cloudeleven
Dryer sheet aficionado
- Joined
- May 25, 2008
- Messages
- 39
I'm 41. Thankfully I'm currently healthy and have never had a hospital stay or expensive treatment, but I was wondering about Americans here who have and had health insurance (not Medicare, Medicaid or other govt program), especially in ACA era (since 2010). How much out of pocket did you end up owing and paying? Any nightmare stories?
I'm pretty scared of healthcare, even just visiting a specialist office for some tests, because of the potential for astronomical bills, even though I have an ACA Silver plan. The only thing I'm comfortable with is my annual physical with my PCP. Although I could easily cover the $1,575 out-of-pocket max (in-network...out of network is $12k!) of my current ACA plan. But there's always the potential for denials, "prior approval required" denials, uncovered stuff, incorrect bills (90% of hospital bills have errors), etc.
A nightmare story like this has me concerned (occurred in 2012. ACA went into effect in 2010, but I'm not sure if it helped her situation or not, seems like it didn't):
https://www.huffpost.com/entry/your...-as-painful-as-the-treatment-itself_b_8926910
She was 39 and had Texas BCBS health insurance which denied coverage of the $60,000 drug her doctors said she needed for survival, and she was totally denied treatment by the hospital with the drug until she paid for the drug upfront. They wouldn't even allow a payment plan. Even the pharma company wouldn't help her. She paid the full $61,131 by having to sell some of her property. They charged her more than 3x what they would charge an insurance company.
The only state that has medical price anti-gouging laws is Maryland that I'm aware of. I live in Arkansas.
I'm pretty scared of healthcare, even just visiting a specialist office for some tests, because of the potential for astronomical bills, even though I have an ACA Silver plan. The only thing I'm comfortable with is my annual physical with my PCP. Although I could easily cover the $1,575 out-of-pocket max (in-network...out of network is $12k!) of my current ACA plan. But there's always the potential for denials, "prior approval required" denials, uncovered stuff, incorrect bills (90% of hospital bills have errors), etc.
A nightmare story like this has me concerned (occurred in 2012. ACA went into effect in 2010, but I'm not sure if it helped her situation or not, seems like it didn't):
https://www.huffpost.com/entry/your...-as-painful-as-the-treatment-itself_b_8926910
She was 39 and had Texas BCBS health insurance which denied coverage of the $60,000 drug her doctors said she needed for survival, and she was totally denied treatment by the hospital with the drug until she paid for the drug upfront. They wouldn't even allow a payment plan. Even the pharma company wouldn't help her. She paid the full $61,131 by having to sell some of her property. They charged her more than 3x what they would charge an insurance company.
The only state that has medical price anti-gouging laws is Maryland that I'm aware of. I live in Arkansas.
Last edited: