New England Pete

Hi, We moved from England to New Hampshire eighteen months ago. My wife got a job with citizens bank and we used their health insurance. We were a while before we went to see the doctor but we did get round to it.

Without going into too much detail, I was referred to the local hospital for an ultrasound. I was in there less than an hour. The bill was $900! the insurance picked up $400 so we are left to pay $500. I now have to see another specialist.

My wife mentioned that she snores and that it sometimes bothers me so she has been referred for sleep apnea consultations. She doesn't have many of the symptoms, she gets good rest when sleeping and doesn't stop breathing in her sleep.

My worry is that unlike the UK where you only get treated if you need it, here there doesn't seem to be any reason for them not to refer you to this person or that because it's not coming out of their budgets, your insurance will pay some and you will be stuck the rest. They are all in the health industry and why not help out their colleagues by just referring you along for another $1000!!

I would like to know other peoples experience and how costs can be reduced. I said to the wife, Holy cow we only need me to have a heart attack and that's the house gone. Only half joking.

People moan about the national health but it's got to be better than a system where they've got you by the short and curly's.

Would really appreciate some feedback.

TexasPenguin

Pete,
We've had multiple threads on the healthcare costs and differences from the NHS-type system that may be worth searching (I've started a couple of them!).

But, for what it's worth, here's the thoughts of someone who has just returned (a year ago) from 15 years under the US system to my native UK and NHS.

You are right, in the US, mentioning during your prostate exam that you occasionally cough is likely to get you swooped on by specialists wanting you to have $10,000 worth of tests. Whereas in the UK the doctor is more likely to do a "Reggie Perin's doc" response of "me too, I wonder what it is"!

I think we Brits are so used to being "grateful" for a free at point of service health system and so used to just therefore blindly doing what we are told (since there's little incentive for an NHS doctor to suggest unnecessary tests or treatment) that we forget that, in the US system, we are the "customers". I would never have dreamt of NOT following my UK doctor's advice on tests, medicines or whatever but I did it all the time with my US doctor. And to his credit, often he agreed the the test he was proposing was "probably not necessary" or, more likely, would not have changed the fact that I was going to live or die (exaggerating, but you get the picture).

Now, back in the UK, my wife is facing the situation of it taking 3 months to see a specialist for a non-life-threatening but debilitating foot condition. She would been seen in a week in the US.
So, it's horses for courses, as they say.
If you have good health insurance and you CAN afford it, then once you realize that you have a choice, you are the customer, I'd go for the US system on balance.
But, of course, if you can't afford it or you don't have good insurance, well, that's another story.

As I say, just my rambling thoughts having experienced both systems, take it as you will..

Cheers,
Andy.

audio

I am sure that is a possibility.

Took Mrs. A to ER for a migraine painkiller shot once. She had her shot, was in the room for 90 minutes and initial bill was over $6,900 WTF with an additional $600 for the doc. Who never even saw her.
I went to the billing department and created hell, they wiped off the doc’s bill and the hospital charge was reduced to a little over $500 with the help of my insurance company’s EoB.
We have very high deductibles so we now go to walk-in clinics and unless you really need them stay well clear of ERs.

kodokan

One of the things you're 'buying' with your insurance is access to reduced negotiated rates for services provided. So the insurance didn't pick up $400 as such, it was more that $900 was the rack rate for people paying cash, but Your Insurer had an agreed rate of $500 for that procedure. This is what makes it so hard to get an advance price for anything and be an informed consumer, as your price will depend not only on which insurer you have, but usually even which plan you have from that insurer. It's infuriating.

Do you know what your deductible is, and your out of pocket max for the year? It sounds like you're on a high deductible plan, if you're paying the full (discounted) amount for procedures rather than a token visit copay of $20-40. If so, then the way to think of the yearly price of healthcare is that the cost is actually the monthly premiums + the annual max out of pocket. Divide that by 12, and that's your actual monthly healthcare cost. Some plans charge high premiums but have little or no deductible; others have low premiums but high deductibles - actuarially, it all comes out in the wash.

Now, the nice thing about a high deductible plan is that if you have no medical issues, you pay only the low premiums and pocket the money not needed for the deductible. With the high premium plans, that money is gone regardless. But it's a good idea to save up 1-3 years of out of pocket max, to cover bumpy years when you otherwise have to find a four or five figure sum.

2016 is like that for me - after some years of paying out perhaps $100 a year total in medical visits, my daughter's broken ankle means we'll be maxing out the $2.6k deductible on doctors and physical therapists. So now the 4 of us are wondering what else to get done, since the deductible is taken care of for this year - have hubby's nagging knee-that-swells-when-he-runs looked at, for example.

People with high deductible plans can also have a Health Savings Account into which they can put around $6.5k annually tax free, for medical spending. If this is done through your employer, you also save the FICA on this money.

petitefrancaise

I wrote up an intro guide for using healthcare in the US for my clients. Please feel free to pm for a copy.

Knowing what type of insurance you have and what it covers is imperative here.
Can you go out of network and still get it paid? - that's happening less and less now. Learn to use the insurer's website, certainly the larger companies have resources telling you how to keep costs down.

Try to get out of the NHS mindset too. You probably weren't referred to a hospital for your scan - that's NHS mindset where you do as the doctor tells you. Your doctor here probably wrote you up for a particular scan. Where you go is your business and your money. I did a quick look on my insurance website and for an MRI of a shoulder the cost varied from $3k (hospital) to $500 ( local radiologists surgery) for exactly the same scan.

As Kodokan says, and no doubt Pulaski will be along shortly (:-) ) Using a High deductible plan with a savings account is probably the way to go in managing your costs.

SanDiegogirl

Your experience is not unusual. Being charged 900 dollars for a scan is about the norm.

It would appear that you are not very conversant with your health insurance as provided by your wife's employer.

Undoubtedly you have a deductible (an amount you pay before your insurance kicks in), co-pays and co insurance. If you have rarely visited the doctor since you arrived, you are, probably, still paying the deductible down.
Hence your 500 bucks bill.

While the medical system can be a mindfield to travel if you know what your insurance covers, what your in network system is, what your co-pays are then you won't get surprises like this.

The US system is not like the UK - everything has a cost and it is shared by the insurance company and the one who pays the premiums.

One thing I would caution on, and that is getting treatment for things like sleep apnea. Some of these types of conditions, together with their treatments are considered as experimental, research treatments and will not be covered by your insurance. My husband had a treatment for neuropathy and the insurance refused to pay as they considered it experimental and unnecessary for his condition.

I would suggest that before your wife undertakes any sleep apnea investigations/treatment that she checks with her insurance company to see if they would cover it.

The medical care I have had while in the US has been first class - never thought I have had treatment which was not necessary. Having said that I am pretty clued up on what my insurance will or will not cover and what my costs are going to be.

sir_eccles

Very wise advice.

As others have said, knowing the details of your plan is very important. Primarily, what is your network as some are very narrow now. What is covered and what isn't covered? What will you pay for a visit? What are the Rx options?

ChocolateBabz

You also have the option to say 'No Thanks' if you think you are being hoodwinked but it does go against the grain when we are used to doing what the doctor or dentist tells us to in the UK. The dude is about to go in to have his wisdom teeth taken out at a cost of $1,500 and that's with insurance - I have seen the x-rays though and they do seem so be coming in at an odd angle so I'll just have to suck it up 🤑

Pulaski

When I am sick I go to the doctor and request diagnosis of the symptoms and treatment accordingly. I generally decline broad-based screening procedures, but the last time I had a "scan", based on an issue I had requested be investigated, it didn't find anything anyway.

In short, you need to be engaged in your healthcare and be prepared to have a discussion about planned procedures and treatments. Americans seem to be slowly waking up to the fact that they don't need to say "yes" to everything their doctor suggests.

Asg123

I've spent hours and hours and hours and hours on the phone trying to sort out my health insurance problems but haven't been able to. When I phone my relatives in London I tell them that they're very lucky.

Pulaski

"Problems?" Premiums, coverage, bills, reimbursement, .....?

Asg123

Our insurance keeps getting cancelled. When I phone Kaiser they tell me Covered California cancelled it. When I phone Covered California they tell me Kaiser cancelled it... I'll deal with it. Thanks for asking.

Pulaski

Weird. I've never heard of that before. Something doesn't sound right, because only the customer should be able to cancel a policy, unless it's for non-payment of premiums.

mrken30

If you want an NHS style service where you only get necessary treatment , you need to opt for an HMO provider. These tend to have higher premiums but generally have lower deductibles and most things are covered just under the copay.

EG I was on PPO and they wanted $600 to take my wisdom teeth out. I switch to HMO and it cost me a $10 co-pay.

The one thing I loved about HMO was no large bills or insurance to deal with.

I now have an HDHP because I have no choice.

mrken30

Providence also has an HMO option in California and have just merged with St Josephs which may give you more options.