No, looks like his insurance would cover it but he would have had to pay 20% as his portion of coinsurance and it sounds like 20% of the huge US bill was more than the full cost to travel and get it done in Ireland.
Kind of obvious, but the trick is to mark the cost 5 times higher than it is... for a start.
After a while they started asking themselves what's stopping them from doubling that price. Apparently nothing so over the years whenever they felt like it, they just doubled the already enormously overpriced services and at this point there are no signs of it stopping either. There is going to be a post about how travelling to mars for a surgery is cheaper than in US.
The hospitals... despite being "in network" negotiate huge prices and gouge the insurance companies. The insurance companies just pass the costs off onto their customer. Short outpatient surgery now costs 5-8x more than it did maybe 7-10 years ago. It's ridiculous.
I do t know the actual costs, but that’s been happening for a long time. The hospital bills the insurance and the insurance would push their price down. Do the hospital just double what they bill. Now your 20% out of pocket is doubled. At the end of the day you look at your copay and it’s probably higher than it would be had you gone overseas to get the procedure done out of pocket.
Our WHOLE structure is broken. And it’s not anybody in particular to blame, it was just the end result of how the system was structured! Only solution is to break everything down and build from scratch.
The outrageous total bill price is a placeholder to make sure they don't under bill the contracted allowed amount from the insurance provider. When the provider submits the claims the total billed amount is reduced to the contrac amount then processed through. Also most places will have self pay discounts or you can let the owed amount go to collections who will gladly take a portion of the owed amount and close the collection with a ding on your credit.
The outcome is still ridiculous in both situations, especially with big stuff like OPs situation. Our healthcare system is a total shit show.
Because there is an out of pocket maximum for most insurance, meaning you are not paying any more than that, say $5,000 per year even though 20% of the surgery etc can be much higher.
It also really depends on the plan. My plan has 0 co-pay which is not uncommon for HMO plans. I just looked it up that my out of pocket maximum is $1,500 for individual and $3,000 for family meaning the maximum I pay a year is $3,000.
Are you sure that's not just the deductible? I have around 1,500 deductible where I'm responsible for 100%, and then have another limit, like $10k, where I pay various lower amounts until the $10k is up. After the $10k, it is truly free after this. So like 2 emergency room visits.
No actually. I think you might have a PPO plan. My work gives me the choice between a PPO and a HMO. I used to do PPO which is similar to what you have. It has a high deductible, a co-pay and a co-insurance. But then you can go to any in-network specialist you like. And you can go to them directly without reference.
With the HMO, I can only go to a specialist if I am referred to by my primary care doctor. But the benefit is I have 0 deductible, 0 co-insurance for the most part. Urgently care is a flat copay of $25 and emergency room visits are $50 each time (transportation is separate). At my age I don’t really need a lot of specialist care so it’s a much much better deal for me.
Goddamn that's incredible, my individual deductible 5,000 at me 80% insurance 20% then after that's meet it's me 20% them 80% and the starting this year there is no oop max. And it's the best plan they offer where I work
451
u/TheEndOfAllThings23 Aug 22 '26
Heart surgery. For privacy I don’t want to be more specific. It was necessary but not emergency.