Comment by briHass | Hacker News Reader

Comment by briHass | Hacker News Reader

I'm generally a fan of HDHPs, but I echo some of the same complaints made in the article. For example, just a few months ago, my toddler was complaining about horrible pain in his stomach. Now, being 5, it's awfully hard to determine exactly how much he's hurting, and of course, the strong recommendation from every nurse, doctor, and UC clinic we talked to was to bring him to the ER. A UC clinic or PCP won't take the liability if it turns out to actually be appendicitis and not just a virus with nausea.

I knew full well the ER visit was going to sting, but I had no idea how much. The amount after insurance was almost exactly what was quoted in this article (almost like they plan that). That pretty much maxed out his OOP max, but I'm not wealthy enough that 5k doesn't make me mad. It shouldn't matter, but it feels worse that it was just a stomach bug, so $2 worth of anti nausea meds (that the hospital charged $150 for) was all we got out of it.

Rationally, I don't really see a way out for (possible) emergencies. That care is expensive, and HDHPs are a bit of a gamble that usually pay off if you're healthy. The OOP max ensures you won't be financially ruined, and 'cadillac plans' or gov care just means you pay far more in premiums or taxes for the majority of the years.

My mom was an RN and almost never took me or my brother and sister to the doctor when we got sick. Vomiting? Sip some 7-Up and rest. 24-48 hrs later I'm back outside playing at 100%. Same with practically every other malady.

I've adopted a similar mindset with my kid, now 18yrs old. Unless he'd broken a bone, is clearly in need of stitches, needs a vaccine or is otherwise laid low for more than a few days we'd try to stay out of the healthcare system.

That may be fine as practical advice, but it’s horrible from a national policy perspective. The best way for people to avoid being bankrupted is to avoid the doctor? It stinks.

Yeah avoid the HDHP if you have children or know you comsume a large amount of healthcare services. Otherwise, HDHP, the associated HSA account, and typically an employer contribition create a triple tax free investment that can't be beat.

Sucks though we have to guess how much health care we might use in the coming year.

On a postivie note if you hit your family max for the year, try and stuff in as much medical care you can.

One relief was that it happened in March, not on Dec 31, so it's not like I wouldn't have paid some of that bill in care, which is now 'free'

The other thing I learned, since the hospital was unwilling to negotiate on total price is that they just want you to commit to paying and will give you a long, low monthly, zero interest payment plan to make that happen. I'm a 'no debt' kind of guy, but if they'll float me a loan for free, I plan to just keep adding future visits to this network to my payment plan indefinitely.

They aren't going to negotiate with the insurance company and then also negotiate some more with the covered party.

Of course, why the insurance company agreed to some ridiculous price is a pretty fair question.

This is one of the big problems: if one went without insurance entirely, the hospital may negotiate 50-75% of the inflated charges away for cash on the spot, but with insurance involved, I have no control over the price I pay for that $150 Tylenol, which insurance knocked down to $75. On a HDHP, I'm out that $75, because the hospital 'isn't allowed' to negotiate further after insurance.

An obvious example of this is with prescription drugs. I have a monthly script that is something insane like $250 'U&C' charge, but after insurance, it's $90. However, at a particular pharmacy, with GoodRx, it's $21. Paying 'cash' with GoodRx ends up being the better deal, even though it doesn't count towards my OOP/deductible with the insurance, because I'm not likely to hit that with a HDHP.

Would my total cash outlay for a hospital visit be cheaper without insurance? Maybe, but the fact that I can't determine that upfront unlike what I can do with a script is what is infuriating.

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