Returning to UK after 7 years in US
Mar 16th 2024, 4:24 pm
#16
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Location: San Diego, California
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Re: Returning to UK after 7 years in US
Sorry, not to sound rude, but would you like to tell our doctor's office & insurance company that??? We just paid the bill.... I've had the medical office tell me "We charge $X. If your insurance company won't pay our rates, the balance is left to you to pay". Seriously, I'm not kidding! I blew a gasket.... Then they had the audacity to turn us over to a legal firm bill collector!!! Legalized crime, IMHO
And, this is the primary reason we are consider emigrating back to the UK. It would be cheaper for me to purchase a BUPA plan on top of NHS. HOWEVER, if we can find a solution to this ordeal we would prefer to stay where we are instead of starting completely over from scratch.... at 66 y/o (me)
And, this is the primary reason we are consider emigrating back to the UK. It would be cheaper for me to purchase a BUPA plan on top of NHS. HOWEVER, if we can find a solution to this ordeal we would prefer to stay where we are instead of starting completely over from scratch.... at 66 y/o (me)
Sounds like you went out of network or something similar,
Personally, after being on Medicare etc for several years, I've never been presented with such a bill.
Mar 16th 2024, 4:25 pm
#17
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Re: Returning to UK after 7 years in US
Very true. It is a very big factor why I am thinking of the possibility of returning home after retirement, but I have to weigh that against kids and grandkids here.
With regard to Medicare can you clarify your elderly friend's experience - was that using original Medicare or Medicare Advantage? There is a big difference. Since the government sets original Medicare reimbursement rates I'm sure some providers drop patients due to lower profits, but folks I know on Advantage plans seem to have much more year-to-year turnover in their network doctor choices. I used to live in an 55+ community (and most were in fact 70+) and in general they seemed happy with original Medicare. But yes, things are never static and there's always an uneasy feeling that if you have good affordable insurance and a good network of specialists this year, that could change next year.
With regard to Medicare can you clarify your elderly friend's experience - was that using original Medicare or Medicare Advantage? There is a big difference. Since the government sets original Medicare reimbursement rates I'm sure some providers drop patients due to lower profits, but folks I know on Advantage plans seem to have much more year-to-year turnover in their network doctor choices. I used to live in an 55+ community (and most were in fact 70+) and in general they seemed happy with original Medicare. But yes, things are never static and there's always an uneasy feeling that if you have good affordable insurance and a good network of specialists this year, that could change next year.
Mar 16th 2024, 4:37 pm
#18
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Re: Returning to UK after 7 years in US
Sorry to hear about your experience. You quoted a price for a blood test which is extraordinarily high, and now you are saying that it's a doctor's bill; and that your insurance company won't pay the doctor's rates.
Sounds like you went out of network or something similar,
Personally, after being on Medicare etc for several years, I've never been presented with such a bill.
Sounds like you went out of network or something similar,
Personally, after being on Medicare etc for several years, I've never been presented with such a bill.
BTW, I was born and raised in SanDiego.... moved to the Bay area in 1995. Lived in Kensington & (Ab)Normal Heights.
Mar 16th 2024, 5:02 pm
#19
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Re: Returning to UK after 7 years in US
I couldn't agree with you more about Medicare! I am on Medicare, my spouse is 10 years away from that. I have never received a bill except for the annual co-pay.
BTW, I was born and raised in SanDiego.... moved to the Bay area in 1995. Lived in Kensington & (Ab)Normal Heights.
BTW, I was born and raised in SanDiego.... moved to the Bay area in 1995. Lived in Kensington & (Ab)Normal Heights.
So, sounds like this bill was for services your spouse received and she is on a company plan and went out of network...?
Mar 16th 2024, 5:25 pm
#20
Joined: Dec 2001
Location: Dixie, ex UK
Posts: 52,448
Re: Returning to UK after 7 years in US
Sorry, not to sound rude, but would you like to tell our doctor's office & insurance company that??? We just paid the bill.... I've had the medical office tell me "We charge $X. If your insurance company won't pay our rates, the balance is left to you to pay". Seriously, I'm not kidding! I blew a gasket.... Then they had the audacity to turn us over to a legal firm bill collector!!! Legalized crime, IMHO
And, this is the primary reason we are consider emigrating back to the UK. It would be cheaper for me to purchase a BUPA plan on top of NHS. HOWEVER, if we can find a solution to this ordeal we would prefer to stay where we are instead of starting completely over from scratch.... at 66 y/o (me)
And, this is the primary reason we are consider emigrating back to the UK. It would be cheaper for me to purchase a BUPA plan on top of NHS. HOWEVER, if we can find a solution to this ordeal we would prefer to stay where we are instead of starting completely over from scratch.... at 66 y/o (me)
One of the most unpleasant twists to the US health insurance system is the "out of network" minefield, and I accidentally stumbled into it a few years ago myself, when visiting a new GP at an in-network medical company's office, but somehow the doctor was "out of network"., leading to a substantial bill from the medical company, when I shouldn't have had to pay anything more than the co-pay and deductible, It turnout that the doctor's registration as an in-network provider had expired, so it was literally a paperwork issue. It took a few weeks for the doctor's office to get his registration with the insurance company restored, and shortly afterwards I received the modest bill that I had been expecting. So, in short, you can get billed erroneously for "out of network services", even if you weren't actually out of network.
rlolney58 I would start by asking your insurance company why they didn't pay the bill. If they say it was out of network, and assuming you can't tell them they made a mistake, that the doctor/ office was, to the best of your knowledge, "in network", then go to the doctor's office and ask them why the doctor (or whatever you were billed for) was out of network when you understood it to be in network.
Last edited by Pulaski; Mar 16th 2024 at 5:29 pm.
Mar 17th 2024, 1:14 pm
#21
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Re: Returning to UK after 7 years in US
I didn't leave the US specifically because of health care costs, but it was definitely one of the main considerations when I asked myself, "Do I really want to work in the US until I retire, and then stay in the US after I retire?" My own answer was "No," with health care being a major, but definitely not the sole, factor. I can't advise you regarding all the preceding technical aspects of private health care in the US, but I can offer a handful of anecdotal experiences.
First is that a good friend and colleague (British) decided to stay on in the US after retirement. He and his wife moved to Vermont, for political reasons, but also because the health care there was (in his words) much closer to the socialised medicine model in the UK. They have had to use the health care system in Vermont multiple times, and have been full of praises for it, both in terms of cost and quality. So a potential question for you might be whether you could move to somewhere like Vermont?
My health is generally very good, even though I'm now and old 'un. My only major experiences with the NHS have been fairly urgent, and in one case, an emergency:
(1) I was hit at great speed by a drunk driver and taken to an NHS hospital in Belfast. After first determining that I did not have a spinal injury, I was left in a hallway on a gurney between midnight and 7 am (it was St Patrick's Day, and A&E was full of very drunk people and people under the influence of drugs).
(2) I had the worst case of food poisoning I've ever had while on a cycling trip from bottom to top of Ireland. I ended up in A&E at Letterkenny Hospital, where I sat in the waiting room for 6 hours, and was eventually treated in, believe it or not, a hospital hallway. (I also caught Covid while I was there, but that's a different story!)
(3) While training for a 120km forced march event, I discovered I had an inguinal hernia. It took 4 weeks to see a specialist who initially was wide-eyed at how big it was and said it was "urgent", which meant I'd get it seen to in ... 6 to 8 weeks. My event was in 5 weeks, so I had it sorted out privately the following week, for £3,000. The 120km forced march event went smoothly and I haven't had any subsequent issues with the hernia site.
From my own experiences, then, I'd say (a) the NHS is severely limited these days [although I know some people who have had excellent attention where they live], but (b) private health care in the UK is probably a lot less expensive than in the US. I'm guessing inguinal hernia surgery in the US would cost a lot more than £3,000, but I could be wrong.
First is that a good friend and colleague (British) decided to stay on in the US after retirement. He and his wife moved to Vermont, for political reasons, but also because the health care there was (in his words) much closer to the socialised medicine model in the UK. They have had to use the health care system in Vermont multiple times, and have been full of praises for it, both in terms of cost and quality. So a potential question for you might be whether you could move to somewhere like Vermont?
My health is generally very good, even though I'm now and old 'un. My only major experiences with the NHS have been fairly urgent, and in one case, an emergency:
(1) I was hit at great speed by a drunk driver and taken to an NHS hospital in Belfast. After first determining that I did not have a spinal injury, I was left in a hallway on a gurney between midnight and 7 am (it was St Patrick's Day, and A&E was full of very drunk people and people under the influence of drugs).
(2) I had the worst case of food poisoning I've ever had while on a cycling trip from bottom to top of Ireland. I ended up in A&E at Letterkenny Hospital, where I sat in the waiting room for 6 hours, and was eventually treated in, believe it or not, a hospital hallway. (I also caught Covid while I was there, but that's a different story!)
(3) While training for a 120km forced march event, I discovered I had an inguinal hernia. It took 4 weeks to see a specialist who initially was wide-eyed at how big it was and said it was "urgent", which meant I'd get it seen to in ... 6 to 8 weeks. My event was in 5 weeks, so I had it sorted out privately the following week, for £3,000. The 120km forced march event went smoothly and I haven't had any subsequent issues with the hernia site.
From my own experiences, then, I'd say (a) the NHS is severely limited these days [although I know some people who have had excellent attention where they live], but (b) private health care in the UK is probably a lot less expensive than in the US. I'm guessing inguinal hernia surgery in the US would cost a lot more than £3,000, but I could be wrong.
Mar 17th 2024, 4:05 pm
#23
Joined: Dec 2001
Location: Dixie, ex UK
Posts: 52,448
Re: Returning to UK after 7 years in US
My wife recently had vaguely similar (to a hernia repair) invasive abdominal surgery in NC, and had to prepay about $6,700 IIRC, being approximately 10% of the total cost. In the end I think she was refunded about $4,000 when all the insurance figures were calculated and bills paid. So the out of pocket cost was in the same ballpark as your £3,000.
Mar 17th 2024, 8:27 pm
#24
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Joined: Aug 2013
Location: Eee Bah Gum
Posts: 4,140
Re: Returning to UK after 7 years in US
When we returned to England in 2017 we took out private health insurance through Aviva. That first year cost £1,080 in premiums and covered health, vision and dental for both of us, in our 60’s. Health portion for use if waiting time on NHS is longer than 6 months, the dental and vision very similar to what you would expect in the USA with a checkup and 2 cleanings per year for us both plus new glasses when prescriptions changed. In 2018 I had a heart Catheter ablation on the NHS, waiting time right at 6 weeks, great service, great results.
In 2020 the premium was £1,192 and this was the Covid pandemic. My wife had cataract surgery then in September I twisted my knee. The insurance includes 5 same-day video doctor appointments per person per year so the day after I twisted it I took a photograph showing how swollen it was and did a video appointment, uploading the photo prior to the appointment. The doctor agreed that an orthopedic consultation was needed so emailed a pdf of a referral letter to me, copy to Aviva. Next day I called Aviva and the agent agreed that it would be a long wait on the NHS and gave me an authorization number for my local private hospital in their plan, The Nuffield, about 15 miles away. I went online, reviewed the bios of their orthopedic consultants and chose 2 or 3. I called and made an appointment for the following week and everything moved along every bit as quickly as I had been used to in the USA. Saw the consultant who ordered an MRI which I had same day at the hospital and saw him again a few days later. Confirmed a bad tear of the meniscus and put me down for surgery which was delayed by about 6 weeks because of Covid - they were also treating non-Covid NHS patients at NHS costs. Surgery went great.
Out of pocket costs including everything was the £300 deductible.Total cost on the invoice including surgery, 4 appointments, MRI scan and 2 follow up appointments was a total of £3,717 which is what I would have paid if I’d gone privately.
In 2020 the premium was £1,192 and this was the Covid pandemic. My wife had cataract surgery then in September I twisted my knee. The insurance includes 5 same-day video doctor appointments per person per year so the day after I twisted it I took a photograph showing how swollen it was and did a video appointment, uploading the photo prior to the appointment. The doctor agreed that an orthopedic consultation was needed so emailed a pdf of a referral letter to me, copy to Aviva. Next day I called Aviva and the agent agreed that it would be a long wait on the NHS and gave me an authorization number for my local private hospital in their plan, The Nuffield, about 15 miles away. I went online, reviewed the bios of their orthopedic consultants and chose 2 or 3. I called and made an appointment for the following week and everything moved along every bit as quickly as I had been used to in the USA. Saw the consultant who ordered an MRI which I had same day at the hospital and saw him again a few days later. Confirmed a bad tear of the meniscus and put me down for surgery which was delayed by about 6 weeks because of Covid - they were also treating non-Covid NHS patients at NHS costs. Surgery went great.
Out of pocket costs including everything was the £300 deductible.Total cost on the invoice including surgery, 4 appointments, MRI scan and 2 follow up appointments was a total of £3,717 which is what I would have paid if I’d gone privately.
Mar 18th 2024, 9:20 am
#25
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Joined: Apr 2019
Posts: 29
Re: Returning to UK after 7 years in US
When we returned to England in 2017 we took out private health insurance through Aviva. That first year cost £1,080 in premiums and covered health, vision and dental for both of us, in our 60’s. Health portion for use if waiting time on NHS is longer than 6 months, the dental and vision very similar to what you would expect in the USA with a checkup and 2 cleanings per year for us both plus new glasses when prescriptions changed. In 2018 I had a heart Catheter ablation on the NHS, waiting time right at 6 weeks, great service, great results.
In 2020 the premium was £1,192 and this was the Covid pandemic. My wife had cataract surgery then in September I twisted my knee. The insurance includes 5 same-day video doctor appointments per person per year so the day after I twisted it I took a photograph showing how swollen it was and did a video appointment, uploading the photo prior to the appointment. The doctor agreed that an orthopedic consultation was needed so emailed a pdf of a referral letter to me, copy to Aviva. Next day I called Aviva and the agent agreed that it would be a long wait on the NHS and gave me an authorization number for my local private hospital in their plan, The Nuffield, about 15 miles away. I went online, reviewed the bios of their orthopedic consultants and chose 2 or 3. I called and made an appointment for the following week and everything moved along every bit as quickly as I had been used to in the USA. Saw the consultant who ordered an MRI which I had same day at the hospital and saw him again a few days later. Confirmed a bad tear of the meniscus and put me down for surgery which was delayed by about 6 weeks because of Covid - they were also treating non-Covid NHS patients at NHS costs. Surgery went great.
Out of pocket costs including everything was the £300 deductible.Total cost on the invoice including surgery, 4 appointments, MRI scan and 2 follow up appointments was a total of £3,717 which is what I would have paid if I’d gone privately.
In 2020 the premium was £1,192 and this was the Covid pandemic. My wife had cataract surgery then in September I twisted my knee. The insurance includes 5 same-day video doctor appointments per person per year so the day after I twisted it I took a photograph showing how swollen it was and did a video appointment, uploading the photo prior to the appointment. The doctor agreed that an orthopedic consultation was needed so emailed a pdf of a referral letter to me, copy to Aviva. Next day I called Aviva and the agent agreed that it would be a long wait on the NHS and gave me an authorization number for my local private hospital in their plan, The Nuffield, about 15 miles away. I went online, reviewed the bios of their orthopedic consultants and chose 2 or 3. I called and made an appointment for the following week and everything moved along every bit as quickly as I had been used to in the USA. Saw the consultant who ordered an MRI which I had same day at the hospital and saw him again a few days later. Confirmed a bad tear of the meniscus and put me down for surgery which was delayed by about 6 weeks because of Covid - they were also treating non-Covid NHS patients at NHS costs. Surgery went great.
Out of pocket costs including everything was the £300 deductible.Total cost on the invoice including surgery, 4 appointments, MRI scan and 2 follow up appointments was a total of £3,717 which is what I would have paid if I’d gone privately.
Mar 18th 2024, 10:15 am
#26
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Joined: Jul 2002
Location: Dreich Alba
Posts: 12,012
Re: Returning to UK after 7 years in US
I paid for the hernia op out of pocket, simply because I had been training for months for the forced march event and so it was worth £3,000 to make sure I didn't miss it. It was touch and go for a while, as I only had 4-5 weeks to recover from the surgery before walking 120 km.
After posting yesterday, it dawned on me that in the same year, I had three other surgeries! As below:
Two cataracts surgeries. Fairly straightforward diagnosis and referral, surgery about 6 weeks later (and the second one a few weeks after). Very happy with everything.
Elbow reconstruction after a fall from my mountain bike. Saw ortho specialist at A&E same day (after about a 2-hour wait). Specialist wanted to schedule the to repair within a week - but I had a visit scheduled to the States so I went all strapped up and they did the surgery a couple of days after I returned. Again, very pleased with the timeliness and standard of the surgery. Considering it was a fairly complex injury (fractured elbow, detached triceps tendon, ruptured bursa), it's healed well and only aches when it rains. And I've ridden several cross-country events since then (including LEJOG), so I can't complain.
So, overall I'd say my experiences illustrate how variable people's experiences with the NHS can be. For me the biggest plus is that if you end up in A&E, you're not sitting in the ambulance wondering how much it will all cost.
Mar 18th 2024, 10:29 am
#27
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Re: Returning to UK after 7 years in US
It is the equivalent of the EOBs that are so easy. My wife has had her cataracts done as well my own knee surgery. We got a single bill for everything, doctor and hospital, showing total cost, how much the insurance paid and how much we owed (the deductible).
Mar 19th 2024, 9:32 am
#28
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Re: Returning to UK after 7 years in US
I couldn't agree with you more!!!! And this is the #1 reason why we are considering such a move.....
Apr 9th 2024, 6:16 pm
#29
Forum Regular
Joined: Jan 2024
Posts: 31
Re: Returning to UK after 7 years in US
I'm lucky to have retiree medical insurance from my employer and pay $100/month for a very comprehensive plan with a $5k deductible. I also pay $25/month for dental insurance and just had some dental surgery and paid $2k of the $6k total cost. I'm relatively healthy so the deductibles have worked out ok so far. I'm also thinking of moving back to the UK depending on the result of the Nov. Presidential election. If I do return to the UK I will probably buy private dental and medical insurance and also choose a place to live with better than average NHS services.
Apr 9th 2024, 11:03 pm
#30
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Joined: Oct 2003
Posts: 38,620
Re: Returning to UK after 7 years in US
For me I think it is fair to say I sympathize with yours and others predicatement re US healthcare. Having been a recipient of both systems in recent years personally and managing family members in the the UK. I still say I woud rather attend an NHS facility than a US one. At least that is my experience.
My rationale, as appears to me to be amplified in these posts, is this; as a US healthcare recipient you are never truly at peace. You are always concerned at a minimum about costs (potntial or actual) and what they might be. For me this weighs heavily on me and I am sure others and I cannot believe it is good for anyones health. The stress of bills (often 6 months or longer later) is just that = very stressful. Even if you know they are managed in a maximum deductible plan.
The feeling that you are owned and have no control over who or what amount might be presented for payment, once you have sought any kind of medical opinion, is extremely one sided. And if you are lucy enought to have a plan, knowing you have to budget for a maximum deductible each year especially in retirement is worrisome and cumbersome.
Compare that with the UK where money is not really an issue apart fromm some small copayments = think prescriptions for some.
I sum it up like this. Compare the difference. You go to a UK ER room late at night and all they want to know is your name and date of birth. You go to a US facility and the first thing they ask for is your picture ID and credit card information. It serves to illustrate where the focus is in the US which in my humble opinion generally speaking is not on the patients welfare but on profit.
I have an elderly (80s) friend and his wife attended a major healthcare provider in the San Diego region recently and was told she had a form of cancer (lump) on her face. The Doctor told her to her face (no pun intended) that he would not be making any money from her procedure??? whether she chose removal or radiation. Oh and that same 80 and 90 year old couple are struggling and scrambling after many years of using the same provider because toward the end of last year the provider summarily kicked them and thousands of others of their plans and refused to accept Medicare because they were not making money?
Versus the UK where a family member in the last 6 months has had a myriad of tests to investigate posible cancer ie multiple bloods tests, MRI, CAT scans, Heart tests etc etc = nothing charged, no charges whatsoever. That in the US would have instantly after the first test have exceeded anyones annual maximum deductible which is usually $6K on average.
No for me its the NHS every time which is why I am transitioning well before Medicare applies.I wish you well in your decision and hope this assists.
My rationale, as appears to me to be amplified in these posts, is this; as a US healthcare recipient you are never truly at peace. You are always concerned at a minimum about costs (potntial or actual) and what they might be. For me this weighs heavily on me and I am sure others and I cannot believe it is good for anyones health. The stress of bills (often 6 months or longer later) is just that = very stressful. Even if you know they are managed in a maximum deductible plan.
The feeling that you are owned and have no control over who or what amount might be presented for payment, once you have sought any kind of medical opinion, is extremely one sided. And if you are lucy enought to have a plan, knowing you have to budget for a maximum deductible each year especially in retirement is worrisome and cumbersome.
Compare that with the UK where money is not really an issue apart fromm some small copayments = think prescriptions for some.
I sum it up like this. Compare the difference. You go to a UK ER room late at night and all they want to know is your name and date of birth. You go to a US facility and the first thing they ask for is your picture ID and credit card information. It serves to illustrate where the focus is in the US which in my humble opinion generally speaking is not on the patients welfare but on profit.
I have an elderly (80s) friend and his wife attended a major healthcare provider in the San Diego region recently and was told she had a form of cancer (lump) on her face. The Doctor told her to her face (no pun intended) that he would not be making any money from her procedure??? whether she chose removal or radiation. Oh and that same 80 and 90 year old couple are struggling and scrambling after many years of using the same provider because toward the end of last year the provider summarily kicked them and thousands of others of their plans and refused to accept Medicare because they were not making money?
Versus the UK where a family member in the last 6 months has had a myriad of tests to investigate posible cancer ie multiple bloods tests, MRI, CAT scans, Heart tests etc etc = nothing charged, no charges whatsoever. That in the US would have instantly after the first test have exceeded anyones annual maximum deductible which is usually $6K on average.
No for me its the NHS every time which is why I am transitioning well before Medicare applies.I wish you well in your decision and hope this assists.
Not that I am in the USA. I am in NZ .
My husband and I have found ourselves suddenly with a choice that we thought had long flown out the window.