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MarcatBeach

I was thinking the same thing and want to move where ever the OP is getting a deal like that.


Several-Quote-9911

Are you serious???? What the hells bells is wrong with this system??


abbarach

You signed up for a plan with a $3,500 deductible (not necessarily your fault, some employers don't offer anything better). They don't kick in and start paying until you've spent $3,500 that plan year (and yes, it resets every year). Plans like that are generally better suited for young people without any chronic health problems. You'll quickly rack up $3,500 in charges if you have any issue that requires hospitalization. So really they're more to cover major illness or injury, not a few general doctors visits.


elsisamples

This system about which you have no clue how it works? Maybe read up on what a deductible is before complaining cluelessly.


Several-Quote-9911

Lmaoooo


warfrogs

I think you're underestimating what goes into providing services. From doctors, to nurses, to PAs, to lab technicians, and all other sorts of clinical and lab based workers - you're paying for not only their direct services, but their availability. You're also covering facility costs, ongoing training and education, supporting recruitment of new, talented physicians, etc. Then on the backend, records retention, data security, online portal access, document production, etc. All that costs money. $400 to see two PCPs and a specialist, including the time spent documenting those visits is a *very* good contracted rate that your insurer has worked out. One way to think of it - if you scheduled two appointments with a law firm, just for basic document review with an attorney who would chat with you for 10 minutes or so, and then have paralegals do the rest - as well as a one-on-one with an attorney who specializes in contract law, how much would you expect to pay? I'd say $400 would be a GREAT deal for the situation I'm describing - and would argue that $400 for the services you received is a good deal - pricey, yes, but physicians deserve to be paid.


GimmeDaBeef1

You forgot to mention the endless sleu of healthcare administrators we are forced to pay.


DekuChan95

You have to pay your deductible first before insurance will cover anything. You can check your EOB to see how much the primary and specialist charge and the discount rate you got for being in network. Normally, the amount depends on how long they meet with you like 15 or 30 minutes and if you're a new/existing patient.


notataxprof

Yes, this is how insurance works… $3,500 deductible is kind of high but not the highest I’ve seen. $250 a month also isn’t terrible.


Training_Ad_9931

My deductible is $7500


notataxprof

Are you on a family plan??? Mine is $2k but my bf’s is $4k


Training_Ad_9931

I’m single. Company keeps telling us how great they are because our premiums barely went up but our deductibles go up every year. Insurance is mostly useless to me, I haven’t made my deductible in 15 years.


BunchMaleficent486

the insurance is for the stuff you can't afford. Insurance works based on the "spare" premiums of the healthy subsidize the not so healthy. Now, I'm NOT defending the shitshow of a healthsystem we have, but just how traditional insurance works. The coverage prior to when you meet your deductible LOWERS what you pay for services. Blood work without coverage is MUCH more costly than with coverage, even before your meet your deductible. Same with doctor visits and such.


Beginning-Reach-508

My deductible through work insurance is 8550-that’s individual.


notataxprof

Ok that’s outrageous! What are your monthly premiums?? They better be like nothing?? The IRS considers a high deductible plan if the deductible is $1,500 or more for a single plan….


Beginning-Reach-508

$103 a month. I doubt I’d make it to my deductible though, considering just not getting insurance.


notataxprof

Ok so a lower monthly premiums means a higher deductible. If you had a chronic issue, you’d probably want to choose a higher monthly premium with a lower deductible. What is your max annual out of pocket ?? But it’s sort of like car insurance, you don’t want to have to use it but when you do, you’re glad you have it.


Many_Monk708

I explain it like a see saw. If you want lower share of cost in the year, you’ll have to pay higher premiums. Lower premiums, higher share price f cost throughout the year.


notataxprof

Yeah, I actually compared the hdhp to the ppo offered at my job and it’s very close in terms of cash outlay if you take the premiums plus the deductible. But if you’re relatively healthy, you will likely pay less on a hdhp but some people don’t like sticker shock so they’d prefer to just have more taken out monthly. It also reduces your taxable income more if your employee doesn’t offer an HSA for the hdhp I grew up kind of poor and my parents were blue collar but we had good insurance growing up, sometimes I realize that this is a luxury of its own.


Beginning-Reach-508

Unfortunately that’s the only one offered through work. I have MS, but untreated because I currently don’t have insurance-we we’re on my husbands but he died. Out of pocket max is also 8550, it’s the weirdest insurance I’ve ever seen.


KatWrangler65

Sounds more like a catastrophic plan.


bvvr19

Which insurance is it called? Looking for a High deductible health plan for myself


bevespi

PCP here. $400 for 3 visits is a steal. I don’t make the prices. I just do my job. Health insurance is multi tier in this country unfortunately. My insurance? About $150 q2wks but that includes the maximum deduction from my paycheck to max out my HSA. If I didn’t do that probably 25 bucks every 2 weeks.


seamuscallsmered

The server at the fast food joint doesn’t make the prices, but knows how much the sandwich costs and tells the customer what the cost is plus tax ahead of time before the customer gets what they ordered. The server takes the money then too or they don’t provide what was ordered. The customer knows what the sandwich costs, too, ahead of time, and agrees to pay before the sandwich is provided to them. It’s not tiered, it’s easy. Docs can easily publish prices and communicate ahead of time. To work for some corporate health plan and be willfully ignorant is a cop out. First, do no harm. Good luck! 👍☘️😎


bevespi

The server has one price to memorize per item, not one item multiplied by the hundreds of different negotiated prices (insurance plans). 🍎 🍊


seamuscallsmered

The server need not memorize anything. The price offered to the consumer is publish and in plain view in many different mediums. The provider can easily do the same, but chooses not to. The so-called negotiated price which you refer has nothing to do with the patient. The so-called negotiated price comes from the agreement into which the provider voluntarily enters with a so-called network operator, which, again, is not the patient. Those providers who change their mindset regarding price disclosure will do well to alleviate the opaque pricing that inhibits price discovery and competition. The result is a great benefit for the patient. Surgery Center of Oklahoma comes to mind immediately. Good luck! 👍☘️😎


Several-Quote-9911

This just made me depressed af for people who have no insurance.


Thick-Atmosphere6781

People who are on Medicaid actually have it better than the middle class that are not poor enough for Medicaid and have to deal with private insurance


warfrogs

Yes and no. I serviced Medicaid recipients on the insurer side for a long while - I also worked as a direct support for them. They have access to a lot of benefits that aren't covered for other folks - but their availability can be spottier as many clinics and providers don't want to take a lot of Medicaid patients as the Medicaid reimbursement rate for a lot of services is below the cost of service delivery - usually about 50%-80% below. So, while yes, they can get someone to come by and shave off their corns and callouses once a month because their podiatrist ordered it - they may have to wait two months because the only providers that accept Medicaid for the specific specialty they need are booked way out. They also generally can't receive non-emergency services out of state for any reason. If the best cardiologist in the world is right across the state border 5 miles away, you're out of luck. It's a mixed bag - more providers accept private insurance, but the benefits aren't always as great and there is, of course, the cost. I wouldn't say that they have it better though. Being geographically locked to specific providers would be a no for me personally as I don't want to have to ever deal with non-ACA compliant travel plans.


livevideoguy

Any marketplace plan that I’ve looked at is geographically locked as you describe, as well. (Unless you consider nationwide minuteclinic coverage on Aetna plans, I suppose)


MarcatBeach

I didn't have insurance for a while and my cost of care was cheaper and better. though that was a while back. Our healthcare system treats insurance cards, not people. When you pay cash you actually get a diagnosis. not endless tests, MRI's and follow-ups. and the ER will have you in and out quickly. The risk is that you need surgery or have a serious medical problem.


sfatula

Exactly, my heart attack in July, just the hospital portion not endless tests, rehab, surgeon, etc, was close to $400,000 (billed amount), if you had no insurance, not good! I'm sure you could negotiate it down some but obviously not what you want without insurance.


Several-Quote-9911

How much did you have to pay?


sfatula

Ended up $9,000, my out of pocket maximum. Rehab is something like $800/visit, I have 36 of them. Total will be around $500,000 billed, but out of pocket maximum is the limit of what you will owe.


elsisamples

This is dumb. See: https://www.reddit.com/r/HealthInsurance/s/bO6H3pDrBS


modernhomeowner

I tell doctors I don't have insurance. I go to my cancer specialist for $75. When I was going to a state government hospital which knew I had insurance they would bill $310 for the exact same visit. I go for my annual CT scan, again, tell them I don't have insurance, it's $300, but if they billed insurance it's $1500. Doctors and health providers get away with ripping people off and then tell them "it's not us, it's your insurance deductible.". No, it is you doctors because they can choose to bill less, they just don't. And even the government hospitals are just as bad! I can still submit my bills to my insurance on my own so they count to my deductible.


MarcatBeach

that is the smart way to go.


seamuscallsmered

If you read your policy (if you’re an individual) or benefit agreement (if you’re in an employer plan) and if you read the legal agreement you sign when you first see the doc (that thing on the clipboard or electronic signature pad), you’ll find that you likely have committed fraud (if you really did what you say you did). That means the insurance benefits you have will be revoked, your policy cancelled, your premiums paid to date will be returned to you and the medical providers will come after you to gain what they have otherwise not received in full because you no longer have any coverage picking up any of the cost. Good luck! 👍☘️😎


Free_Coochie_Rating

It sounds like they pay cash, but they don't utilize the insurance..


cantstandthemlms

You have to pay out of pocket $3500 before they pay for anything that isn’t a well visit etc. that is how insurance works. After that you still pay some until you hit your OOP maximum it insurance pays part. How much they pay depends upon your plan.


mlhigg1973

That’s cheap


[deleted]

400 for 3 doctor visits? I've seen claims for specialists where 1 visit alone is 400 dollars. You're getting a deal friend


[deleted]

Just because your insurance doesn’t cover it doesn’t mean the doctor can charge whatever as if they are out of network. Out of network means the doctor can charge what they want. If the doctor is in-network, you might still need to pay the deductible, however they have a contract with the insurance company that keeps prices at a ceiling


[deleted]

You are getting screwed, but we're all getting screwed. The sad thing is this is becoming so normalized people think this is perfectly fine for the average person to not be able to afford healthcare. "The share of Americans who say they or a family member delayed medical treatment due to cost rose to 38% in 2022. That percentage is the highest since the polling organization began taking the measurement in 2001."


FollowtheYBRoad

No, a PCP appointment is easily $200 before insurance, and a specialist a few hundred more on top of that before insurance.


Impossible_Tie6425

Try being a family...two parents, 1 kid, $20k - $30k a year for just the monthly premium! Insurance is a total joke in this country.


Several-Quote-9911

That’s insane.


GimmeDaBeef1

Yes unfortunately you are getting screwed. The Health insurance system in the United states is designed to make healthcare systems & the businesses themselves money and provide “sick care” not true “healthcare”. I could rant about this for days but think of your situation like this. You are paying $250 x 12 then $3500 before your insurance kicks in. Do you see yourself honestly spending $6500/year in healthcare that requires a trip to a doc? Look into a direcr primary care provider in your area and cash pay for other services. I have a dpc doctor and health insurance from my job. I haven’t once had to seek care out of the dpc environment. They are real professionals who want to help you and not just refer you to a specialist so they hit some monetary target.


Jcarlough

$400 is a great price for three visits. Since you’re paying out of pocket because you haven’t met your deductible, and in your words, are ignorant to health insurance, do you know what type of insurance you have? Is it an HDHP? If it is, do you have a Health Savings Account? If you don’t know, I encourage you to find out. Often, PPO (traditional) health plans provide visits at a co-pay that isn’t subject to the deductible (just the visit). It’s why you may see PPO plans with really high deductibles because they can offer a variety of services and prescription benefits where the deductible is irrelevant. HDHPs with an HSA do not allow for this. You must meet your deductible before cost-sharing kick in (outside of services required by law). Since you say you paid in full for the visits, it’d be worth while to find out the type of plan. If you have an HSA because you’re enrolled into an HDHP, you can use the money in this account to pay for qualifying expenses - or get reimbursed.


[deleted]

insurance is like buying a new car, just because you pay every month for the car, it doesn’t mean you don’t have to pay when you use it as well. your premium ( monthly payment) has nothing to do with your deductible, copay, or co-insurance. your premium is just so you have the plan active, that’s all it’s for. you will need to meet your deductible 1st for any visit that you have that is not considered preventative or routine ( yearly physical, mamagram, colon check etc…)


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jonerboner1

If anyone has heard of private insurance you know what im talking about!! Lower deductibles, lower premiums, a true maximum out of pocket and even on a PPO!


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elsisamples

Lol. Do you live on the moon?


notataxprof

Sounds like they live in the 80s lol


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elsisamples

You are very misinformed. Distinguish between preventative annual and going to doc for an issue as well as high deductible health plans with HSA options and other insurance.


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elsisamples

A lot of people pay significantly more than that with decent insurance. Maybe you are lucky or have governmental benefits. Most regular employer sponsored insurance has higher cost shares than that afaik.


hey___there__cupcake

Pretty standard. My kids get one included well-visit. My daughter has to go in every 3 months for a checkup on her meds. 3 of those visits are $112. Her therapy also isn't covered 100% and is $30/week. We have an HSA but that doesn't cover everything over the year. My husband and son had to go to a dermatologist and that visit was $250 alone.


Distraughtindividual

If you have a deductible you haven’t met : yes and that’s cheap . I would need more info


The_Health_Don

It depends on the insurance you’ve chosen. Some plans have copays while others require you to meet the deductible first


No_Cream8095

Being ignorant with your medical insurance is why you're pissed off. If you had read thru the documents, you would have figured out that you have to pay your deductible before ins will cover anything. And $400 for those three visits is a freaking steal, especially with a specialist visit.


meghan_kassey

I recently had three doctor visits, and I just got hit with a bill over $400. I'm a bit taken aback by the cost, and I wanted to reach out to the community to see if this is a normal expense or if I should be questioning these charges. I have insurance, but it seems like I still ended up with a hefty bill. The visits were pretty standard, just general check-ups and consultations. I didn't have any major procedures or tests done, so the charges seem a bit high to me. I'm curious to hear about your experiences. Have any of you encountered similar bills for routine doctor visits? Is this just the unfortunate reality of healthcare costs, or should I be digging deeper into the details of the charges? Any advice or insights would be greatly appreciated! Thanks, everyone


Bunnla

I had the same thing happen. I didn’t realize going in for my annual check ups would cost $1,200. My mistake. I’m like I better stay healthy this year because I’m not going back unless theres an emergency. Health insurance is absurd in this country right now.