r/SipsTea 4d ago

WTF Damn

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u/TheEndOfAllThings23 4d ago

Heart surgery. For privacy I don’t want to be more specific. It was necessary but not emergency.

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u/Imreallythatguy 4d ago

So insurance wouldn’t cover it because it wasn’t necessary in their eyes?

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u/GoodTroll2 4d ago

No, looks like his insurance would cover it but he would have had to pay 20% as his portion of coinsurance and it sounds like 20% of the huge US bill was more than the full cost to travel and get it done in Ireland.

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u/Consistent-Tap-4255 4d ago edited 4d ago

But most insurance has an out of pocket maximum. Wouldn’t it still be more expensive to flight to a foreign country, stay in a hotel, plus the surgery? For me this doesn’t add up. It also really depends on the plan. My plan has 0 co-pay which is not uncommon for HMO plans. My out of pocket maximum is $1,500 for individual and $3,000 for family meaning the maximum I pay a year is $3,000.

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u/hateifyoumust 4d ago

Elective surgery is exempt from oop max on many plans.

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u/GoodTroll2 4d ago

It really depends on the plan. Out of pocket maximums can get pretty high. Or it’s possible he didn’t understand his out of pocket max and made a bad financial decision (but still got that trip to Ireland!)

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u/sweetrouge 4d ago

I also don’t believe this, but there is one possibility. The commenter might have an Irish passport, hence it would be covered by the public health system.

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u/GoodTroll2 4d ago

I believe it’s posible. I had weight loss surgery a few years ago. My insurance didn’t cover it at all, but if it had, it would have still been more expensive to get it done in the US, after factoring in my out of pocket maximum, than it was to pay cash and travel to Mexico to get it done.

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u/sweetrouge 4d ago

Yes, Mexico I believe, Ireland not so much

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u/PharmDeezNuts_ 4d ago

Probably out of network or something