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Comment by lostapathy | Hacker News Reader

It also doesn't help how insurance handles ER visits.

I was in the ER earlier this year. Had an ultrasound done and a BUNCH of labs. $500 copay for the whole visit and insurance eats the rest - regardless of where I am on my deductible.

I'd had the exact same ultrasound done "routinely" 2 days prior, at the same hospital, and similar lab the week before.. I had to pay about $1,300 for the privilege because that all falls to my deductible. (Insurance paid nothing)

So it cost me almost 3x as much to go during the day than it costs during the ER - but my insurance paid out about 6x as much for the ER visit. I wonder how many "ER Abusers" have figured out it's actually cheaper for THEM to go to the ER than "normal doctors"?

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That makes perfect sense, assuming your annual deductible was met after you paid your $500 copay. Deductible means you pay for the first $x in a year. After that, your insurer starts paying some portion (your portion is called copay). Then you hit your out of pocket maximum (for in network services), after which insurer pays 100%.

No - I hadn't hit my out of pocket max, by a long shot, even after the second encounter. They could have happened in either order - and the emergency visit would have been MUCH cheaper out of pocket for me.

Then I don't know what definition of deductible your insurance company is using, but it doesn't match my experience with any insurer ever, health or otherwise.

It's simple - I have a flat $500 copay for an "ER encounter" regardless of what they do in the ER. Just like you have a $40 or whatever copay for a regular doctor visit.

The deductible must be paid before copays come into play. If you have a $2,000 deductible, then you will pay whatever the insurance company has negotiated with the in network provider for the billing codes the provider bills, up to $2,000. After that, the copays amounts come into effect.

https://www.investopedia.com/ask/answers/051415/what-differe...

No, that's not how it works.

Most health insurance plans have a few services that are copay-limited even before you hit your deductible. i.e., the $40 for an office visit to your primary care doctor, $90 to see a specialist, and in my case $500 for the ER visit. Imaging and procedures are my problem from the start, up to the deductible though ... apparently unless they happen in the ER.

Like I said way up-thread, the way it's structured puts the incentives in the wrong place for me. Had my two visits for ER and scans been in the opposite order, I would have been out of pocket the same total.

Anyway - I'm done arguing with you. I know how my plan works and what I've paid this year, whether you believe me or not.

I also had an emergency hospital visit a few months ago. Multiple X-Rays, a CT scan, two surgeries and innumerable drugs. I don't have health insurance. Cost to me? Zero.

But then I live in Australia.

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