[jimmy1]

I think your phenomena might be due to startups? Obviously this is a startup focused board so I am not saying this to mean go one way or another, but I ditched the startup, job hopping life a little while ago, and had to deal with "insurance bs" roughly two times in 7 years.

I am either the luckiest person alive, or maybe there is additional benefits not obviously well represented here to working for a stable, revenue producing organization, but I don't seem to encounter what seems to be the well-represented insurance pains documented here (probably a little bit of both, in my guess).

[dwater]

My partner has been employed with the same large international company for 8 years. She had an elected procedure done that is required by law to be fully covered by insurance. She had 3 calls leading up to the procedure with her health insurance company each time asking them if they were certain it would be covered 100%. I thought that this was overkill but she was worried to the point of being paranoid about it. They assured her each time she would not have to pay any money at all for anything.

The procedure was in December. After the procedure she received a 6-figure bill, which she then had to follow up with hours of phone calls back and forth to the insurance company, hospital, and doctor's office. They sent her a revised bill for somewhere around $8,000, and then another revised bill for around $4,000.

The insurance company says it's because the doctor coded the procedure incorrectly. The doctor says the hospital coded it incorrectly. She has had to file an appeal with the insurance company, and the only reason it looks like it will work out is because the insurance company records all phone calls and was able to get records of her original calls before the procedure asking if it would be fully covered. She has still been told to expect that they will deny her first appeal and she'll have to appeal a second time in order to get it covered. This has been causing her immense stress for the past 4 months as she does not have enough money to pay even the $4,000 bill out of pocket.

My experience is that your experience actually is extremely uncommon in America today. Most people who have to interact with the health care system beyond annual checkups have to deal with something like this.

[pxeboot]

She is lucky she is getting that even partially covered if she only got a verbal agreement. My insurance policy has a clause that anything they say over the phone is not a promise to pay. You have to call AND get something in writing to even be eligible for a dispute later.

[jimmy1]

I am fortunate to have had the experience of growing up with a rabid Greek mother who would get to the bottom of any shenanigans with any sort of insurance agency, bill collector or anything. I now have my own experience. Yes the first time was stressful, but reading your story, trying to put myself in your partner's shoes this would not have ended up causing me any stress, especially if I knew the law is on my side. I certainly wouldn't paid any bill until it was all sorted out. I also have experience where a medical charge that was suppose to be covered as a legitimate procedure was not and charged off onto my credit (because again, I refused to pay). I was easily able to negotiate with the credit reporting agency to remove this negative mark on my credit. (Negative marks due to medical bills affect your credit much less than say missing a credit card payment, IIRC, I was still able to obtain credit cards, get loans, and generally had decent overall credit).

My father currently undergoing treatment for lung cancer. He has medicare and supplemental coverage through Humana. Bills are still in excess of 150,000, so I definitely understand the other side of it.

[pnutjam]

My previous employer had my insurance totally wrong. According to everything I signed at open enrollment, I had a $6k deductible and $6.6k Out-of-pocket max. This was for the family, no individual deductible.

When I go to the insurance site, it lists me with a $2k individual & $4k family deductible. It says my OOPM is $7.5k. Of course I hit my deductible this year, so I'm getting billed an extra thousand.

My employer and insurance company both swear it's the other one's fault and even filing a complaint with the state insurance commission doesn't seem to have helped. :(

[sjg007]

In the future the way to avoid this is for the hospital/doctor to submit a prior auth request. Then you have it in writing.

[Glyptodon]

I'm not at a startup and have better than average insurance, however it's still a clown show.

For example, I recently got prescribed a medical device, but was then told that if I didn't have a follow up appointment between certain dates I'd be billed out of pocket for the device.

The prescribing physician, of course, has no open appointments until a couple months after the given follow up interval, despite knowing the potential issue and prescheduling the followup.

And of course the device provider, the physician, and the insurance company all tell me completely different things about the situation.

The current "solution" is "just see your primary care instead," not sure how it'll go.

[helen___keller]

Not due to startups necessarily so much as changing insurance a lot. I'm on my 6th insurance plan in 4 years (Job 1, not a startup, lasted 9 months. Job 2, a startup, changed insurance 2 months after I started then again the next year for a total of 3 plans over 2.5~ years on the job. Job 3, a startup, had better than average insurance (with a weird/awesome reimbursement plan so I pay 0 deductible and 0 premium and get to cover my wife for free too!). Then one month after I started we got acquired and so in 2019 I now have a normal (still good) corporate insurance policy.

On top of that insurance frustrates my wife so before we were married when she was on PhD student insurance I generally managed that too, plus her transition to my insurance after marriage.

So I'm definitely out-of-norm on this. If anything I like to think that means I'm more qualified to call out how bullshit the world of insurance is, atleast in terms of end-user UX, but obviously that's just my opinion.

[organsnyder]

I think it depends on your state's insurance market as well as the priorities of your employer. If your state has a plethora of plans available, your employer is tempted to shop around more often. In that case, it depends on the priorities of your employer, weighing the cost savings versus the cost (financial, employee morale, time) were they to switch to a cheaper plan.

I've worked for employers of varied sizes and profitability (self-employed, small nonprofit, very large health system [including its own insurance plans], midsize for-profit), and I haven't noticed a consistent pattern that would differentiate them in terms of health plan stability. In all cases, the goal is to minimize cost while providing an acceptable level of coverage.

Of course, job hopping and employer-provided coverage are a painful combination. My family had to reach our deductible twice last year, which wasn't fun (the increased salary and other benefits of the new job made it worth it).

I'd love to see health coverage detached from employment. If traditional Medicare-for-all isn't feasible, then let's go with Medicare-Advantage-for-all instead.

[tareqak]

The phenomena is linked to how often someone switches jobs in the United States irrespective of the type of company or employment (full-time, part-time, self-employes etc).

No matter what an individual’s stance is with respect to another individual’s professional history in terms of frequent changes or gaps, I don’t think that has to correspond to level of healthcare that the latter individual is able to obtain.