Author Topic: Medical Bills  (Read 4053 times)

Hotstreak

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Medical Bills
« on: October 07, 2015, 10:13:21 AM »
I hit my out of pocket maximum of $5000 in late August, and the last of the bills just came in.  I missed a LOT of work this year, drove to many appointments, and also spent about $500 for various things insurance didn't want to cover.  I am sending in the last payments TODAY and I am proud to say I don't have any credit card balances and didn't need to borrow any money to do it.  I could never have done this without the MMM modifications I made to my spending over the past few years.  My salary is $49k/year.  I am looking forward to getting these medical issues fully resolved by the end of my insurance calendar, so I can put all this cash towards investments and savings next year!

terran

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Re: Medical Bills
« Reply #1 on: October 07, 2015, 10:39:24 AM »
Well done!

Totally fine if you don't want to say, but if you don't mind sharing what was the medical issue? I'm curious what kind of emergency leads to hitting the out of pocket maximum since we've never had anything big (knock on wood) and it weighs in to decisions about what type of insurance to go for.

Mississippi Mudstache

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Re: Medical Bills
« Reply #2 on: October 07, 2015, 10:50:57 AM »
Great job OP! We were caught off-guard the first time our bills were high enough to hit OOP max, but now we just plan it into our annual budget as a regular expense. This is the third year in a row, and we will probably continue to hit it every year until our son is independent and able to go on Medicaid (15 years from now).

Well done!

Totally fine if you don't want to say, but if you don't mind sharing what was the medical issue? I'm curious what kind of emergency leads to hitting the out of pocket maximum since we've never had anything big (knock on wood) and it weighs in to decisions about what type of insurance to go for.

For us, it was our son's disabilities (from birth, not an accident). Lots of medical supplies, doctor's appointments, and therapy sessions add up to many tens of thousands in medical expenses per year. Just his catheters alone cost $1200/month.

I'm a red panda

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Re: Medical Bills
« Reply #3 on: October 07, 2015, 11:02:57 AM »
Well done!

Totally fine if you don't want to say, but if you don't mind sharing what was the medical issue? I'm curious what kind of emergency leads to hitting the out of pocket maximum since we've never had anything big (knock on wood) and it weighs in to decisions about what type of insurance to go for.

Not the OP:
For a number of years my OoPM was (individual) $2,000.  I hit it 5 years in a row, never for something I would call an "emergency" but always for something involving physical therapy. Twice it was for patellar tendonitis (uh, knee pain). I wouldn't have though it was an emergency; my knees hurt when walking, I fell once because I couldn't support my weight on the unstable joint. It was bilateral- so getting both knees to resolve was difficult. That was mostly on physical therapy, but also had a visit to a rheumatologist to make sure it wasn't arthritis. The next year it was bursitis and a labral tear (though I didn't get surgery to fix it) in my hip. Last year it was a semi-emergency for costs associated with breaking my T1 transverse process in a car accident- ER, non-surgery neurosurgeon appointments, scans, PT.  I was in a cervical collar for the summer while the bone healed, but mostly just really incredibly severe headaches was the issue. (The total billings for that were close to $50k if you are wondering what portion insurance covered.)

The other severe issue I've had was an anterior spinal fusion along with an ICU stay and then an in-patient rehab stay after breaking my neck/ temporary paralysis. I think that hit the out of pocket max in like the first day between the ambulance, the ER, the scans, the neurosurgeon, and the surgery team. That was definitely an emergency. I think our (family) OoPM was $20k then (this was a long time ago).  I can't even begin to imagine how much $$$ was billed to insurance for this type of injury.

I'm a red panda

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Re: Medical Bills
« Reply #4 on: October 07, 2015, 11:08:11 AM »
I hit my out of pocket maximum of $5000 in late August, and the last of the bills just came in.  I missed a LOT of work this year, drove to many appointments, and also spent about $500 for various things insurance didn't want to cover.  I am sending in the last payments TODAY and I am proud to say I don't have any credit card balances and didn't need to borrow any money to do it.  I could never have done this without the MMM modifications I made to my spending over the past few years.  My salary is $49k/year.  I am looking forward to getting these medical issues fully resolved by the end of my insurance calendar, so I can put all this cash towards investments and savings next year!

Great job!

I hope you get all the issues resolved. If you've already met the OoPM- this is the time to get little things in :) (Assuming you have time to do it.)

takeahike

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Re: Medical Bills
« Reply #5 on: October 07, 2015, 11:38:22 AM »
Great job OP! We were caught off-guard the first time our bills were high enough to hit OOP max, but now we just plan it into our annual budget as a regular expense. This is the third year in a row, and we will probably continue to hit it every year until our son is independent and able to go on Medicaid (15 years from now).

Well done!

Totally fine if you don't want to say, but if you don't mind sharing what was the medical issue? I'm curious what kind of emergency leads to hitting the out of pocket maximum since we've never had anything big (knock on wood) and it weighs in to decisions about what type of insurance to go for.

For us, it was our son's disabilities (from birth, not an accident). Lots of medical supplies, doctor's appointments, and therapy sessions add up to many tens of thousands in medical expenses per year. Just his catheters alone cost $1200/month.

Not the OP but when I lived in the States I had catastrophic type insurance before ACA (early 2000's).. I was living on 20K/yr and in December started having severe stomach pains. Had to get expensive scans etc. Found out that my gallbladder doesn't empty out fully and is aggravated by fatty foods, stress.  By the end of December had maxed out $2500 out of pocket portion.. but still had to get more tests in January.  GAH a new calendar year so the 2500 started anew. So in a short 2 months had nearly $5000 in medical expenses.. and I'm otherwise a shining example of health. I now live in Canada and never have to budget such bullshit.

badger1988

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Re: Medical Bills
« Reply #6 on: October 07, 2015, 11:44:00 AM »
Having premature twins is an easy way to hit your max out-of-pocket. We've got $300,000+ worth of claims this year. Thankful for good insurance.

Sailor Sam

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Re: Medical Bills
« Reply #7 on: October 07, 2015, 12:10:46 PM »
The other severe issue I've had was an anterior spinal fusion along with an ICU stay and then an in-patient rehab stay after breaking my neck/ temporary paralysis. I think that hit the out of pocket max in like the first day between the ambulance, the ER, the scans, the neurosurgeon, and the surgery team. That was definitely an emergency. I think our (family) OoPM was $20k then (this was a long time ago).  I can't even begin to imagine how much $$$ was billed to insurance for this type of injury.

Congrats, OP. Also, Holy Fucking Jesus on a Bike, iowajes. Outside of childbirth, it doesn't get much more emergency than your experience. Congratulations on not being paralyzed. I can't imagine how scary that must have been.

I have Tricare active duty, so I don't get bills but I do get summaries. So far my torn ACL has cost the government (aka: many of you. Sorry 'bout that) $27,773.24.

Edit: missed a decimal.
« Last Edit: October 07, 2015, 05:46:01 PM by Sailor Sam »

I'm a red panda

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Re: Medical Bills
« Reply #8 on: October 07, 2015, 12:16:03 PM »
Congrats, OP. Also, Holy Fucking Jesus on a Bike, iowajes. Outside of childbirth, it doesn't get much more emergency than your experience. Congratulations on not being paralyzed. I can't imagine how scary that must have been.


I think heart attack is what ranks higher on the emergency scale. Since I didn't die right away, chances are I wasn't going to- thankfully I broke C5, so my breathing wasn't in danger. I didn't even get sirens on my ambulance. It was just a matter if I could walk or use my arms again, which thank God I can.  I was really really lucky that the on-call neurosurgeon was pretty much the best one in the state of Texas. And I was way too out of it to realize how scary it was until after the fact (though it probably was for my parents). I'm more scared about the eventual refusion (because of degeneration)- because I'll have to go in KNOWING I'm about to have a major spinal surgery done.  I'm also planning a natural birth, because the idea of an epidural/spinal block and not feeling my legs is my worst fear. (I know an epidural you normally can move a bit, but my OB couldn't guarantee it.) Hopefully my childbirth will not be an emergency- I know they can be; but most can be classified as routine.

My sister had premature twins. I can't imagine the stress of that either; knowing whether they were going to make it. Thank god for insurance, because that one hits the out of pocket max really quick.

Basically- insurance is really really important. You just never know what is going to happen. And when things happen they cost A LOT.
« Last Edit: October 07, 2015, 12:17:59 PM by iowajes »

terran

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Re: Medical Bills
« Reply #9 on: October 07, 2015, 12:33:16 PM »
Thank you all for sharing!

What strikes me is that most of what has been shared seems to fall in the realm of really bad and would probably max out just about any insurance. I think it reassures me in our choice to go with an HSA eligible plan. Sure something smaller might hit the out of pocket max on the HSA plan, but not the PPO plan, but much of what I'm reading hear seems like it would hit the max on both which for us at least is only $1000 more on the HSA plan (which is much less than the difference in premiums each year).

Hotstreak

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Re: Medical Bills
« Reply #10 on: October 07, 2015, 01:21:33 PM »
Well done!

Totally fine if you don't want to say, but if you don't mind sharing what was the medical issue? I'm curious what kind of emergency leads to hitting the out of pocket maximum since we've never had anything big (knock on wood) and it weighs in to decisions about what type of insurance to go for.

Thanks everyone!  For me it was largely trying to get two physical injuries resolved at the same time, one neck/shoulder and one foot.  So far this year I've had 3 X-Ray's, 3 MRI's, 60+ physical therapy appointments, more than a dozen office visits with specialists, three injections including one guided by ultrasound and one by x-ray (fluoroscope).  The injuries happened last year, so I started treatment in January knowing for sure I would hit deductible, and that I would possibly hit OoPM as well.  Because of that I got some recurring sinus issues checked out including an endoscopy and CT scan, and also saw a therapist to address some unresolved PTSD (with the common comorbidities), which resulted in rather large bills being sent to insurance on a weekly basis. 

I made a prior year contribution to my HSA with annual bonus & front loaded my contributions this year so only ended up paying a few hundred dollars from my bank account instead of HSA, which I am thankful for.  I'm also very glad that I didn't have to dip in to my cash savings, and that I was able to keep making enough 401k contribution to get my full match.  As a bonus, I'm really good at navigating my health insurance company.  Maybe a side biz opportunity there?

I'm a red panda

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Re: Medical Bills
« Reply #11 on: October 07, 2015, 01:36:40 PM »
Thank you all for sharing!

What strikes me is that most of what has been shared seems to fall in the realm of really bad and would probably max out just about any insurance. I think it reassures me in our choice to go with an HSA eligible plan. Sure something smaller might hit the out of pocket max on the HSA plan, but not the PPO plan, but much of what I'm reading hear seems like it would hit the max on both which for us at least is only $1000 more on the HSA plan (which is much less than the difference in premiums each year).

I don't know where you are on your journey to financial independence, but for me $1,000 is not a deal breaker at all when it comes to out of pocket max. That's small money for medical issues when we are talking about maxes.

I'd compare premiums and deductibles to make the decision.

Louis the Cat

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Re: Medical Bills
« Reply #12 on: October 08, 2015, 09:33:59 AM »
Having premature twins is an easy way to hit your max out-of-pocket. We've got $300,000+ worth of claims this year. Thankful for good insurance.

Maybe our OoPM is low but they don't have to be premature. My twin pregnancy cost about $3000 one year and the OoPM of $4000 the next year (delivered in January). The ultrasounds (and I didn't have as many as a lot of twin pregnancies) darn near did it by themselves in the first year. If I'd had any complications in the first year, we'd have gone over while I was still pregnant. Luckily? the complications didn't start until January so we didn't hit the max twice. The delivery itself was 5 figures (scheduled C section) so the minute I was admitted for the delivery, we went over. It was all still more cost effective with an HDHP and HSA than traditional HMO insurance in our case.

terran

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Re: Medical Bills
« Reply #13 on: October 08, 2015, 11:30:43 AM »
I don't know where you are on your journey to financial independence, but for me $1,000 is not a deal breaker at all when it comes to out of pocket max. That's small money for medical issues when we are talking about maxes.

I'd compare premiums and deductibles to make the decision.

Sorry for the confusion, that was exactly my point. It seems from the stories that the times when people have hit an OOP Max it wouldn't really matter what (reasonable) insurance you're on, you'd still hit whatever that plan's max is. So for us the max is $1000 more on the HSA plan than it would be on the PPO plan, which isn't that much at all, especially when you consider the difference in premium in one year is $3000.

I'm a red panda

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Re: Medical Bills
« Reply #14 on: October 08, 2015, 12:38:47 PM »
Sorry for the confusion, that was exactly my point. It seems from the stories that the times when people have hit an OOP Max it wouldn't really matter what (reasonable) insurance you're on, you'd still hit whatever that plan's max is. So for us the max is $1000 more on the HSA plan than it would be on the PPO plan, which isn't that much at all, especially when you consider the difference in premium in one year is $3000.

Yep- that makes perfect sense.

For me, the OOP Max for my husband's HSA plan is something like $10,000- where for my PPO it is $2,000 - so it makes a bit more of a difference.