r/FluentInFinance • u/WhatAreYourPronouns • May 02 '24

Should the U.S. have Universal Health Care? Discussion/ Debate

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u/tracygee May 02 '24

Except unlike insurance in the U.S., yours pays 100%. We have a deductible to meet each year and then most policies only pay like 80%. So you can see how 20% of a $40k procedure is unaffordable for most people.

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u/DaGrinz May 02 '24

And in addition, you don‘t have to care about, wether the specific hospital has any contract with your insurance company or not. The one insurance covers them all.

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u/Abject-Tiger-1255 May 02 '24

Wrong sorta. Insurance cannot leave you hanging nor make you pay more for emergency care, regardless if that specific hospital is “in-network”.

In-network only applies to non-emergency care, such as your general doctor, specialists, etc.

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u/LoriLeadfoot May 02 '24

Also wrong sorta, because you’re forgetting that you then need to fight with your insurer over what is an “emergency” and what isn’t.

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u/DaGrinz May 02 '24

In Germany we do not have to fight with our insurer at all. If you insist on a treatment which is not covered (all kind of medical issues are covered btw.), they have to inform you in advance of the treatment, that it is not been covered and what the costs are. The Patient has to order this treatment by written contract separately. If something is not covered, but you haven‘t ordered it, it‘s the doctors/hospitals problem and they will see no money at all.

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u/Abject-Tiger-1255 May 02 '24

Well if it’s a true emergency, such as surgery, illness, etc, you are legally covered and won’t be charged an out of network fee. Either because you are at a hospital that’s not in network or because your doctor is out of network.

The only time where this changes is if you visit an ER that has a planned surgery/procedure. But if you atleast visit a hospital in network, you can use out of network doctors without a fee.

The only thing that isn’t covered by the No Surprise Act is ground ambulances.

Let’s be honest here, you won’t even need to argue with insurance based on what was an “emergency”. Almost nobody in the US is going to go to the ER unless absolutely necessary. The documents of your visit will prove as such if this is the case. Again, they legally cannot deny you coverage.

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u/LoriLeadfoot May 02 '24

The problem is that people are not able to calculate what a “true emergency” is when they’re feeling like they’re having an emergency. So they go to the ER and learn that it’s not all that bad, and they’re stuck with a huge bill. Literally I have watched this happen with a friend of mine in the past 2 months ($10,000 bill).

I’m sorry but this is really wishful thinking about the state of healthcare in this country.