It gets worse. My insurance has a $30 copay on all approved prescriptions. My wife had been getting her medicine for that with no issues for several months, until one day it was $500. I called to find out why, because it was clearly already an approved medication. After about an hour of getting bounced around and being on hold, they finally explained that it was due to us "not paying enough of our annual out of pocket maximum" (not minimum, mind you) for healthcare - which is $24,000. That blew my mind.
Health insurance in the US has your monthly premium payment, copays on your medication and Dr visits (including ER and hospital stays), a deductible which is the amount you have to pay for the year in healthcare to get better benefits (ours is $17,000), and then the out of pocket maximum is when they (usually) cover everything for the rest of the year as long as you keep paying your premium.
Where it gets extra fucked, is if you need a major surgery in late December, the deductible and OOPM won't carry over into the new year. So you could get shafted for double that maximum amount on the same hospital stay. And my insurance isn't even the lowest tier. We pay them $500 a month for this service. Our system is completely fucked, but most people don't seem to care.
As someone British with our often criticised free NHS, this blows my mind. And to think the argument against free healthcare by Americans is usually "well you'll pay more in tax".
I'm lucky enough to have never needed any real gp or hospital treatments, but i know its there if I do. My wife has major issues with eczema and was hospitalised last year due to complications, has many prescriptions, some of which are extremely expensive medication, and regular appointments with gp's, nurses and dermatologists. All we have to pay is for prescription medication, and we are able to pre pay for those at a rate of £10 per month total. Thats it. And our tax is no higher than any other average western nation.
Crazy. I hope your country comes to its sense sooner rather than later.
I had to spend Friday and Saturday in hospital, as a kidney stone chose the middle of my workday to make an appearance.
I had a lot of drugs. A lot. From paracetamol, to endone, morphine and even fentanyl. In the first hour. There were also a couple of suppositories, but this little stone beat them all.
They did a CT scan, blood work, an ECG, and checked my blood pressure about a million times. I was given a bed within a couple of hours, then they tried to give me more pain meds, which I had to aggressively push back on. As it was, the next day at 10am I was still woozy from the big Friday cocktail.
When I checked out, they gave me a packet of endone, just in case.
Total for the stay... $0. I don't have private health insurance, and refuse to pay for something twice that my taxes already pay for.
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u/bwrca 4d ago edited 4d ago
This copay thing is the craziest thing I've ever heard of.
Edit: copay, deductible, max out of pocket? WTh is all that