Hey all, I’m British so I don’t really know the ins and outs of the US healthcare system. Apologies for asking what is probably a rather simple question.
So like most of you, I see many posts and gofundmes about people having astronomically high medical bills. Most recently, someone having a $27k bill even after his death.
However, I have an American friend who is quick to point out that apparently nobody actually pays those bills. They’re just some elaborate dance between insurance companies and hospitals. If you don’t have insurance, the cost is lower or removed entirely. Supposedly.
So I’m just asking… How accurate is that? Consider someone without insurance, a minor physical ailment, a neurodivergent mind and no interest in fighting off harassing people for the rest of their life.
How much would such a person expect to pay, out of their own pocket, for things like check ups, x rays, meds, counselling and so on?
https://www.anthem.com/dam/medpolicies/abcbs/active/guidelines/gl_pw_a050126.html
Anthem BCBS classifies it as not medically necessary so they will not pay for it since April of this year.
Jesus. That’s disgusting.
Edit: Hang on I just skimmed that document it seems to indicate it IS considered medically necessary.
Edit edit:
* Prolonged or therapeutic endoscopic procedure requiring deep sedation such as endoscopic retrograde cholangiopancreatography (ERCP) or repeat colonoscopy due to tortuous colon; **or** * A history of or anticipated poor response due to cross tolerance or paradoxical reaction to standard sedatives used during moderate (conscious) sedation specifically due to narcotics or benzodiazepines; **or** * Increased risk for complication due to severe comorbidity (American Society of Anesthesiologists \[ASA] class III physical status or greater. See Appendix for physical status classifications); **or** * Individuals over 70; **or** * Individuals under the age of 18; **or** * Pregnancy; **or** * History of drug or alcohol abuse; **or** * Uncooperative or acutely agitated individuals (for example, delirium, organic brain disease, senile dementia); **or**Uncooperative or acutely agitated individuals. Tell the doc to tell the insurance that it makes you crazy without it and you can’t tolerate it. Jeez is your doctor new at doing these things? That’s what they do they submit whatever criteria is accepted that they don’t have to prove with charts.
When Boston BCBS did it they put their clause in to include fear of the procedure. Aetna is apparently in the running for biggest piece of s***.
Well I sincerely wish you the best. But I would put up a fight and keep fighting.
It’s not big enough on the news yet when everybody finds out this is what’s going on they’ll raise a big enough stink to get it reversed.