues.

That’s certainly a piece of it, but it’s just barely scratching the surface. It’s not so much a volume of treatment issue (though again, reducing that helps), but a cost PER treatment issue.

 

[tvguy]

Just like a Disney Cruise is an affordable vacation...

 

[MillauFr]

The issue is that our government already spends more per capita on healthcare than any other nation on earth and that’s without universal healthcare. Until we are willing to get serious about cost containment and all the pain that could come with that, any notion of universal healthcare is really putting the cart before the horse.

Ironically, if we could just get serious about cost containment, we probably wouldn’t need universal healthcare.

I agree with you that every single hospital here in Seattle looks like a luxury 5 star resort with sick people. The amount they spend on expansions and new facilities is outrageous.

 

[morgan98]

I agree with you that every single hospital here in Seattle looks like a luxury 5 star resort with sick people. The amount they spend on expansions and new facilities is outrageous.

I have mentioned this before on threads and others say that is a drop in the bucket. I don't think it is when you spread it across thousands of facilities across the county. You do not need hardwood floors in patient rooms decorated like Pottery Barn, waterfalls and grand pianos to deliver good care. It is a hospital not a spa. If people need all of the fancy frills around them have them pay out of pocket. We need to provide effective, high quality treatment, but I think peoples expectations are a bit out of whack.

 

[disneychrista]

So the penalty for not having cover is around $100 / month vs $500 month for a plan that isn't going to cover anything but major. Honestly, I think it is worth the gamble to not have coverage for a few months. With any luck the tide will change at my current employer and we will start coverage up again or I will have a new job that has coverage. The only "planned" use will be in August for my annual exam.

 

[DisneyHardin]

I believe this is true is most cases for non life threatening situations. However, due to EMTALA laws, I do not think hospitals can ask during a life threatening situation about one's ability to pay. Hospitals have had to sign and pay out settlements when this has occurred. Now, once you are treated, they most definitely can ask payment status and can then negotiate payment, etc.

This was our experience the one time we had an emergency situation. DH was rushed to the hospital in an ambulance with chest pains. By the time I got there, he has already been taken into the ER, assessed and given medications. After I had been there about an hour or so, someone came and asked if I could give them some information. I got his wallet to give them his insurance card and ID and filled out all the admittance paperwork.

 

[Pea-n-Me]

I apologize for not being more thorough in my prior post. I do not mean that you would receive inferior care while at the hospital being treated as an uninsured patient, because you are right, the actual caregivers do not know what your payment situation is. However, being uninsured or under insured most definitely has an impact on say where you can be transferred for long term care, etc. I also meant that to say the when you lack good insurance coverage you are way less likely to get treatment early on, making health issues worse in many cases. I guess these are the types of things I mean when I talk about quality of care. I am in no way saying that doctors or nurses provide inferior care. Hope this makes sense.

Yes, and sorry, I didn't mean to say you didn't, I was just explaining.

I believe this is true is most cases for non life threatening situations. However, due to EMTALA laws, I do not think hospitals can ask during a life threatening situation about one's ability to pay. Hospitals have had to sign and pay out settlements when this has occurred. Now, once you are treated, they most definitely can ask payment status and can then negotiate payment, etc.

Yes, it depends how emergent one is. They deal with the details once one is stabilized.

I'm sorry. I just meant to say that other systems exists in the world and works and the people in the US should fight for that.

Sickness can strike anyone and choosing, has a society, to left no one behind seems a no brainer.

I just can't imagine going through what we are right now (my husband is 30 years, never smoked, never drinks, we have to kids 7 and 2 yo and he only have 30% chance of being alive in 5 years) and adding financial stress and lifetime debts to that... it's crazy. I'm sorry.

Not everyone wants it; it's not as easy as it seems; it may not solve all the problems some think it will - here.

I agree with you that every single hospital here in Seattle looks like a luxury 5 star resort with sick people. The amount they spend on expansions and new facilities is outrageous.

I have mentioned this before on threads and others say that is a drop in the bucket. I don't think it is when you spread it across thousands of facilities across the county. You do not need hardwood floors in patient rooms decorated like Pottery Barn, waterfalls and grand pianos to deliver good care. It is a hospital not a spa. If people need all of the fancy frills around them have them pay out of pocket. We need to provide effective, high quality treatment, but I think peoples expectations are a bit out of whack.

I have also mentioned on other threads that hospitals are businesses that have to compete - especially in urban areas where there are many choices for patients, and where they have to drive into the city, pay to park, etc. Nobody today is going to go to a dump when they can have better, more modern facilities right next door. Old facilities cannot handle all the equipment and new technologies of today. Patients also prefer private rooms today. There are security issues today. Sanitation issues today. More stringent fire codes today. We know the benefits of peaceful and open green spaces - and waterfalls, lol. And on and on.

 

[morgan98]

I have also mentioned on other threads that hospitals are businesses that have to compete - especially in urban areas where there are many choices for patients, and where they have to drive into the city, pay to park, etc. Nobody today is going to go to a dump when they can have better, more modern facilities right next door. Old facilities cannot handle all the equipment and new technologies of today. Patients also prefer private rooms today. There are security issues today. Sanitation issues today. More stringent fire codes today. We know the benefits of peaceful and open green spaces - and waterfalls, lol. And on and on.

I know we have discussed that. I get hospitals are competing for business, but people do not want to PAY for these amenities. So hospitals often struggle under piles of debt for new facilities and people complain because they do not want to pay high premiums or out of pocket expenses. However, who do they think is going to pay? Once you factor in costs of covering the uninsured, under insured, lawsuits, etc. it is all very expensive and will remain so until we collectively try to solve it.

I mean wouldn't everyone rather have a Maserati, but guess what, the Honda gets you from point A to point B too.

If people want premium surroundings then they need to be willing to pay for them.

 

[mnrose]

That’s certainly a piece of it, but it’s just barely scratching the surface. It’s not so much a volume of treatment issue (though again, reducing that helps), but a cost PER treatment issue.

But, a big part of the reason that the cost PER treatment (which I agree is very high) is because there are so many people who are uninsured/underinsured and therefore the hospitals/doctors are forced to make their treatment costs exceedingly high to cover the people who don't pay at all. Another big part of the reason is that medical device costs and drug prices in THIS country are significantly higher than in other countries. Why do we pay so much more than Canadians or Germans for the same drugs? Hmmmm. Such a mystery.

 

[NotUrsula]

The issue is that our government already spends more per capita on healthcare than any other nation on earth and that’s without universal healthcare. Until we are willing to get serious about cost containment and all the pain that could come with that, any notion of universal healthcare is really putting the cart before the horse.

Ironically, if we could just get serious about cost containment, we probably wouldn’t need universal healthcare.

The thing is, without universal healthcare, the dog chases its tail. When medical providers and pharma companies are financially-unregulated for-profit entities, cutting costs is the last thing that they want to do. Then you add in the hospitals' habit of jacking up costs for the insured in order to cover their losses on the uninsured, and it becomes a self-fulfilling prophecy. The only way to truly control costs is to take the profit motive out of the equation. Countries with universal healthcare regulate the markup over cost that their suppliers can charge; if you can't live with that level of profit, then you don't seek the business.

I've got a lot of family in the UK and Ireland, and one them happens to be a surgeon in the NHS system. We have discussed the pros and cons many times over. One of the few places where he thinks that US practices are superior is in the adoption of private-rooms-only in hospitals, because it keeps down infection.

 

[Pea-n-Me]

I know we have discussed that. I get hospitals are competing for business, but people do not want to PAY for these amenities. So hospitals often struggle under piles of debt for new facilities and people complain because they do not want to pay high premiums or out of pocket expenses. However, who do they think is going to pay? Once you factor in costs of covering the uninsured, under insured, lawsuits, etc. it is all very expensive and will remain so until we collectively try to solve it.

I mean wouldn't everyone rather have a Maserati, but guess what, the Honda gets you from point A to point B too.

If people want premium surroundings then they need to be willing to pay for them.

I am certainly not an expert on the administrative side, but I am on committees that discuss a lot of things and sit in on many presentations, etc. And have for 30 years so lots of them, and I've watched the progression of things. There are separate budgets for operating costs and capital expenditures. Hospitals in cities also have a lot of wheeling and dealing with government, for instance they need to contribute back to the city in order to obtain an expansion, and things like that that are very complicated and longstanding. There are also big donors that often contribute greatly to the types of things we're talking about.

I think we have to remember that in the 90s, many hospitals closed their doors because of regulatory changes in the industry. Those who survived needed to figure out ways to contain costs, and they did. More recently they've had to figure out how to get people in their doors, and it's also a matter of survival - again. There's little doubt there will be more problems to face as we move forward. But I'll have to argue that the waterfalls and other niceties are a necessary part of operations in hospitals today in order for them to stay competitive. I can't really explain it better than that, but I know that it's not something done just for kicks and giggles. Patients can choose many places to get their care. And they are concerned not only for themselves, but for their families, and how convenient and nice things are for them, too. This is just how it is today.