odanny
Diamond Member
This is a good explanation of the healthcare insurance nightmare that looms one accident away for every American. While my provider is pretty good with my insurance (such as Max. Out Of Pocket capped at $2500) what happens if I'm traveling and need care in a dreaded "out of network" hospital?
This is what Republicans continue to DEFEND, this is what they are fighting FOR. It's mind boggling these rubes have been convinced this is what works best, when countries all around the world have something far BETTER.
The patient: Phil Gaimon, 35, a former professional cyclist, a YouTuber and blogger who earns most of his income through sponsorships. He paid about $500 a month for his insurance policy with Health Net through Covered California, the state's health insurance exchange. He also had a secondary health insurance policy with USA Cycling.
Total bills: $151,804 from Lehigh Valley Health Network and $49,526 from the Hospital for Special Surgery. He had additional bills from various physicians. Health Net has paid approximately $27,000 to Lehigh Valley, according to Gaimon. His secondary insurance, with USA Cycling, paid $25,000 to the Hospital for Special Surgery and his surgeon there.
Service providers: Lehigh Valley Hospital-Cedar Crest in Allentown, Pa., part of the nonprofit Lehigh Valley Health Network; and the Hospital for Special Surgery, an academic medical center, in Manhattan, New York.
Medical procedure: surgery for a fractured collarbone at Lehigh Valley Hospital and surgery for a broken scapula at the Hospital for Special Surgery.
What gives: Gaimon collided with three health system dangers in this physically and financially painful crash: an out-of-state emergency, out-of-network care and gold-plated prices from both hospitals that treated him. Gaimon said he could sell his house and pay these bills, "but I shouldn't have to. I have insurance."
His situation is a scenario that many patients have encountered when they need emergency care outside their provider's network. It's known in medical jargon as "balance billing." Hospitals and insurance companies without mutual contracts often don't agree on the price of services, and the patient is left to pay the difference.
www.npr.org
This is what Republicans continue to DEFEND, this is what they are fighting FOR. It's mind boggling these rubes have been convinced this is what works best, when countries all around the world have something far BETTER.
The patient: Phil Gaimon, 35, a former professional cyclist, a YouTuber and blogger who earns most of his income through sponsorships. He paid about $500 a month for his insurance policy with Health Net through Covered California, the state's health insurance exchange. He also had a secondary health insurance policy with USA Cycling.
Total bills: $151,804 from Lehigh Valley Health Network and $49,526 from the Hospital for Special Surgery. He had additional bills from various physicians. Health Net has paid approximately $27,000 to Lehigh Valley, according to Gaimon. His secondary insurance, with USA Cycling, paid $25,000 to the Hospital for Special Surgery and his surgeon there.
Service providers: Lehigh Valley Hospital-Cedar Crest in Allentown, Pa., part of the nonprofit Lehigh Valley Health Network; and the Hospital for Special Surgery, an academic medical center, in Manhattan, New York.
Medical procedure: surgery for a fractured collarbone at Lehigh Valley Hospital and surgery for a broken scapula at the Hospital for Special Surgery.
What gives: Gaimon collided with three health system dangers in this physically and financially painful crash: an out-of-state emergency, out-of-network care and gold-plated prices from both hospitals that treated him. Gaimon said he could sell his house and pay these bills, "but I shouldn't have to. I have insurance."
His situation is a scenario that many patients have encountered when they need emergency care outside their provider's network. It's known in medical jargon as "balance billing." Hospitals and insurance companies without mutual contracts often don't agree on the price of services, and the patient is left to pay the difference.
Cyclist's Olympic Dream Becomes $200,000 Medical Bill Nightmare
Cyclist Phil Gaimon was competing in a race that could have won him a spot in the Tokyo Olympics. Instead, a crash landed him in two hospitals where his out-of-network surgeries garnered huge bills.
www.npr.org
