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skooma512
Feb 8, 2012

You couldn't grok my race car, but you dug the roadside blur.

Main Paineframe posted:

nope

gunshow spends $396 per pay period (depending on their employer, this could be per week, per two weeks, twice a month, monthly, or possibly something else) for health insurance. this is the premium

this health insurance covers nothing* until either gunshow or their spouse has spent at least $800 that year on medical expenses. this is the deductible. note that the deductible is per-person, so gunshow and their spouse each have to separately reach the deductible before insurance starts paying out for their care. if only one of them meets their deductible, insurance will only cover that person. family deductibles can come into play with larger families but aren't relevant here

once the deductible has been met, the insurance will pay no more than 75% of any further medical costs gunshow accumulates that year, assuming that the insurance company does not find some reason to deny them... (this is the co-insurance)

...until gunshow has spent $3.6k of their own money that year on health costs (this is the out-of-pocket maximum). and no, premiums don't count toward this number. once the out-of-pocket maximum has been met, the insurance company will cover the rest...until the end of the year or plan year, at which point all these numbers reset. like the deductible, the out-of-pocket maximum is per-person in this case, so gunshow's spouse can still rack up medical costs even if gunshow themself has met the OOP maximum

this is american healthcare at its finest. have fun decoding it

also, depending on the specific details of the plan, all of these numbers may only apply to doctors that have directly contracted with the specific insurance company in question (this is what it means to be "in-network"). any services from doctors that don't have a network agreement (out-of-network) could be subject to less coverage

*a lot of insurance plans have special charges for certain treatments, and Obamacare requires certain things be free or discounted under certain conditions, so specific details may vary from these general numbers

But if we don't do it this way we'll have higher taxes :qq:.

1. Health Insurance is basically a tax anyway

2. I did the math and if you didn't need any healthcare at all for a year and ignored the premiums, an American earning 45k a year would "save" 1000 dollars versus a Brit earning a comparable amount, but if you needed treatment that gap would quickly close with the deductible.

But I'll have to wait in line :qq:

My doctor won't have available appointments for weeks, and I waited at the ER at the hospital I work in for 4 hours.


So the service is just as bad if not worse here and more expensive, but the media misinformed the gently caress out of everyone so they think it's the greatest.

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Finicums Wake
Mar 13, 2017
Probation
Can't post for 8 years!
[me, every year at open enrollment]: ah, thank god for all these choices

Crakkerjakk
Mar 14, 2016


Streak posted:

real talk I can't even get through this paragraph without my attention span drifting or getting so mad I have to stop

Just like the FIRE sector, the point of all the complicated jargon and intricacies is to obscure how you're being hosed while making it harder impossible to avoid being hosed.

skooma512
Feb 8, 2012

You couldn't grok my race car, but you dug the roadside blur.

Finicums Wake posted:

[me, every year at open enrollment]: ah, thank god for all these choices

Gunshow Poophole
Sep 14, 2008

OMBUDSMAN
POSTERS LOCAL 42069




Clapping Larry

Crakkerjakk posted:

Just like the FIRE sector, the point of all the complicated jargon and intricacies is to obscure how you're being hosed while making it harder impossible to avoid being hosed.

this phenomenon is also a knock-on benefit (to the rich fuckers) of peoples' increasingly transient employment status these days.

can't see year to year changes in this poo poo if you only work at a company for like 2 years!

Being in the same job for 10 years has radicalized the hell out of me, both in that it's a huge boon to my mental health to have job security and also a ridiculous clown shot of obviously being ground into a fine paste with every passing year of accumulating profits


it's Falling Down all the way as soon as I hit a sub-6 month prognosis

Jenny Agutter
Mar 18, 2009

Jonny 290 posted:

the grossest part of the HSA grift to me is how they always point out "use it or lose it!" so they helpfully suggest that you go and just spend a bunch of money for OTC meds and wrist braces and ace bandages every December to burn up your leftover balance


people are starting to take ubers to the hospital now

you’re thinking of an fsa, hsa is no limit carry over (besides the yearly contribution limits)

Probably Magic
Oct 9, 2012

Looking cute, feeling cute.
My badass story about health insurance was getting a United Healthcare plan through Obamacare when I turned 26 that I thought would be good until halfway through the year I got letters from them that they were going to bail out of the individual market for the state at the end of the year. Then I find out my epilepsy medication gets its price hiked to twice its amount. Now, I was taking the brand medication at the time because my doctor and I had figured out that worked better for me, but I thought, "Maybe it'll be cheaper as the generic, as it traditionally is." So I started going through scenarios with my pharmacist. Nope, generic similarly expensive. Okay, what if I take out an order for 60 days instead of 30 days? Same price, weirdly enough. I could have theoretically "screwed" the insurance company if the value of my medication was actually what they were claiming. My pharmacist's jaw was just dropped the entire time. It made no goddamn sense. I wanna say I was paying over five hundred dollars a month for this poo poo.

This was back in 2016. That and my experiences with Wells-Fargo radicalized the poo poo out of me because I just began finding out American capitalism isn't even about profit, it's about pure naked exercises of abusive powers. You can't even bribe them into treating you better because you just don't matter.

jimmyjams
Jan 10, 2001


King Kong of Megadongs
Gobblin' them mega schlongs
Makin' sure they mega long
Stroke' 'em if they mega strong
man all this poo poo sounds like it sucks. i have this weird idea though, why dont we just like, make the hospitals paid for with taxes instead, like roads and fire departments and poo poo, and then you dont have to worry about insurance or whatever. idk seems like a good idea to me???????

jimmyjams
Jan 10, 2001


King Kong of Megadongs
Gobblin' them mega schlongs
Makin' sure they mega long
Stroke' 'em if they mega strong
like for real though how is the united states healthcare industry not just one of the world's biggest open-air scams at this point

Finicums Wake
Mar 13, 2017
Probation
Can't post for 8 years!

jimmyjams posted:

man all this poo poo sounds like it sucks. i have this weird idea though, why dont we just like, make the hospitals paid for with taxes instead, like roads and fire departments and poo poo, and then you dont have to worry about insurance or whatever. idk seems like a good idea to me???????

ok, but what about choices? also, markets good and government bad

Gunshow Poophole
Sep 14, 2008

OMBUDSMAN
POSTERS LOCAL 42069




Clapping Larry

jimmyjams posted:

like for real though how is the united states healthcare industry not just one of the world's biggest open-air scams at this point

i mean, it is

as to why it continues wihtout being challenged: because the medical care that people DO get will be whisked away from them entirely, resulting in a huge portion of them dying, if they complain too loudly. people are subconsciously aware of this but cannot articulate or embrace the solidarity required to propose or advocate for an alternative.

further the action of demanding said alternative will result in a large portion of us dying either in jail or at the end of a cop's gun

and it's all been beaten out of us for... well forever, but in the last 40 years

WampaLord
Jan 14, 2010

jimmyjams posted:

man all this poo poo sounds like it sucks. i have this weird idea though, why dont we just like, make the hospitals paid for with taxes instead, like roads and fire departments and poo poo, and then you dont have to worry about insurance or whatever. idk seems like a good idea to me???????

But what about the part of the economy that makes money from this nightmare?!?

You want those ghouls to lose their jobs?!?!?!?!?!

BENGHAZI 2
Oct 13, 2007

by Cyrano4747

skooma512 posted:

You're supposed to comparison shop while unconscious even though nobody posts their prices and every health plan is different so "we take Aetna" doesn't even necessarily mean they take your Aetna plan.

I found this out when "we take blue shield" became "you have to pay the whole thing out of pocket anyway", and this was from a list provided by Blue Shield themselves.

This is a free market.


Fun fact: Insurance is the only industry exempt from anti-trust laws.

My new job has insurance through Blue Cross, and it's total dogshit. Its like 25 or fifty a check (so weekly), plus copay, plus you have to deal with blue Cross and youe deductible is poo poo and you want to die

Or

New York isn't completely insane and they have a plan for people who were on Medicaid but make a little too much but still not enough to be okay where you pay like forty a month Max and maybe a small copay and you get the same thing as when you had Medicaid so you don't even have to change doctors

I almost cried when I found out about that plan, I'm going to be making too much for Medicaid but my therapist doesn't take blue Cross. The ten minutes where I thought I only had six months left with her were horrendous

BENGHAZI 2
Oct 13, 2007

by Cyrano4747
I'm dreaming, literally, of getting a job with the state after I take the civil service exam in a couple weeks and getting that sweet sweet state benefits

Like I wake up in the morning sad I'm not working in an office

Main Paineframe
Oct 27, 2010

jimmyjams posted:

man all this poo poo sounds like it sucks. i have this weird idea though, why dont we just like, make the hospitals paid for with taxes instead, like roads and fire departments and poo poo, and then you dont have to worry about insurance or whatever. idk seems like a good idea to me???????

but then rich people might have to pay for poor people's healthcare, and one of the giant parasite industries composed entirely of malevolent middlemen might lose jobs

yellowD
Mar 7, 2007

jimmyjams posted:

paid for with taxes instead, like roads and fire departments and poo poo

I'd like to introduce you to crumbling bridges, toll roads, and volunteer fire departments funded by bingo

Former DILF
Jul 13, 2017

thanks obama :rolleyes:

Gunshow Poophole
Sep 14, 2008

OMBUDSMAN
POSTERS LOCAL 42069




Clapping Larry
getfsical killin it like always

https://twitter.com/getfiscal/status/1187118329112256513

Hedningen
May 4, 2013

Enough sideburns to last a lifetime.

BENGHAZI 2 posted:

I'm dreaming, literally, of getting a job with the state after I take the civil service exam in a couple weeks and getting that sweet sweet state benefits

Like I wake up in the morning sad I'm not working in an office

State benefits are great. At least, until they start trying to reduce benefits by hiring an outside firm and trying to convince people that costs going up are justified by worse coverage and weak “lifestyle” benefits that are meant to data mine employees.

Also trying to kill the pension in favor of a 401k despite it being fully funded.

gently caress ghoulish conservatives and their desire to destroy public institutions is my take-away.

the bitcoin of weed
Nov 1, 2014

the best part of the arcane insurance networks being the only thing between you and a life-ruining bill is when you get surgery and take pains to make sure all of the doctors involved are in network and then once you are in the room they bring in an out-of-network anesthesiologist. this is apparently very common!

just read all the replies to this for that :d2a: vibe
https://twitter.com/BernieSanders/status/1173027398356545537

Gunshow Poophole
Sep 14, 2008

OMBUDSMAN
POSTERS LOCAL 42069




Clapping Larry
there used to be a website that I have requested be posted before where it juxtaposes a USA healthcare story with a different country's

it's http://www.pluralofanecdote.com/

Gunshow Poophole has issued a correction as of 02:26 on Oct 24, 2019

comedyblissoption
Mar 15, 2006

just a reminder that the per capita US spending in taxes alone is greater than all private and public spending of the UK's nationalized health service and many other OECD countries and we still have 30 million people uninsured nevermind the 80-90 million figure bernie cites for underinsured

private and public spending in the US is of course over twice that of the UK's

Crakkerjakk
Mar 14, 2016


comedyblissoption posted:

just a reminder that the per capita US spending in taxes alone is greater than all private and public spending of the UK's nationalized health service and many other OECD countries and we still have 30 million people uninsured nevermind the 80-90 million figure bernie cites for underinsured

private and public spending in the US is of course over twice that of the UK's


Yeah, one of my annoyances on the "we'll raise taxes but overall you'll still pay less" for M4A. Like, that is better, sure. But we literally don't have to pay another cent in taxes to get universal high quality health care, and we know this because other people manage to do that with what we currently pay.

Main Paineframe
Oct 27, 2010
https://twitter.com/BonusEruptus/status/1187422550068023304
https://twitter.com/BonusEruptus/status/1187423514338435073

death, taxes, and medical bills

comedyblissoption
Mar 15, 2006

https://twitter.com/profwolff/status/1187411428598259712

Gunshow Poophole
Sep 14, 2008

OMBUDSMAN
POSTERS LOCAL 42069




Clapping Larry
my PCP resigned from the doctor's office I use, so I A) have to find a new one which sucks and B) just went to the websit eto schedule a physical exam which you know is a yearly thing that is good to have

no appointments for 28 days with any doctor

lmfao

BUT THE WAIT TIMES

Corny
Feb 18, 2006

i am scared
god i loved turning 26 and not being able to see the doctor who i had been seeing for 10+ years because i couldn't use my parents insurance :^) since i got kicked off of it :^) but doctor choice folks am i right

skooma512
Feb 8, 2012

You couldn't grok my race car, but you dug the roadside blur.

Gunshow Poophole posted:

my PCP resigned from the doctor's office I use, so I A) have to find a new one which sucks and B) just went to the websit eto schedule a physical exam which you know is a yearly thing that is good to have

no appointments for 28 days with any doctor

lmfao

BUT THE WAIT TIMES

lol I love how people buy that scare story even though most regular people who see the doctor at all know how much of a pain in the rear end it is to get an appointment.

Nocturtle
Mar 17, 2007

Main Paineframe posted:

A helpful jargon decoder
The only thing to add to this is that the coinsurance/out-of-pocket maximum values only applies to approved costs. So if your exam or treatment costs more than the approved amount then it's your problem with no upper limit on the amount that might have to be paid.

Willie Tomg posted:

non-US people having health insurance explained to them from first principles as they get steadily more and more shocked is some of my favorite posting on this forum.
As a Canadian living in the US my main observation is that Americans have to spend so much more time thinking about health insurance and health care costs. Everything is super-complicated and there are surprise costs everywhere even if you have "good" insurance. It's exhausting and I don't think Americans really understand it isn't like this in other places.

Xaris
Jul 25, 2006

Lucky there's a family guy
Lucky there's a man who positively can do
All the things that make us
Laugh and cry

skooma512 posted:

lol I love how people buy that scare story even though most regular people who see the doctor at all know how much of a pain in the rear end it is to get an appointment.

tbf Kaiser Permanente is very nice for this. I’ve never had to make an appointment more than 48 hrs in advance to see my specific GP, or can go nearly anytime for a generic one. it’s generally a decent machine if you know how to work it (ie don’t be a meek pushover and actually advocate for yourself)

but ya most hc America is bad and worse than any other country

Gunshow Poophole
Sep 14, 2008

OMBUDSMAN
POSTERS LOCAL 42069




Clapping Larry

Xaris posted:

tbf Kaiser Permanente is very nice for this. I’ve never had to make an appointment more than 48 hrs in advance to see my specific GP, or can go nearly anytime for a generic one. it’s generally a decent machine if you know how to work it (ie don’t be a meek pushover and actually advocate for yourself)

but ya most hc America is bad and worse than any other country

I actually pay extra for this provider in NYC with a flat yearly fee because it's so atrocious otherwise

and yes this is bourgeois s hell but I'll fuckin out my own neck in the lunette if it does away with profit motive healthcare

Xaris
Jul 25, 2006

Lucky there's a family guy
Lucky there's a man who positively can do
All the things that make us
Laugh and cry

Gunshow Poophole posted:

I actually pay extra for this provider in NYC with a flat yearly fee because it's so atrocious otherwise

and yes this is bourgeois s hell but I'll fuckin out my own neck in the lunette if it does away with profit motive healthcare

oh nice, i thought it was mostly a west-coast centric provider given its hq here in ca and didn't know they had a east coast presence as well. its actually the cheapest option here, and for most of my life it's been "da poors use it" provider. except now republicans have been pushing high-deductible bad scam plans on all the poor/middle people instead so i guess that makes it luxurious. though its still a lot cheaper than blue shield aetna whatever garbage options i could pick from which were anywhere from 20 to 100% more expensive

get that OUT of my face
Feb 10, 2007

i got to stay on my medicaid plan this year because my combined income from my two jobs in 2018 put me below the threshold. even though i'm over the threshold now, i'm able to stay on it until the next enrollment period

hopefully some kind of progress is made with the New York Health Act next year, i don't want to ever actually have to do this stupid song and dance

El Mero Mero
Oct 13, 2001

It's open season for the guillotine hunt

Tunicate
May 15, 2012

My old plan no longer exists, so I'm on a new and different plan next year

I'm sure glad I'm not being forced off my old plan by the Government!!!!!!!!!!!!!

Larry Parrish
Jul 9, 2012

by Jeffrey of YOSPOS

Nocturtle posted:

The only thing to add to this is that the coinsurance/out-of-pocket maximum values only applies to approved costs. So if your exam or treatment costs more than the approved amount then it's your problem with no upper limit on the amount that might have to be paid.

As a Canadian living in the US my main observation is that Americans have to spend so much more time thinking about health insurance and health care costs. Everything is super-complicated and there are surprise costs everywhere even if you have "good" insurance. It's exhausting and I don't think Americans really understand it isn't like this in other places.

it makes sense why people are hostile to the idea of single payer tbh. because if your main experience with the federales is cops and arguing with the social security office, the idea of doing the same thing to go to the doctor is horrific

fabergay egg
Mar 1, 2012

it's not a rhetorical question, for politely saying 'you are an idiot, you don't know what you are talking about'


skooma512 posted:

lol I love how people buy that scare story even though most regular people who see the doctor at all know how much of a pain in the rear end it is to get an appointment.

the last specialist appointment i tried to make had a 9 month wait time

PenguinKnight
Apr 6, 2009

:abuela: look at all the people that love their insurance! how about we introduce Medicare For Some Who Qualify With the Most Stringent Means Testing Possible, But It’s Actually Privatize Insurance Still. now MFSWQWTMSMTP,BIAPI might seem a bit cumbersome, but you’ll still have the same freedoms you get to enjoy now! :abuela:

ive recently had to seek legal advocacy recently because my insurance considers anything related to transgender care cosmetic and not covered(maybe not for hormones, but I’ve asked them 5 times over the past 2 months and they’ve yet to respond). I’m lucky that that’s the worst of my problems outside of death by a thousand cuts from all of the copays.

two friends of mine just lost their dad after he fell into a coma from a head injury (if you’re an alcoholic, please don’t quit cold turkey); they had to set up a go fund me page for paying the medical bills for the short time he was on life support. things shouldn’t loving be this way in this country :smith:

also hsa’s and fsa’s are gigantic scams

ikanreed
Sep 25, 2009

I honestly I have no idea who cannibal[SIC] is and I do not know why I should know.

syq dude, just syq!
Guess whose employer switched to a slightly cheaper much suckier plan

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Apoplexy
Mar 9, 2003

by Shine
The Minnesota Medicaid version of this: You make too little money? Here's 2 to 4 options of health insurance providers for your district. I pay $0 a month no matter which I choose. Each policy is nearly identical and has you paying, at most, $3 per non-emergency medical visit or non-generic Rx.

That's it. In the 2000s when I turned of age and had to go off my parents' insurance, I was getting a BCBS MN policy for about $250 a month. How in the everloving gently caress are people paying $400 every 2 weeks, not even getting 100% coverage, and not literally rioting over it? I would be. Probably wouldn't even need to be 10 grand a year in medical insurance premiums to get me to that point, either.

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