Hey all, I’m British so I don’t really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.
So I’m just asking… How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
I work at a large, private university health system.
Annual up front cost for insurance is $4967 for medical insurance and $609 for dental. Those cover me, my wife, and two of my three children. The insurance is a plan funded by my employer, but managed by Independence Blue Cross, AKA “Personal Choice”.
There are three “tiers” of coverage.
First tier is for facilities that are part of my employer. Generally, for procedures performed at my employer’s facility there is no additional charge. For a primary care provider who is part of my health system, there would be a $20 copay per visit. Specialist would also be $20, and an ER visit would be $200.
There is an “in network” tier, made up of external providers that accept personal choice. Primary care copay is $35, specialist is $50, ER $200.
The third tier is “out of network”. If we see someone out of network, we would have to pay them directly, then try to get partial reimbursement from insurance.
There’s also a prescription plan, but we get a discount by using the hospital’s outpatient pharmacy.
Everyone always talks about the cost to give birth. All three of my kids were born at the hospital where I work, and none of the births cost us any additional money.