MsElui

Just wanted to give another example of healthcare costs for those looking for examples regarding healthcare and insurance costs.

My husband tore his rotator cuff in his shoulder after a small fall in our home. He had an operation as an 'outpatient' in a surgery center (ie not a hospital just a medical center that has a full operating suite for these kinds of simple injuries).

His doctor advised him that his 'charge' would be around $6000, but that he should expect to to get bills from the anesthetist, the surgery center facility, physiotherapy afterwards and possible for ancillary medical staff like assistants in the theater. There was also prescriptions for pain meds but as he had generic meds we didnt have any cost from those with our policy.

On the day he went in about 6.30 am and left the center at 11am ish so he was there less than 5 hours. His actual operation took less than 45 minutes. He was in a curtained cubicle off a corridor full of similar cubicles for the duration of the time he was not in theater (so it wasnt some uber plush fancy room).. The surgery was keyhole - so 4 small incisions of around 1cm each. he came out with a dressing and a very substantial padded sling effort.

We are getting the bills in now and so far they are in the following ballpark

surgeon $5600
anesthetist $930
surgical facility $16400

Our insurance negotiated just over $7k off the bills so the 'bill' will come to at least 15-16k. Luckily our annual max deductible is just $3k so that's all we will pay for him.

He's recovering well and glad it is over but we were surprised at the other costs that are coming in (over the $6k we were told about), and we have not yet seen anything for the physio as its just started. (still wont cost us as will will have met the deductible). So even something like a small fall in a healthy (albeit clumsy lol) adult can cost your dearly.

Bob

Ouch

Just shows best to get the best insurance you can afford to get as there's bound to be something daft happening at some point, especially anyone living in a snowy type area

edmontron

Another example to show how grateful we should be, in countries that have a decent public healthcare system, for any social democratic governments contribution over time to create a social welfare state.

columbo

Ms Elui, That's a frightening set of bills!!!!!!! My wife and I are hoping to retire to the States (Florida) in a couple of years and private healthcare costs are one thing that concern us. However, I've heard of this healthcare exchange ? that is to be introduced in 2014 that will subsidise the premiums for citizens and LPRs according to your income. That's all I know, can anyone add to that? Will it make healthcare more affordable? I would be grateful for anyone's thoughts on this. Mike

Jerseygirl

Before Christmas my husband had a nuclear heart test. The procedure was done at our doctor's group practice surgery. It is a large practice and is now owned by Atlantic Healthcare...who own the local hospital (Morristown Memorial). When he went for his follow up appointment the cardiologist was attending to an emergency...so he saw the cardiologist's practice nurse.

In the mail this week was a bill for several hundred dollars for the latter appointment. It seems the nurse is not in network...so the insurance company refuse to pay for the appointment.

GeoffM

Hope hubby's ok.

That is just crazy, the surgical facility bit especially. The anaesthetist is "only" about 50% more than what mine charged privately in the UK. Surgeon was about $1000 roughly I think. Use of the theatre for 2 hours, eye surgery, overnight stay, drugs (while admitted), theatre staff and ward staff, and a very nice shepherds pie after waking up, totaled about $2500.

Bob

No it won't and that isn't the aim, the aim is to allow you to be able to find cover when you would other wise be denied cover for having pre-existing conditions or have had a break in cover.

Might be different for the USC's, but I doubt they'll change things up much for LPR's with the "do not become a public charge" thing.

scrubbedexpat099

You will have a sponsor.

Michael

It is for anyone that doesn't have employer provided health care insurance or unemployed families including LPR's. In fact. it is also supposed to be available to some non immigrant visas also (believe F1 visas and maybe some others).

The current temporary risk pool is for people with preexisting conditions until the exchanges kick in at 2014.

Now here is the kicker for legal permanent residents. The current law says that LPR's aren't eligible for medicaid (government sponsored health care) until they have been a resident for 5 years but the exchanges provide free medicaid coverage to families with incomes below 125% the poverty level. Therefore LPR's that are below the 125% poverty level would not be eligible to use the exchanges for the first 5 years. Since the exchanges provide private health insurance coverage and not medicaid for LPR's above the 125% poverty level, LPR's are covered if they exceed that threshold.

http://voices.washingtonpost.com/ezr...ort_shrif.html

http://healthreform.kff.org/SubsidyC...spx#calcParams

Also there is the issue of medicare for all since the exchanges are normally for people under 65. Not sure what happens when someone reaches 65 and is not eligible for medicare.

scrubbedexpat099

Sounds like you would need a good accountant to restructure your finances to make sure you qualify. My guess is that would hit people worst in 'conventional' employment.

For example, I could take zero income but could repay myself money invested, same effect in my pocket but much better for the exchange.

avanutria

Depending on whether those other charges were made in 2011 or 2012, you may have a reset deductible for the 2012 year and be starting again from scratch. Hopefully some or all of them were charged in January which would prevent you from having to shell out another $3k deductible. (ETA unless your insurance will consider it all part of the same event in 2011 and not double charge you...not sure what the convention is there.) I'm glad he's recovering and was able to get the treatment in the first place!

Duncan Roberts

It depends on what you mean by affordable. It should make getting a policy easier if you were uninsurable or at a lower price than you may have been quoted. The flip side is that they are still only selling insurance policies and you will get what you pay for. The cheaper plans will probably have lower coverage than the more expensive ones that you can get, for instance you may be offered a cheap one with a $20,000 deductible. So, it may be possible for somebody who rarely uses health insurance to make out a little on the price but I don't expect it to make things any more affordable than they are now if you compare like for like policies. Unless you are on the poverty line or just above it, I wouldn't count on subsidies making any meaningful dent in the price you will pay. I wouldn't be surprised if there would be ramifications for your sponsor should you end up here and accept a subsidy, it's not really fair to voluntarily turn up at somebodies house and expect them to partially pay your way.

Michael

The exchanges are government subsidized for incomes up to 400% of the poverty level and for those with incomes above 400%, they pay premiums for what it would cost for people with no preexisting conditions for that age group.

There are also only 3 plans available in the exchanges and if a person falls in the less than 400% of poverty level, they would pick the A plan which has minimal deductible (about $100) at no additional cost. The primary difference between the A plan and the C plan is the deductible but I think even the C plan (worst plan), the deductible is less than $2,000.

Unlike the current free market health insurance plans that can have very high deductibles, very high co-pays, restricted coverage, and can cancel you at anytime, the plans in the exchanges have none or those and you can't be refused or canceled by an insurance company offering health insurance through the exchanges.

Rete

Wow when I had mine, I did not receive any invoices for the procedure and I, too, used their cardiologist instead my own.

augigi

Nurse or nurse practitioner? A nurse is not a provider and can't even bill you.