Negotiating hospital bill after deductible

[Alexsei]

Ask any Canadian what they think of

Don't become sick in Canada.

[Alexsei]

https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2021.html#a4.2

https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-medical-assistance-dying-2022.html#a4.2

[Sam Finkelstein]

The best way to beat the system is to have a spouse work any government job.

Even if it’s just 20k as a public school para, the benefits can easily be worth another 20-30k.

[Saver2000]

I looked at a recent hospital EOB and it has a massive charge (billed to my insurance) for bad debt and charity

They billed your insurance policy for costs unrelated to your hospital visit?

[Saver2000]

To provide some context, this bill was for a birth. My family was recently terminated from Medicaid, leaving me no choice but to enroll the baby in my high-deductible individual plan. The challenge arose when converting the plan to a family plan, which doubled the deductible.

Isn't the newborn child covered under the parents policy for 30 days?

[Sam Finkelstein]

Isn't the newborn child covered under the parents policy for 30 days?

Seems to be a misconception. The parent’s policy may pay out benefits for the first 30 days, but you’re supposed to retroactively add the child to the policy. In this case, the mother was still on her parents’ insurance and therefore they didn’t pay anything for a grandchild.

[etech0]

Seems to be a misconception. The parent’s policy may pay out benefits for the first 30 days, but you’re supposed to retroactively add the child to the policy. In this case, the mother was still on her parents’ insurance and therefore they didn’t pay anything for a grandchild.

At least in some cases the child is covered for 30 days even without adding them on for the long term.
I know of situations where the grandparent's policy covered the baby and situations where it didn't, I guess it depends on the company.

[Saver2000]

In this case, the mother was still on her parents’ insurance and therefore they didn’t pay anything for a grandchild.

I'm pretty sure that's irrelevant. The insured person had a baby. It shouldn't matter if they are the policy holder. But I'm no expert in this area.

[Saver2000]

The parent’s policy may pay out benefits for the first 30 days, but you’re supposed to retroactively add the child to the policy.

You don't need to add the child, however if you do eventually add the child as a "qualifying event" (prior to the next open enrollment period) , it will become active retroactively to the date of birth.

I guess it's best not to add them, or to wait until the next enrollment period so you get 30 days free.

[ushdadude]

They billed your insurance policy for costs unrelated to your hospital visit?

yes
apparently it's part of the New York State's Health Care Reform Act

[Sam Finkelstein]

At least in some cases the child is covered for 30 days even without adding them on for the long term.
I know of situations where the grandparent's policy covered the baby and situations where it didn't, I guess it depends on the company.

I'm pretty sure that's irrelevant. The insured person had a baby. It shouldn't matter if they are the policy holder. But I'm no expert in this area.

You don't need to add the child, however if you do eventually add the child as a "qualifying event" (prior to the next open enrollment period) , it will become active retroactively to the date of birth.

I guess it's best not to add them, or to wait until the next enrollment period so you get 30 days free.

This was not my experience at all with this birth. All the baby’s care went under my insurance, with mother’s (her parents’ policy) not picking up the tab at all.

Our child before that was on Medicaid so we never got a bill for anything in the hospital, though we did take him to two non-Medicaid providers in the month after birth. Got a bill from one, never got a bill from the other (though I think they had a dysfunctional back office).

[mevinyavin]

Socialized medicine for the win?

From the Pros and Cons list regarding Yerushalayim

Yerushalayim
Pros
...Medical insurance, even if you pay for the best categories

con medical system

I put this in the pros. We can agree to disagree, if you like, or I can happily explain my reasoning. I have been around in the decade I've been here, seen a few emergency rooms, scheduled a few operations for my kids, called a few ambulances, needed a few specialists and had to wait to get them, been denied coverage and had to fight to get it ... but I still think it is great.

I'm starting to suspect that those who call it a con fall into one of two categories: those who had a horror story, which I concede seems to be common but suspect it isn't that much less common elsewhere, and those who don't know how to best use the system that is in place.

[mevinyavin]

IL
1) Get a hitchayvut for the emergency room
  1a. Ask the receptionist if there is a doctor with appointments in any of the six clinics in walking distance who is willing to see you and agree that this needs stitches
  1b. If there isn't one, check to see if this is the day that the Chutznik doctor who is a friend of yours's secretary has hours, so you can phone him and ask his secretary to issue the hitchayvut.
  1c. If you succeed at 1a or 1b, go to the emergency room. If not, go to 2).
2) Call the kupah's hotline and ask for a hitchayvut to the emergency room. They will tell you to wait for the next morning and go to 3). If you cry to them ("It really hurts and I can't take care of my baby like this!"), they will issue the hitchayvut most of the time. Total cost: 42 shekel. If they do not issue the hitchayvut, go to 3).
3) If it isn't during the five hours per day that they are closed, go to your kupah's extended hours clinic. Wait anywhere between twenty minutes and three hours to be seen and stitched up. Total cost: nothing or 18 shekel or 36 shekel or 42 shekel, depending on how it is filed (not your choice).

Please note: this should not be used as an accurate description regarding what you should do for a real-life situation, as inaccuracies may likely be in there due to my not personally having dealt with stitches (DW chose not to bother me in yeshiva). See, for example, LongTimeLurker's comment below.

[Fish Tank]

The best way to beat the system is to have a spouse work any government job.

Even if it’s just 20k as a public school para, the benefits can easily be worth another 20-30k.

Any ideas of a government job that would be eligible for benefits, with remote capability? 
Office type of work, etc.

[LongTimeLurker]

IL
1) Get a hitchayvut for the emergency room
  1a. Ask the receptionist if there is a doctor with appointments in any of the six clinics in walking distance who is willing to see you and agree that this needs stitches
  1b. If there isn't one, check to see if this is the day that the Chutznik doctor who is a friend of yours's secretary has hours, so you can phone him and ask his secretary to issue the hitchayvut.
  1c. If you succeed at 1a or 1b, go to the emergency room. If not, go to 2).
2) Call the kupah's hotline and ask for a hitchayvut to the emergency room. They will tell you to wait for the next morning and go to 3). If you cry to them ("It really hurts and I can't take care of my baby like this!"), they will issue the hitchayvut most of the time. Total cost: 42 shekel. If they do not issue the hitchayvut, go to 3).
3) If it isn't during the five hours per day that they are closed, go to your kupah's extended hours clinic. Wait anywhere between twenty minutes and three hours to be seen and stitched up. Total cost: nothing or 18 shekel or 36 shekel or 42 shekel, depending on how it is filed (not your choice).

Stitches automatically render an er visit payable by the kuppa, as does a host of other things even if you're not admitted.  It's in the law.

If you're not sure it needs stitches then get the hithayvut.

[mevinyavin]

automatically render an er visit payable by the kuppa

Edited the above.
Anyways:
I was almost hung out to dry by an ER visit that should have been covered but was not determined to be covered. We had to fight for it to be even partially covered, with (thankfully) a Meuchedet secretary that took our side against the office's determination in Tel Aviv. I believe in the end she got us covered with a small co-pay, but as a result, I always get the hitchayvut when I feel ER is necessary.
(Story was: our first infant looked like she was having a seizure. DW knew what those looked like because she had been on call for a relative's infant who had been prone to them. We went to the ER, where after eight hours, the baby was diagnosed with ... severe reflux. The ER doctor conceded that it looked exactly the same...
The Meuchedet secretary said that since the diagnosis was something mundane, the executive office ruled that the visit was not covered and wanted to charge good money. She pointed out that the hitchayvut in advance would have saved us the trouble of needing to fight for it. As noted, I believe we had to pay something but not on the same scale.)

[aishel]

My own personal data point was from when I was visiting Florida for pesach from Maryland and I had to go to the emergency room for severe acute pain that required a CAT scan. Bill came in at over $7,000. I let the first few notices go, and then when I called, I asked about setting up a payment plan of $15 a month. She then said that if I could pay $3,200 today, that would settle everything. And that's what I did.

[zh cohen]

My siblings and I were recomended to have a certain screening done bec of a siblings medical issue. A normal routine screening just a couple of decades before it's done by everyone.
The US siblings paid $3600+
The IL siblings: 36NIS and no issues getting an appointment

When I was in Yeshiva (pre-obamacare) I went to a doctor for something minor. He had a student with him, and while he was treating me he told her that he would usually do a certain test, but wouldn't for me since I was "self-pay."

[Definitions2]

Ask any Canadian what they think of

I've asked a British person and the only complaint I heard is that it takes forever to get an appointment. My personal experience here is that specialists also take months to get an appointment. I vaguely remember that person say that even regular doctors take long.

Are there urgent care centers in Canada/UK?

All I know is that in the US the healthcare industry are highway robbers. The cause is still undermined in my mind. Combination of schooling costs and red tape and somehow I'm willing to bet government funding.

[Alexsei]

Are there urgent care centers in Canada/UK?

I can't talk for the entire Canada but where I live it's almost non-existent