Complex Numbers

Mutually Insured Destruction

I try to stay away from overly political issues here, but this one affects all of us here in the US. Other countries, here's your chance to pile on and laugh at us.

https://www.theguardian.com/us-news/2019/nov/14/health-insurance-medical-bankrup...

'I live on the street now': how Americans fall into medical bankruptcy
Having health insurance is often not enough to save Americans from massive debts when serious illness strikes

“I paid my $300 copay. After the surgery, I started receiving all these invoices and came to find out the only thing covered was my bed because the hospital was out of network,” said LeClair. “My bills were hundreds of thousands of dollars, so I had no choice but to file bankruptcy.”

One of the biggest issues I had to face upon early retirement was health care. Or, to be precise, how to pay for it; the nearest hospital is less than two miles from me, and it's one of the best.

Fortunately, my ex and I parted on good terms, and we stayed legally married for several years specifically so I could stay on her health insurance (she worked in a lab associated with said hospital, so there was no "in-network" question).

A good thing, too, because it was during this period that I had a heart attack. I don't remember what the total pre-insurance cost of the ER, treatment, and subsequent hospital stay was, exactly, but there were six numbers before the decimal point. The two after the decimal point were irrelevant. Nor do I remember how much I had to pay out of pocket, because it wasn't a hell of a lot.

When we finalized the divorce, I was able to continue through COBRA, to the tune of about $550 a month.

When he lost his job due to the prolonged hospital stay and leg amputation, his employer offered Cobra, a health insurance program for employees who lose their job or have a reduction in work hours, but he couldn’t afford it.

I paid that premium every month, on time, but the people administering it are complete morons who, moreover, don't give a damn. And when the 18-month extension ran out, I got a notice that the insurance was cancelled, not because time ran out, but, according to their termination notice, for "non-payment."

This happened in a July, and the official "non-payment" declaration meant that I couldn't sign up for Obamacare even if I tried. So there I was, "pre-existing condition" and all, screwed.

When the open enrollment time rolled around - the following December - the cheapest plan I could find, the one with the highest deductible, was about $1500 a month -- and the nearby hospital, the one where all my doctors were, was, you guessed it, out of network. $1500 a month, if you're not math-inclined, is $18,000 a year, which is more than I got paid at my first full-time, salaried job. Which included health insurance as a benefit.

In short, fuck that.

I spent a year and a half uninsured. Not a huge deal in hindsight, because I was fortunate in that I have relatively cheap prescriptions and only three doctor visits a year, with only one of those being a specialist (cardiology). But if I'd fallen seriously ill again, I'd have been boned.

It was only this past December that I found a slightly more affordable plan, with my hospital in network, though it still requires a high deductible.

However, I have recurring nightmares of them deciding to simply not pay for anything that actually happens to me, like the person in the linked article:

At the time, Hillman was receiving several collection notices in the mail for past hospital stays and tests amounting to several thousand dollars, often having no knowledge of the bills that health insurance didn’t cover until receiving the collection notices.

So, you can pay them $800 a month, with a $7500 deductible (for those of you in civilized countries, that's the amount I have to pay out of pocket each year before insurance kicks in -- assuming of course that I get billed for that much, which, to be frank, is easy, because that's like two aspirins and an EKG) with absolutely no guarantee that insurance would actually cover something you need.

“One of the biggest hurdles you face as a patient is just the sheer confusion of the process. You think you just show up and present your card, sometimes pay a copay, and that’s it. You don’t expect all these plan limitations and authorizations,” Hillman added. “What are you going to do if your authorization gets denied? You don’t really have a choice to not go get care. All these processes that are in the finest of fine print. And sometimes it feels like you are literally paying for nothing.”

Oh, but I do have a choice. I can refuse treatment, and possibly die as a result. This might be difficult to implement in practice, though. If I were to collapse on a sidewalk somewhere, it's unlikely that they'll just let me croak there like I want, instead of charging me $100,000 for an ambulance ride to the ER. After all, someone might trip over my corpse and then sue... I dunno, someone.

Thing is, I'd rather die rich than live poor. But I don't know how to communicate that to the paramedics.