Just was thinking about this the other day while looking at my insurance. How do people in the U.S. accumulate huge bills without hitting their max out of pockets? Are cancer treatments not usually covered by insurance? Are the doctors that provide the treatment just happening to be out of network?
I guess I’m wondering if there is anyway I can plan to not be in a situation of me or my husband rejecting treatment and dying or having huge medical bills cripple us. We’re relatively healthy now, but the future is near.
I’d like to understand better how it seems to be so *common* for people to not be covered by their out of pocket max.
Thanks.
In: 4623
Because even if you have decent insurance (either through an employer or the ACA):
* Deductible is often a few thousand ($4k for my family)
* OOP max is often significantly more ($6k for us)
* There may be a separate (even higher) deductible for out of network providers. Often providers you didn’t even realize were out of network, like the anesthesiologist who worked alongside the in-network surgeon.
* Health insurance just straight up excludes coverage for some forms of treatment you wouldn’t expect, like… orthotics for flat feet. Some prosthetics are excluded. Or for private/out of network ambulance services. Or, say, that $25k air ambulance ride to get your dying kid to a children’s hospital with equipment that could actually be used for them.
Or maybe you lost your health insurance when you got too sick to work (or because the stress of dealing with a severely ill family member tanked your performance and you got fired), and with no job you couldn’t afford to keep paying the whole premium under COBRA, but you still needed treatment.
Health insurance companies make money off premiums. They lose money every time they pay out on a claim. They have armies of bureaucrats (and computer algorithms) *dedicated* to making sure they deny any claim they can possibly get away with denying, including stuff they’re *supposed* to pay for, but think you won’t have the knowledge, time, or energy to fight them on. They wouldn’t pay that army of bureaucrats if it didn’t save them more money in denials than what said army’s salary costs them.
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ETA2: I think my point there is that their whole business model is based on making money by NOT covering you. How is that different from any other kind of insurance? Well, because in other types of insurance, like home & auto, the company gets to take actuarial data and make a *risk decision* about whether to cover you at all, and they can more freely adjust the premium to account for the risk you present. Health insurers mostly don’t get a choice about who they cover (laws typically require them to cover everybody who can pay the premium, especially since the ACA), and they can only jack the premiums so high to compensate.
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And the healthcare lobby is absolutely gargantuan, and dedicated to preventing legislation that could reign in these practices, let alone any kind of universal coverage. Healthcare spending in the US accounts for almost a fifth of our entire GDP, ffs…
See also: [https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html](https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html)
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ETA:
>I guess I’m wondering if there is anyway I can plan to not be in a situation of me or my husband rejecting treatment and dying or having huge medical bills cripple us.
Yeah, there is: Start working on getting Canadian residency now, while you’re healthy.
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