A terrible guide to the terrible terminology of U.S. Health Insurance

September 26, 2022 11:27 AM

As predicted in 2020 by futurology site Hard Drive, Brian David Gilbert spends 30 minutes explaining the basics of U.S. Health Insurance.
posted by simmering octagon (41 comments total)

What a disaster.
I experienced a taste of this in Alberta when getting dental work.
Both an anaesthesiologist and a dentist filling in for my regular dentist have been whatever the local equivalent of out of network is, costing surprise thousands extra. I didn't know until it was over!
HSAs and co-pays exist here, too.
Boo to the whole thing. Burn it to the ground.
posted by Acari at 12:39 PM on September 26, 2022 [6 favorites]

I'm a dual US/Canadian living in Canada and I have zero desire to move down south due to the healthcare issues alone.

Sometime I ask myself what it would take to draw me back. Someone offering to double my salary would not come close to cutting it. But what kind of income would it take to make healthcare costs as invisible to me in the US as they are in Canada? $300,000 a year? $500k? A million?
posted by thecjm at 12:41 PM on September 26, 2022 [10 favorites]

thcjm, $300,000/year would be plenty if your employer had really good insurance with no surprises. Most people have really crap insurance and have no idea until they actually try to use it, though. Source: I work for a hospital.

I'm also a dual US/Canadian but living in the US, and I would not have moved here if I had really understood how healthcare expenses permeate every single g.d. decision you make about your entire life. It's a good thing I love my job, because I am absolutely trapped here due to having actually good insurance (by American standards).
posted by joannemerriam at 1:18 PM on September 26, 2022 [17 favorites]

But what kind of income would it take to make healthcare costs as invisible to me in the US as they are in Canada? $300,000 a year? $500k? A million?

Significantly more. Especially with dependents. And here is the thing - you can still be a high earner and then find out your provider doesn't take insurance, or there is some other deficiency in provider coverage - and suddenly it is all too visible. Data point: I'm currently looking at options for a child's residential treatment that run around $450 a day (so about $160k a year !)...despite paying well over $1k a month in premiums for the family...and I'm arguing with insurance whether their proposed in-network facilities * literally on the other side of the US* would constitute a burden for participating in regular in-person family therapy (sure I guess if travelling cross country either other weekend on your own dime is no big thing to you). And that's on the very *best* plan my employer offers - which compared to others I've seen - is really actually a great plan.
posted by inflatablekiwi at 1:29 PM on September 26, 2022 [10 favorites]

this is about as funny and otherwise entertaining a video as I could imagine one making on this particular subject matter, and it still ends up feeling pretty fuckin bleak by the end

"ARE YOU BRAD PITT??"
posted by Kybard at 1:30 PM on September 26, 2022 [2 favorites]

Remember, being paid more doesn't make up for the explosion in administrative and bureaucracy you'd have to deal with *even just for paying more*.
posted by danhon at 1:31 PM on September 26, 2022 [4 favorites]

I didn't know until it was over!
posted by Acari

Is it ever really over?
posted by Splunge at 1:52 PM on September 26, 2022

Right-on. Good healthcare isn't just getting cared for inexpensively or free, it's also not being assaulted by relentless paperwork and bureaucracy.
posted by seanmpuckett at 1:52 PM on September 26, 2022 [16 favorites]

relentless paperwork and bureaucracy

but but something something private sector something something efficiency something

and and and, USPS and DMV! So socialist public health can't possibly work, so there
posted by flabdablet at 1:59 PM on September 26, 2022 [2 favorites]

~relentless paperwork and bureaucracy
~but but something something private sector something something efficiency something

I can assure you, the insurance droids will tell you with a straight face that it’s the government requiring them to build all the bureaucracy and paperwork.

See also: Every industry in america claiming they are the most regulated industry in america.
posted by Thorzdad at 2:10 PM on September 26, 2022 [13 favorites]

Remember, being paid more doesn't make up for the explosion in administrative and bureaucracy you'd have to deal with *even just for paying more*.

Exactly. Could not agree any more with this comment. At some extreme level of wealth I guess you just charge everything to a credit card and never be concerned by cost (assuming that wealth extends to all dependents and is extensive enough to handle the most difficult life changing long term medical events for them all). But even then there will be paperwork and administration - can you find a provider who is accepting patients? do you need to handle pre-payment/deposit and enrollments paperwork? who will coordinate care across all the providers you are paying for individually? will you provider accept you specifically as a patient based on your medical history and the provider's risk tolerance for being sued by a mega-wealthy client? Do you have all the medical records that need to go from provider A to B? Do you have the releases in place to let provider A talk to provider B? Does Pharmacy C accept prescriptions from Provider A? Who approves refills? Hell - even just opening every bit of mail and making sure all the bills are paid when your ambulance ride sends multiple bills because they forgot about the bandaids they used in the first bill, and you can only pay them though some god forsaken payment website that doesn't seem to ever remember who you are? It's just relentless. I mean you could hire someone to deal with this. But now you are talking top 1% of the 1% type wealth.

At some point the cost of an investment passport for multiple countries with decent socialized medicine may be cheaper given it covers other types of risk (not just medical, but political/geographic/climate risk) as well
posted by inflatablekiwi at 2:32 PM on September 26, 2022 [2 favorites]

and and and, USPS and DMV! So socialist public health can't possibly work, so there

I always love this particular talking point because like, yeah, I want the health insurance equivalent of shipping a letter across the US in a couple of days for less than a dollar with the kind of highly organized and straightforward "do this, get this" service I get at the BMV.

I always wonder what is going on with people's lives when they complain about the BMV but I assume they just have really crap local offices.
posted by Pope Guilty at 3:50 PM on September 26, 2022 [5 favorites]

Good video.

I hate that US insurance is so tied to employment.
When I lived in the UK it was quite a change to notice the outlook of locals my age - to just go to the GP if needed. It wasn't even a question. No looking up YouTube videos for home surgery (seriously). No rationalizing how dire it should be before taking care of yourself while calculating money worries.
posted by PistachioRoux at 4:56 PM on September 26, 2022 [10 favorites]

This kind of thing is why I will never work in a field I love, because those are expendable and don't have insurance.

My HMO is in the news lately for a mental health strike because they are absolutely terrible at mental health services, don't care, and it's cheaper for them to pay punishment fees or whatever than doing mental health care. I love how it says at the end of this article that frankly, there's no point in trying to find an HMO that's any better, because none of them are going to do any better.
posted by jenfullmoon at 5:08 PM on September 26, 2022 [2 favorites]

As usual, no one who calls for a more rational single-payer gives much thought to what will befall the poor innocent health insurance executives.
posted by morspin at 5:33 PM on September 26, 2022 [6 favorites]

I always wonder what is going on with people's lives when they complain about the BMV but I assume they just have really crap local offices.

I assume, as most things, it's because they have to intermingle with the poors and other fellow citizens who aren't fine upstanding citizens such as themselves.
posted by Kyol at 5:41 PM on September 26, 2022 [5 favorites]

As a parent trying to find medical and psychiatric care for my kids, I have three words to describe the US healthcare system: Total Fucking Nightmare. Transgender care? There's more words for that. Much more than three. The only people who compare the US system positively to other so-called developed nations are those who haven't had to actually use the US healthcare system.
posted by AJScease at 7:01 PM on September 26, 2022 [5 favorites]

hcjm, $300,000/year would be plenty if your employer had really good insurance with no surprises. Most people have really crap insurance and have no idea until they actually try to use it, though. Source: I work for a hospital.

I don't think the kind of insurance provided under single payer actually exists in the U.S. I mean is there insurance that will just cover 100% of everything with no deductibles and no co-pays and no-networks and you can go to absolutely any doctor you want (with no difference in what happens depending on which doctor you go to), and no matter where you go or what you do, not only do you not have to pay, but you never even know who paid how much for what, but you just walk in and out of the doctor's office or hospital without having any awareness of what money is changing hands as a result? Can that be bought for any price in the U.S.?

I remember when I lived in the U.S. all the health insurance ads talking about how great this insurer was or that insurer was because they had these awesome customer service representatives who are always willing to talk to you and help you and I'm thinking "Why would i want to call my insurer? Like I can think of no conceivable reason why I would want to call them that did not involve them having done something wrong. So all these ads are basically 'we do a lot of stuff wrong and lots of people call us.'"

I also remember Tufts Health Insurance in particular running an ad saying "We think every new mom deserves a home visit from a nurse" and how my roommate hated when that ad came on because I'd start yelling at the TV "Then why do you lobby against a single payer system where EVERY new mom could have that instead of just the ones who buy your insurance???" ARGH.
posted by If only I had a penguin... at 7:07 PM on September 26, 2022 [20 favorites]

I always wonder what is going on with people's lives when they complain about the BMV but I assume they just have really crap local offices.

Right? I’ve been to BMV offices all over this state, and they’ve all been well-run, efficient, friendly, and relatively quick. Maybe it’s a hoosier thing?
posted by Thorzdad at 7:57 PM on September 26, 2022 [1 favorite]

I don't think the kind of insurance provided under single payer actually exists in the U.S. I mean is there insurance that will just cover 100% of everything with no deductibles and no co-pays and no-networks and you can go to absolutely any doctor you want (with no difference in what happens depending on which doctor you go to), and no matter where you go or what you do, not only do you not have to pay, but you never even know who paid how much for what, but you just walk in and out of the doctor's office or hospital without having any awareness of what money is changing hands as a result? Can that be bought for any price in the U.S.?


It could. 15 years ago, anyway. I was a fresh-faced young naif of 22 when I went to work for my first employer, which was (importantly) a company owned by and run by MDs. I never thought twice about it, since this was pre-ACA and I was just happy to have health insurance. Then one fateful day I showed up at the ER with neck pain, disorientation, and the worst headache I'd ever had. Five days later I was discharged with my meningitis deemed cured. When the bill showed up a week later, I was pleased to see that my plan had a $100 ER copay, but they waived it if you were admitted. I had sprung for the PPO, which cost me a few bucks more every month but had no deductible. Total out of pocket cost: $0 of the $95K billed to insurance.

Today I'm a much more senior person at a similar job at a different company, with supposedly good insurance. And yet I'm 100% sure that if such a thing were to happen to me or a family member, we'd be on the hook for tens of thousands of dollars in copays and deductibles and bullshit "we didn't cover this because Reasons" charges that would take hours of phone calls to resolve. The insurer is the same. I bet my company pays 5x as much for premiums as they did in 2007. I wonder what might have changed.
posted by Mayor West at 8:03 PM on September 26, 2022 [7 favorites]

I've lived in the UK & NZ. The UK has public health care, longer life expectancy than the US, and spends less than half per person compared the US. NZ has public health care, longer life expectancy than the US, and spends about a third per person. So we can take as given that the US health system is a flaming dumpster fire.

So here's what baffles me. Can someone explain why angry, crazy, heavily-armed American men choose to shoot up schools, malls, and supermarkets, instead of the health insurance companies that are causing Americans so much misery?

Or do those companies spend a portion of their huge profits on really heavily defended offices?

[For clarity, I'm not suggesting this would be helpful. It wouldn't. I'm asking why they are not considered targets by the kind of men who do this kind of thing.]
posted by happyinmotion at 10:02 PM on September 26, 2022 [7 favorites]

So here's what baffles me. Can someone explain why angry, crazy, heavily-armed American men choose to shoot up schools, malls, and supermarkets, instead of the health insurance companies that are causing Americans so much misery?

Those men are generally shooting people and places they understand as a threat to the existing hierarchical power structures- white supremacy, patriarchy, and so on, all of which the health insurance industry serves loyally.
posted by Pope Guilty at 10:34 PM on September 26, 2022 [10 favorites]

...and malls dont?
posted by happyinmotion at 10:48 PM on September 26, 2022 [1 favorite]

I am an American expat living in Japan, and for all the faults of Japanese society, healthcare is not one of them. For an American, Japan's healthcare is a dream. It's not single-payer, though; like the U.S., it's mostly employer-based healthcare. But two big things (well, probably a lot more but from my limited perspective it's two): One, there's a "public option" of government healthcare. Don't have employer-based insurance? Then you can get government health insurance. In fact I believe it's kinda sorta compulsory to get it. Two, you pay a very nominal price for doctor's visits and prescription fills. A thousand yen (ten bucks) here, two thousand yen there...and that's it. Depending on where you live, most kids' healthcare is in fact single payer--most doctor's visits and basic medicine is completely free.

But there are tiers. For example I went to the dentist for a filling. Even with my employer-based insurance, if I wanted the nice ceramic filling, that was 10,000 yen (100 bucks) out of pocket. But a metal filling was only 1,000 yen. But still--the good filling for a hundred bucks? I'll take it. And of course anything remotely elective will cost you out of pocket. But even then, the costs are reasonable.

Now when I go back to the states with my family to visit, I get travel insurance.
posted by zardoz at 12:11 AM on September 27, 2022 [3 favorites]

malls dont?

Because of what hierarchies are, the people in charge are a substantial minority and the more stuff they're in charge of the fewer of them there are. So the chances of injuring somebody in one of the upper layers of the existing power structure are way way lower if the stochastic terrorism is inflicted in egalitarian spaces like malls than on an office building that might be an executive's workplace.
posted by flabdablet at 1:15 AM on September 27, 2022 [1 favorite]

I just loved to the UK from the US. And they're doing their best to dismantle the Nhs from what I can see. And I'm going to have to go private for 1-2 years for mental health treatment. And I had to pay 5 years of Nhs premiums up front and will pay them again in taxes.

I'm not going to explicitly say that it's cheaper. But it's easier. I need to sign up for a local doctor now that we've got a permanent place. There's a wait list for most of the ones in my area. (see :the Tories envying the US and attempting to replicate the worst parts of it), but there's still one that I can join easily that's within easy waking distance. I'm not pouring through a list of "local" doctors who take my insurance and are taking new patients. The UK system has problems and it leaves me missing the Japanese state healthcare, but it's still better than the US for the majority of people.
posted by Hactar at 2:40 AM on September 27, 2022 [4 favorites]

Can someone explain why angry, crazy, heavily-armed American men choose to shoot up schools, malls, and supermarkets, instead of the health insurance companies that are causing Americans so much misery?

I think everyone's response is along the same lines - and I agree - they're also missing a crucial component : shootings in such places here are more horrifying because they seem senseless.

The men (boys, really, and I'd normally say "folks" to be more inclusive, but ... America) want to feel power above all and it's hard to just waltz into a large conglomerate insurance company building (and, frankly, it's probably a giant corporate office with about 100 other companies occupying said building so it would be hard to find the "Blue Cross Billing Department" section) with little more than a pocket knife.
posted by revmitcz at 3:00 AM on September 27, 2022

Dealing with the complete insanity of the US system right now. My partner was hit by a driver on his way to work about a month ago. Luckily it was a relatively slow speed collision. Not so luckily it blew up his knee - tibial plateau fracture (explosion, really) which required surgery to install a plate and several screws. There was initially a possibility he'd need 2 surgeries, one the day after the collision, so he spent one night in the hospital anticipating a surgery that didn't end up happening the next morning. Actual surgery was 2 weeks later.

The bills are starting to come in and it's a nightmare of paperwork and confusion. He had to pay his portion of the surgery up front, so he's hit his maximum out of pocket, but all the other bills are being processed first so he's getting billed for this and that and the other thing. We are wealthy and privileged and he's on short term disability so he has time to be on the phone and it's still awful and scary and exhausting. A lot of it is just waiting for everything to come through, and my understanding is that will take months; meanwhile you have all these scary bills piling up.

He's hired an attorney and ideally will get all of his costs reimbursed at some point, but who knows how long that will be.

While in the ER, he got pre-surgery bloodwork in anticipation of the first surgery that didn't end up being needed. Got a letter from his insurance company that vitamin D testing isn't covered so that'll be $250 please. As if he was reading a menu of blood tests and asked for it, or even knew that was one of the things they were testing. Plus, his vitamin D was low - seems pretty relevant when your bone is shattered into pieces to know if you need to be taking vit D supplements.

Also love the insurance limit of 20 PT sessions. His knee is in literal pieces, he can't even put weight on it for three months and then will have to learn to walk again, but sure, 20 PT sessions should be plenty.

But his insurance company has been VERY diligent about sending 4 copies of the same "BEWARE OF OPIOIDS" letter because he got some hyrdrocodone after surgery that he's not even taking.
posted by misskaz at 4:55 AM on September 27, 2022 [8 favorites]

It could. 15 years ago, anyway. I was a fresh-faced young naif of 22 when I went to work for my first employer,.. When the bill showed up a week later, I was pleased to see that my plan had a $100 ER copay, but they waived it if you were admitted. I had sprung for the PPO, which cost me a few bucks more every month but had no deductible. Total out of pocket cost: $0 of the $95K billed to insurance.

ok, see, I would RAGE, RAGE if that happened to me.

"When the bill showed up later.."?? WTF. I mean even if you don't have to pay any of it, you just had fucking meningitis. Why are they bothering you with mail? Why were you "pleased to see"? I mean that implies you were kind of worried it might be different. Why should a person with meningitis be worried that they might have to pay a lot of money, instead of just worrying about their inflamed brain bits? Why did you have to pay $100 if you weren't admitted? Why did they even bother you by telling you this? And would this have worked out identically if you'd gone to a different hospital? Been seen by a different doctor? Maybe, maybe not, is my understanding.

It's absolutely insane to me what is normalized and even seen as pleasing under the U.S. system. I want to go to the doctor or hospital, get fixed, and never ever give a thought to, be talked to about, get mail about or anything else, how this is getting paid for. I don't want to see bills. I don't want to sign insurance forms. I don't want to get pre-approvals. I just want to walk in and walk out of any medical establishment and never ever hear anything non-medical about it. Why you put up with any less, especially given how much you pay, is mystifying.
posted by If only I had a penguin... at 6:33 AM on September 27, 2022 [8 favorites]

What are you, some sort of Communist?
posted by GallonOfAlan at 6:48 AM on September 27, 2022 [2 favorites]

ok, see, I would RAGE, RAGE if that happened to me.

As I mentioned above, I'm a dual Canadian/American living in the US. Every year during open enrollment, I outline my amazing-by-American-standards healthcare costs for my Canadian friends on Facebook. I consider this a public service to inoculate them against Conservative rhetoric - working for a self-insuring hospital is pretty much best case scenario down here and I "only" pay like 15% of my income towards healthcare coverage which my Canadian friends rightly understand as an extra 15% tax on income rather than the savings Conservatives always try to pitch healthcare reform with.

Every year, my comments are full of Canadians going holy shit you have to pay how much what does this terminology mean how are there not riots in the streets and Americans going what are you even bitching about, you have a max out of pocket.
posted by joannemerriam at 6:54 AM on September 27, 2022 [13 favorites]

rather than the savings Conservatives always try to pitch healthcare reform with

Ain't that the truth. Just before the pandemic, I was at a party where a guy was banging on about how "Canada's health care spending isn't sustainable and we need to adopt a U.S. style system, something something it's cheaper and more efficient yadda yadda personal responsibility."

And I was like, "Dude, that's a prescription for a more expensive system."

So then I had to cite what U.S. expenditures on health care (as a percentage of GDP) look like when compared to other OECD countries that have some type of universal public health care system/insurance (i.e., significantly higher, and with worse outcomes in areas a country with its wealth should be doing way better on).

Then he just fell back on "Well, personal responsibility, blah blah blah."

Then I said some things that were probably deeply unkind, but at least got him to go away.

Anyway, from the OECD:

Health expenditure and financing (share of GDP)

Understanding differences in health expenditure between the United States and OECD countries (pdf)

Related to the video in the post, especially the Premium and Deductible sections, here's the pseudonymous Dr. Glaucomflecken with a couple of 90-second videos:

How US Health Insurance Works

Flesh Covered Bags of Money

From this article on him, and how he used his own sudden cardiac arrest to point out what a clusterfuck U.S. health insurance is:

After a three-day ICU stay, Flanary would be fitted with a temporary defibrillator, undergo surgery to get a permanent one, and — most important for his comedy — navigate the hellish reality of American health insurance.

In his first video to get more than 1 million views, posted that July, Flanary plays two roles: the flabbergasted patient saddled with a massive bill, and the unnervingly calm customer service representative explaining that if he had simply chosen an in-network doctor while he was unconscious, all of this could have been avoided.
posted by mandolin conspiracy at 8:37 AM on September 27, 2022 [3 favorites]

the unnervingly calm customer service representative explaining that if he had simply chosen an in-network doctor while he was unconscious, all of this could have been avoided.

In the retelling of my partner's injury, there's always the fun part of describing him trying to look up which urgent care is in his network on his phone while sitting on a curb, unable to put any weight on his leg. And then arriving at said urgent care and before letting them bring him in, shoving his insurance card in front of someone and asking if he was in network.
posted by misskaz at 9:38 AM on September 27, 2022 [5 favorites]

Ironically (or not) - the Alan Rickman diary (discussed in the thread just below this one) -

4 January 2010
… trying to negotiate the American healthcare system – everything starts with “How will you pay?”

posted by Dotty at 10:31 AM on September 27, 2022 [2 favorites]

Suggestion: There is a LOT of weeping/wailing/gnashing of (poorly treated at exorbitant prices) teeth, but no real 'this needs to change' exclamations. The people who 'represent' the voters do (I believe) receive FREE health care (as do their families) FOR LIFE. Someone please correct me if I am wrong regarding this.

The portrayal of Universal Health Coverage (UHC) is oft in the realms of screaming headlines of 'THIS IS SOCIALISM!!!!' etc. A 'single payer' healthcare system is social healthcare where everyone pays an equal proportional percentage of their income to cover the costs of illness. It is beneficial to the whole of society that people who are sick are not an economic burden upon society. Preventing illness and providing quick recovery from any illness that could become a major one are the goals. With a single payer system the health care providers and government/s can determine how much money is going into the pot and establish clear policies to meet with arising demand (diabetes, Covid, obesity...) as it occurs. It is preventative rather than reactive to circumstance.

IF you wish to have (or your employer provides a carrot of) private health coverage then you can have the OPTION to take it out. You can mix and match the coverage to ensure the best form of preventing or curing an illness when it hits you.

But... in America... it means it would not be profitable and, rich or poor, you would be co-mingling with plebeians were you taken sick and wealthy...
posted by IndelibleUnderpants at 6:48 PM on September 27, 2022 [1 favorite]

Well, someone has achieved national treasure status.
posted by mollweide at 7:10 PM on September 27, 2022

where everyone pays an equal proportional percentage of their income

Well not that part. It's progressive so people at the bottom pay a lower proportion of their income. That's by design, since they can obviously afford to give up less of their income.
posted by If only I had a penguin... at 7:48 PM on September 27, 2022 [2 favorites]

I always wonder what is going on with people's lives when they complain about the BMV but I assume they just have really crap local offices.

Having experienced the nightmare that is the California DMV Offices (particularly the ones in major cities), I suspect that's the origin of the trope. Given that so much mass media has its origins in CA, it seems likely. I recently moved to Washington state and the DoL here is so much easier to deal with, I was in and out in less than 30 minutes, while a CA DMV visit with an appointment would still have me waiting around for 2 hours or more at the locations I went to while I lived in the Bay Area. There was a 30 minute line just to check in for the appointment.
posted by Aleyn at 12:56 AM on September 28, 2022

The people who 'represent' the voters do (I believe) receive FREE health care (as do their families) FOR LIFE. Someone please correct me if I am wrong regarding this.

You are wrong regarding this.

Under the ACA, members of Congress have to eat their own dog food and sign up for a gold Obamacare policy and the feds pay *looks* 72% of it (unless they have access to other insurance through their spouse or earlier employer). Before the ACA, they participated in one of the standard federal health insurance plans. Retired MCs have access to the same health benefits as other federal retirees under the same terms as other federal retirees if they serve 5+ years.

Currently serving MCs also have access to the Capitol Physician and DC-area military hospitals. These are free for outpatient care but only for outpatient care. The Capitol Physician doesn't normally do anything beyond routine care and diagnostics, and the military hospitals bill at full rate for inpatient care.
posted by GCU Sweet and Full of Grace at 5:30 AM on September 28, 2022

I enjoyed this video, Gilbert's sense of mildly surreal humor is right up my alley.

Our open enrollment nightmare every year is that, between our two jobs, my wife and I have something like five different plan options available to us. However, our open enrollment periods don't overlap. What that means in practice is that, if we ever want to switch to her insurance, we would need to fully cancel my insurance first. And her company (for whatever reason) does not provide their plan information ahead of time, so if we cancel my insurance then we have no idea what we're going to get from her company until there's no other choice.

I've been a low-deductible PPO person for my entire working career for exactly the reasons outlined in the video - what if I need an ambulance ride? What if I'm away from home and get sick? The fifty page plan summary doesn't provide enough info, but it's a PPO so it shoooouuullld cover things (mostly)... But then this past year, we decided we're still fairly young and healthy so why don't we switch to a high deductible plan so we can take advantage of an HSA?

Actually getting into the HSA was absolutely terrible. I had to tell them during open enrollment how much to take out of my paycheck to put into the account, and then January 1 rolls around and... the money is just gone? It took them, I think, two or three months to actually get around to mailing me a letter on how, exactly, to access the money in that account. And then, oh yeah, you can invest it! But not yet, because you don't have enough money in the account. So then you have to wait longer for the account balance to build up to a point where you can start putting it in the funds that are supposed to make it such a good deal.

So of course since we opted for the high deductible plan this year, I got sick. Nothing serious, it seems, but it's the first time ever I've actually been billed by a doctor for services (beyond a regular copay which I always paid in the office). The total services I received:
-In-office visit with the doctor
-Blood draw at the office
-EKG at the affiliate hospital
-Follow-up telehealth consult with the doctor
-Follow-up blood draw back at the office

At the first doctor visit, I walked up to the reception desk with my wallet out expecting to give them the usual copay. "Oh no, don't worry, we'll bill you." Huh, ok. About a month later, I get an itemized bill for the following:
-Telehealth consult (regular price $250, billed $170)
-Follow-up blood draw (regular price $10.50, billed $7)
No charges for anything else, no explanation why. Because I have insurance (albeit a high deductible plan that didn't cover any of these services because I hadn't hit the deductible limit), the bill was given a "negotiated discount." I have no idea if I'm going to get another bill for the rest of the services. I guess I will just keep my wallet open and waiting if and until I get a bill for the rest of it?
posted by backseatpilot at 12:03 PM on September 28, 2022

There are fifty states (plus DC and territories) in the US. Each one has its own agency for motor vehicles. If your experience with your own state's agency, in your own personal situation, doesn't align with what you're hearing about other people's experiences, then perhaps allow for the possibility that you are experiencing different things, and not that the other person simply has glaring character flaws.

There are absolutely states where the DMV is a nightmare. (Source: I've lived in them.) The offices have limited hours, so you often need to use PTO. The wait times are interminible. The staff are petty bureaucrats with dead eyes who hate their jobs (who can blame them), and also hate you. They will inform you, crossly, that you've been waiting at the wrong window this entire time, and that you should have filled out form TP904 and taken it to window 3. (When you say that you were merely doing as instructed by another DMV employee, they will just tell you that the first employee was wrong.) And God forbid that anything about your situation deviates from the three scenarios that they're trained to deal with.

It happens. It's real.
posted by escape from the potato planet at 5:06 AM on September 29, 2022