Glasgow Girl

The billed amount and what is actually paid are two vastly different amounts. My real life example, I was quoted almost $6,000 for knee surgery going through insurance and a 3 month wait. I asked about private pay and was quoted $2,800 to be performed in the next week which I gladly accepted. The MRI that that I needed was about $2,000 going through insurance and about $1,000 by private pay. There are times when I consider giving up my private insurance since self pay is frequently significantly less cost. I am self pay, but keep it simply to guard against the huge expenses associated with cancer, heart issues or other catastrophic illnesses. With all that said, I think the system over here is superior to the NHS because you have rapid access to most treatments, excellent preventative care, and for the most part it is affordable to most people, because either you qualify for employer plans, or if you are self pay you qualify for subsidies or you have the means to pay for it. It isn’t free, and not inexpensive by any means, but it is priceless if you have an unfortunate prognosis,

TexanScot

I don't think that the companies are necessarily bothered about where the research is done, so long as they are able to commercialize it afterword.

There's some very good science that gets done in the UK, although of course there are simply more institutions in the US than there are in the UK. Grant funding is an issue too and it will be an increasing problem post-Brexit, although it remains to be seen what the long term impact of that will be.

There's absolutely a lot of that going on too. After all, why spend all that money bringing a new drug to market when you can just sponsor a study to support a new indication for an existing drug?

Steerpike

Is the roof over your head (a home you own and live in) considered as a 'resource' in this case?

Steerpike

I guess the question raised by John123456 is, 'what happens to your insurance if you stop paying the premiums' (due to inability to work). Can the insurance company stop covering in-progress treatment? Company-provided ("group") insurance is probably a complicated matter, but with an ACA plan, if your income changes (or ceases) you would then become eligible for subsidized premiums. Here in CA, they are advertising '$1' premiums on ACA plans.

civilservant

Yes. It can be liened after your death to recoup what Medicaid paid out for you, but not before your death.

Steerpike

Why do you think your wait-time was so much shorter for the self-pay option? Speed of payment (a sort-of 'cash flow' argument)? I understand the reasons why the 'insurance' price is much higher, but not so much the wait time.
I presume you opted for 'private pay' because you were not close to your annual deductible, so the $2,000 'insurance' cost was really going to come out of your pocket anyway? At some point in the year, if you have enough expenses, then the 'Insurance cost' would be irrelevant as it would be fully covered by insurance. The only downside of going the 'private pay' route might be that you will take that much longer to reach your annual out-of-pocket max - but that's hardly a factor to consider I guess.

So for these procedures, do you simply ask the doctor 'what if I pay cash'? I've had little exposure personally to medical procedures (thankfully!) but when I have tried to have 'cost' discussions, the doctors have no interest in engaging in such matters, and defer to the 'front office' folks. They, in turn, seem clueless. The insurance companies obviously don't want to discuss. So who exactly do you have these 'self-pay' discussions with? I did recently talk to an old doctor about getting an annual physical at a 'cash price' and it was surprisingly cheap - I got a full-blown 'old fashioned' physical for about $280 (my new doctor treats the annual physical as a '10 minute chat'; my old doc spent an hour poking and prodding!).
I presume you mean, you keep insurance but opt for self-pay when possible?

EDIT TO ADD: - if you go 'self pay' - does the money you spend even count at all towards your annual deductible?

ddsrph

Tricare is insurance for the Military. Military dependents can get Tricare for a very reasonable price and when the active duty members retire they also can get on it. I am a retired reservist and my wife and I were both on Tricare. When I turned 65 and on Medicare my standard Tricare became a free Medicare supplement that pays 100% of what Medicare doesn’t pay. Standard Tricare was free for me (after I retired) but recently my wife who isn’t quite Medicare eligible has to pay for her Tricare standard which is a 80/20 policy $150 deductible and $2500 max yearly out of pocket. Free for both of us until last year and now she has to pay an astounding $12 per month. At 65 it will convert to a free Medicare supplement like I now have called “Tricare for life” This insurance could be a good reason for anyone eligible to consider joining reserves.

Giantaxe

I certainly wouldn't risk having traditional Medicare without supplemental insurance, but apparently many people do.

Giantaxe

Pre- or post-ACA? I can see how it might occur if the latter, for example because the insurance didn't cover certain treatments, but with the ACA outlawing premiums based on medical history, pre-existing condition exclusions and lifetime caps on policies, the chances are way lower.

Giantaxe

It depends on the specific disability insurance policy and on how you paid for it. My state has mandatory short term disability insurance which lasts up to a year with, I think, a one week waiting period. But that's unusual. Long term policies here kick in after that and 60% is a common replacement percentage. The good news is that if you pay premiums with post-tax dollars the disability income is federally tax-free. Not sure whether it's generally state tax-free as well.

John123456

Yes, I fully agree, the US health care system is very fragmented, not sure who exactly purchases these drugs for their patients in the US, it's prbably being done by hospitals who then pass the costs onto their customers , ie health insurance prividers/patients, but these are small buyers, without any buying power, so the drugs manufacturers can dictate their prices, when on the other hand single payer system is represented by one single buyer, such as it is the case in the UK, where NHS represent a goup of over 60 million customers, so NHS can dictate their condition and set prices they are willing to pay, and it is either take it or leave it for drugs manufacturers, otherwise they might lose a very large customers that will go looking for an alternative product somewhere else

Here is an interesting article describing the process:

https://lowdownnhs.info/drugs/billio...-does-it-work/

Looks like US Medicare tries to achieve the same

What’s the Latest on Medicare Drug Price Negotiations?

https://www.kff.org/medicare/issue-b...-negotiations/

John123456

I have read soemwhere on here, on some previous thread, someone had some health condition and some problems with her/his health insurance in the US, or maybe it was no health insurance, and she/he then did research and found out that going back to the UK, and doing the same in the UK privately would cost a quater of what it would cost to do the same thing in the US.

The other thing I have learned is that it is very difficult or almost impossible to find how things would cost in the US if you didn't have a health insurance and wanted to pay for everything by yourself privately.
There's even a website that lists places where you could go to have something done and how much it would cost, I took a look , but there not many hospitals/clinics that could be available around the country, that could povide their prices for various procedures/treatments.
I remember one is in Oklahoma city, I watch a video once about it, I'll try to find it and post it.

This short video says it all , I guess, but it's not the one I was having on my mind:


That's the clinic I mentioned earlier, that is transparent with their prices, so no surprises when it comes to paying, and prices seem reasonable



Another idea would be to go and have things done in Mexico, Malaysia, Thailand, Philippines, I've heard some insurance companies pay their clients to have things done in France, or in other parts of the world, where you know private healthcare is very good and you could pay less.
Has anyone of you thought about it?

John123456

Yes, that Tricare sounds like an attractive perk.
what are the requirements when joining reserves? haha

Lion in Winter

I can give you an example of "real" cost, although it's always hard to say because doctors and hospitals make deals all the time. It's not called the Health Care Industry for nothing.

We are currently paying through the nose for a decent health plan since I became self-employed last year due to being a Covid layoff. Be that as it may, OH recently had an outpatient procedure in a hospital. We were there for maybe three hours - prep time, procedure time, and recovery time. It involved sedation and a local anesthetic, but not a general, and a very minor amount of cutting/stitching/messing about inside. The "real" bill was about 150,000 USD, all in. We paid our out of pocket max of 3k. We pay A LOT in premiums for the two of us, so don't at all get the idea that the insurance is cheap! It's better if you are on a group plan at work, but still expensive for complete coverage.

civilservant

I would agree with that. It can seem like a lot, but even one incidence of inpatient care makes it more than worthwhile.