Ash UK/US

One of the sublects so frequently asked about on these boards by new comers to the US is about health insurance, Do I need health insurance? Do I need more than basic coverage? Will emergancy coverage be fine?

My opinion, get the best coverage you can!

I wanted to share my recent experiance in the hope it will help people understand why health insurance is so important.

Anyhow here goes...

I am in pretty good health. Up until this past year I have only seen my doctor twice out side of the routine stuff and pre/post natel, I have lived in the US just over 6 years.

In late June (2008)I thought I had a stomach bug, after being in constant pain in my stomach, back and shoulders for 3 days I went to see my GP. He told me he thought it was Gall Stones and sent me for a ultra sound. When the results came back they called me and told me it was gall stones and I was referred to a surgeon. Off I go to see the surgeon (early July) he does not beat around the bush, he tells me my gall bladder needs to be removed and sets me up with a surgery date (in mid august).

I was told that the surgery was going to be done by key hole and that it was a straight forward proceedure and that I would be in and out of the hospital within a day.

In early august I begin feeling unwell, thinking it is just another attack I took OTC medication, that didn't work very well so I call my doc and got a prescrip for Vicodin, combined with the OTC meds it worked fine and I was pain free. 4 days laters I wake up in extreme pain and end up in ER, they give me a IV pain killer and I am discharged an hour later with a prescrip for stronger Vicodin. That didn't work so I call doc and I am prescribed Davocet. Still no relieve, at this point I am literally crawling the floor and telling my hubby to take me back to ER... all this in the same day. Back at the ER they decide to admit me. The next day I am sent for a ERCP (kinda like an endoscopy) turns out I have a gall stone lodged in the bile duct that is now infected. The day after that I have my gall bladder removed. 2 days later I go for a endoscopy to see if they can get the stone out. They were unable to because of the swelling. At this point I also have jaundice so they put a stent in around the blockage. 2 days later I am discharged from the hospital.

After 3 weeks I went back for a third endocopy and they did get the stone out.

So my simple 1 day out patient surgery turned into quite the drama. 6 days in the hospital and 4 procedures/surgeries!

I was told by my doc that my gall bladder was in a 'nasty' condition and that I would be dead if it were not removed.

I do have insurance, I have 80/20 coverage with a $1750 out of pocket max.

The hospital/doctors billed my insurance company $51,635.

After the discounts are given my insurance paid out $33,637

and I paid my out of pocket.

I could not even begin to imagine going though that and having no insurance.

fatbrit

Been there! Morphine is the only thing that works. I was quite unhappy when they got around to operating and I lost my twice daily fix.

Ash UK/US

I got some really good stuff in the ER too... then they billed my insurance $500... for one IV pain drug.

Chrissywissy100

Wow! Hope you feel much better now! Thanks for the example though.. it really does hit home how much it costs, and how much we save (financially and emotionally) by having insurance!

nethead

Hope you're feeling much much better now Ash, I was wondering where you had been lately. I totally agree with regards to health coverage, something like that can happen to someone who is in great shape and seemingly good health at any time.

englishinfl

Shows what a huge financial advantage to people the NHS is in the UK too, for anyone that's thinking of knocking it. Seems like a good reason to suggest that becoming older in the USA is a far less appealing idea than growing old in the UK.

Janek66

Good heavens Ash! What a horrible thing to go through. So glad you are on the mend.

After living here so long I really don't understand why anyone would knock the NHS. It is run by humans and mistakes are made but on the whole they do a fantastic job and as a patient or family member of, money is the last thing that is worried about.

starky

Actually as it happens I have unfortunately just had my first dealings with the American medical system.

For those in the Boston area you will remember the 12/19 was the first big snow storm of the season. I was due to meet some friends from home down in NY on the sat (12/20). I was trying to decide if I should drive or get the bus. I checked the forecast for Sunday and it said 1-3 inches of snow, so I figured I would drive down.
Then on Sunday (01/22) I left NYC about 11am to get home. There was a good bit of rain as I was heading north. Eventually I hit I-90 or the mass pike as they call it here, and that was when the fun really began. The snow started falling very hard and fast, and I was basically driving on an unploughed freeway. As I was pulling away from the toll the car (rear wheel drive BMW) started to shift under me, and then what did I do??? Of course something that someone who does not have a clue how to drive in snow does, I hit the brakes. The car went flying around in a big 360, I was terrified. Thankfully everyone was driving slow and I did not manage to hit anyone / anything.

Eventually after some more near misses on the interstate I decided, that if I did not get off it then I was going to cause an accident. I managed to get off 90 and then tried to find a hotel for the night out in Worcester. Of course every time I hit a hill the car kept getting stuck. At one point I was out trying to dig the car, and I think I stepped down into a small drift of snow and my ankle went from under me. I went flying and my foot got kind of stuck in the snow. A few seconds later I was in agony. I managed to get back into the car and on to the hotel, using my snow shovel as a crutch!
First thing the next morning, I hobbled to the nearest tyre place and had them fit winter tiers.

After three days of pain, I decided to go and have it x-rayed at the ER and low and behold I had a spiral fracture of my distal fibula. (AKA broken leg)
I was totally shocked, I had sort of been getting around on it for the three days prior to the x-ray, thinking it was a sprain. The doc put a cast on it and gave me crutches and said "keep off that leg till you can get to an orthopedic surgeon". It happed so easily and quickly, very scary.

After many panic calls to my insurance company, and loads of questions I finally made an appointment with a surgeon. He told me that I need surgery on it ASAP.
I waited about a week for an appointment and finally yesterday I had my surgery now I'm currently at home in bed doped up to the eyes on vicodin!.

As of yet I don't know how much its going to cost me, my annual out of pocket max is $1000 so its at least going to cost me that I reckon. Some basic Internet research puts the costs in the region of 10k +

I am 30 year old fairly active, gym 4/6 times a week in very good health and I never even considered something like this happening. I think of emergences along the line of life threating illness, or bad car accidents. A broken leg while not life threating thank god, still lands you out work, and will cost you a good bit of money to put right here in the US. Insurance over here is so important, you just don't know whats around the corner.

Thankfully as I am in IT, I have been working from home, so it has not impacted my job/salary too much. I am taking the rest of this week off sick as working + vicodin is not a good combination.
I do have a very good short term disability policy at work which kicks in after 7 days sick leave, and they will pay me 4 weeks full pay then 6 weeks 60%. I am hoping to be back working again from home next week, so I wont need to cash in the old short term disability policy.

The one thing I will say is that I am extremely impressed with the hospital system over here, its unbelievable the difference between it and the public system in Ireland. The place was more like a hotel, it was hard to believe that I was actually even in a hospital. that smell that has been in every hospital I have ever been in was just not there. All the staff were amazing, they could see I was nervous about the whole thing and they were just great, they made it all seem very easy and put my at ease with the whole procedure.

This has shown me that going with out insurance here is just not an option. You never know when you will need it.
I am definitely in good spirits now, just need to recover now and get back to normal. Its incredibly boring being house bound!

Janek66

My husband did the same thing in the summer, both tib and fib down by the ankle. Long story short, he did it on a Saturday, got it in a splint at the ER (in WV) (3 hours and some good coke based pain meds), saw the ortho surgeon on the Monday in VA, then on to WV hospital for cat scan , back hospital in VA for pre-op tests on Tuesday, WV hospital on Weds for another cat scan, surgery on Thursday in VA. All that driving around on bumpy roads made him green with pain. He actually doesn't remember that week at all. He had a 7 inch plate inserted in his leg.

Total cost $25, 000, out of pocket expenses for us was about $500.

Giantaxe

My recently out of college underemployed daughter recently had her appendix out. She will likely declare bankruptcy as there is no way she can pay the bills. It's ok saying "get insurance", but when the only insurance premiums you can afford come with such high deductibles that it will bankrupt you anyway, what's the point? Compare and contrast to the NHS, where this situation would be merely of a medical nature and her credit record wouldn't be damaged for up to ten years...

Ash UK/US

I completely agree, I am certainly an advocate of the NHS, it may not be perfect but I would choose it over an insurance system without hesitation.

Over the years on these boards I have seen lots of people question what coverage to get all I am trying to say is get the best you can.

Seems like people use going back home and using the NHS as a back up plan, that whould not have been an option for me. I would also be in alot of debt right now if I only had accident coverage.

Sorry your daughter has been put in that postion.

Janek66

Sorry for your daughter.

The actual medical care you get over here is top notch, not faulting that at all, its the insurance crap thats all wrong. We got three bills from the same hospital, different depts. None of which was sent to our ins. co. However, when my OH was at that hospital, they wouldn't give him the pain meds until they had all that ins info, 'i's dotted 't's crossed etc. 2 hours he had to wait.

Starky I don't know how you managed to hobble around on it for so long before getting an x-ray.

fatbrit

Not sure I agree on that one. For many it'd be much cheaper to get a catastrophic-type policy and keep the deductible in savings. The savings in premiums are considerable.

Ash UK/US

If people have the restraint to actually save the money that might work, in some situations.

Janek66

I have to say I agree with Ash. We must have had 30 odd different bills for my OH's leg, all for different things, they literally nickled and dimed us to hell and back.
And who determines what is catastrophic? My OH needed a cat scan (so doctor could plan the op) on his ankle but we couldn't get it done at the hospital where the surgery was being done because our insurance wouldn't cover it. Had to drive 30 miles to a god awful city hospital in WV with his ankle totally unstable and him in a tremendous amount of pain. It was that or, have some doctor at the insurance company, who probably hadn't practiced medicine since square wheels were made of stone, decide whether the cat scan was necessary......