Health Insurance in USA - what are we exactly paying for?

[music4u4]

Recently one of my friends had a surgery. She had a fibroid tumour that was removed surgically. They didn't do a hysterectomy. She was admitted early in the morning and operated on the same day during the morning hours. She was in considerable pain in the evening and would have preferred to stay in the hospital for the night. She is a Registered Nurse by profession and wasn't really comfortable going back home. However, her insurance will not cover overnight stay. So, she has no option to go back home with narcotic painkillers.

This amazes me. She has been religiously paying for health insurance for years since she has started working approximately 20+ years back. What good is this insurance wherein you cannot even get approved for an overnight stay at the hospital after a surgery?

The healthcare situation in this country is really bad.

[FB2020]

Recently one of my friends had a surgery. She had a fibroid tumour that was removed surgically. They didn't do a hysterectomy. She was admitted early in the morning and operated on the same day during the morning hours. She was in considerable pain in the evening and would have preferred to stay in the hospital for the night. She is a Registered Nurse by profession and wasn't really comfortable going back home. However, her insurance will not cover overnight stay. So, she has no option to go back home with narcotic painkillers.

This amazes me. She has been religiously paying for health insurance for years since she has started working approximately 20+ years back. What good is this insurance wherein you cannot even get approved for an overnight stay at the hospital after a surgery?

The healthcare situation in this country is really bad.

It is. Similar case for my wife's hernia surgery few years. It was so hard to climb the stairs at home, but she had to come back the same day.

We're paying for outrageous health care costs. A single tylenol tablet costs $10 at the hospital - yes 1 tablet.. Talk about their margins!!

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Recently one of my friends had a surgery. She had a fibroid tumour that was removed surgically. They didn't do a hysterectomy. She was admitted early in the morning and operated on the same day during the morning hours. She was in considerable pain in the evening and would have preferred to stay in the hospital for the night. She is a Registered Nurse by profession and wasn't really comfortable going back home. However, her insurance will not cover overnight stay. So, she has no option to go back home with narcotic painkillers.

This amazes me. She has been religiously paying for health insurance for years since she has started working approximately 20+ years back. What good is this insurance wherein you cannot even get approved for an overnight stay at the hospital after a surgery?

The healthcare situation in this country is really bad.

Absolutely. Health "insurance" is the biggest scam ever perpetrated. You should be able to access hospitals and pay a reasonable price for their services. The poor and the middle class is just bled so that the rich and hedge fund managers can get their money.

The situation is slightly better in other Western countries that have state-funded healthcare but even here one constantly reads about over-stretched and under-funded services. In India, one can't even think about going to government hospitals. With private hospitals one is always worrying about being over-charged, one always has to show that one knows people and one is very important, otherwise they shall eat you. It's just pure and utter hell everywhere.

[VS007]

The main cause for this misery are the republicans who are filthy rich who want no reform!

[VadheraHalli]

Absolutely terrible if you have one of the hard to diagnose type issues. Too much to pay $150 -200 per doc visit and $120+ for blood tests etc. That's after some sticker shock of seeing $3500; you will gladly pay the "discounted" price. Often medicines for chronic conditions are brought from out of country.

At least the diagnosis part and independent lab tests, like in an Apollo lab is still affordable in India. Even if a specialist charges Rs.750/visit and similar blood test costs Rs.6000 (or Rs.600 if you have a discount program), it's manageable.

[greyfri]

Recently one of my friends had a surgery. She had a fibroid tumour that was removed surgically. They didn't do a hysterectomy. She was admitted early in the morning and operated on the same day during the morning hours. She was in considerable pain in the evening and would have preferred to stay in the hospital for the night. She is a Registered Nurse by profession and wasn't really comfortable going back home. However, her insurance will not cover overnight stay. So, she has no option to go back home with narcotic painkillers.

I had a relative who had the same operation (myomectomy). My recollection is that she was in the hospital for at least 3 nights. It may be a different type of myomectomy surgery, or larger fibroids. Insurance covered everything.

Insurance companies generally won't cover something unless it's SOP for that procedure or a doctor certifies that it's medically necessary. Unless there's a possibility of infection, or the patient needs IV or a catheter, a night is probably not considered medically necessary. I know one can get angry at insurance companies, but with hospital room costs at several thousand $$s a night, and pressure to keep insurance premiums down, I really can't blame them.

Personally, I think it's a good idea to get out of hospitals unless you really need to be there for medical observation. The possibility of infection in hospitals is far higher.

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Personally, I think it's a good idea to get out of hospitals unless you really need to be there for medical observation. The possibility of infection in hospitals is far higher.

I agree. A hospital is the last place one should be if one is unhealthy.