A month or two ago, I was trying to set up a pediatric dentist visit for my son. Not a medical emergency, but a matter of some urgency. I spent about three hours on a total of a dozen phone calls or so. Some to the insurer, and some to various dentist offices in the region to inquire about scheduling and logistics. I learned that I needed to switch my son's primary office before he would be eligible to receive care. This could only be done once per month. Fortunately, by luck, this would take effect at the close of business on that very day. Next I needed to find a covered provider. Of course, the insurer could not tell me which ones would have openings at short notice, so I had to call several. Then I learned that in order for a pediatric visit to be covered, it needed a referral from a general dentist. The pediatric office helped me find a dentist who could fill out this paperwork, which felt lucky. I verified that my policy worked with this dentist office. Several hours on the phone, but I had a sense of accomplishment for sorting it all out.
The day of the appointment came. The visit went smoothly. Then I found out that it wouldn't be covered because the insurance will not cover pediatric dentistry above the age of 6, but my son is 7.
I think I'm going to opt out of dental insurance altogether in the next enrollment. All the individual people seemed to be doing their best to help me, but the end result is a system that is impossible for me to use.
It took a doctor offering to misdiagnose it as a dermoid cyst to get the imaging and hysterectomy ordered and approved, and that still took 2 months. By the time it happened, the cancer had metastasized.
The imaging would've cost a few thousand dollars. The hysterectomy would've cost about $20k-40k. Chemo was unsuccessful, and she died 9 months and about $2 million in medical bills later.
Fwiw, if one has a passport and some funds, one can travel abroad for cheaper surgery abroad. It won't guarantee an outcome, but it ought to be better than delaying it. Of course this in no way excuses the insurance firm.
I know this might appear foolish, but fighting with a corporation whose incentives are adverse to my own (both on the medical side and the insurance side) makes me a little sick to my stomach.
You're often able to negotiate discounts for cash payment from providers, but back when I had insurance that excluded a pre-existing condition I ran into providers who steadfastly demanded the full list price (under threat of collections). It only takes one of those standing pat on a high 5 or low 6-figure bill to cause you to lose on your "bet".
I also understand the hesitancy to pay for two months at a “retreat-like inpatient psychiatric facility.”
In publicly funded system, it’s likely facilities like this would not exist or would be strictly private pay.
I’m not aware of any country that makes such a thing available on short notice like this.
I also understand the frustration, as often times facilities like this are all that exist in terms of medium-term care. And often times some of their services are at least formally in-network.
The understanding is you pay for it by selling your house.
We’ve been tempted to do this (sell our house), but been advised against it - but the reasoning in our case is patient specific.
I wish insurance was clearer about what covered and what isn’t. I wish we had more mainstream (not retreat-like) medium term care places.
Maybe I’m misreading the phrase retreat-like.
But id this isn’t something a public system would pay for, it seems inappropriate to blame a private system to not pay for it, unless it’s clearly in the wording.
Regardless, mental health care in America stinks, and you can always argue over the details.
We are graduate students and get a pretty good health insurance through our university's BCBS plan. She is financially independent from her parents, but she is additionally involuntarily insured on her father's EmblemHealth plan with no right to remove herself (her father could do this for her, but has refused to).
Last year she had some medical bills, and neither insurance company is willing to pay: the issue is that both plans have a clause that makes them secondary to any other insurance (this is apparently very common for student plans, and is also also somewhat common for additional family members on regular plans). For over a year now we have been sending certified mail to both insurers' coordination-of-benefits offices, but neither will acknowledge being the primary insurer and EmblemHealth has been ignoring us altogether for the last ~5 months.
The generally recommended strategy in this situation is apparently to involve regulators. However, regulation is state-by-state and and our university is in Massachusetts while her father lives in New York. Massachusetts' Division of Insurance found that the Massachusetts insurer (BCBS) was correct that the New York insurer (EmblemHealth) should be primary, but they have no jurisdiction to force the New York insurer to accept this finding.
The New York regulators were even more useless. New York's Department of Financial Services---the only state regulator for health insurance---responded that they had no jurisdiction to regulate the plan since it was self-funded (meaning that it is not technically insurance for regulatory purposes). The only remaining regulator was the US Department of Labor, but they eventually got back to us saying that they had no jurisdiction either: the problem is that my partner's father is a municipal employee of New York City, and for some complicated constitutional/political reasons the DoL isn't able to enforce labor laws on state/local governments.
I basically don't know what to do now. We have been on a waitlist for a legal clinic for about 4 months with no end in sight, and in the meantime regularly get mail from medical debt collectors. This is despite having insurance and making considerable effort to do everything "right." Clearly something here is extremely broken.
Considering this person has a high-paying job and it seems like a short-term intervention would have created a long-term positive outcome, it’s not clear to me why they didn’t simply insist on the care without insurance coverage.
My contingency plans for these situations are to pay out of pocket and figure out reimbursement later. In practice, paying out of pocket is just a promise to pay out of pocket. Often one isn’t charged until afterwards and I experienced sufficient mechanisms to delay payment until the whole thing had been sorted out.
Permanent conditions (like, say, brain death) are a different story. But in my case, the bill I was ostensibly facing was hundreds of thousands of dollars and I proceeded with it on the grounds that rapid intervention would yield results and I can figure out the payment structure later. If I were facing the worst case scenarios of a family medical bill bankruptcy or family member loss I think that usually I’d prefer the former. It’s hard to make a decision in the moment, but if the healthcare provider determines that more care is required and the insurance provider that it is not, I am more likely to follow the former though not without bound.
This is not a universal billing practice, often clinic visits are billed upfront before meeting with the provider.
Specifically regarding mental related items are treated as lesser than physical issues. I have Kaiser who has actively been punished by the US Department of Labor [1](2026) [2](2021) for delays in behavioral health care and pushing for out of network therapist. They tried to push these therapist on me twice, both through RULA and it was really a terrible experience. The therapist literally ended my meeting 10 minutes into our discussion when I told him I hadn't finished reading the book he recommended. I am now with an in-house kaiser therapist that is working well. I worry about the psychiatric side of the house as well, they set me up to only meet with my psychiatrist once every three months. That doesn't feel frequent enough to get my medication tuned right.
I don't see this getting better in the future with the current leadership in the US advocating for a "return control to the patients" by reducing SSRI prescriptions. [3]
My only advice for people out there is to take their mental health seriously, if you are having suicidal thoughts talk to your doctor. It may end up being a difficult journey but its better than being alone.
1. https://www.dol.gov/newsroom/releases/ebsa/ebsa20260210
2. https://calmatters.org/health/2023/10/kaiser-permanente-cali...
3. https://www.pharmacytimes.com/view/announcing-new-initiative...
More than once I was on the hook for a $15k set of injections that I had to run on a credit card. At this point, I'm maxed out, paying out of pocket for what I can and it sucks... I'm hoping to convert to a City employee (temp) vs contractor which at least gets decent medical, but my own experience has me doubtful even then. I've worked my whole adult life, didn't even take vacation time through my 20's and 30's... and never planned to retire... I don't want to, but I'm facing a reality that may not give me a choice in the long run.
I don't think shifting to public healthcare is the answer in the US... but would like something similar to fiduciary safeguards around medicine and insurance.
In this particular instance, the insurance company saved money to give to shareholders and their C-suite by not treating the patient further. They lose no money by allowing him to die.
This is all by design.
I'm not a fan of fully socializing medicine, but having a non-profit with negotiating power in the mix could only help.
Anecdotally though, I've found that my current insurer (United) denies and delays care far, far, more often than when I had a similar plan with BCBS. And I'm not talking about small bills, my son was in the NICU for 41 days, at a cost of ~$150,000. Through BCBS I paid like a grand of that. United denies the most random things, a referral to a specialist, meds for on brand usage while they'll pay for other meds that are off brand, for instance.
I do have a platinum level plan, I am _extremely_ lucky to have this. I know the vast majority of Americans, most of my friends and family, fight with their insurance companies for far less than my complaints.
People are against paying for nothing, not against paying for services. There's just no confidence that the amount of services rendered can change away from "as little as they can get away with", so there's no enthusiasm for paying at all.
You see, dear, your critical error was in believing that psychiatry is “medicine”, and that mental health treatment is “health care”.
Oh for sure, they present you “doctors” and “nurses” with the same credentials, wearing white lab coats, ties, scrubs, and even stethoscopes. They can prescribe “drugs” and run “hospitals”.
From the outside, they are indistinguishable from physicians who treat the physical body, but it is all a satiric cosplay. It is done this way for reasons, chiefly not to scare people too much.
Mental health should be considered more of the “Pre-Crime Division” or Department of Corrections For Stuff That’s Not Your Fault.
Don’t ever believe they’re in “Health Care”. This is a fatal category error.
For a clear case like this, an insurance denial shouldn’t even be shared with the suicidal patient, their spouse should shield them from that and just pay from their checking account. The life of your spouse is worth more than a few more dollars in retirement.
> In publicly funded system, it’s likely facilities like this would not exist or would be strictly private pay.
In France, 80% is paid by the public healthcare if a psychiatrist greenlit you, which still make you liable for ~30€ per day in a room you share with another patient (and if you want a private room it's ~90€/day out of pocket) (maybe the prices around Paris are a bit higher though, i'm a country boy)
[edit] more accurate numbers, i had to check and correct them. Also, 30€ per day also covers medication if needed and a spa session
> Le délai d’attente d’un lit disponible est en moyenne de 3 à 4 semaines
3 to 4 weeks vs. the next morning in the article. Interesting. I wonder what would have happened in the intervening weeks.
0: https://clinique-du-parc.ramsaysante.fr/vous-%C3%AAtes-patie...
I'm surprised the author makes no mention of those sorts of programs in the article. It makes it sound like the options were a luxury 8 week inpatient or nothing, when there's really a lot of stuff in between.
I didn’t want to mentioned it my initial post, but these sorts of programs seem a happy combination of keeping costs down and maximizing autonomy, while focusing on full-time on mental illness.
Some is these are technically “in-patient” at home programs, which are growing in popularity in all fields on medicine.
But they’re not appropriate all the time, and I don’t want to “recommend” them. Talk to your doctor.
Sadly it seems these sorts of programs are simply unavailable in much of the country.
>But six days into Randy’s eight-week hospital stay, our health insurance company denied any further inpatient care.
>The facility appealed Randy’s case, providing psychiatrist’s notes that clearly outlined his need, but the outcome did not change. Because Randy had no prior history of mental illness, the insurance company determined he shouldn’t need to be hospitalized and stopped paying for his care. A day later Randy was forcibly discharged.
This is definitely a case where the insurance company holds the majority of the blame.
What facts are the basis of your conclusion? There is no health system in the developed world where a doctor's recommendation will guarantee expensive inpatient treatment without a layer of bureaucratic review.
If Americans had the fortitude to have grown-up conversations about what should be socialized, how care should be rationed, etc, the public could exert some control over the design of the "system". As it stands, the "system" has mostly been shaped by corporate interests while the public has been distracted by inflammatory rhetoric pumped-out by all the entrenched players designed to play to partisan feelings about "fairness" and "freedom".
> often providing services that are unnecessary
Thank a lawyer. "Patient with symptom X would have survived if only the doctor had tested him for Y". Now every patient with symptom X is issued a $5600 scan for Y -- not because of medical science, but because of liability. Every time a courts awards 10 figure settlement because "that insurance company is good for it," all of society pays for it.
it's inherently the wrong model for providing a necessary feature of life (health), and combine it with a highly litigious society, and well, this is the result
The insurance companies are running the system more than any of the others — it is the finance "wizards" there who put the constraints on the rest of the system. I'll agree somewhat on the pharma companies too, who are also extractive.
You even said it yourself: "Hospitals try to eke out the most out of insurance companies...". Exactly! Because the hospitals and doctors are constrained to do "WHAT IS IN THE BEST INTEREST OF THE PATIENT" — that is their charter (and BTW, that is also the magic phrase to use whenever questioning what they propose to do for a patient or escalating a case). Perhaps a few hospitals or physicians occasionally overdo it, and there are some frauds, but your accusation overall is BS.
The insurance companies have no such constraint — if they do have such a mission goal, it is to OBTAIN MAXIMUM VALUE FOR THE SHAREHOLDERS. And the insurance companies are literally so amoral that they will reward agents for killing people for profit. That is not rhetoric, it is sworn testimony before congress of a person who cut off a patient's coverage, causing their death, and got promoted.
I have seen directly and personally an insurance company deny coverage for a test ordered for a close family member by the Chief Of Cardiology at Mayo Clinic. Mayo Clinic, and that physician are so overbooked they have ZERO motivation to order anything not necessary for the patient in front of them. It took days, and significant extra expense to get it reversed.
There is no way on the planet that anyone in an insurance industry should be able to override the doctors orders of the Director of Cardiology for Mayo Clinic. Or any physician, for that matter.
Medicine is one of the things that should never be run for a profit, and if I were on Luigi Mangione's jury I would acquit on Jury Nullification.
Woman charged $143,396.66 for a breast biopsy https://www.marketwatch.com/story/a-doctors-prescription-to-...
Numerous studies have found that when doctors have a financial stake in a hospital, they tend to order more tests and procedures, raising costs for Medicare and other insurers. https://www.nytimes.com/2011/12/13/health/policy/republican-...
But... I've come to realize that it is impossible to make people understand it or change it.
So, I've been proposing a lesser change: In theory Insurance companies business model is to hedge against the risk of people getting sick ok? Well, let's make the bet fair and remove them the ability to decide who gets covered and who doesn't. In the case of the original article: Let a neutral third party panel of professionals be the ones that decide whether the Health Insurer has to cover or not the case.
Otherwise, Insurers are behaving like Casinos that decide to pay or not to pay to people who win a game.
Why's that? Between mortgage, repaying education debt, supporting children, recovering from a husband's failed business venture...what is hard to believe about having trouble paying for another expense, especially after you've been reassured that the expense would be at least partially recompensated and that turns out to not be the case?
For example, that mortgage, did you stretch the very limit of your income or did you buy something reasonable?
Nobody forced you to buy a house, you could also rent or commute longer.
I lived in a crappy rental for five years and commuted and was able to fully pay off my student loans at the beginning of my career. As an example
Education debt can be put on forbearance or deferment under many life circumstances.
Given high income level, you also have many options available to you like personal loans.
Yes.
> If everybody had to pay for medical care, medical care would need to be affordable to survive.
How would people with zero income afford it?
I don't think there is a society in the world that ever had that successfully executed in practice. I live in Norway, and even if the public heath system is probably as good as it gets here, I often use private providers for non-urgent things simply because waiting time can be up to six month otherwise.
And even if you somehow manage this on paper, you'll be very surprised on how markets work. They don't need legal recognition. They don't even need money. See: USSR. Health care was public and medics weren't even a particularly attractive profession because there were too much of them already. Still if you wanted to survive an appointment you'd better have a package of some deficit wares ready.
What denies public healthcare money isn't "wealthy trying to cut public spending down". It's bureaucrats wanting their share of the pork barrel.
In my experience with family members, inpatient hospital stays at many hospitals in the US are one of the least therapeutic environments possible, and once you've gone through an ER or psych ER (which most of them make you do), you have no control over which hospital you end up at. In the end your stay is unlikely to be any more than 7 days.
PHP programs on the other hand tend to fill the role that work had previously taken in someone's life for a few to several weeks. They're typically 9-3, held in office parks, and are mostly quality group therapy with a daily or weekly psych visit.
As long as we’re throwing anecdotes, access to forbearance and deferment is shaky at best. I’ve personally had inconsistent success across various income levels.
Which charities have the funding to cover a $1M NICU stay?
My kiddos were born the day before the third trimester and spent two months in the hospital. Staff it at minimum wage, cap the costs at just the stuff used, and you're still talking a lot of money.
And your examples justify obviously incompetent insurance people vetoing doctor's orders, exactly how?
Doctors are generally forbidden to treat patients without directly examining them and knowing their cases. How is it that insurance companies are allowed to make life-and-death decisions over medical care —with less competent bureaucrats (who may or may not have a medical license)— without ever even seeing the patient? How is this good for the patient?
Of the 33 developed countries, 32 have figured out how to deliver medical care to all of their citizens, and do so for roughly half or less of the cost in the US. Moreover, those countries are seeing continued longer lifespans, while lifespans in the US are declining, again while spending twice the money. Clearly, for-profit medicine and insurance performs worse on every metric.
What is the difference between the 32 developed countries who successfully deliver healthcare to all their residents, vs the wealthiest country of all of them who still fails, and yet spends twice what the rest spend?
Private Insurance runs the whole thing.
And it is a sh*tty business. Insurance company profits do not account for near the 2X difference in spending. That is in the massive waste and bureaucratic overhead of every party trying to keep their heads above water while jumping through the insurer's hoops.
Entire bureaucracies exist just to oppose the insurer's bureaucracies.
And feeding those bureaucracies consumes an insane amount of physician resources.
And exactly zero of it delivers any healthcare to patients.
[0] https://healthcareuncovered.substack.com/p/2025-big-insuranc...
If you have health insurance (in the US) and you have a catastrophic event, your finances are going to be totally wrecked anyway. You're likely to have to declare bankruptcy unless you are pretty wealthy. At least, that's how it's gone with every friend and family member of mine that had to navigate such an event. That's on top of the painful nightmare that is dealing with insurance company claims (which, to add insult to injury, you have to do when you're injured or sick).
The premiums are also so high that I'm very far from convinced that holding an actual health insurance policy is a better option than putting that premium money into an emergency fund.
I got $300,000 in coverage for a catastrophic event and wound up paying $ 3,100.
But I did have good insurance with United Healthcare.
I had quite a few not-bills of the sort you see there totaling more than a few hundred thousand. Insurance coverage did work in my case.
I'm happy with the ROI I've had with my insurance premiums over my life. I haven't had a catastrophic event but I've certainly had reasonably sizable claims. If I'd invested the last 20+ years of premium expense (about $400K to date) and had no claims I'd have a ton more money, but not enough to cover a catastrophic event later in life. The principal would also have been completely wiped-out a couple of times when I did have claims, however.
I pay the premiums because I'm not comfortable holding bets on both the market and on my health. I'm also unwilling to consider bankruptcy as a morally / socially acceptable solution.
This mixed socialized and capitalist "system" we've allowed to grow up feels like the worst possible one. Healthcare and health insurance expense are a mechanism to extract value from the middle class (i.e. everyone who has money but isn't wealthy enough to buy their way out of the "system").
My preference would be for a fully socialized system, built primarily around protection for catastrophic loss, where everyone contributes w/ no opting-out permitted.
Failing that I'll grudgingly take a fully capitalist system where people who can't afford to pay are left to fend for charity or die.
What we've got is a mix of the worst parts of both.
For most people, this is not true. Half of cancer patients and survivors say they have medical debt, and of those half have less than $5,000: https://www.fightcancer.org/releases/survey-finds-majority-c....
> WASHINGTON, D.C. – Nearly half (49%) of cancer patients and survivors report being burdened by medical debt alongside some (13%) who report expecting to incur medical debt as part of their treatment plan, according to a new Survivor Views survey by the American Cancer Society Cancer Action Network (ACS CAN). Interestingly, nearly all (98%) were insured when medical debt occurred.
> Among those with cancer-related medical debt, nearly half (49%) have carried more than $5,000 in debt, a majority (69%) of whom have carried this debt for more than a year. Respondents also reported most commonly owing their medical debt to a hospital (76%).
...
> According to the survey, an individual with cancer-related medical debt was three times more likely to be behind on recommended cancer screenings in comparison to those who have been able to pay for their care without accumulating debt. Nearly half (49%) saw their credit score decrease with 30% having difficulty qualifying for loans.
> Cancer-related medical debt is also not felt equally and further deepens disparities. Black (13%) and Hispanic (14%) patients and survivors with medical debt were twice as likely as White respondents to report being denied care due to their debt. Black respondents were also more likely to report being contacted by collections agencies (66%) and to feel harassed by them (44%).
How many big medical systems/districts in your region can you run up a balance until none will serve you, except through the E.D.?
As to the why, it's because I switched jobs and got my regular labs done and apparently was between coverage that week... they tried to charge me a large multiple of what they charged insurance for the same labs, so I refused to pay.
I also had several bills that were never paid from a week long hospital stay in my mid 30's... Most of them got paid if they'd agree to reasonable payments or settle for lower amounts when I had the money (tax return time, bonus, side work). After 7 years, they were all off my credit and I stopped bothering...
This one is pre-ACA but the insurer focused on an "omission" to justify the rescission: https://www.cnn.com/2009/POLITICS/06/16/health.care.hearing/...
Look how many people in this thread are thinking about avoiding health insurance based on the premise that you’ll be financially wiped out by a catastrophic event even if you have insurance. That’s what happens when you put framing over facts. It’s important for people to understand the facts so they can make good decisions.
What you can't be sure of is the real cost in terms of resources, and how that would be accounted and paid for. The price of your childrens' stay, to you personally, could be far less than what you originally paid personally if healthcare was not reliant on private subsidy. You would also likely be subsidizing the costs of other children staying in the hospital through public subsidy using your tax dollars. I reckon that last point is where a lot of people in the US get hung up.
I am making the claim that the cost will be prohibitive to handle via charity, especially as a national healthcare strategy, as proposed upthread.
And closed-minded accounting rules, such as the rule that debits must equal credits in every transaction. And physics.
I do not think charity makes up a particularly signficant portion of that cost, no.
That's not charity!
Not according to any common definition.
I, too, can win every argument if I get to make up the definitions.
> compulsory collective charity
Compulsory makes it not charity. That's a tax.