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Re: US billing system » maxime

Posted by Snoozy on June 6, 2003, at 23:33:43

In reply to Re: Never, ever had a problem,... Jay, posted by maxime on June 6, 2003, at 12:51:57

Hi -

I was reading these posts, interested to hear what Canadians had to say about their health care system.
>
> BTW, I still have bills from the U.S. that I have to pay and I had insurance through my job. It was awful. A trip the the ER for meningitis cost me $5000!
>
> Max

Maybe this wouldn't apply to you, and I don't know how familiar you are with our "system" in the US. But that being said.... You say you had health insurance through your job when you went to the ER? In my policy, and a lot of others, the situation might be like this: I have an emergency, I go to the ER like my primary care doctor probably would have told me to do. And I have my insurance and they get all of that information at the hospital. Months later, when paperwork has gone through its channels, I might get a statement from my health insurer and a bill from the hospital. Let's say the whole thing is $15,000. My health insurance would probably tell the hospital, we only pay $8,000 for this procedure, and that's what they would pay the hospital. Sometimes the hospital will go to you for the remaining $7,000 of their original charge. I think a lot of policies have a provision that says providers can't balance bill you, that they have to take what the insurance company pays as full payment (minus any deductibles or co-insurance).

Of course, then there are the different permutations of HMOs and PPOs, etc. (I'm going to go grab something for this headache I've developed :)

I don't know if what I'm saying makes any sense or applies to your case. But I know that it can be confusing, frustrating and annoying to deal with this stuff. Which is what some providers rely upon, that you won't put up a fuss and you'll pay what your policy doesn't require you to pay. Cynical? A tad. Experienced, yup.


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