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A Maryland woman treated for a snake bite received another shocker: a $55,000 medical bill.

Jules Weiss had stopped to take a photo at an overlook along the George Washington Parkway. On the way back to her car, she felt something bite her.

"It felt just like a bee sting," Weiss told local station NBC4. "There were two fang marks with liquid coming out."

The former emergency medical technician had suffered a copperhead snake bite. Within an hour, she said, her foot turned

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But the woman

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Oh no! Things like this is why I keep insurance. You can't afford to be without it.

Wouldn't have helped much in this case. Insurance would only cover the first bag in most cases because its the standard dose. After that, shes going above and beyond and has to pay the remaining 2 bags out of pocket. According to law, insurance only has to cover standard care and medications, anything beyond that is on the patient.

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Oh no! Things like this is why I keep insurance. You can't afford to be without it.

Very true.

 

Basic plans aren't excessive and could serve as very good catastrophic care gap plans when needed. I used to pay ~$120/m for a very good catastrophic level plan for my wife because it was cheaper than adding her to my healthcare at work (remember preventative care is free on all plans).

 

$120/m seems expensive, but it is about the same as people tend to spend on their cell phone or cable tv bills.

Wouldn't have helped much in this case. Insurance would only cover the first bag in most cases because its the standard dose. After that, shes going above and beyond and has to pay the remaining 2 bags out of pocket. According to law, insurance only has to cover standard care and medications, anything beyond that is on the patient.

Not true, the insurance will cover whatever the doctor says she needs and is allowed on her specific plan. The patient isn't forced to tell the doctor "you can only give me one pain pill because two is excessive and they won't pay for the second one."...

 

At least this is how it works in the US...

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Yet another reminder of how broken the US healthcare system is.

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Yet another reminder of how broken the US healthcare system is.

I think the government needs to do more to hold the feet of hospitals to the fire. Fortunately, here in Philadelphia charity care is very common and good. My wife had to go to the ER for an issue a couple of years ago and due to some messes with the health insurance company she didn't have coverage. The hospital waived almost all the charges and allowed us to pay a flat $99 for the ER visit. People shouldn't be murdered financially over medical issues, but it is a hard chestnut to crack.

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Not true, the insurance will cover whatever the doctor says she needs and is allowed on her specific plan. The patient isn't forced to tell the doctor "you can only give me one pain pill because two is excessive and they won't pay for the second one."...

 

At least this is how it works in the US...

What you described is not how it works in the US. In the US, the insurance company decides what your treatment can be that they will cover and you choose from that. Anything outside of that treatment they won't cover. For instance, medicare will give you no preventative treatment for crowns on your teeth that are caused by grinding your teeth at night. A night guard is the treatment for that. Hence, you pay out of pocket for that. Now that medicare is the national standard, that is what insurance companies are saying is what they will cover. Insurance companies decide what they will cover and what treatment options you have. Not you, not your doctor. If you choose anything other than what your insurance companies says, you pay 100% of the cost.

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I think the government needs to do more to hold the feet of hospitals to the fire. Fortunately, here in Philadelphia charity care is very common and good. My wife had to go to the ER for an issue a couple of years ago and due to some messes with the health insurance company she didn't have coverage. The hospital waived almost all the charges and allowed us to pay a flat $99 for the ER visit. People shouldn't be murdered financially over medical issues, but it is a hard chestnut to crack.

 

I've worked in data mining insurance claims for years now, and one thing I've always found is hospitals overcharge for ER visits like nuts when it gets sent to insurance... heck they will change your carrier $1,000 for an ER visit, that an uninsured person can get for $50... we've had doctor offices charge $250 to insurance for a patient to "fill our paperwork".... some of their claims are just ridiculous... including $500 for a box of gloves when you know they used a couple pair at most! Then they probably charged the next 100 people for that same box of gloves that costs $20 to buy at medical wholesale

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What you described is not how it works in the US. In the US, the insurance company decides what your treatment can be that they will cover and you choose from that. Anything outside of that treatment they won't cover. For instance, medicare will give you no preventative treatment for crowns on your teeth that are caused by grinding your teeth at night. A night guard is the treatment for that. Hence, you pay out of pocket for that. Now that medicare is the national standard, that is what insurance companies are saying is what they will cover. Insurance companies decide what they will cover and what treatment options you have. Not you, not your doctor. If you choose anything other than what your insurance companies says, you pay 100% of the cost.

Dental coverage falls into a separate category. Yes, in dental they typically say yes or no to individual things and the coverage is separate from medical coverage.

 

Medical coverage in the US has dollar value limits (which will mostly disappear next year) and not individual treatment limits. So, your plan would, for instance, cover $1M in medical care in a year, but it wouldn't say anything about what the doctor could spend that $1M on while you're admitted to a hospital.

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Yet another reminder of how broken the US healthcare system is.

Not many here know this but I was sick in January and I was in the hospital for nearly a week. My medical bill was over $40,000. I ended up owning around $3500 out of pocket. Still paying on some of these bills. I pay some every month. I'm still not sure it's broken, maybe just in need of some work.

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Dental coverage falls into a separate category. Yes, in dental they typically say yes or no to individual things and the coverage is separate from medical coverage.

 

Medical coverage in the US has dollar value limits (which will mostly disappear next year) and not individual treatment limits. So, your plan would, for instance, cover $1M in medical care in a year, but it wouldn't say anything about what the doctor could spend that $1M on while you're admitted to a hospital.

You haven't read your contract have you? Read the coverage limits. Yes you have a $1M limit but that is a limit on your approved coverage. If you receive anything that is not approved by your insurance company, you pay out of pocket.

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Not many here know this but I was sick in January and I was in the hospital for nearly a week. My medical bill was over $40,000. I ended up owning around $3500 out of pocket. Still paying on some of these bills. I pay some every month. I'm still not sure it's broken, maybe just in need of some work.

Whats crazy is that some hospitals will run credit checks and tell people to come up with the money now from other sources because they don't want to take up the credit risk. People are dumb enough to do it and if they default on an outside loan to pay this bill, they can no longer file for medical bankruptcy.

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I've worked in data mining insurance claims for years now, and one thing I've always found is hospitals overcharge for ER visits like nuts when it gets sent to insurance... heck they will change your carrier $1,000 for an ER visit, that an uninsured person can get for $50... we've had doctor offices charge $250 to insurance for a patient to "fill our paperwork".... some of their claims are just ridiculous... including $500 for a box of gloves when you know they used a couple pair at most! Then they probably charged the next 100 people for that same box of gloves that costs $20 to buy at medical wholesale

Yeah this is just part of the system's structure. Not saying it is good, but the reality is the US healthcare system has an middle man who argues down prices (insurance companies) and medical providers do their best to find ways to not have to lower those prices. The end result is they might agree to take a loss on regular office visits, but make it up by over billing for things like gloves.

 

 

You haven't read your contract have you? Read the coverage limits. Yes you have a $1M limit but that is a limit on your approved coverage. If you receive anything that is not approved by your insurance company, you pay out of pocket.

I have read every health insurance insurance contract I have ever had. They do not tell me how many gloves a doctor can use when I'm in the hospital or how many pills of morphine I can have is. The requirement that I obtain any per-approval, or contact and deal with the insurance company at all, is only if I go to an out of network hospital.

 

To make this a little clearer this is a snippet from my current insurance plan. Notice how much it says they pay for "In-Network" and that it mentions nothing about me being limited to one pain killer or two...

 

There are a lot of problems with the US healthcare system. Don't mistake my statements as some blanket support for the status quo, but I also think it is important that we're dealing with reality and not conjecture here.

 

[attachment=341523:Medical Snippet.PNG]

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Yeah this is just part of the system's structure. Not saying it is good, but the reality is the US healthcare system has an middle man who argues down prices (insurance companies) and medical providers do their best to find ways to not have to lower those prices. The end result is they might agree to take a loss on regular office visits, but make it up by over billing for things like gloves.

 

 

I have read every health insurance insurance contract I have ever had. They do not tell me how many gloves a doctor can use when I'm in the hospital or how many pills of morphine I can have is. The requirement that I obtain any per-approval, or contact and deal with the insurance company at all, is only if I go to an out of network hospital.

 

To make this a little clearer this is a snippet from my current insurance plan. Notice how much it says they pay for "In-Network" and that it mentions nothing about me being limited to one pain killer or two...

 

There are a lot of problems with the US healthcare system. Don't mistake my statements as some blanket support for the status quo, but I also think it is important that we're dealing with reality and not conjecture here.

 

attachicon.gifMedical Snippet.PNG

Again, you are looking at the amount covered of treatments actually covered. You can't just get whatever treatment you want and then bill insurance companies. Read the ENTIRE contract, not just the marketing tables.

 

Easy example. I have to test my blood multiple times a day to control my Type 1 diabetes. Insurance coverages materials for 3 tests a day. Doctor wants me to test 6 times a day and my pump manufacturer wants me to test 9 times a days. Because insurance only covers 3 times a day, they pay 80% of the cost of those supplies. For the other 3 tests, I pay 100% of the cost. I can't afford pay 100% for 6 more times a day so I had to go with 3 times a day.

 

If your insurance covers 80% of your in network costs, that means 80% of your approved in network costs, not 80% of 100% of costs.

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Not true, the insurance will cover whatever the doctor says she needs and is allowed on her specific plan. The patient isn't forced to tell the doctor "you can only give me one pain pill because two is excessive and they won't pay for the second one."...

 

At least this is how it works in the US...

Tell that to my wife, who's insurance claim came back with a ton of "not medically necessary" refusal to cover.  And, she didn't ask for anything; it was all standard procedure or directly instructed by the doctor.

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Again, you are looking at the amount covered of treatments actually covered. You can't just get whatever treatment you want and then bill insurance companies. Read the ENTIRE contract, not just the marketing tables.

 

Easy example. I have to test my blood multiple times a day to control my Type 1 diabetes. Insurance coverages materials for 3 tests a day. Doctor wants me to test 6 times a day and my pump manufacturer wants me to test 9 times a days. Because insurance only covers 3 times a day, they pay 80% of the cost of those supplies. For the other 3 tests, I pay 100% of the cost.

Marketing labels? This is the actual contract...

 

I left out the part defining "Eligible Expenses" which makes it seem like they could come back and say "hey 2 venom bags were too expensive and we'll only pay for 1", but that isn't the case and I'll add the definition below.

 

The only area it all gets hairy is once you go "out of network", but that is the case with any insurance product since they can't negotiate a rate "out of network" beforehand.

 

[attachment=341525:Medical Snippet Expenses.PNG]

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Yeah this is just part of the system's structure. Not saying it is good, but the reality is the US healthcare system has an middle man who argues down prices (insurance companies) and medical providers do their best to find ways to not have to lower those prices. The end result is they might agree to take a loss on regular office visits, but make it up by over billing for things like gloves.

It's more than just that, though. The US pays more for healthcare in relation to GDP than any other nation yet internationally it is ranked 37th by the World Health Organisation for the service it provides. Large numbers of people are left with obscene levels of debt (even those who have good healthcare plans), while it is calculated than nearly 40,000 people die a year as a result of not having access to healthcare. People are fired from their jobs in order to save the employer money. The quality of care is high but the system certainly isn't equitable or efficient.

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Marketing labels? This is the actual contract...

 

I left out the part defining "Eligible Expenses" which makes it seem like they could come back and say "hey 2 venom bags were too expensive and we'll only pay for 1", but that isn't the case and I'll add the definition below.

 

The only area it all gets hairy is once you go "out of network", but that is the case with any insurance product since they can't negotiate a rate "out of network" beforehand.

 

attachicon.gifMedical Snippet Expenses.PNG

Dude... READ. They cover 80%(assuming yours is the same on the percentage amount) of approved expenses. That means they don't cover anything from non approved expenses. If you get more treatment than what is approved, you pay 100% of that non approved treatment. How are you not getting this? It is written into everyone health insurance contract. Stop cherry picking and ignoring that simple fact. If you do something that is not approved by your insurance company, they have no legal obligation to cover it. That is even in Obamacare. Your insurance company decides what you get covered and what treatments you should get, not you. If only 1 bag is approved, you pay 100% of the cost of the second bag.

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Not many here know this but I was sick in January and I was in the hospital for nearly a week. My medical bill was over $40,000. I ended up owning around $3500 out of pocket. Still paying on some of these bills. I pay some every month. I'm still not sure it's broken, maybe just in need of some work.

That's a lot of money to have to spend for treatment and it will inevitably lead to people to avoiding going to hospital when they really should. I have some relatives that live in Philadelphia and they're facing massive healthcare costs because my aunt has been diagnosed with brain cancer - that's despite my uncle having a decent healthcare policy.

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Dude... READ. They cover 80%(assuming yours is the same on the percentage amount) of approved expenses. That means they don't cover anything from non approved expenses. If you get more treatment than what is approved, you pay 100% of that non approved treatment. How are you not getting this? It is written into everyone health insurance contract. Stop cherry picking and ignoring that simple fact. If you do something that is not approved by your insurance company, they have no legal obligation to cover it. That is even in Obamacare. Your insurance company decides what you get covered and what treatments you should get, not you. If only 1 bag is approved, you pay 100% of the cost of the second bag.

I'm not sure what you're reading, but the document clearly states that they will pay 100% of any eligible expense* (that isn't a physician billing charge) as long as the hospital is "in network".

 

* Eligible expense is anything they have agreed to a price on with the hospital. It mentions NOTHING about it having to be an insurance approved expense. The only thing this would exclude is in-network hospital services where they don't have a contracted rate with the hospital, such as experimental care.

 

It's more than just that, though. The US pays more for healthcare in relation to GDP than any other nation yet internationally it is ranked 37th by the World Health Organisation for the service it provides. Large numbers of people are left with obscene levels of debt (even those who have good healthcare plans), while it is calculated than nearly 40,000 people die a year as a result of not having access to healthcare. People are fired from their jobs in order to save the employer money. The quality of care is high but the system certainly isn't equitable or efficient.

Yeah we do, like I said, the system has a LOT of flaws that need to be worked out. There is too little information for consumers and too much control in the hands of insurance companies. Then you have the hospitals who blatantly ignore federal law on providing benefits to anyone so long as they receive medicare dollars.

 

I think an overhaul is needed, but one that brings transparency to the forefront.

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Yet another reminder of how broken the US healthcare system is.

A bit like the UK health system then :-

http://www.bbc.co.uk/news/health-23612539

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A bit like the UK health system then :-

http://www.bbc.co.uk/news/health-23612539

Nobody is disputing that the NHS is facing major management and financial issues

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A bit like the UK health system then :-

http://www.bbc.co.uk/news/health-23612539

 

And yet regarded as one of the most efficient and highly regarded health services in the World. 

 

Good job HSoft. 

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Dude... READ. They cover 80%(assuming yours is the same on the percentage amount) of approved expenses. That means they don't cover anything from non approved expenses. If you get more treatment than what is approved, you pay 100% of that non approved treatment. How are you not getting this? It is written into everyone health insurance contract. Stop cherry picking and ignoring that simple fact. If you do something that is not approved by your insurance company, they have no legal obligation to cover it. That is even in Obamacare. Your insurance company decides what you get covered and what treatments you should get, not you. If only 1 bag is approved, you pay 100% of the cost of the second bag.

 

Approved expenses being something the insurance company is aware of, has set a cost to, and has qualified in your plan. I think you'd have to have a pretty lousy health insurance plan to not have as much antivenom as prescribed by a  doctor covered.

 

I also don't see how $40,000 is expensive, given what it takes to make and store anti-venom. There are conventional made bio-pharmaceuticals which can cost more than that per dose.

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And yet regarded as one of the most efficient and highly regarded health services in the World. 

 

Good job HSoft. 

lmao - by whom?  I'm sure lots of other countries want to have to have a system that is unsustainable causing them to pump and billions and billions it and that has so many restrictions and rules on who can get what care and when.

Even the people in the UK know it's broken, hence the big increase in people going private.

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