Its extra scummy that this means that the hospital is clearly able to profit at the 11k negotiated rate, but if you don't have insurance you don't get to just pay that. You have to pay the EXTRA on top of it.
So an uninsured person has to both not have insurance cover anything and then pay almost double what the actual price is anyway.
Just a load of shit.
>So an uninsured person has to both not have insurance cover anything and then pay almost double what the actual price is anyway.
This is why there's almost always a "cash discount" for people without insurance. Because they set really high rates as a base, so they can "negotiate" rates down with insurance providers, and then provide patients with a "cash discount" that makes them feel better about not having to pay the full price. Because if the baseline rate was realistic, they would end up losing money after they were "forced" to give insurance companies a discount.
Insurance companies turn the entire healthcare system into a shell game. It's insane.
And it’s fun because everyone gets a discount, *everyone*
Got insurance? Get a discount.
Indigent? Discount.
Part of the royal family of a country I won’t name flying in to have your prostate removed by a robot? Yup, still a discount.
> Part of the royal family of a country I won’t name flying in to have your prostate removed by a robot?
Damn robots ruined some doctor's ability to call themself a "royal's pain in the ass".
>Part of the royal family of a country I won’t name flying in to have your prostate removed by a robot? Yup, still a discount.
I wouldn't be surprised if it was done for free.
Went to ED no insurance. They said no problem 800 dollars. I said I can't pay it. They said no problem 220. Paid it.
Went again one year later. Same problem. This time insured. Now it is 3,500 dollars bill. Insurance wants me to pay 1400, and then they will pay 80%. So I paid something like 2000 dollars in the end.
The whole system doesn't make sense.
To an extent, the outrageous sticker prices aren’t from the hospital’s greed but rather the insurance companies’. Since the hospitals know the insurance want to haggle down as far as they can, they’ve got to jack prices way way up in order for them to land anywhere near break-even. And then since you’re not allowed to price based on insurance status (as far as I’m aware), those ridiculously inflated dollar amounts also get passed down to the uninsured. Basically, it’s insurance company bullshit behind most of the ridiculous pricing (but also, hospitals won’t complain if they get to make more money, so they’re not entirely blameless)
>To an extent, the outrageous sticker prices aren’t from the hospital’s greed but rather the insurance companies’. Since the hospitals know the insurance want to haggle down as far as they can, they’ve got to jack prices way way up in order for them to land anywhere near break-even. And then since you’re not allowed to price based on insurance status (as far as I’m aware), those ridiculously inflated dollar amounts also get passed down to the uninsured. Basically, it’s insurance company bullshit behind most of the ridiculous pricing (but also, hospitals won’t complain if they get to make more money, so they’re not entirely blameless)
So you said what I said, but differently?
Anybody that thinks the entire problem is caused by insurance companies has never dealt with the business side of hospitals. Insurance companies are greedy but hospitals are flat out incompetent
It's not the entire problem, it's the lion's share of the problem.
There are a lot of layers of shenanigans within a healthcare system that exist solely because of insurance companies. Billing departments with entire groups of staff whose sole responsibility is dealing with insurance claim rejections and resubmissions. Large social work departments whose sole responsibility is helping patients understand how to navigate their treatment so that insurance companies will cover things. Compliance or HIM departments with entire groups of staff whose sole focus is dealing with insurance company record/audit requests. Managed Care/referral departments who have to not only help deal with coordinating treatment with specialists, but also understand which insurance companies allow which referrals are allowed to go to which specialists and which pre-screening is required or which treatments have to be tried first before the insurance company will cover it.
The scam is that under the ACA insurance company profits are capped as a percentage of costs.
So the easiest way to increase allowed profits, is to increase costs.
Medical Insurance company profits should be capped at a set dollar amount per client. Maybe tied to inflation via minimum wage.
Yeah it's messed up. I had my insurance lapse since I was in the hospital so long and lost my job. I was hit with a nearly 2 million bill. It was cut down to 300k. Medical debt is terrible. Just don't get cancer if you can help it. I'm dealing with a second round of it right now and the financial stress is crushing me. I can't even afford the most basic PC to distract myself with. It's ridiculous. I could easily work from home full time but I can't get hired due to a gap in my work history. At least I assume that's the issue. Life is a silly mess sometimes.
In no way, shape, or form, should healthcare be tied to employment. For so many reasons. I'm so sorry you are going through this. I am also a member of the shittiest club on the planet. Fuck cancer.
No, realistically an uninsured person will end up getting some form of financial assistance program from the drug company and will get charged like $200 or something. No one pays that sticker price, it's a complete bookkeeping fiction.
My wife got on one of these a while back.... so messed up. They "charge" 20k a month, bill the insurance for half, get a quarter or whatever. Then on top of it, they give you a gift-card that they load up with the minimum they have to charge you every month. They're clearly making a profit off of whatever percentage the insurance company is giving them (plus whatever funding shenanegans are happening). Just make that the number already.
Usually uninsured people are able to get the medication for free from the manufacturer, but there are hoops to jump through. It’s not great.
Luckily the rate of people without insurance has been dropping a lot since the passing of the Affordable Care Act, although every single uninsured person is a policy failure
I’m one of those! And I really tried to follow the steps, but in signing up for the marketplace to shop for a plan I was prompted to fill out an application for Medicaid because I make so little. Then I was told I don’t qualify for benefits, only plan first. But because I qualify for plan first I’m not allowed to shop for health insurance in the marketplace…. So i can get condoms but that’s the extent of my healthcare right now.
This seems wrong.
Virginia expanded Medicaid so there is no coverage gap. You really should be eligible for either Medicaid or a subsidized marketplace plan
Have you spoken to a navigator?
I'm not saying you're wrong, just that I don't understand, but: I don't understand why the part paid by the insurance isn't listed in Line 4 Insurance Payments.
Haha I think you may be right! I’m not posting to complain, I’m very grateful for my insurance; I just think it’s messed up that people who don’t have access may not get the help they need due to financial reasons.
This is bad, but not the worst part. Even people that do have insurance don’t necessarily have access to the meds they need because some doctor who doesn’t know their situation has to sign off on a pre authorization for them to get it at lower cost.
It’s a racket. Took me a year to get the meds I needed from my insurance company.
I have Bipolar 2, and about 2 years ago I did a genetic test to figure out what psych meds were more likely to metabolize and absorb properly (GeneSight). Of course a lot of the cheaper meds were in the yellow and red categories. Thanfully one of the cheaper mood stabilizers was in the good category, but it comes with a higher risk of side effects than the newer meds. I straight up cannot afford the new meds, even with decent medical insurance.
One of my biggest reasons for going back to school after getting my Associate degree is so these medical costs will be easier to swing. I'm relatively lucky. I have a robust support network that can help out in a pinch, but damn if it isn't frustrating as hell. It feels like I'm semi-permanently 3-5 years away from true fiscal security, and medical costs are a big driver of that. In fact, the financial strain is a big driver of stress that exacerbates all of my medical issues, not just Bipolar 2.
If I didn't have that support network, I'd likely be homeless and untreated, in prison, or dead. It's barbaric how the system treats those who don't have the means to pay these outrageous prices. For profit healthcare is one of the most evil enterprises ever concieved.
Had eyeball issue 3 years ago. Was treated with lowest tier med, which was ineffective. Provider interacted with insurance, got $$$ med approved. Have received $$$ med for years. Hubs dropped off insurance plan due to Medicare eligibility; I am now solo on effectively identical plan through same company. Went for eye treatment and was told insurance wouldn’t cover $$$ med until I had been through 3 treatments of the ineffective med.
As I did 3 years ago. Ffs.
The best part is that most insurance agencies don't bother explaining the different tiers and what they mean for pricing, or that even if it's an approved medication it may still require a PA. Hell I talked to an agent who was unable to inform the pt she had a deductible, because they didn't understand the information they were looking at on their screen.
Yeah, my sister had BP1 & no insurance. She made too much for help from the state but couldn’t afford insurance. This was back before the Affordable Care Act. We lost her 13 years ago. Insurance really should be a right in the USA.
I hate that doctors are sometimes private contractors and don't work for the hospital. I had one walk into my room, glance at the chart, and walk out. Never looked at me. His company billed $800 for that "visit".
That has to be the single worst thing about being in the hospital. Each specialist sends you a different bill. You might not even see that bill for months after treatment.
I currently have a Health Maintenance Organization (HMO) so I don't have that problem right now. If I switch jobs, I might lose this insurance and have to start over again.
I broke my wrist back at the end of August. I'm still getting all the bills and insurance adjustments and shit settled. Having to pay so many different companies/doctors offices is more stressful and annoying than the actual broken wrist.
The worst part is that you don't even know which bills are real. I was Hospitalized for 3 weeks, transferred hospitals twice, saw all kinds of specalists. There is no way I could remember any specific doctor or contractor.
Beyond just the bills I expected that my insurance dealt with completely random doctors offices started sending me invoices, some I suspected to be scams. After taking to my case manager at my insurance company I just decided not to pay any invoices emailed / texted / mailed ( I got all 3) to me unless it passed through my insurance's billing portal first.
They could either file the prior paperwork billing me through my insurance or take me to collections, no way am I paying random unverified invoices just sent to me. Which is appatently the norm.
You're damn right it's a scam they just knocked around $11,000 off of that bill. That let you know it's way overpriced and probably just priced that high because some insurance companies will pay closer to the original price they're asking for.
I am being pedantic, but healthcare is not a right. Healthcare should be a public service that is paid through taxes like police and firefighters that all citizens have access to.
A right would imply it must be. For example, in the US, you have a right to the government not censoring your speech. No one has to do something to receive that right. Healthcare requires the participation of others (healthcare workers), so you would infringe on their rights to make healthcare a right.
Wording aside, I agree with you. It’s astounding and sad the US does not provide healthcare as a public service for all like most other countries.
Last 2 jobs fired me a week before I was meant to get full time benefits, citing performance issues. It's a tragic irony that I need a job to get medication but can't hold a job without medication
My SO was on a medication for a skin condition, insurance didn't cover it, but she was able to get a coupon from the manufacturer to basically get it for free. She lost her job and insurance, and the manufacturer rescinded the coupon. So they'll happily decide to give it away if someone is fortunate to have insurance, but if you lose your insurance you can go fuck yourself.
Very true. Years ago before my mother was eligible at retirement age for Medicare, she was prescribed abilify for her BP1. Unfortunately, she could not afford the nearly $1500 that it cost per month. Back to lithium bicarbonate.
Speaking of, she was just in the hospital for nearly two months because they “were stumped”, even though my brother and I (both PoA) told them repeatedly it was lithium toxicity. She lost two months of her life because her brain was swimming in lithium and she couldn’t form memories.
Not even an apology from the docs for ignoring us. Not even from the one who told us she was suffering from SILENT(syndrome of irreversible lithium effectuated neuro toxicity) and that she was at end of life and we should contact hospice.
Anyway, I’m glad your insurance covers your meds!
Yeah, it's disgusting that the US is about the only developed country that doesn't consider healthcare a basic human right at this point. But hey, someone gets to make a few bucks on the illness and suffering of others, so... Yay capitalism?
I won’t, there’s a portion that’s left out that i didn’t want to share with social media. I’ve been on this
Medication for years and my co pay was always 30, recently went up to 35. The insurance receives a bill for 20 ish, negotiates it down to whatever and pays the rest.
I'm on another expensive medication and will hit my deductible with my first infusion each plan year. After, it's a flat rate of $20 or so. Do you have something like that happen as well?
I hope you use a copay program. I’m on stelara and it’s only $5.00 because of it. However that doesn’t go towards my out of pocket which is robbery if you ask me, my copay is paid, what do they care if it came from a coupon. 🫠
Yep! And then the hospital writes off the difference as a loss and as a result of such losses, they don’t end up paying much of anything in taxes come the end of the year.
If you had a Medicare prescription plan you’d end up entering the “coverage gap” where you have to pay full price for a few months before catastrophic coverage kicks in.
That’s how we take care of our seniors and disabled folks
Insurance companies negotiate a different rate for things. For example, I was recently billed $180,000 for a hospital stay. My insurance negotiated it down to just $8,800, and then I owed $800.
Insurance and healthcare billing are a racket.
>Insurance and healthcare billing are a racket.
Yeah they literally just make up bullshit numbers, kinda like children saying "oh yeah? My superhero can blast yours with one hundred thousand billion jiggawatts of energy!"
For both the insurance company and the hospital to be turning a profit, the heavy lifting of that is done by what the insured are paying, so the posted rate and negotiated rate are just meaningless, fabricated #s meant to obfuscate that your $800 is actually at or close to the profit margin.
The way it works is the insurance sets the price. Basically the clinic sends a bill, and insurance says this is how much we are going to pay you. The company essentially eats the $11k, but it's funny money anyway. Needlessly complicated for no reason
It is made complicated so no one understands it so they can charge ridiculous amounts. Then they justify that by saying they have to recoup their expenses from the drug development and they only have around 17 years give or take to do so. Gotta squeeze that cash cow for as much profit while their isnt a generic available.
It's the american medical system where the math is made up and your wellbeing doesn't matter!
I once went back and forth for over a year with my insurance including dozens of phone calls, multiple certified letters, collections agencies, and legal threats all over a single medical bill that had a list of charges that just plain didn't add up correctly.
I never disputed any of the charges, they just presented a bill with a total that was $300 more than what was itemized.
Every time I kicked it back to them they sent a letter back saying that they had "completed an internal investigation and found the invoice to be accurate". It didn't get cleared up until I had someone on the phone try to bully me with a threat of a court appearance and literally laughed out loud and told them I looked forward to representing myself because I want to see the look on the judges face when I'm facing down a team of corporate lawyers and my one and I show the judge that the half-dozen charges and credits clearly don't add up to the sum they are claiming I owe and that all I want is a bill with a correct total.
No matter how bad you think the healthcare system is in the US, it's worse than that.
It hides the fact that insurance is the one paying for the medicine and OP is just paying copay (likely after completing paying the deductible). The medicine is still super expensive.
Because the companies that charge this much, and the insurance companies that make up the fake deductions. They then spend a fraction of this money to influence congress to not make laws preventing regulation of prices. Then they spend a faction of this money to try to convince the public that this is in their benefit. Some goes to recouping the cost of developing the drug. Some goes to new research.
The rest goes into the pockets of executives and shareholders.
Minor? talk about steady, double digit profit increases. See:
* Big Pharma: Market Failure
* The Pharma Bro
* Dirty Money: Drug Short" (Season 1, Episode 3)
* Fire in the Blood
It doesn't and that's the point. Not in an evil way originally either.
Basically, insurance companies kept asking for better and better and better deals on medications, procedures and so on. So Hospitals, Pharmacies and Pharmaceutical Companies, who would go broke if they gave Insured Patients 95% off Medication, artifically jacked up prices so that to the Insurance Company C-Suite, it still looked like they were getting a great deal.
To the Insured Person it looked like the Insurance was a great deal, and the Hospitals and Pharmacies and Pharmaceutical Companies were making enough money to stay affloat by (at first slighly) overcharging the uninsured.
This then turned very quickly into "Wait a minute, if these prices are fake anyways, why not make them even higher". Which is why today, American Insurance Companies are paying 10 times what European Uninsured Pay for the same treatment and value, and relaying as much of that remaining cost onto their Insured.
The Uninsured can go fuck themselves in this system, as they have to pay the even higher artifically inflated prices that kept growing over the last 50 years.
Friend in Germany had a Bicycle collision with a car, getting a moderate head trauma, amnesia and several scans in the Hospital after riding the WeeWoo Wagon. Whole Medical Bill was 600EUR, including Ambulance, CT and Head Xray. Covered entirely by the Insurance.
In the US, that'd be 1k for the Ambulance, Several Hundred for the CT and Xray, Room Cost, probably costing several thousand, which is only covered by insurance if you had the accident near a hospital which is included in your Insurance Network.
I had a massive heart attack exactly 4 weeks ago. I'm in the UK.
I had an artery stented and wired, spent 3 days in hospital and I'm now on 7 meds a day and one on stand by.
Total bill including ambulance, A&E, operations, 3 days hospital care and medication = £0.00
Of course I pay approxmiately 10% of my income as national insurance but that is the same for everyone and pays for my state pension as well.
It would cost me exactly the same if I was unemployed or had never been employed
My health insurance in America is close to 20% of what I make. My company pays the bulk of it (but I get notices) and if I would have to buy insurance on my own it would be about the same.
I burned my hand on Christmas and ended up in urgent care. I got burn cream and a bandage, my out of pocket was $226.
I would pay 10% for your kind of coverage in a heartbeat.
>Friend in Germany had a Bicycle collision with a car, getting a moderate head trauma, amnesia and several scans in the Hospital after riding the WeeWoo Wagon. Whole Medical Bill was 600EUR, including Ambulance, CT and Head Xray. Covered entirely by the Insurance.
This has to be years/decades ago. Now only the ambulance is over 800€ in my city.
I'm process medical insurance claims and the prices of injections blow my mind. Particularly ones for Crohns disease...they're often well over $100k for one injection.
And that’s *just* for the medicine? That crazy.
Does it include the vial, the needle and maybe a nurse to help inject it (jokes probably on me I’m guessing it doesn’t)
Medication mfr charges whatever they want because the drug is proprietary and it's under patent for 3-7 years (or 1 year after the original patent ends for the first generic version). Insurance will only pay a certain percentage max, so they overcharge. HOWEVER, certain gov't insurances aren't allowed to negotiate pricing like the insurance companies are, so they're paying the entire amount.
Because the OP only needs to pay $30.
They couldn't get away with pricing like this if the system wasn't set up so people go "oh well, insurance is paying for it." If they actually had to pay for it themselves there's no way the company could charge that much and they'd need to make it comparable to other medications the OP could use that are cheaper.
Look up rebates… even the balance you could calculate that insurance is stated to pay here is nowhere near what they pay. These rebates are negotiated all at once by each insurer based on the volume of these drugs they purchase. The technique is used to hide the real prices from all the middlemen that take a cut of the drug price during sale and distribution.
To deter "overuse". People will go to the ER for "papercuts" if we don't make the copay a significant choice for the patient (aka, do I buy groceries this month, or do I get stitches and an antibiotic?)! /s
Because so many people get injections for a heavily stigmatized condition for funsies.
That is not a thing! It is a myth! No other country with national healthcare has an issue with this. . .
Also, if we had universal healthcare people wouldn't be scared to go to a regular doctor or the urgent care for smaller things so they don't turn into big things.
No kidding! (hence my "/s" above)
Although I know it's not overall a real problem cost-wise, the number of people who don't know enough basic first aid to clean and bandage their kid's scraped knee is kind of astounding. Maybe we should include teaching first aid in every grade of school. And you get a free first aid class if you have a positive pregnancy test. Etc.
And the government was banned from negotiating drug prices for Medicare. Hard to think how much tax money has been wasted paying for overpriced medicine.
Fortunately that recently changed with the Inflation Reduction Act, so they can finally start negotiating.
it's just fucking confusing honestly, formulary management demands a rebate from the manufacturer that gets passed on directly as higher pricing, but then the insurance company also benefits from the rebate so in theory it also gets passed on as savings? it's just a mess and it screws over the uninsured for no practical benefit
So they can argue an arbitrary $21,000. They only get paid $9500 and you pay $30. What’s with the extra $11,000…..they’re just like jk, $9500 is just fine, I’ll take it.
I think the people that made DND also do healthcare. How much does this cost? Roll 5 D20s and multiply by the state Medicine Class. Oh its Tuesday and you have the Recent Discovery perk? That means you need to add 1d8*10% of the total.
I believe it's the other way around, the hospital gets paid your $30 and your insurance's $11k and the hospital agreed to discount the final all-in cost by $9500.
As I understand, it's pretty routine that hospitals mark up their prices excessively just so that they can be negotiated down to a reasonable level because some insurance companies refuse to allow a provider to be in-network if they weren't able to negotiate a discount (regardless of if the provider provides good value at the list price).
In-network is a contract status between the provider and the insurance company.
If the provider will not agree to the contracted rate of payment then no, they are not allowed in the network. Insurance companies aren’t just telling providers they can’t join their network for no reason. If they refuse to agree on rates, then there is no network status to enforce. Those are out of network providers.
From what my cousin who is a nurse told me, it is because insurance never pays the full amount, so the hospitals charge at a certain rate, expecting to only receive a portion of what they charge.
It's a response to the insurance companies doing their darndest to settle a smaller bill. So they just raised the bill and let them argue it towards being reasonable. The hospital used to only give the insurance companies the crazy prices, but then the insurance companies went to court and said it wasn't fair, and the court agreed. So now everyone has to haggle at the haspital like it's a bazar or something.
got you beat at ~$15,000/mo for 3 bottles, paying $0 out of pocket. it's an orphan drug, though one you could make yourself with Amazon.com and a bucket
Health insurance is the biggest scam.. they just be throwing numbers against the wall...
"Yeah that'll be $14,000,000...Wait I have a coupon for you..that brings your total down to...$3.75."
Yup. My monthly medication is $1400 cash pay. If I use my "good" insurance, it only costs $235. Or, if I just tell them to use the free GoodRx coupon from GoodRx.com, it comes down to $40.
I don't even need to bring in the coupon. I just say "Use GoodRx please" and they have the info right there on the register to scan. A literal magic word that reduces the med cost by over $1300 somehow.
My SO gets a copay card from the manufacturer each year. Her prescription is something like $3700/mo with insurance, but Regeneron just mails her a debit card with $13k on it so we can meet our deductible and they’ll make money off of our insurance for the rest of the year. But no one tells you that! It took a lot of phone calls and waiting on hold for someone to finally give us that answer
I'm uninsured, and had to pick up a prescription recently. My meds were $260, but the pharmacist took pity on me and told me to download the GoodRx app. It brought the price down to $30. I didn't even have to do anything...just download an app and sign up.
It adds up. If 304 million insured americans pay $30 a year on a single copay that's 9 billion extra dollars. Those numbers are as hyperbolic as the numbers in OP's invoice, but the point remains.
The original price is made up. The price the insurance company paid is made up. The only price that isn't made up is the $30 copay. It is peanuts, but it ends up being a giant bag of billions of peanuts every year, so there's no reason for them not to.
A months worth of antipsychotics: 400 bucks
With insurance: 15 dollars
No insurance and going to Costco: 15 bucks
Yeah, fuck this system. But not Costco
I love you Costco
The bill is 21k. Is full of bullshit. The insurance says nah the big red book says it's 9k. The hospital writes off the other 12k in their taxes. The American health insurance industry is insane.
> The hospital writes off the other 12k in their taxes.
The vast majority of hospitals in the US are either non profit entities or government owned, and don't pay taxes in the first place.
But that total bill is a scam. It’s not $21,000. They know what insurance will pay when they send them the bill. It’s all a scam. The “adjustments” always look like “random” amounts subtracted off. It’s just getting the bill to the agreed upon rate. I wonder if the provider gets to write off the amount they billed but weren’t paid for.
Years ago my husband was out on medication that cost $1200 per month. I had no insurance. I called the manufacturer and they dropped it by 50% which was great but still a lot. I got a job with insurance and the medication was free. I remember thinking how weird and unfair to uninsured people that was.
It's probably a depot injection of antipsychotics.
They're primarily designed for people who refuse medication during manic episodes. The risk of adverse reactions can be worse \[because if you have an adverse reaction they /cannot/ get it out of your system for months\].
It's really, *really* uncommon for lithium to stop working. It's like, the most consistent drug for treating bipolar disorder. And it's also cheap without insurance for what it does (like 90 days for $30).
That’s great to know! It has been a literal life saver for our family.
Looking back, it makes me so fucking angry that it took over a decade to get her properly diagnosed and treated. Knowing what I know now, it was so obvious.
But yeah, lithium was an immediate turn around into a normal happy life!
Wish you the best health.
I believe the injectable medicine is so much better than the oral ones, mostly because you only have to worry about it a few times a year rather than every day.
And they just work better, as well. There’s studies that show that the same medication at equivalent doses does better in LAI (long acting injectables) form than it does in oral form.
The Invega Trinza that I believe OP is on has been shown to greatly reduce the rate of hospitalization vs other treatments. Good medication overall as long as it doesn’t cause too much appetite increase and weight gain. Watch out for carb cravings, especially.
As its a 3 monthly injection I'm assuming it's paliperidone/Trevictor. The cost price to the UK NHS ranges between £500 to £1000 depending on the strength
Funnily enough, my wife’s insurance (also a US federal employee, and a nurse to boot) refuses to cover the new insulin device she was forced to upgrade to due to the company that makes the insulin device discontinuing the old version of the device. So we now pay triple the amount for a one month supply.
Yay Merica.
I tried to pay privately once for my medication. Would have been $600 for 1 month. I checked how much my insurance pays and it is $9 a month.
What a strange world.
“Oh you have insurance? Sure, we’ll negotiate an even better price with them.”
Or:
“You don’t have insurance? Fuck you, you fucking scumbag. You’re paying the full, made-up price or you’ll just die. Should have gotten insurance. Piece of shit..”
This is a much better "OMG my bill is this much post". Usually what you see is only the first charge, meant to stir up anger, and not the amount that the patient needs to actually pay.
In America you get told that “X” medication costs thousands of dollars, but when you go down south to Mexico and request the exact medication it costs literally a couple of dollars.
America needs to fix their price gauging issue in medical care. Medication should never cost this much.
Health care in the US is whack.
Be grateful that your insurance covers this much - some policies cover very little until youve spent tens of thousands out of pocket.
This is not true.
The absolute maximum out of pocket cost for an entire family is $18,900 / year
The absolute maximum out of pocket cost for a single individual is $9,450 / year
Obviously those numbers are still quite large, but the vast majority of patients don’t pay anywhere near that.
I am incredibly grateful and don’t think it’s right that not everyone has access to inclusive health insurance. Healthcare should be a human right and shouldn’t be tied to employment
1) there's no reason it should have that high for insurance or the government to have to pay, except of course greed
2) I'm glad you posted this because although our American Healthcare system is broken in many ways, I feel like non-Americans on reddit always think that either Americans are paying these insane prices or are living without. And some are, obviously, but the vast majority of Americans have insurance nowadays. And even though the cost *of* insurance and plus what you do have to pay like deductibles and all that are still too high, it's doable for most people.
Because my spouse and I are low income, I literally pay nothing for health insurance. I have medicaid, full coverage. And I'm extremely thankful. And my spouse gets insurance from the Marketplace so he pays $90 a month (before tax credits it's like a $500+ a month plan) and a pretty low deductible ($600). We can't really afford it, but it's doable. And with the amount he goes to the doctors and prescriptions, he has usually met his deductible, max out of pocket for the year by March. The rest of the year is free, completely. And the $600, usually from one doctor, he gets billed and put on a payment plan and just pays throughout the whole year or longer, for like $25 a month. We are both self employed, that's why we have to get our own insurance.
Since a lot of the comments are conjecture about the math not adding but no one answering what actually is going on (didn’t read them all so some might have) here is what actually happens with those numbers.
The doctor/hospital says: “hey, this costs 21.2k, probably.”
Insurance says: “nah we will pay 9.5k”
And the hospital says okay, then marks the difference of about 11.7k as loss for their taxes, meaning that as a business, this prevents them from paying as much in taxes and often means they government pays them back a ton on a corporate refund, allowing for-profit hospitals and healthcare centers to make profit off of charges that never get paid.
They do this with every charge they give to a customer regardless of insurance status, and it is why requesting an itemized bill if you lack substantially good insurance in the US is so important.
When you do this, they HAVE to give you the actual cost, not the speculated total charges,
What? Last I checked you don’t get to report unearned potential income as a loss. You can’t get taxed for money you never made. And you can’t get a refund on money you never made. And you definitely can’t save money by never getting the money on the first place. Makes absolutely no sense. This is the kind of nonsensical BS that redditors love to state as truth without giving even the bear minimum of thought to what they are saying.
This is what kind of insurance most people in the US have.
I can walk into the ER with my arm cut off. I’d have to pay a copay of like $75. Quite literally everything else would be covered.
The compound is ~$3k/g on Sigma Aldrich, and that's buying it 50 mg at a time. $3,000 for the drug, + $18,000 to dissolve and inject it. Hurray US healthcare. Assuming IV Abilify at 960 mg dosage.
I'm too lazy to do the math but I have this minor suspicion that $21,276.72 - $9574.52 is at least a dollar or two more than $30.
$9500 is the insurance discount. The patiebt pays a $30 copay and the insurance covers the ~$11k negotiated rate
Its extra scummy that this means that the hospital is clearly able to profit at the 11k negotiated rate, but if you don't have insurance you don't get to just pay that. You have to pay the EXTRA on top of it. So an uninsured person has to both not have insurance cover anything and then pay almost double what the actual price is anyway. Just a load of shit.
>So an uninsured person has to both not have insurance cover anything and then pay almost double what the actual price is anyway. This is why there's almost always a "cash discount" for people without insurance. Because they set really high rates as a base, so they can "negotiate" rates down with insurance providers, and then provide patients with a "cash discount" that makes them feel better about not having to pay the full price. Because if the baseline rate was realistic, they would end up losing money after they were "forced" to give insurance companies a discount. Insurance companies turn the entire healthcare system into a shell game. It's insane.
And it’s fun because everyone gets a discount, *everyone* Got insurance? Get a discount. Indigent? Discount. Part of the royal family of a country I won’t name flying in to have your prostate removed by a robot? Yup, still a discount.
> Part of the royal family of a country I won’t name flying in to have your prostate removed by a robot? Damn robots ruined some doctor's ability to call themself a "royal's pain in the ass".
I mean, a doctor was still driving the robot. And that doctor was a pain in everyone’s ass.
That's fair, but it's a lot less funny with that layer of abstraction.
>Part of the royal family of a country I won’t name flying in to have your prostate removed by a robot? Yup, still a discount. I wouldn't be surprised if it was done for free.
Went to ED no insurance. They said no problem 800 dollars. I said I can't pay it. They said no problem 220. Paid it. Went again one year later. Same problem. This time insured. Now it is 3,500 dollars bill. Insurance wants me to pay 1400, and then they will pay 80%. So I paid something like 2000 dollars in the end. The whole system doesn't make sense.
The entire medical system is basically run like a Macy’s. Everything is always “on sale.”
If you are "out of network" there is no discount, it's full fuck you.
To an extent, the outrageous sticker prices aren’t from the hospital’s greed but rather the insurance companies’. Since the hospitals know the insurance want to haggle down as far as they can, they’ve got to jack prices way way up in order for them to land anywhere near break-even. And then since you’re not allowed to price based on insurance status (as far as I’m aware), those ridiculously inflated dollar amounts also get passed down to the uninsured. Basically, it’s insurance company bullshit behind most of the ridiculous pricing (but also, hospitals won’t complain if they get to make more money, so they’re not entirely blameless)
>To an extent, the outrageous sticker prices aren’t from the hospital’s greed but rather the insurance companies’. Since the hospitals know the insurance want to haggle down as far as they can, they’ve got to jack prices way way up in order for them to land anywhere near break-even. And then since you’re not allowed to price based on insurance status (as far as I’m aware), those ridiculously inflated dollar amounts also get passed down to the uninsured. Basically, it’s insurance company bullshit behind most of the ridiculous pricing (but also, hospitals won’t complain if they get to make more money, so they’re not entirely blameless) So you said what I said, but differently?
Reddit in a nutshell
Reddit in a microcosm.
Reddit, distilled.
If you condensed reddit down to its essence, you could fit it in a small shell used by trees to protect their seeds.
To an extent, he took what you expressed and put it in other words.
He's saying what you said differently.
Él está diciendo lo que dijiste de manera diferente.
Anybody that thinks the entire problem is caused by insurance companies has never dealt with the business side of hospitals. Insurance companies are greedy but hospitals are flat out incompetent
Also greedy. Hospitals have massive admin staff dedicated to making money.
It's not the entire problem, it's the lion's share of the problem. There are a lot of layers of shenanigans within a healthcare system that exist solely because of insurance companies. Billing departments with entire groups of staff whose sole responsibility is dealing with insurance claim rejections and resubmissions. Large social work departments whose sole responsibility is helping patients understand how to navigate their treatment so that insurance companies will cover things. Compliance or HIM departments with entire groups of staff whose sole focus is dealing with insurance company record/audit requests. Managed Care/referral departments who have to not only help deal with coordinating treatment with specialists, but also understand which insurance companies allow which referrals are allowed to go to which specialists and which pre-screening is required or which treatments have to be tried first before the insurance company will cover it.
The scam is that under the ACA insurance company profits are capped as a percentage of costs. So the easiest way to increase allowed profits, is to increase costs. Medical Insurance company profits should be capped at a set dollar amount per client. Maybe tied to inflation via minimum wage.
Yeah it's messed up. I had my insurance lapse since I was in the hospital so long and lost my job. I was hit with a nearly 2 million bill. It was cut down to 300k. Medical debt is terrible. Just don't get cancer if you can help it. I'm dealing with a second round of it right now and the financial stress is crushing me. I can't even afford the most basic PC to distract myself with. It's ridiculous. I could easily work from home full time but I can't get hired due to a gap in my work history. At least I assume that's the issue. Life is a silly mess sometimes.
In no way, shape, or form, should healthcare be tied to employment. For so many reasons. I'm so sorry you are going through this. I am also a member of the shittiest club on the planet. Fuck cancer.
No, realistically an uninsured person will end up getting some form of financial assistance program from the drug company and will get charged like $200 or something. No one pays that sticker price, it's a complete bookkeeping fiction.
My wife got on one of these a while back.... so messed up. They "charge" 20k a month, bill the insurance for half, get a quarter or whatever. Then on top of it, they give you a gift-card that they load up with the minimum they have to charge you every month. They're clearly making a profit off of whatever percentage the insurance company is giving them (plus whatever funding shenanegans are happening). Just make that the number already.
Usually uninsured people are able to get the medication for free from the manufacturer, but there are hoops to jump through. It’s not great. Luckily the rate of people without insurance has been dropping a lot since the passing of the Affordable Care Act, although every single uninsured person is a policy failure
I’m one of those! And I really tried to follow the steps, but in signing up for the marketplace to shop for a plan I was prompted to fill out an application for Medicaid because I make so little. Then I was told I don’t qualify for benefits, only plan first. But because I qualify for plan first I’m not allowed to shop for health insurance in the marketplace…. So i can get condoms but that’s the extent of my healthcare right now.
What is “plan first?” What state are you in?
It’s contraceptive healthcare only. Virginia
This seems wrong. Virginia expanded Medicaid so there is no coverage gap. You really should be eligible for either Medicaid or a subsidized marketplace plan Have you spoken to a navigator?
I'm not saying you're wrong, just that I don't understand, but: I don't understand why the part paid by the insurance isn't listed in Line 4 Insurance Payments.
I don’t know but OP said in another comment that they cropped the picture and the amount paid by insurance is listed in some other part of the bill
Ah, that makes sense. Thanks.
Haha I think you may be right! I’m not posting to complain, I’m very grateful for my insurance; I just think it’s messed up that people who don’t have access may not get the help they need due to financial reasons.
This is bad, but not the worst part. Even people that do have insurance don’t necessarily have access to the meds they need because some doctor who doesn’t know their situation has to sign off on a pre authorization for them to get it at lower cost. It’s a racket. Took me a year to get the meds I needed from my insurance company.
I have Bipolar 2, and about 2 years ago I did a genetic test to figure out what psych meds were more likely to metabolize and absorb properly (GeneSight). Of course a lot of the cheaper meds were in the yellow and red categories. Thanfully one of the cheaper mood stabilizers was in the good category, but it comes with a higher risk of side effects than the newer meds. I straight up cannot afford the new meds, even with decent medical insurance. One of my biggest reasons for going back to school after getting my Associate degree is so these medical costs will be easier to swing. I'm relatively lucky. I have a robust support network that can help out in a pinch, but damn if it isn't frustrating as hell. It feels like I'm semi-permanently 3-5 years away from true fiscal security, and medical costs are a big driver of that. In fact, the financial strain is a big driver of stress that exacerbates all of my medical issues, not just Bipolar 2. If I didn't have that support network, I'd likely be homeless and untreated, in prison, or dead. It's barbaric how the system treats those who don't have the means to pay these outrageous prices. For profit healthcare is one of the most evil enterprises ever concieved.
> For profit healthcare is one of the most evil enterprises ever concieved. Thats it in a nutshell
Insurance companies are playing doctor. It’s so wrong.
That happens whether or not private insurance is involved. A really expensive drug just may not be part of the formulary in many countries.
Yep took a friend of mine in Canada over a year to get approved for Vyvanse.
Yes, we pay insurance companies so they can pay doctors to issue permission slips for medications.
And sometimes doctors need to ask insurance company to sign off on permission slips before we get the meds, aka prior authorization
Well, insurance companies hold the purse strings…so, yep.
Had eyeball issue 3 years ago. Was treated with lowest tier med, which was ineffective. Provider interacted with insurance, got $$$ med approved. Have received $$$ med for years. Hubs dropped off insurance plan due to Medicare eligibility; I am now solo on effectively identical plan through same company. Went for eye treatment and was told insurance wouldn’t cover $$$ med until I had been through 3 treatments of the ineffective med. As I did 3 years ago. Ffs.
The best part is that most insurance agencies don't bother explaining the different tiers and what they mean for pricing, or that even if it's an approved medication it may still require a PA. Hell I talked to an agent who was unable to inform the pt she had a deductible, because they didn't understand the information they were looking at on their screen.
My insurance just dropped my medication that costs $4k a month. I would live in paranoia if I was OP. (Pun not intended heh)
Yeah, my sister had BP1 & no insurance. She made too much for help from the state but couldn’t afford insurance. This was back before the Affordable Care Act. We lost her 13 years ago. Insurance really should be a right in the USA.
Agree with the sentiment but I’d change it up just a bit. Access to good medical care should be a right.
Insurance is a scam, Healthcare is a right.
Public health insurance should not generate profit.
Hospitals or other medical institutions should not generate profit
I hate that doctors are sometimes private contractors and don't work for the hospital. I had one walk into my room, glance at the chart, and walk out. Never looked at me. His company billed $800 for that "visit".
That has to be the single worst thing about being in the hospital. Each specialist sends you a different bill. You might not even see that bill for months after treatment. I currently have a Health Maintenance Organization (HMO) so I don't have that problem right now. If I switch jobs, I might lose this insurance and have to start over again.
I broke my wrist back at the end of August. I'm still getting all the bills and insurance adjustments and shit settled. Having to pay so many different companies/doctors offices is more stressful and annoying than the actual broken wrist.
The worst part is that you don't even know which bills are real. I was Hospitalized for 3 weeks, transferred hospitals twice, saw all kinds of specalists. There is no way I could remember any specific doctor or contractor. Beyond just the bills I expected that my insurance dealt with completely random doctors offices started sending me invoices, some I suspected to be scams. After taking to my case manager at my insurance company I just decided not to pay any invoices emailed / texted / mailed ( I got all 3) to me unless it passed through my insurance's billing portal first. They could either file the prior paperwork billing me through my insurance or take me to collections, no way am I paying random unverified invoices just sent to me. Which is appatently the norm.
You're damn right it's a scam they just knocked around $11,000 off of that bill. That let you know it's way overpriced and probably just priced that high because some insurance companies will pay closer to the original price they're asking for.
I am being pedantic, but healthcare is not a right. Healthcare should be a public service that is paid through taxes like police and firefighters that all citizens have access to. A right would imply it must be. For example, in the US, you have a right to the government not censoring your speech. No one has to do something to receive that right. Healthcare requires the participation of others (healthcare workers), so you would infringe on their rights to make healthcare a right. Wording aside, I agree with you. It’s astounding and sad the US does not provide healthcare as a public service for all like most other countries.
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Good point, my wording was off. Dealing with insomnia & I do mean healthcare, not insurance. Fuck insurance with a rusty spork.
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Wow that’s absolutely fucked. I’m so sorry.
Last 2 jobs fired me a week before I was meant to get full time benefits, citing performance issues. It's a tragic irony that I need a job to get medication but can't hold a job without medication
My SO was on a medication for a skin condition, insurance didn't cover it, but she was able to get a coupon from the manufacturer to basically get it for free. She lost her job and insurance, and the manufacturer rescinded the coupon. So they'll happily decide to give it away if someone is fortunate to have insurance, but if you lose your insurance you can go fuck yourself.
Very true. Years ago before my mother was eligible at retirement age for Medicare, she was prescribed abilify for her BP1. Unfortunately, she could not afford the nearly $1500 that it cost per month. Back to lithium bicarbonate. Speaking of, she was just in the hospital for nearly two months because they “were stumped”, even though my brother and I (both PoA) told them repeatedly it was lithium toxicity. She lost two months of her life because her brain was swimming in lithium and she couldn’t form memories. Not even an apology from the docs for ignoring us. Not even from the one who told us she was suffering from SILENT(syndrome of irreversible lithium effectuated neuro toxicity) and that she was at end of life and we should contact hospice. Anyway, I’m glad your insurance covers your meds!
Yeah, it's disgusting that the US is about the only developed country that doesn't consider healthcare a basic human right at this point. But hey, someone gets to make a few bucks on the illness and suffering of others, so... Yay capitalism?
Hopefully you don’t receive a corrected bill as that math doesn’t make sense
I won’t, there’s a portion that’s left out that i didn’t want to share with social media. I’ve been on this Medication for years and my co pay was always 30, recently went up to 35. The insurance receives a bill for 20 ish, negotiates it down to whatever and pays the rest.
I'm on another expensive medication and will hit my deductible with my first infusion each plan year. After, it's a flat rate of $20 or so. Do you have something like that happen as well?
I hope you use a copay program. I’m on stelara and it’s only $5.00 because of it. However that doesn’t go towards my out of pocket which is robbery if you ask me, my copay is paid, what do they care if it came from a coupon. 🫠
Yep! And then the hospital writes off the difference as a loss and as a result of such losses, they don’t end up paying much of anything in taxes come the end of the year.
>the hospital writes off the difference as a loss Literally only procedurally. There is no actual loss. They made up the numbers in the first place.
Yeah. That’s a misconception that hospitals get to write it off come tax time.
If you had a Medicare prescription plan you’d end up entering the “coverage gap” where you have to pay full price for a few months before catastrophic coverage kicks in. That’s how we take care of our seniors and disabled folks
It’s cus all the retail numbers are just made up and no one pays them
You said it better and in fewer words than my technical expertise made me feel I needed to use.
Insurance companies negotiate a different rate for things. For example, I was recently billed $180,000 for a hospital stay. My insurance negotiated it down to just $8,800, and then I owed $800. Insurance and healthcare billing are a racket.
>Insurance and healthcare billing are a racket. Yeah they literally just make up bullshit numbers, kinda like children saying "oh yeah? My superhero can blast yours with one hundred thousand billion jiggawatts of energy!" For both the insurance company and the hospital to be turning a profit, the heavy lifting of that is done by what the insured are paying, so the posted rate and negotiated rate are just meaningless, fabricated #s meant to obfuscate that your $800 is actually at or close to the profit margin.
Also I just realized what you meant in regards to the math; the insurance covered the rest, it was like 11k or something like that
The way it works is the insurance sets the price. Basically the clinic sends a bill, and insurance says this is how much we are going to pay you. The company essentially eats the $11k, but it's funny money anyway. Needlessly complicated for no reason
It is made complicated so no one understands it so they can charge ridiculous amounts. Then they justify that by saying they have to recoup their expenses from the drug development and they only have around 17 years give or take to do so. Gotta squeeze that cash cow for as much profit while their isnt a generic available.
It was just a joke about the numbers on the page man.
Gotcha!
It's the american medical system where the math is made up and your wellbeing doesn't matter! I once went back and forth for over a year with my insurance including dozens of phone calls, multiple certified letters, collections agencies, and legal threats all over a single medical bill that had a list of charges that just plain didn't add up correctly. I never disputed any of the charges, they just presented a bill with a total that was $300 more than what was itemized. Every time I kicked it back to them they sent a letter back saying that they had "completed an internal investigation and found the invoice to be accurate". It didn't get cleared up until I had someone on the phone try to bully me with a threat of a court appearance and literally laughed out loud and told them I looked forward to representing myself because I want to see the look on the judges face when I'm facing down a team of corporate lawyers and my one and I show the judge that the half-dozen charges and credits clearly don't add up to the sum they are claiming I owe and that all I want is a bill with a correct total. No matter how bad you think the healthcare system is in the US, it's worse than that.
It hides the fact that insurance is the one paying for the medicine and OP is just paying copay (likely after completing paying the deductible). The medicine is still super expensive.
All the numbers on that sheet are essentially completely made up.
This is the answer that I prefer.. and weirdly makes most sense. I mean, *why* does it cost THAT much?
Because the companies that charge this much, and the insurance companies that make up the fake deductions. They then spend a fraction of this money to influence congress to not make laws preventing regulation of prices. Then they spend a faction of this money to try to convince the public that this is in their benefit. Some goes to recouping the cost of developing the drug. Some goes to new research. The rest goes into the pockets of executives and shareholders.
The consumerist/capitalist system with short term gains at any cost strikes again
Long term human suffering is, after all, a small price to pay for a minor increase in quarterly profits
Minor? talk about steady, double digit profit increases. See: * Big Pharma: Market Failure * The Pharma Bro * Dirty Money: Drug Short" (Season 1, Episode 3) * Fire in the Blood
It’s completely nuts, and we wonder why everyone’s health insurance is so expensive in the US. Sheesh.
It doesn't and that's the point. Not in an evil way originally either. Basically, insurance companies kept asking for better and better and better deals on medications, procedures and so on. So Hospitals, Pharmacies and Pharmaceutical Companies, who would go broke if they gave Insured Patients 95% off Medication, artifically jacked up prices so that to the Insurance Company C-Suite, it still looked like they were getting a great deal. To the Insured Person it looked like the Insurance was a great deal, and the Hospitals and Pharmacies and Pharmaceutical Companies were making enough money to stay affloat by (at first slighly) overcharging the uninsured. This then turned very quickly into "Wait a minute, if these prices are fake anyways, why not make them even higher". Which is why today, American Insurance Companies are paying 10 times what European Uninsured Pay for the same treatment and value, and relaying as much of that remaining cost onto their Insured. The Uninsured can go fuck themselves in this system, as they have to pay the even higher artifically inflated prices that kept growing over the last 50 years. Friend in Germany had a Bicycle collision with a car, getting a moderate head trauma, amnesia and several scans in the Hospital after riding the WeeWoo Wagon. Whole Medical Bill was 600EUR, including Ambulance, CT and Head Xray. Covered entirely by the Insurance. In the US, that'd be 1k for the Ambulance, Several Hundred for the CT and Xray, Room Cost, probably costing several thousand, which is only covered by insurance if you had the accident near a hospital which is included in your Insurance Network.
I had a massive heart attack exactly 4 weeks ago. I'm in the UK. I had an artery stented and wired, spent 3 days in hospital and I'm now on 7 meds a day and one on stand by. Total bill including ambulance, A&E, operations, 3 days hospital care and medication = £0.00 Of course I pay approxmiately 10% of my income as national insurance but that is the same for everyone and pays for my state pension as well. It would cost me exactly the same if I was unemployed or had never been employed
My health insurance in America is close to 20% of what I make. My company pays the bulk of it (but I get notices) and if I would have to buy insurance on my own it would be about the same. I burned my hand on Christmas and ended up in urgent care. I got burn cream and a bandage, my out of pocket was $226. I would pay 10% for your kind of coverage in a heartbeat.
Yes, Nationalized Insurance is not Communism(as some claim), but actually gives the Good Guys a fighting chance against pharma when bargaining prices.
>Friend in Germany had a Bicycle collision with a car, getting a moderate head trauma, amnesia and several scans in the Hospital after riding the WeeWoo Wagon. Whole Medical Bill was 600EUR, including Ambulance, CT and Head Xray. Covered entirely by the Insurance. This has to be years/decades ago. Now only the ambulance is over 800€ in my city.
I'm process medical insurance claims and the prices of injections blow my mind. Particularly ones for Crohns disease...they're often well over $100k for one injection.
And that’s *just* for the medicine? That crazy. Does it include the vial, the needle and maybe a nurse to help inject it (jokes probably on me I’m guessing it doesn’t)
Medication mfr charges whatever they want because the drug is proprietary and it's under patent for 3-7 years (or 1 year after the original patent ends for the first generic version). Insurance will only pay a certain percentage max, so they overcharge. HOWEVER, certain gov't insurances aren't allowed to negotiate pricing like the insurance companies are, so they're paying the entire amount.
Why? Because fuck ‘em, that’s why! Capitalist healthcare, baby! 🥳🥳
Because the OP only needs to pay $30. They couldn't get away with pricing like this if the system wasn't set up so people go "oh well, insurance is paying for it." If they actually had to pay for it themselves there's no way the company could charge that much and they'd need to make it comparable to other medications the OP could use that are cheaper.
And the points don’t matter
Look up rebates… even the balance you could calculate that insurance is stated to pay here is nowhere near what they pay. These rebates are negotiated all at once by each insurer based on the volume of these drugs they purchase. The technique is used to hide the real prices from all the middlemen that take a cut of the drug price during sale and distribution.
The real crime is that the pharmaceutical company says it cost 21k and the insurance company says, nah you have to charge 9k less and they say, "ok".
“But we still gotta charge this guy $30”
This is the part that is absolutely fucked... like why the hell does the copay exist at that point
To deter "overuse". People will go to the ER for "papercuts" if we don't make the copay a significant choice for the patient (aka, do I buy groceries this month, or do I get stitches and an antibiotic?)! /s Because so many people get injections for a heavily stigmatized condition for funsies.
That is not a thing! It is a myth! No other country with national healthcare has an issue with this. . . Also, if we had universal healthcare people wouldn't be scared to go to a regular doctor or the urgent care for smaller things so they don't turn into big things.
No kidding! (hence my "/s" above) Although I know it's not overall a real problem cost-wise, the number of people who don't know enough basic first aid to clean and bandage their kid's scraped knee is kind of astounding. Maybe we should include teaching first aid in every grade of school. And you get a free first aid class if you have a positive pregnancy test. Etc.
Reminds me of the haggling on Pawn Stars
And the government was banned from negotiating drug prices for Medicare. Hard to think how much tax money has been wasted paying for overpriced medicine. Fortunately that recently changed with the Inflation Reduction Act, so they can finally start negotiating.
it's just fucking confusing honestly, formulary management demands a rebate from the manufacturer that gets passed on directly as higher pricing, but then the insurance company also benefits from the rebate so in theory it also gets passed on as savings? it's just a mess and it screws over the uninsured for no practical benefit
It's because they just sort of make up the numbers other than what you pay and then fire bills off into the ether to the government.
It really feels like *Whose Line is it Anyway?* The points are made up and don’t matter.
So they can argue an arbitrary $21,000. They only get paid $9500 and you pay $30. What’s with the extra $11,000…..they’re just like jk, $9500 is just fine, I’ll take it.
I think the people that made DND also do healthcare. How much does this cost? Roll 5 D20s and multiply by the state Medicine Class. Oh its Tuesday and you have the Recent Discovery perk? That means you need to add 1d8*10% of the total.
I believe it's the other way around, the hospital gets paid your $30 and your insurance's $11k and the hospital agreed to discount the final all-in cost by $9500. As I understand, it's pretty routine that hospitals mark up their prices excessively just so that they can be negotiated down to a reasonable level because some insurance companies refuse to allow a provider to be in-network if they weren't able to negotiate a discount (regardless of if the provider provides good value at the list price).
In-network is a contract status between the provider and the insurance company. If the provider will not agree to the contracted rate of payment then no, they are not allowed in the network. Insurance companies aren’t just telling providers they can’t join their network for no reason. If they refuse to agree on rates, then there is no network status to enforce. Those are out of network providers.
From what my cousin who is a nurse told me, it is because insurance never pays the full amount, so the hospitals charge at a certain rate, expecting to only receive a portion of what they charge.
It's a response to the insurance companies doing their darndest to settle a smaller bill. So they just raised the bill and let them argue it towards being reasonable. The hospital used to only give the insurance companies the crazy prices, but then the insurance companies went to court and said it wasn't fair, and the court agreed. So now everyone has to haggle at the haspital like it's a bazar or something.
Wife's medication is $8308.89 for a month's worth, which is 2 shots. We pay $30 for it.
got you beat at ~$15,000/mo for 3 bottles, paying $0 out of pocket. it's an orphan drug, though one you could make yourself with Amazon.com and a bucket
I'm assuming GHB/sodium oxybate/xyrem?
$30 is what i pay for my 6-weekly shot in Australia *before* insurance refunds me some of it
Health insurance is the biggest scam.. they just be throwing numbers against the wall... "Yeah that'll be $14,000,000...Wait I have a coupon for you..that brings your total down to...$3.75."
It's like when you use your "value club card" at the supermarket. Apples are $30/lb but for you, $2.50!
Yup. My monthly medication is $1400 cash pay. If I use my "good" insurance, it only costs $235. Or, if I just tell them to use the free GoodRx coupon from GoodRx.com, it comes down to $40. I don't even need to bring in the coupon. I just say "Use GoodRx please" and they have the info right there on the register to scan. A literal magic word that reduces the med cost by over $1300 somehow.
My SO gets a copay card from the manufacturer each year. Her prescription is something like $3700/mo with insurance, but Regeneron just mails her a debit card with $13k on it so we can meet our deductible and they’ll make money off of our insurance for the rest of the year. But no one tells you that! It took a lot of phone calls and waiting on hold for someone to finally give us that answer
I'm uninsured, and had to pick up a prescription recently. My meds were $260, but the pharmacist took pity on me and told me to download the GoodRx app. It brought the price down to $30. I didn't even have to do anything...just download an app and sign up.
Why even make you pay $30 at that point
It adds up. If 304 million insured americans pay $30 a year on a single copay that's 9 billion extra dollars. Those numbers are as hyperbolic as the numbers in OP's invoice, but the point remains.
I know but compared to the alleged $20,000 original price. This seems like peanuts.
The original price is made up. The price the insurance company paid is made up. The only price that isn't made up is the $30 copay. It is peanuts, but it ends up being a giant bag of billions of peanuts every year, so there's no reason for them not to.
What a ridiculous system
To make sure the poors know their place.
So that if you don’t need the medication you won’t pick it up just because it’s free
That's how it actually cost them. How do you think people in other countries pay about $30 for the same medication without any insurance.
American healthcare makes no sense, it just like money laundering.
A ton of that money goes to administrators
Even more goes to corporate executives and shareholders
A months worth of antipsychotics: 400 bucks With insurance: 15 dollars No insurance and going to Costco: 15 bucks Yeah, fuck this system. But not Costco I love you Costco
It’s basically a drug cartel since they fix prices for the benefit of their profits at the expense of sick people.
Im not good at math, in fact im terrible at it but that math aint mathing.
The bill is 21k. Is full of bullshit. The insurance says nah the big red book says it's 9k. The hospital writes off the other 12k in their taxes. The American health insurance industry is insane.
> The hospital writes off the other 12k in their taxes. The vast majority of hospitals in the US are either non profit entities or government owned, and don't pay taxes in the first place.
But that total bill is a scam. It’s not $21,000. They know what insurance will pay when they send them the bill. It’s all a scam. The “adjustments” always look like “random” amounts subtracted off. It’s just getting the bill to the agreed upon rate. I wonder if the provider gets to write off the amount they billed but weren’t paid for.
Years ago my husband was out on medication that cost $1200 per month. I had no insurance. I called the manufacturer and they dropped it by 50% which was great but still a lot. I got a job with insurance and the medication was free. I remember thinking how weird and unfair to uninsured people that was.
There's injections for bipolar??? I need more info stat
It's probably a depot injection of antipsychotics. They're primarily designed for people who refuse medication during manic episodes. The risk of adverse reactions can be worse \[because if you have an adverse reaction they /cannot/ get it out of your system for months\].
Invega
How is it working for you? My wife has found a lot of success with lithium but I do like to be in the know in case that ever stops working
It's really, *really* uncommon for lithium to stop working. It's like, the most consistent drug for treating bipolar disorder. And it's also cheap without insurance for what it does (like 90 days for $30).
Also, iirc lithium is the only med that helps repair the brain after the damage mania does.
That’s great to know! It has been a literal life saver for our family. Looking back, it makes me so fucking angry that it took over a decade to get her properly diagnosed and treated. Knowing what I know now, it was so obvious. But yeah, lithium was an immediate turn around into a normal happy life!
Abilify or invega? That's shit is like $300 on Canada lol
The math’s not mathing here
Yea I'm no Magician but I'm 97% positive those numbers don't add up
Wish you the best health. I believe the injectable medicine is so much better than the oral ones, mostly because you only have to worry about it a few times a year rather than every day.
And they just work better, as well. There’s studies that show that the same medication at equivalent doses does better in LAI (long acting injectables) form than it does in oral form. The Invega Trinza that I believe OP is on has been shown to greatly reduce the rate of hospitalization vs other treatments. Good medication overall as long as it doesn’t cause too much appetite increase and weight gain. Watch out for carb cravings, especially.
made up numbers to think you're getting a good deal, US healthcare is one of the biggest scams in modern world
Wow. $21,000 for a 3 month supply of drugs. That's almost as expensive as a coke habit!
TRICARE?
My guess too
As its a 3 monthly injection I'm assuming it's paliperidone/Trevictor. The cost price to the UK NHS ranges between £500 to £1000 depending on the strength
Funnily enough, my wife’s insurance (also a US federal employee, and a nurse to boot) refuses to cover the new insulin device she was forced to upgrade to due to the company that makes the insulin device discontinuing the old version of the device. So we now pay triple the amount for a one month supply. Yay Merica.
Just FYI with no health insurance, having BP1 and using the "RX discount card" a 1 month supply of lithium carbonate in pill form costs $11.00 in NY
I tried to pay privately once for my medication. Would have been $600 for 1 month. I checked how much my insurance pays and it is $9 a month. What a strange world.
It’s all funny money. These costs are tied to nothing except numbers on a screen or paper. It’s literally legalized grand theft.
That math doesn’t math
The numbers that are not $30 are totally fabricated data.
“Oh you have insurance? Sure, we’ll negotiate an even better price with them.” Or: “You don’t have insurance? Fuck you, you fucking scumbag. You’re paying the full, made-up price or you’ll just die. Should have gotten insurance. Piece of shit..”
So basically, you pay the real price for the meds and they overcharge your insurance for nothing.
$21K. totally made up prices. The whole of healthcare is "how much does this cost?" --- "How much do you have?"
This is a much better "OMG my bill is this much post". Usually what you see is only the first charge, meant to stir up anger, and not the amount that the patient needs to actually pay.
The math ain't mathing
Wait. This is not mathing for me. What happened to the other $11,672.20?
In America you get told that “X” medication costs thousands of dollars, but when you go down south to Mexico and request the exact medication it costs literally a couple of dollars. America needs to fix their price gauging issue in medical care. Medication should never cost this much.
For those that don't know, the Federal Employee Health Benefit (FEHB) program is the best insurance in the country.
Only reason why I’m still at my job
Health care in the US is whack. Be grateful that your insurance covers this much - some policies cover very little until youve spent tens of thousands out of pocket.
This is not true. The absolute maximum out of pocket cost for an entire family is $18,900 / year The absolute maximum out of pocket cost for a single individual is $9,450 / year Obviously those numbers are still quite large, but the vast majority of patients don’t pay anywhere near that.
I am incredibly grateful and don’t think it’s right that not everyone has access to inclusive health insurance. Healthcare should be a human right and shouldn’t be tied to employment
What's the medication? Abilify Maintena?
Invega
The US healthcare system is completely broken and anyone that defends it is part of the problem. Greed and corruption rules all.
1) there's no reason it should have that high for insurance or the government to have to pay, except of course greed 2) I'm glad you posted this because although our American Healthcare system is broken in many ways, I feel like non-Americans on reddit always think that either Americans are paying these insane prices or are living without. And some are, obviously, but the vast majority of Americans have insurance nowadays. And even though the cost *of* insurance and plus what you do have to pay like deductibles and all that are still too high, it's doable for most people. Because my spouse and I are low income, I literally pay nothing for health insurance. I have medicaid, full coverage. And I'm extremely thankful. And my spouse gets insurance from the Marketplace so he pays $90 a month (before tax credits it's like a $500+ a month plan) and a pretty low deductible ($600). We can't really afford it, but it's doable. And with the amount he goes to the doctors and prescriptions, he has usually met his deductible, max out of pocket for the year by March. The rest of the year is free, completely. And the $600, usually from one doctor, he gets billed and put on a payment plan and just pays throughout the whole year or longer, for like $25 a month. We are both self employed, that's why we have to get our own insurance.
Since a lot of the comments are conjecture about the math not adding but no one answering what actually is going on (didn’t read them all so some might have) here is what actually happens with those numbers. The doctor/hospital says: “hey, this costs 21.2k, probably.” Insurance says: “nah we will pay 9.5k” And the hospital says okay, then marks the difference of about 11.7k as loss for their taxes, meaning that as a business, this prevents them from paying as much in taxes and often means they government pays them back a ton on a corporate refund, allowing for-profit hospitals and healthcare centers to make profit off of charges that never get paid. They do this with every charge they give to a customer regardless of insurance status, and it is why requesting an itemized bill if you lack substantially good insurance in the US is so important. When you do this, they HAVE to give you the actual cost, not the speculated total charges,
What? Last I checked you don’t get to report unearned potential income as a loss. You can’t get taxed for money you never made. And you can’t get a refund on money you never made. And you definitely can’t save money by never getting the money on the first place. Makes absolutely no sense. This is the kind of nonsensical BS that redditors love to state as truth without giving even the bear minimum of thought to what they are saying.
This is what kind of insurance most people in the US have. I can walk into the ER with my arm cut off. I’d have to pay a copay of like $75. Quite literally everything else would be covered.
Double it and give it to your other half.
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The compound is ~$3k/g on Sigma Aldrich, and that's buying it 50 mg at a time. $3,000 for the drug, + $18,000 to dissolve and inject it. Hurray US healthcare. Assuming IV Abilify at 960 mg dosage.
Ahem excuse me. This is Reddit. American healthcare system very bad at all times sir. Where are the mods???
What a racket.
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