Sometimes services are rendered which insurance does not deem required, and then refuses to pay for, and some items are simply not covered at all. For example, insulin may be covered by insurance, but needles and syringes are not.
On top of that, it's basically impossible to anticipate the cost ahead of time for many procedures. One person I know was quoted $2,000 to $30,000 for a portion of a surgery that is not covered by insurance, depending on exactly what needed to be done. How do you even plan for that? At one end, it's like buying ~2 new refrigerators of pain, and the other end is a brand new, top of the line Chevy Bolt.
For many people, hitting max out of pocket is simply not possible without debt. It's common to see 3-5k MOOP, but taking a modest standard of living on an average salary, it's an incredible amount of time to make up for it.
E.g. $5,000 household income (60k annual)
* $800 rent
* $1,000 childcare
* $250 gas
* $200 utilities
* $500 groceries
* $500 income taxes
* $250 student loan payments
* $100 car insurance
$1,400 leftover, but there have been no incidental expenses, $800 is probably lower than you could find a 2 bedroom apartment in Iowa, and I'm assuming they own their car outright. Once you hit January 1, your deductible and max out of pocket reset, so you could be like a friend of mine and get MRI's on December 31 and January 1 while staying in the hospital for a couple days on either end. They had to pay their full max out twice because of the timing in the year when they got sick.
That's terrifying. The healthcare issue with the US is what seriously makes me want to live in Europe, at least to try it. The thought of your whole life falling apart just because you need medical care is horrible. I'm living the double-software-engineer-income, no kids life with my partner, and even then I think a major medical issue would be life changing. As a risk-averse person, the US feels like a place to get high rewards as a SWE, but there are massively high risks that don't get talked about often enough.
It's not like you can get whatever, whenever medical care in Europe. Whether private or public, the entity that's paying the bills will be making decisions on what procedures are or are not "necessary" and how much they will pay.
My uncle in Denmark had cancer, and they basically put him in a hospice-type facility to die, because anything else would have not been justified due to his age, the cost, and the low probability of success.
In the USA, he or his family would likely have demanded aggressive surgery and/or chemo or radiation, he would have died anyway, and there would have been hundreds of thousands of dollars of "medical debt" created.
I suspect many people who like the idea of socialized medicine are not prepared for the reality of the limits on care that would bring, particularly for the old and terminally ill.
> In the USA, he or his family would likely have demanded aggressive surgery and/or chemo or radiation
In the US, if you can't afford it, medical care basically isn't even an option. If you have a lot of money, then you're set. In Europe if you don't have much money, you at least have some options, and if you have a lot of money, you can still go to the US. Or if you're open to $100k's of debt, you could've easily gone to the US for treatment, too. Your scenario just proves my point that the situation is way better in europe
Well, I'm saying that he had no options. He went to a (very nice) facility to die. They kept him comfortable and relatively pain-free.
Any other option he had, should he have wished to pursue it, would have been outside of the Danish social medical system.
That may be "better" than what would have happened in the USA under Medicare/Medicaid, but my point was there really wasn't a choice in the matter for him. He didn't have to pay for it, other than the taxes he paid his whole life, so I guess there's that.
> Well, I'm saying that he had no options. He went to a (very nice) facility to die. They kept him comfortable and relatively pain-free
I'm just saying that's an option that he took. Just because it wasn't ideal, doesn't mean it wasn't something. If he was in the US, that wouldn't have been an option in the first place. Still a massive improvement over the US.
> Sometimes services are rendered which insurance does not deem required, and then refuses to pay for
This shouldn't be legal.
Do insurance companies even employ actual medical doctors that are educated, trained, and experienced in health care so that they're qualified to make these calls?
They do employ medical doctors to review cases, give prior authorization for specific treatments and diagnostic tests, etc. There can also be doctor to doctor calls to explain why a particular item was justified. The thought of some random doctor reviewing your file and the notes generated from a visit and making a determination having never seen you sucks. It's been passed ok'd as "ensuring doctors are following the best practices and ensuring consistent standards of care", which it may to an extent.
As with most aspects of US healthcare, when viewed through through the perspective of the recipient, it's atrocious. Every medical facility requires you to sign a paper that you'll pay all the medical expenses if they aren't covered by insurance. They can't give you an estimate that they promise they'll stick to in terms of cost. There's no way a non-doctor could know what the typical course of treatment would be, so they're stuck trying to get straight answers from an insurance company if they don't want a surprise massive bill.
Provider bills insurance an insane amount which is then arbitrarily discounted. Provider can't bill different amounts for insured or uninsured patients (illegal from my understanding). If insurance doesn't cover something, it's between the patient and provider to settle.
On top of that, it's basically impossible to anticipate the cost ahead of time for many procedures. One person I know was quoted $2,000 to $30,000 for a portion of a surgery that is not covered by insurance, depending on exactly what needed to be done. How do you even plan for that? At one end, it's like buying ~2 new refrigerators of pain, and the other end is a brand new, top of the line Chevy Bolt.
For many people, hitting max out of pocket is simply not possible without debt. It's common to see 3-5k MOOP, but taking a modest standard of living on an average salary, it's an incredible amount of time to make up for it.
E.g. $5,000 household income (60k annual) * $800 rent
* $1,000 childcare
* $250 gas
* $200 utilities
* $500 groceries
* $500 income taxes
* $250 student loan payments
* $100 car insurance
$1,400 leftover, but there have been no incidental expenses, $800 is probably lower than you could find a 2 bedroom apartment in Iowa, and I'm assuming they own their car outright. Once you hit January 1, your deductible and max out of pocket reset, so you could be like a friend of mine and get MRI's on December 31 and January 1 while staying in the hospital for a couple days on either end. They had to pay their full max out twice because of the timing in the year when they got sick.