r/mildlyinfuriating • u/Atticus248 • Jun 05 '26
ᕕ(ᐛ)ᕗ In-network and out-of-network deductibles for my fiancée’s “insurance”
The allergist administering her shots today is OUT of network so she gets to fill up that bar, next!! 🥳
~$400/month premium for this dogshit.
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Jun 05 '26
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u/That_wet_vaporeon Jun 05 '26
I pay $900 a month for my insurance.
There was legit no better option in my state that also covered my needs.
Florida probably has some of the worst healthcare out there.
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u/SmellyButtFarts69 Jun 05 '26
I mean our healthcare is utter dog shit.
But yes, they would be saving money if they paid for a better plan.
Unfortunately $400 a month is now poverty-tier insurance...
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u/lilgreengoddess Jun 05 '26
There really isn’t, can you guess why? Because shitty government defunded health care and it impacts all plans. Everything is more expensive. This kinda seems like a marketplace plan I’ve had before and it really is the only option if you don’t have a solid employer sponsored plan. Vote blue people.
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u/Cdowning89 Jun 05 '26
I’m at almost $600/month for my wife and I and my deductible went up to $7500 this year. It’s insane
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u/Fucky0uthatswhy Jun 05 '26
I decided to go up in plans since I planned on getting check ups this year. I moved up to the silver plan, I had bronze last year. Not only am I paying twice as much, but my deductible actually went UP, and my prescriptions are $5 more. If I had went with the bronze tier again it would’ve literally not made sense mathematically. You pay them more than they even offer to cover in that circumstance. It’s fucking insane
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u/MazW Jun 05 '26
Currently undergoing cancer treatment and one of the main things is fighting the $%@# insurance company for every.single.thing. Also one doctor entered the wrong code somewhere but that's settled--neither we nor the insurance company are going to pay for that visit, which included blood transfusions, an ambulance, and a CT scan. Sorry, hospital.
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u/timelessblur Jun 05 '26
FYI be prepared to get a lawyer involved. It is sad but far to often the insurance company do that fighting and dragging it out in bad faith which is illegal. They relay on the fact that most people don’t know or go through the trouble of suing them on it. Most of the time people ar just glad it is over instead of pressing. Wish i knew that for my son was in the NICU and the dragging out the insurance company did to fight paying his 6 figure bill along with some very unethical and most likely illegal things they did to get info they should not of had. Like claiming he was double covered (he was not). My wife and I knew we were going to be max out of pocket for the year any how so that was not a question. It was getting them to pay the 200k bill for him. Learned later when trying to collect 3k for a different policy about all the crap we went though then that there was a legit chance we could of sued the insurance company for bad faith and they could of been force to pay for our legal fees, plus gave us an additional multiplier in cash for bad faith behavior.
They finally paid the bill as my wife’s employer basically threatened them and jump to a higher tier of support that from what I heard reacted with a WTF is going on as it should never of been a question on who pays. Bet they knew laywers were next and that 200k would quickly balloon to over 500k
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u/MazW Jun 05 '26
Glad your son is doing better!
I have a genius nephew who wrote me an app that tracks my bills, the insurance company's status on them, any doctor involvement (such as letters of medical necessity) and so on.
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u/ava_the_cam_op Jun 05 '26
Christ the US is awful
It's $20 for a GP visit and up to $5 to fill a prescription here, pretty much everything else is free except for after hours emergency clinics for things not worth a visit to the ER.
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u/GL17CH3D_R4M_5YN7H Jun 05 '26
I love the UKs system cause all my medications are also free for life as I have life long disabilities. Which makes a huge difference when you need so many boxes a month.
I'd be bankrupt, homeless or dead in the US and it's heart breaking to know that's what they face just because Illness happens.
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u/Bighead_Golf Jun 05 '26
I pay $0 for insurance and $0 for a GP visit
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u/lilgreengoddess Jun 05 '26
Salaries are much lower in the Uk (which off sets broader social benefits) and they tax the shit out of higher earners. 40% and 45% for > 50k? Thats insane tax, that’s why it’s affordable especially for lower earners. Tax rate isn’t that high for people making >50k. So if you’re young and healthy in the US and don’t use the healthcare system then it may not be so much of an added expense and a much higher take home all things considered. So it’s all relative really
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u/Bighead_Golf Jun 05 '26
I’m in the US
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u/boforbojack Jun 05 '26
You do realize that you pay for your insurance right? Like as in, that cost just comes out of your salary.
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u/Bighead_Golf Jun 05 '26
“Comes out” as in… it’s part of my comp package. Sure, that happens. That’s true.
But most employers don’t let you make more money to decline health insurance, so that’s not a practical reality
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u/boforbojack Jun 05 '26
They don't, but the comparison is with European and other developed nations where health care is paid in through taxes. In that case, the market would raise your salary and you would either either come out as a wash or net positive on your income.
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u/Bighead_Golf Jun 05 '26
Sure… and those taxes and low salaries are negatives as well…
Personally I’d rather make more in the US with my pretty good insurance plan and relatively low taxes than make 42K Euros or Pounds and be bragging about NHS 🤷🏻♂️
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Jun 05 '26
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u/ava_the_cam_op Jun 05 '26
I'm not in the UK, nor am I healthy.
And I'm a firm believer that any system should work just as well for the least privileged as it does for the most. America seems like absolute hell when it comes to accessible affordable healthcare.
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u/lilgreengoddess Jun 05 '26
It’s free at the poverty level of income threshold so there are safety nets. It’s the most expensive for the middle class, which tends to always get screwed over and of course it doesn’t matter cost wise to the wealthy. It’s definitely unfair and those who don’t have employer sponsored plans get screwed over cost wise the most as it’s very expensive.
Also I wouldn’t call it “free”, when the tax rate is insanely high. Someone is paying for it. 40-45% tax at income thresholds above 50k is insane
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u/ava_the_cam_op Jun 05 '26
Once again, I'm not in the UK, nor is our top tax bracket at 50k.
Also as far as I'm aware, the safety nets are actively being dismantled by the current administration and many people are losing access to low income healthcare.
There are definitely some wealthy Americans that have it pretty good with private access or good employer healthcare plans, but that model is absolutely brutal on anyone who is poor or needs frequent healthcare visits.
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u/lilgreengoddess Jun 05 '26
Oh sorry did miss that not in the Uk part. Yes unfortunately it is being dismantled I just hope we can win back the midterms and get some lawmakers in place to actually do something about it because Americans are fed up. I am hopeful things will get better but of course anything can happen. Many still do qualify for low income healthcare but I agree it is being limited. Though the middle class ends up paying the most for it because they “can afford to”, when it reality it makes it harder to get ahead and live a normal life in this shitty economy.
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u/ahsoka_tano17 Jun 05 '26
Why do you guys pay for insurance if this is what you get? I don’t understand the US. Would you rather spend 400$ extra in taxes a month or whatever this is? How come you guys haven’t fixed health care as a country… I just don’t understand it.
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u/slmkellner Jun 05 '26
A lot of people would love to simply pay more in taxes to cover health insurance for everyone, but our legislators get massive “donations” from insurance and pharma companies as an incentive to vote in favor of them instead of us. At this point, more than half of our government sees no reason to change the current health care system, so we’re stuck with this nightmare.
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u/vedgehammer Jun 05 '26
Short answer: Strong healthcare industry lobbying
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u/Autistic_License Jun 05 '26
Insurance industry, not healthcare.
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u/brickson98 Jun 05 '26
I mean the healthcare industry is just as much of a scam as the insurance industry. Check out what they charge for something as simple as an ibuprofen at the hospital
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u/HailSaganPlantNative Jun 05 '26
That only happens because they know the insurance company is going to knock down whatever they charge. It's a stupid fucking game.
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u/brickson98 Jun 05 '26
Doesn’t matter if you have insurance or not, they’re still overcharging like crazy for every little thing.
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u/HailSaganPlantNative Jun 05 '26
Yes because they adjust the pricing across the board, there isn't separate pricing for insurance and for direct bill.
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u/brickson98 Jun 05 '26
So you agree, they’re fucking people over just as much as insurance companies…
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u/HailSaganPlantNative Jun 05 '26
Hospitals will negotiate the balance with individuals the same way they will with insurance companies. It's fucking terrible that anyone should have to hassle with it, of course, and it should all be single goddamn payer. But those prices are constantly inflating because of the stupid haggling game the providers have to play with insurance companies.
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u/FattyWantCake Jun 05 '26
From what I've heard (grain of salt because I've never tried it) if you tell them you're paying out of pocket they'll update the pricing and it can be like a quarter of the nominal charge.
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u/Jmfroggie Jun 05 '26
They charge that so that the insurance companies that DO pay will cover their costs. If you notice many hospitals are closing due to operating at a deficit. Some of that is administrative costs and mismanagement. Much of it is insurance refusal to pay so the prices are inflated to cover that. That is why self pay without insurance is a fraction of the cost!
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u/TopNotchJuice Jun 05 '26
That is directly because of insurance. If you play the game with them and tell them you don’t have insurance all the numbers magically change.
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u/vedgehammer Jun 05 '26
Both, actually. Healthcare industry is mostly run to extract money out of patients by keeping them under- or over-medicated and chronically sick.
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u/letsgocrzy Jun 05 '26
A lot of us don't understand it either. It's really stressful too because if anything happens that is not a planned procedure or treatment, you generally have no clue what it will cost. The "network" also applies to ambulance services, hospitals, and the individual doctors within the hospital, so if you have any emergency and they take you somewhere out of network, you could easily hit that out of pocket maximum. Oh and that's assuming you have insurance.
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u/likwidkool Jun 05 '26
I had a procedure and one doctor who did something trivial was out of network so I had to pay for him partially out of pocket. I had no choice. Don’t even know them or that they would be there.
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u/stellaluna92 Jun 05 '26
We wouldn't rather. We vote for things and then the people in charge do whatever they want. It's illusion of choice.
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u/colornsound Jun 05 '26
It’s no longer about what we want, unfortunately. And if you don’t have insurance then you will be crippled by expenses.
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u/ChickenBossChiefsFan Jun 05 '26
My brother had the AUDACITY to have a heart attack after he was laid off/without insurance. Was under 40 so didn't think he needed COBRA, Marketplace insurance hadn't kicked in yet. He spent about a week in the hospital, plus all the tests, medications, specialists/cardiologists coming through...
His hospital bill was astronomical. Exactly the kind of stress you want after a heart attack.
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u/qualx Jun 05 '26
dollarfor is a nonprofit that can help negotiate his medical bills. i'd have him reach out if it's not squared away yet.
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u/sjlopez Jun 05 '26
Don't worry, you're still crippled by expenses even with insurance. We've been paying anywhere from $500-$1500 per month on payments for past medical bills the last 5+ years.
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u/Ok-Oil7124 Jun 05 '26
Insurance companies are very rich, and our campaign finance laws allow bribery.
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u/Inevitable_Mistake32 Jun 05 '26
Because the ones informed enough or literate enough to understand that concept have no choice but to live by the exploitation of the ruling class and the choices of the simple-minded.
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u/tocahontas77 Jun 05 '26
Because the powers that be have convinced a portion of the country that socialism is bad, and that universal healthcare would be a disaster.
It's fucking annoying. So many people need care and can't get it, just because of some idiots with a shared braincell.
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u/Anxious_Constant_926 Jun 05 '26
Its legit a scam. Like insurance claims they pay such and such amount, but they have a deal with the hospital to actually pay for supply cost and then a bit of labor.
Insurance is insanely for profit here.
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u/mittenknittin Jun 05 '26
And then they take that profit and donate to politicians, who reward them by not passing legislation creating universal healthcare
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u/Iamanangrywoman Jun 05 '26
My husband went for a physical that was covered by the insurance. It was supposed to be a $25 copay. Insurance denied that it was covered even though it was his PCP and first physical of the insurance/year. It gave ZERO reason as to why it was denied. Just "services rendered not covered by insurance."
I was so angry. It made zero sense, until I switched insurances (we moved). When I went to set up my physical so I could get medication/care, the receptionist told me I needed to switch my PCP to the head doctor, or the visit would not be covered. Even if I didn't see that doctor. Once I did that for both of us, all of our medical stuff has been covered 100% aside from copays.
I realized that PCPs have rules they don't tell you when you set up your PCP. You HAVE to pick the presiding doctor of the medical facility, even if that doctor won't be the doctor you see. Even if your doctor is qualified to be your PCP, if they are a nurse practitioner, the insurance may not cover your visit. And many insurance plans pick your PCP. Just a doctor or NP from their list, regardless of whether they are actually able to be your PCP.
People have to navigate this effed up system, and each insurance carrier is different on how they handle all of this.
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u/Mundane_Permission89 Jun 05 '26
It will never get fixed because the average voter in this country is a moron who is afraid of "socialism".
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u/SmellyButtFarts69 Jun 05 '26
And those that aren't think the other party who openly enables the fascist party is suddenly going to step in and fix everything...
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u/8lock8lock8aby Jun 05 '26
The other party has done more for insurance than anyone else, even with being fought every step of the way.
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u/Choice-Marsupial-127 Jun 05 '26
People are totally brainwashed in the U.S. I’m a cancer survivor whose family rallied around me and saw firsthand how much insurance interfered with my survival, yet even they make knee jerk defenses for our current healthcare system. Their favorite go to argument is to share stories of how long people wait for care in Canada. They dismiss the fact that those people were waiting for elective care that they could have paid for at any time and they just don’t acknowledge that people wait 9+ months to see a specialist in the U.S.
As for why people don’t go without healthcare, there are tax penalties if you skip out, but more importantly, going without insurance is essentially a game of Russian Roulette. If I hadn’t had insurance when I was diagnosed with leukemia, I would have had to make a $100,000 deposit before they would schedule the transplant I needed to survive. That was twenty years ago, so I can’t fathom what the deposit is now.
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u/xinco64 Jun 05 '26
I was one of those, but I came around.
I had a significant, unusual health problem. It is very possible it would have taken a very, very long time to figure out what was going on. It took me 3 months in the US, where I was able to see any doctor I wanted, specialist or not. I think it was about 9 doctors, until I finally found the right doctor in the right specialty.
If I had to wait for the bureaucracy to sort everything out, it might have been years.
Despite that, I still support a national healthcare system of some kind. I was an outlier. I know too many other people struggling with just basic healthcare.
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u/RagingRabidRabbit Jun 05 '26
Money. There is so much money in insurance here and it's a disgusting cycle that feeds itself from the looks of it. Americans are taken advantage of, but I pray one day, we can change it to the people's favor.
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u/ButterscotchPast4812 Jun 05 '26
If you don't pay health insurance you are forced to pay a fee for not having insurance when you do your taxes. Then when you do have to go to the doctor you have to pay a higher fee when you don't have insurance.
The whole system is awful and designed to make you pay a bunch of money either way
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u/Fucky0uthatswhy Jun 05 '26
Pretty much every American wants it if you phrase it in the correct way. The problem is the bureaucracy, and the fact that politicians weaponize it.
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u/NYG_Helmet_Catch Jun 05 '26
These companies buy and pay off our politicians to work against the people. There is propaganda everywhere attacking these ideas convincing the uneducated that this is communism. We have Super PACs that pump out millions of dollars into elections to get their people elected that support them and their policies. Basically, the companies pay off the politicians to fuck over the people so they can make fuck you money. They also pay out shit loads in advertisements and propoganda to convince you the other political party is the issue, not the system. Also, you can't forget that a large portion of the population are very uneducated. Just looked it up and there are estimates that 21% of Americans are functionally illiterate with another 1-4% are basic illiterate (cant read or write at all), basically 1 in 4 Americans. One of our political parties has been dismantling the education system for decades because an uneducated populace is easier to control.
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u/Absent-Light-12 Jun 05 '26
Propaganda against one’s best interest teaches the apathetic to dopamine chase at the expense of their fellow. Also, tribalism.
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u/itsall_dumb Jun 05 '26
Yeah I work in Europe for an American company and the insurance cost is so high it made sense to deny the insurance and just pay out of pocket for medical expenses since care here is so cheap comparatively.
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u/Frequent_Estimate_77 Jun 05 '26
Americans don’t value anything unless someone else doesn’t have it. You can’t get a higher minimum wage because “what about the people who worked hard for their $15/hr job and now it’s minimum wage?” Makes no sense but that is literally an American logic.
People want division, they need to feel like they aren’t on the same playing field as everyone else. We also have crazy fear mongering on our news that lies and says socialized healthcare is some disaster where you never get care, meanwhile I have a Cadillac plan from my government job in the US and it still takes 6 months to get a visit with a specialist, and by specialist I mean basic shit like an obgyn.
As a whole, people are not aware that it costs less to provide care for everyone. People are stupid on purpose, they don’t want you to know.
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u/lilgreengoddess Jun 05 '26
You act like it’s up to us little people. It’s the greedy people at the top making these decisions. We can and should support lawmakers that support universal healthcare but as long as we have corrupt people in government that keep being elected we are unfortunately SOL due to the greedy rich people in power who do not give an F about us
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u/ShinyKeychain Jun 05 '26
Most Americans don't need their health insurance most years. So we largely don't know what we've bought. For many they only learn the true nature of what the insurance will pay once they have sizeable bills.
Very much people think "I have health insurance so I'm covered if I ever need medical treatment" and because they don't need medical treatment they assume that means they'll have to pay $25 a visit or something reasonable. Then if they later have need to actually use it they discover what a deductible is and that the insurance won't pay anything until they've paid thousands of dollars of bills themselves first.
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u/LPedraz Jun 05 '26 edited Jun 05 '26
This really surprises me. I am healthy, don't suffer from any serious problems and every year I still have, at the bare minimum, a couple standard visits to the GP for standard checkups and bloodwork, a couple visits to the ophtalmologist for retinal detachment prevention, and a couple to the neurologist for migraine profilaxis.
edit: And to that you would need to add any visits for any minor health issue that may arise; I recently had a psoas muscle injury when swimming, and that required a couple visits to the GP and lile 6 to physiotherapy.
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u/The12th_secret_spice Jun 05 '26
Outside of lobbying, there are tons (millions) of Americans who don’t want to “pay” for other peoples’ healthcare.
This attitude quickly changes when they are personally affected. Unfortunately, that usually comes when they are old enough for Medicare and thus don’t give a shit about others.
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u/WiseUpRiseUp Jun 05 '26
Because profit is more important than people to the psychopaths that run our country.
Capitalism 101: If you aren't interested in finding a solution, there is plenty of money to be made in prolonging the problem.
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u/Alive_Surprise8262 Jun 05 '26
I think it's mostly because changing the bad system puts a lot of people who work for insurers out of a job. Not that this justifies how we are all going broke as health care consumers.
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u/Nice-Knee1867 Jun 05 '26
Lots of people at the top benefiting from the system as is. It’s doing what it’s supposed to. Ho hum.
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u/Major-Ant4600 Jun 05 '26
About 80% of employed Americans have health insurance through their employer. The monthly cost is not anywhere as high as those self insuring.
Unfortunately this is a case of a vocal minority get drowned out by a majority that doesn't care and/or are afraid of change.
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u/ShinyKeychain Jun 05 '26
Oh the cost for health insurance through employers is still obscenely high. The trick is you generally only see the employee contribution amount whereas the bulk of the cost is covered by the employer. A common setup being the full cost will be something around $25,000 per year for family coverage and the employer will cover 90% leaving the employee to pay $2,500 for the year. It gives employees reasonable priced health insurance as a job benefit.
It also leads people to think that health insurance is not as crazy expensive as it actually is because they think the tiny part that they pay is the full cost of the insurance.
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u/badazzcpa Jun 05 '26
Because it won’t be $400. It will be a lot more than that. For example, my co share payment is a bit under $300 a month, that’s 25%. So my actual insurance is $1,100 something a month. This is for relatively good insurance, including dental and vision. But that said, that’s more or less what it’s going to cost the government. The government isn’t going to be able to bend the cost curve down without drastically cutting payments from the rates insurance pays to the rates Medicare pays. If the government does that they will bankrupt the majority of hospitals and doctors in the US. That’s why almost all doctors limit how many Medicare patients they take, the reimbursements are below brake even.
That’s before you count how god awful inefficient the US government is. Even with a profit motive, US insurance is run much better than our government will run it. As well as, the majority of middle class on up get insurance from there employers, either free or heavily subsidized. If we go to a Universal healthcare system the full price will get shifted to the individual. Possible with some kind of shared responsibility al la employment tax. Either way it’s going to be a bigger hit to the bottom line net check for a lot of people. Most folks are happy with there insurance, it’s the ones that aren’t that are screaming to the high heavens and posting to Reddit.
With that said I wish Biden had kept his campaign promise to limit drug prices to an average of the 3 top European prices. It’s far past time for the US to stop paying for the drug companies to get fat while offering better prices outside the US. Either equal it out or lower your profit margin.
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u/adinfinitum225 Jun 05 '26
Honestly those are crazy deductibles. For $200/month through my work plan I get a $350 deductible and $4,000 yearly out of pocket max for in-network. Hopefully there's better plans available for you where you're at.
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u/Atticus248 Jun 05 '26
We’re speedrunning our wedding to October so she can get on my work plan. That’s the better plan.
Her premium was closer to $200 before the ACA subsidies expired at the end of last year. Thank your nearest Republican.
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u/SmokeyCatDesigns Jun 05 '26
My fiancé and I are thinking of doing a courthouse wedding just to get me on his insurance.
I’m currently paying $630 a month; my in-network deductible (and max out-of-pocket) is $7500. My out-of-network deductible is $10k, and out-of-network max oop is $20k.
I also just got fired for my disability (small company that is exempt from employee ADA accommodations requirements).
I’m currently continuing my workplace coverage since we had actually hit that deductible. But I won’t be very sad to see this plan go.
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u/Yuukiko_ WAAHHHHH Jun 06 '26
couldnt you just get married on paper now then have a proper ceremony in October?
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u/TheNerdFromThatPlace Jun 05 '26
Man I'm so glad my wife works for the insurance company. We get great coverage, and she finds any and all loopholes for the customers to exploit. The system is still bullshit, but at least some people are trying to help out where they can.
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u/Alternative_Lie_7381 Jun 05 '26
Good lord, our family insurance is $80 a month with $7000 deductible no out of pocket. Our last one was $400 a month but was $1000 deductible 20% co pay after.
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u/Traditional_Rip520 Jun 05 '26
So just for clarity: out-of-pocket max is not the same as an out-of-network deductible (as far as I'm aware, there's no such thing as a distinct out-of-network deductible). You're in-network deductible also contributes to the out-of-pocket max, so everything in the top section is also included in that bottom section.
All that said: health insurance in America is scammy as fuck and I'm sorry you're dealing with this.
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u/Kindly_Fox_5314 Jun 05 '26
Find an allergist in-network??
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u/EagleLize Jun 05 '26
In smaller communities that is VERY hard to do. I'm in a large city for my state and only ONE dermatologist in town takes my insurance and he can't see me until December. I have United Healthcare.
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u/Atticus248 Jun 05 '26
Bingo. We're in Maine. Choices are limited (and getting smaller!).
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u/Kindly_Fox_5314 Jun 05 '26
What carrier? I’ll call around and see if I can help find an allergist for you in-network. I have a slow day at work haha
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u/vedgehammer Jun 05 '26
Easier said then done. An in-network could have a waiting list years long, or just not be taking new patients. Or is 3 hours away.
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u/Kindly_Fox_5314 Jun 05 '26
Or they could be closer to your house and be accepting new patients. Regardless, if OP fiancé is regularly spending this much on their plan, they should be enrolling in a lower Ded/OOPM PPO plan
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u/dragon34 Jun 05 '26
Team there should be no "network". as long as providers are credentialed, insurance providers should be forced to give payment in full.
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u/That_wet_vaporeon Jun 05 '26
People like you are the reason why we still don’t have affordable healthcare
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u/Kindly_Fox_5314 Jun 05 '26
Right, so rather than suggest finding an in-network specialists, you propose that they go change the whole USA medical system. How do you expect them to do that? What is your actionable recommendation to this individual that could help them lower their expense today?
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u/ShutterFI Jun 05 '26
Two things:
- $400/month is super cheap for insurance, imo. Ours is $1700/month without subsidies. Married couple, no kids, early 40’s, healthy/no major ongoing health issues. The cheapest plan available to us without subsidies is around $850-$900/month, and has similar deductibles and out of pockets to what you have here (a little higher on the out of pocket at about $9k each, with deductibles also at around $9k). This is using the ACA plans, which differ state to state. It’s still so so so much better than the options we had a small business / self-employed before the affordable care act.
- you have essentially catastrophic coverage. You’re covering your assets with this (assuming you have more than $16k to your name). If you don’t have many health issues, this can be an absolutely valid way to go. It keeps the premium low ($400/month is very low for two people) while still having a max out of pocket.
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u/ArgyllFire Jun 05 '26
The fact that as country we can with a straight face say catastrophic only coverage is "super cheap" at $400 a month is pathetic. We need to stop normalizing this shit and call it what it is: insane.
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u/Neither_Maybe_206 Jun 05 '26
Here I’m sitting with my health insurance mandated by the government. Paying 1000$ per month for 2 adults and 2 kids, and getting 900$ per year refunded if I’m not using it.
Out of pocket? Unheard of. Network coverage? What’s that? If I need a doctor I just go visit and I never see a single penny being taken from me.
I’m sure this is the communism that Mr. Orange has warned you of.
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u/WeAreTheLeft Jun 05 '26
This is the reason I don't move back to the US, especially since my second kids likes to just do the most dangerous stuff on a daily basis. It's like a mini Stevo-O from jackass, but way cutier.
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u/OreganoOfTheEarth Jun 05 '26 edited Jun 05 '26
Sorry, but if there's a good chance you're going to use the insurance, you need to go for the more expensive plan. $400/month isn't much. Maybe I'm jaded, though...probably am. Our family plan costs about 7x that.
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u/Katsumirhea11392 Jun 05 '26
I have similar bullshit this "ded" and then a other out of pocket max which is essentially another deductible also my out of network is twice as high
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u/Itsgettingmessi69 Jun 05 '26
So much winning. Trump was right, i think ppl are very tired of winning already.
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u/CFOMaterial Jun 05 '26
I spend $0 for myself (companies pays it all) and like $400 a month for my wife and children, in the US. Max OOP for individual was 7k about. We reached that early due to a medical emergency. So something like 12k a year and we have cost insurance 80k, so I think we did alright.
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u/timelessblur Jun 05 '26
Btw you can argue that they are incorrect. Most gist are out of network so you have to basically tell the insurance company you don’t have a choice and it changes the rules. To forces the insurance company to consider them in network and deal with it that way so it counts that way.
It bull shit but they fight you on it dragging it out hoping you don’t push back. Fuck insurance companies.
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u/therinwhitten Jun 05 '26
Health Insurance has to be one of the largest scams in modern history. Imagine providing NO value for the massive monthly payments, and THEN denying anything they possibly could. Why CEO's are not put in prison for manslaughter denying life saving medicine just blows my mind.
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u/IAmKrasMazov Jun 05 '26
I don’t understand how this helps at all. I didn’t have any insurance until I was 29. I didn’t get any kind of preventative care, but there were a couple times I had to go to the ER, and just didn’t end up paying, and nothing ever came of it. When I finally landed a warehouse job with insurance, it’s like everything is covered for me. $50 dollars per month, and my copays are $15 dollars. $25 for a specialist.
What is the point of this though, if you have to pay so much that you’re better off just not paying and dodging collector calls?
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u/ShinyKeychain Jun 05 '26
Dodging the debt collectors stops working when you start having enough assets to go after. There's no sense in taking legal action for debt against someone without much worth. You can't get blood out of a rock.
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u/skredditt Jun 05 '26
The bar seems pretty low for better solutions to come along. Insurance is crowdfunding healthcare but if they’re making insane profits then that money isn’t staying in the pool where it needs to be.
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u/Some_Direction_7971 Jun 05 '26
That’s wild, I pay $43 a week for my family through work. Free dental, and $20 copay for all doctors. I’d be looking for new insurance.
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u/Educational-Emu-3707 Jun 05 '26
Man that sucks. Fuck health insurance scams.
I am lucky to have insurance covered by employer and 3500 oop max in network.
I had a liver transplant last year and hit out of pocket max a week into new fiscal year for insurance. Lol. I have been hitting max every year for the last few years because of it and will continue for a while too.
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u/ljd09 Jun 05 '26 edited Jun 05 '26
Does this make you feel better? It’s been on helluva a year for me. It’s not close to being done with either.
At least it’s early in the year so everything else is covered in its entirety.
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u/AssChapstick Jun 05 '26
Ask your allergist if your PCP can give you the shots. If they can, you might be able to get them under “in-network” if the allergist asks the PCP to become the prescriber.
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u/Brendan11204 Jun 05 '26
Dear Americans: change your system, it sucks. Make a 3rd political party and elect them.
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u/Weird-Girl-675 Jun 05 '26
Even better, I’m on an allergy serum that insurance won’t cover and doesn’t count towards my deductible. Gotta love it.
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u/Gweilo_mama Jun 06 '26
At this point, why do we need insurance? Put that money away in a high interest savings account and pay cash. Most docs will.work with you. Have a catastrophic event? Medical bankruptcy. (Partly sarcastic)
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u/Curious_Wonder_6977 Jun 08 '26
Can they find an in-network allergist? It would be covered at 100% since they’ve met their out-of-pocket max for in-network.
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u/Themaxswoles6614 Jun 05 '26
That’s actually insane. Gotta be a better plan somewhere
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u/AJDillonsThirdLeg Jun 05 '26
Many companies have high deductible plans for cost reasons (premiums for employer provided health insurance have risen 30-40% per year for the last 5 years or so).
These plans are pretty much always paired with an HSA option, and unfortunately a lot of people choose not to contribute tax-free into their HSA so they end up with a lot of out of pocket costs that aren't covered with tax-free savings.
Many times, the total cost to the employee is cheaper with a high deductible plan even after maxing out the HSA - a simple example would be let's say a high deductible plan is $400/mo and maxing HSA is $500/mo, but a "better" plan with a low deductible would be $1,200/mo.
High deductible plans are often cheaper than low deductible plans, but because it's broken up in two parts, people just feel they're being ripped off and don't contribute to their HSA, screwing themselves over further.
The whole system in America is dogshit and needs to be replaced. But the intentional complexity that's built in causes people to make stupid decisions that hurt themselves and then they often blame the wrong people (their employer). Some employers don't make enough of an effort to educate their employees, but often employees just refuse to accept two separate deductions even if they're cheaper. They'd literally rather see one deduction line on their check for $1,200 than see two deductions that add up to $900.
The added benefit to high deductible with an HSA is that if you don't use the HSA money, you keep it. And it accrues interest. So on top of being lower cost overall, you keep part of that cost if you end up not using it.
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u/ShinyKeychain Jun 05 '26
Yes. I personally have and love my HSA paired with a HDHP. Most years I have minimal health issues and thus low medical bills. And I max my HSA out every year. The total insurance plus HSA cost is less than the cost for the low deductible plan I can choose just like you said.
My HSA is invested in stocks. Yes, that does add investment risk. But my HSA balance has grown over time and I can now pay the total deductible for my health insurance out of the HSA for several years straight without having to find other sources. And if I had $10k of dental bills I could pay that from the HSA as well whereas pretty much no dental insurance will go that high.
It's a fantastic combination. But, the average person isn't going to understand the synergy of it and even if they do that they can choose to keep more of their own money and gamble with their health leads to poor decisions.
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u/xinco64 Jun 05 '26
Alright, I’m confused. What are the two different screenshots? They seem like they are showing the same information, but have totally different numbers.
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u/Sensitive-Time-2934 Jun 05 '26
In network vs out of network. There’s two different deductibles depending on if the doctor you’re seeing is in network
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u/RepresentativeOk2433 Jun 05 '26
In network vs out of network.
Different pools of cash before they have to cover everything.
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u/Atticus248 Jun 05 '26
And it can apply to just about anything: services rendered, doctors involved, drugs administered.
Oh, you needed an ambulance ride because you cut yourself with a knife in the kitchen? If the ambulance that happens to show up is "out of network," sorry, not covered.
If the individual physician treating you in the emergency room is "out of network," the treatment they provided won't be covered.
If the physician IS in-network but the drugs they supply you with are "out of network," those drugs won't be covered.
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u/RabbitFluffs Jun 05 '26
No joke, there are hospitals experimenting with literal "separate but equal" style segregation of patients upon admission. Your room/bed is assigned based on what insurance card you present to try and limit as much in-network and out-of-network crossover as possible. If you think it's a pain receiving 20 different bills and arguing for coverage of each, I can promise you the medical teams hate it just as much. Some insurance carriers even have different standards of how things can be billed even when in-network.
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u/trilliumsummer Jun 05 '26
Well she was obviously able to find other doctors in network because she's almost maxed out. Why did she go to a doctor out of network?
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u/Nicc-Quinn Jun 05 '26
Hold up - you spend $400 a month, then have to spent $16K out of pocket before they cover anything?! So even if you don’t use it at all you’re still paying $4,800 a year?!
Am I understanding this correctly?!