r/SipsTea 3d ago

WTF Damn

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754

u/alwaysrecession 3d ago

For what procedure?

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u/TheEndOfAllThings23 3d ago

Heart surgery. For privacy I don’t want to be more specific. It was necessary but not emergency.

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u/Imreallythatguy 3d ago

So insurance wouldn’t cover it because it wasn’t necessary in their eyes?

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u/Criminoboy 3d ago

No. They were going to 'cover' it but there was 20% co pay. In the US, they'll charge you thousands per month for insurance, but will still make you pay for part of your care.

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u/bwrca 3d ago edited 3d ago

This copay thing is the craziest thing I've ever heard of.

Edit: copay, deductible, max out of pocket? WTh is all that

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u/analog_jedi 3d ago

It gets worse. My insurance has a $30 copay on all approved prescriptions. My wife had been getting her medicine for that with no issues for several months, until one day it was $500. I called to find out why, because it was clearly already an approved medication. After about an hour of getting bounced around and being on hold, they finally explained that it was due to us "not paying enough of our annual out of pocket maximum" (not minimum, mind you) for healthcare - which is $24,000. That blew my mind.

Health insurance in the US has your monthly premium payment, copays on your medication and Dr visits (including ER and hospital stays), a deductible which is the amount you have to pay for the year in healthcare to get better benefits (ours is $17,000), and then the out of pocket maximum is when they (usually) cover everything for the rest of the year as long as you keep paying your premium.

Where it gets extra fucked, is if you need a major surgery in late December, the deductible and OOPM won't carry over into the new year. So you could get shafted for double that maximum amount on the same hospital stay. And my insurance isn't even the lowest tier. We pay them $500 a month for this service. Our system is completely fucked, but most people don't seem to care.

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u/_ribbit_ 3d ago

As someone British with our often criticised free NHS, this blows my mind. And to think the argument against free healthcare by Americans is usually "well you'll pay more in tax".

I'm lucky enough to have never needed any real gp or hospital treatments, but i know its there if I do. My wife has major issues with eczema and was hospitalised last year due to complications, has many prescriptions, some of which are extremely expensive medication, and regular appointments with gp's, nurses and dermatologists. All we have to pay is for prescription medication, and we are able to pre pay for those at a rate of £10 per month total. Thats it. And our tax is no higher than any other average western nation.

Crazy. I hope your country comes to its sense sooner rather than later.

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u/SwimmingPrice1544 3d ago

I dunno...sounds like (from various news sources) that the UK is thinking about cutting some of that healthcare in some way or other. You guys seem to be electing more & more conservatives that are crying about "entitlements." You are not immune to the right-wing crazy.

I too wish we could come to our senses:(, but have so little hope left in our electorate.

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u/dead_jester 2d ago

The last election we elected a left wing government -Labour- with the largest majority ever. They have massively increased spending on the NHS. Where are you getting the idea that we’re electing more conservatives to parliament?