Is Health Insurance Really Necessary?

@verbum I just posted about about what my husband and I have done. Feel free to DM me if you have any other questions. It’s such a nightmare out there, but while not perfect, what we’ve done has saved us a ton and worked out better than expected.
 
@p8089 It was in March. So far the only bills I've gotten have been about 3100. I told them upfront that we had no insurance and no access to Medicaid (we make $250 too much a month). I'm not sure who decided what but they got our barely breathing baby in, admitted, and treated, and have only sent that amount so far. 🤷‍♀️ Maybe there are still bills to come, but that's all I've seen so far.

ETA: for the 1st well child visit, they billed us $940. I called and asked for clarification. The billing department said it was billed at the insurance price. The cash price was $75. Perhaps that has something to do with it. Same with urgent care. It was a flat rate of $200 visit, and $100 for x rays. Total. Or when I was pregnant with my 2nd, the out of pocket price for the NIPT with insurance was about $240 (that I would have to pay). The cash price was $90. I'm starting to wonder if cash is just the way to go.
 
@verbum Expect more bills. I live in a fairly low cost area. 1 ER (with pediatrics) visit was $3,500. 3 day hospital stay was $36,000. A 5 day stay was $60,000. 23 day stay was $102,000.
 
@verbum You may get bills from the hospital, each doctor, the respiratory therapist, the imaging department, etc. Hard to say how many bills but it will take a little time.
 
@verbum
It was in March

You very likely haven't received all of the bills yet. It can take months for all of the bills to arrive from a hospital visit. Expect to receive separate bills from the hospital, ER doctor, hospitalist, radiologist, pathologist, etc.

On average, an ER visit rubs around $1709 and being admitted is around $2870 per day. Obviously the actual cost varies based on why you are there, procedures you have, and level of care (i.e. ICU costs more than med-surg).
 
@verbum This is exactly why the health industry is fucked. These are more normal prices, but get highly inflated so that insurance will cover based on the percentage they are willing to pay.

I went to a dermatologist a few years ago because I was concerned about a spot on my nose, I told them I had no insurance. Office visit was $75, they removed the spot and did a biopsy. No extra charges, $75.

Now I go, pay $550/month for insurance and a $65 copay.
 
@penny65 The prices are so inflated to make up for Medicare, Medicaid, Tricare, and people like this whose payment doesn't even cover the coat of providing care to the patient. That $75 is meant to cover the expense of all the admin staff who scheduled, checked in, and worked any billing; the MA who roomed you, took vitals and got some initial info; thr doctor who saw you and performed a biopsy; all the equipment used which is generally all single use; the use of the room; transporting the specimen to the lab; the lab staff who processed it; and finally the pathologist who looked at it and gave a report.

Hospital expenses are huge and insurances just get worse and worse to thr point that a lot of systems across the country are in a financial crisis right now. They're struggling to stay afloat while still caring for the community by accepting Medicaid patients and offering low cash prices to people without insurance.
 
@p8089 Yeah, that seems super cheap. I remember the ER charged my insurance company $2,000 just for walking in the ER. The bill said “Emergency room” $2000 😂 I wasn’t even admitted
 
@verbum My father needed triple bypass surgery at the age of 57. He didn’t have health insurance. The bill was well over $100,000 which he didn’t have. They put liens against the property. He got depressed. Two years later he got an infection in his finger and he ignored it because at that point he was anti-doctor. He died within a week. The liens against the property became our problem. The end.

Don’t take chances; get at least catastrophic insurance. Yes, It sucks and yes, the US sucks for having such a shit system.
 
@verbum Count yourself lucky if lesser-cost catastrophic policies are available in your state. The useless do-gooders in California made that impossible for us. It's a good option if you're healthy and have enough cash for the maximum out of pocket in case something happens.
 
@verbum My husband just stayed 5 days in the hospital, admitted through an ER visit for back pain and had acute kidney failure. The bill for just his hospital stay was sent to our insurance for 82000. Never mind his primary care doctor visit, radiologist, any doctor who saw him in the hospital, biopsy, etc. with insurance we owed his out of pocket max of $5000.

We’re a healthy, 32 year old family. This was not expected.
 
@therepublicsfinesthour I (28, healthy, no pregnancy complications) had a C-section, a hemorrhage, a mass rapid transfusion, a 2nd emergency surgery, and an extended hospital stay, all while my baby was in the NICU. Unexpected emergencies suck ass and are very expensive, I am well aware. But there is no denying we are paying over inflated prices. Its excellent that you and your family were insured in a time of need, but I am curious how your emergency or my emergency would look with cash prices, not "billed to insurance" prices.
 
@verbum
I am curious how your emergency or my emergency would look with cash prices, not "billed to insurance" prices.

That's easy enough, just look at your EOBs which will tell you how much was actually paid. Everyone understands the prices billed to insurance aren't real, this is nothing new.
 
@joscar But that's not correct. Each insurance/provider has different negotiated prices, percentages, so on. For example the cash price with no insurance billed for my NIPT was $90. Had I had them run it through my insurance, the EOB would have shown several hundred dollars including the $240 ish I would have had to pay out of pocket for "my portion". The Explanation Of Benefits, well, it explains benefits. Not cash prices.
 
@verbum Well, cash price is whatever you can negotiate. The amount your insurance pays is what they’ve negotiated. You might be able to do better, but this gives you a number that isn’t completely made up like the billed amount is.

If your cash price is less than half what insurance pays, there’s probably a bit of charity involved and it’s not really a reflection of the true cost.
 

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