I hope this is the correct sub, if not, please direct me somewhere.
Let me preface this – I do not live in USA.
I’m an interpreter from Poland, currently during training. Since we’re going to help Poles living in USA with, for example, health insurance, we’re being taught how it works.
But in theory it’s all nice and dandy, while in reality it seems horrible. I can’t find the middle ground and how it’s applied to real life situations. Trainer denied explanations, claiming interpreters are not allowed to have opinions (or at least express them), but I think this knowledge would allow me to better understand the context of the situation.
If there are deductibles and then copay and then out of pocket maximum (that apparently nobody ever reaches anyway), then why people have such high med bills even though they’re insured? If out of pocket maximum is for people with serious medical issues ending up with hospitalisation, why insurance companies suggest setting up gofunmes? If insurance or M4A work, then why people can’t afford their insulin, or don’t go to therapy? Why do I see people complaining about “insurance don’t cover my basic meds and I have to pay full price” if there are these… PPOs? I think that’s what they’re called. Insurance should direct them to where they can get a price at least partially covered by the insurance.
I don’t understand, but since I don’t live over there, I probably miss something that is obvious to people who do.
In: 1
Many people cannot afford insurance, or only afford the most basic available which has very high deductibles (amount you much pay out of pocket before insurance starts covering). And even somebody with a decent job, company subsidized insurnace may still see themself with bills higher than they can afford.
My insurance to cover me, my wife and son cost me $350 every 2 weeks through my employer. We then have a $4000 family deductible. I work in a corporate HQ of a large public company, in a marketing job, so this is GOOD insurance (PPO), not the garbage plans offered to people who work at Wal-Mart or fast food. So I’m paying about $9000 in premiums, and then another $4000 in deductibles — that’s $13,000! I had spine surgery a couple years ago, wife’s been having medical issues the past year or so, so we’ve been hitting that deductible cap. I make enough to absorb all those costs, but imagine somebody in a lower tier job, making $30-50k. That’s a HUGE chunk of their income, but their income is too high for programs like Medicaid.
And insurance often denies things… I couldn’t get the preferred surgery my surgeon wanted to do (artificial discs to replace ruptured ones) and had to settle for spine fusion. Wife has been fighting to get approval for a particular medication — she took it in the past, got off it to get pregnant and now needs to get back on but insurance wants her to try other cheaper ones first, despite fact she did all that 7-8 years ago when her issue first popped up. Without insurance, that drug would run $600/mo.
Latest Answers