Surprise medical bills - is this the inevitable future?

[Freedom2016]

This NYTimes article has struck fear into my heart about the impending birth of my second child:

http://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html

Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.

He was blindsided, though, by a bill of about $117,000 from an “assistant surgeon,” a Queens-based neurosurgeon whom Mr. Drier did not recall meeting.

I've seen a lot of threads here about the cost of health insurance, but am not sure I've seen any about peoples' experiences receiving surprise bills, and how they handled them (Did you pay? Dispute and win? Dispute and lose?). If you read the comments at the end of the article you'd get the impression that this is becoming a rampant practice, particularly as reimbursement rates are being reduced. Do you think we will see a lot more of this in the coming years? Is it inevitable unless there is even more reform/change in the health care system?

I've had a few examples of outrageous and unexpected charges. One was an MRI that should have been covered as a diagnostic test, but the hospital billed it as an outpatient surgery. When I tried to dispute it, insurance and hospital blamed each other, no one would help me, and an appeal went nowhere. Another was being double billed by two facilities for a 2nd opinion consultation (I never stepped foot into one of the facilities); a third was being billed almost $1000 for a single blood draw for our son.

It does seem like the system is stacked against the consumer and personally, I find it outrageous that we, as consumers, are expected to do all the legwork to understand/fight unfair billing practices when the system is set up to be a black box with no transparency on pricing.

I am thinking of taping a note on my delivery room door that says, "I will not pay for any out-of-network services or providers, given that this facility is in-network."

Would be interested in peoples' experiences along these lines, and even more so, in successful strategies for fighting surprise charges. I could imagine that peoples' FIRE plans could be significantly thrown off by a big enough surprise...

[Zamboni]

I've been through quite a bit of this, especially the "these specific doctors weren't in network even though the hospital was" and the "oops you had two children get the same routine service on the same day, so this must be a double billing."  If the insurance doesn't pay, I document all of my phone contacts with both them and the doctor's office, and then I file a formal written complaint with my state's department of insurance.  DOI has issued some pretty big fines in my state, and with this strategies all parties shape right up.  After filing two such complaints, now I just threaten to file a complaint during my first contact, saying I am making a good faith effort to straighten it out today but if it isn't completely taken care of my next step is a formal written complaint with the DOI.

Honestly I have no idea how the very seriously injured or elderly cope with the influx of medical bills from different "providers" from a single hospitalization.  Our local state hospital will put you on a no interest "payment plan," but every time a new bill rolls in you have to call them up again to have them add it to your existing plan, even if all of the services were on the same day.

[Abe]

Regarding the NY Times article and the operations - ask the surgeon who will be assisting them. Specifically, is the assistant a PA (Physician Assistant - most common scenario outside of academic hospitals, they are salaried and assisting is part of their regular duties) or a resident (academic hospitals, also salaried). In rural areas, you may have another surgeon assisting because the practice does not have a PA. This is fairly rare now. If they say another Surgeon is assisting, ask to see them also, see their credentials and ask why specifically they are needed (complex operation or preceptor for the primary surgeon on a new technique are the usual reasons). If they can't give a straight-forward answer, be suspicious. 

To tell you the truth, some surgical subspecialties are very money driven. This is especially true in private practices. If the group is not part of the staff of the hospital, they are more likely to try to squeeze more money from your care.

Also, no operation requires $117,000 worth of effort/skill. That is absolutely ludicrous and shameful. I hope the NY Medical Board examines that surgeon further after this article. Our cardiac surgeons are paid much less than that for heart transplants! Average payment to surgeons for fairly complex operations is a small fraction of this bilker's charge.

[Freedom2016]

Abe, I see where you're coming from but in the NYTimes cover story, the patient in question thought he had covered his bases in terms of researching what his costs would be. It's only in retrospect that you can say, "he should have asked who was assisting!" How was he to know, in advance, to ask that question? How many of us know who shows up in our OR unless we are TOLD in advance that this will be a possibility and/or is an established practice? I had 2 surgeries a few years ago and I have NO idea who else was in the room, other than my surgeon, plastic surgeon, and anesthesiologist. In those cases it seems I should count my lucky stars that I wasn't hit by a surprise charge by some "assistant" I had no idea would be present and did not consent to (being unconscious at the time).

In my upcoming situation - a pending birth without a specific scheduled date/time: My midwife and the hospital where I will deliver are both in-network. I will do my best to find out which OB's and anesthesiologists deliver there - in case I have any complications (I did last time, requiring OB/anesthesia). Do I also have to research whether any of their L&D nurses are contract/out-of-network? Do I have to get a list of every neonatal specialist who might get involved if my baby has problems? How many hypotheticals do I need to anticipate, research, and negotiate in advance? Should I refuse consults by anyone other than a predetermined list of providers? Should I research whether the room in which a procedure may be done will affect how it is billed? (That is what happened in my MRI situation!) Should I, in all seriousness, post a sign in my room that I will not pay out-of-network fees for services provided at my in-network hospital?

IMO it's onerous and inappropriate to place the burden for researching this kind of thing on patients, especially given the black box of medical coding and pricing.

[RetiredAt63]

Totally feel for you guys - I knew the American system was horrible to navigate compared to the Canadian system, but this is amazing in a negative way.

When I had our daughter, my Quebec Health plan paid for everything (and we almost ended up having a C-section, that would have been covered also), and my private insurance paid for the semi-private room.  When my Mom had heart-valve replacement surgery, Ontario Health Insurance (OHIP) paid almost everything and my parents' private insurance covered the semi-private room.  When my Dad got very sick and then died, OHIP covered it and the little bit they didn't, his insurance did.  Basically the hospital booked the Provincial system and the private insurance company.  None of this in-network/out-of-network confusion.  All we had to do was provide our provincial health cards and our insurance information.

Stories like this make me wonder why Americans are so protective of their present system - it sounds like a horror show.  Dealing with this paperwork when you are already sick and stressed is right up there with planning a funeral when you are sick with grief - not the best time for the brain to make good decisions.

[GuitarStv]

Stories like this make me wonder why Americans are so protective of their present system - it sounds like a horror show.

It's a lottery that many Americans not only want to play, but feel that they can win.  The health lottery.  No matter how many horrific stories come out of it, a large number of people from the US really enjoy taking a gamble on this.  I think that most of the rest of the world sees US health care as being pretty insane. . .

[Scandium]

I (like 90% of people?) don't understand medical insurance. So, as far as I understand, once you hit your out-of-pocket maximum will the insurance company will pay 100% of the cost. Does this apply to out of network charges, like these, as well?

After ACA the OOP max is $6,350, so would I never have a medical bill larger than this?
per http://www.consumerreports.org/cro/news/2013/12/what-s-the-difference-between-a-deductible-and-an-out-of-pocket-limit/index.htm

[Zamboni]

I am not at all protective or defensive of the state of the American health care billing system.  It is a horror show.  Or a crap shoot, to roll from GuitarStv's analogy.

I work in education and many, many young people want to become doctors because they see this as a path to becoming rich in the US.  So stories like this article do not at all surprise me.  I could not in good conscience charge $117K for less than one day of work, but I am not primarily driven by greed.  While many good, caring people enter medicine for the right reasons, the AMA ensures a chronic shortage of doctors by limiting medical school expansions.  This drives up salaries which encourages the greedy to pursue medicine for the wrong reasons.  I see it all the time in the 18-22 yo population as I watch their "cover story" for why they want to be a doctor evolve.  Then doctors of all motivations are left with working hours that are too long due to the doctor shortage, so after a while I'm sure everyone in that kind of work environment thinks they need to make bank.  And then the insurance companies jump in to muck up the billing, cause the doctors to need to hire a whole layer of administrative people to handle paper, and that makes it all 1000x worse. 

The whole system is messed up here.  But you are right, people defend it like someone is trying to take their guns away.

[MayDay]

We have had huge huge issues with this. 

The worst was when H had a surprise triple bypass two years ago.  Obviously the bills were astronomical, we shot past our OOP max in a hot second.  But for some reason, the insurance company just would.not.pay this one bill for about 1000$.  It was tiny compared to the total cost of his surgery and hospital stay (total negotiated amount was about 200k iirc).  But for whatever reason, they wouldn't pay it.

So I played this back and forth game for months, calling the hospital, trying to get an explanation for what it was, what was the billing code, could they possibly bill it as anything else, then calling the insurance company to try to get them to fucking pay it, then calling the hospital back to say I was working on it and please don't assess late fees or send to collections.  Repeat over and over and over and over.  It was my first time going through this, so I didn't realize until after the fact how much they were screwing me around.  Finally after about six months of this I called the insurance company and wouldn't get off the phone until I spoke to several levels of supervisors up, got a direct phone number to call them back, and then called me directly, daily, until it was resolved.  Once I had a direct number of a higher up person, and I bugged them, it magically got resolved.  Fuckers. 

Now I know better, and just do that in the first place (and good tip from the PP to invoke a complaint with the insurance commission!) things go more smoothly.  But I imagine most people give up well before they ever figure that out, and just pay the bill so it doesn't go to collections. 

Anyway, they also try to screw you over in all kinds of small ways.  Every year we have to send in a form saying we don't have any other insurance.  We send it in, but for each person in the family, the first claim of the year, they just deny it.  Then we have to call them and tell them verbally to pay the fucking claim because no we don't have other insurance, bastards. 

Or they have this magical seperate mental health coverage that is in tiny print, and has a totally different set of in network providers.  So we go to a clinic that is in network for everything else, but since we took my son for a mental health eval, nope, not covered.  3k out of pocket.  (In that case luckily there was a state mental health coverage for children program that did pick up the cost, but it was a one time deal, so if we ever need to use it again, welp, too bad.)

Or once, a hospital sent us a bill, insurance won't cover.  We call, much confusion ensues.  Finally we figure out, it wasn't a bill from 6 month ago, it was from a YEAR and 6 months ago.  They were billing the wrong insurance.  But oh, the old insurance won't pay either.  And basically there is no time limit (in my state anyway) for how long they can take to bill you.  That one the hospital eventually wrote off after I fought it and fought it.

So, long story short, universal health care and death panels for everyone!

[zhelud]

The very interesting blog "The Incidental Economist," written by doctors and health economics experts, addressed this issue recently.

http://theincidentaleconomist.com/

The writer suggested that the solution may have to involve state insurance commissioners and the Department of Labor as well as HHS.

[KBlynx]

Course11, you do have cause for some worry. The best thing you can do now is stay strong and don't let the medical team do ANYTHING without questioning the validity of it. Especially with births. They often try to speed things along so they can get home for dinner so never let them rush the process with meds/procedures. Births take time and it doesn't mean anything is wrong, but they like to get everyone out of there and free up the bed...cha ching! Make sure you guys have a birth plan, write it up and let the Dr.s and staff know that they can give no meds and do no procedures without consulting you first, physically hand them the letter and be prepared with lots of research.

If you are not hard set on the facility you are using, and the birth is expected to be low/no risk, perhaps consider out of hospital? I had my daughter at a birth center, right next to, but not affiliated with the hospital. They had midwives and a structured payment plan that was clear as day. No matter how long I was there it cost X amount. Granted there are also no drugs, but the low, non-panic inducing cost kept me strong. I did my research and after insurance the birth center was $1,500 + $800 for one ultrasound out of the center (this included all of my check-ups for my entire pregnancy) and the hospital started...just started at $6,500.

You have options and knowledge about possible procedures is your best ally. If you needed heart surgery you really don't have an option, but with a low/no risk birth there are ways to guard against cost before you accrue them.

[Freedom2016]

Course11, you do have cause for some worry. The best thing you can do now is stay strong and don't let the medical team do ANYTHING without questioning the validity of it. Especially with births. They often try to speed things along so they can get home for dinner so never let them rush the process with meds/procedures. Births take time and it doesn't mean anything is wrong, but they like to get everyone out of there and free up the bed...cha ching! Make sure you guys have a birth plan, write it up and let the Dr.s and staff know that they can give no meds and do no procedures without consulting you first, physically hand them the letter and be prepared with lots of research.

If you are not hard set on the facility you are using, and the birth is expected to be low/no risk, perhaps consider out of hospital? I had my daughter at a birth center, right next to, but not affiliated with the hospital. They had midwives and a structured payment plan that was clear as day. No matter how long I was there it cost X amount. Granted there are also no drugs, but the low, non-panic inducing cost kept me strong. I did my research and after insurance the birth center was $1,500 + $800 for one ultrasound out of the center (this included all of my check-ups for my entire pregnancy) and the hospital started...just started at $6,500.

You have options and knowledge about possible procedures is your best ally. If you needed heart surgery you really don't have an option, but with a low/no risk birth there are ways to guard against cost before you accrue them.

Thanks, I appreciate this, though feel well equipped to "defend" myself from unnecessary medical interventions - I had a med-free natural birth last time, expect to do the same this time, and this hospital is "friendly" in that sense. They have a big midwife practice. I do want to be in a hospital setting, however.

What I am worried about is some random provider turning out to be out-of-network. Who knows who will be on-call when I go into labor - if my own midwife isn't present, who will be taking her place? (Last time, my own midwife didn't deliver my child - a different one did). Who is going to get involved if anything goes wrong? I am not going to have the luxury of hand-picking each person in advance - and that is where my concern comes in.

[Eric]

Is the Times running a special segment on this?  Because I just read this one about Emergency Room procedures being out of network at in-network hospitals:

http://www.nytimes.com/2014/09/29/us/costs-can-go-up-fast-when-er-is-in-network-but-the-doctors-are-not.html?_r=0

That's even more abhorrent in my opinion.  It's the Emergency Room!  Who has time to ask questions about insurance networks during a medical emergency?

[Paul der Krake]

Ah, the beautiful US system, where the only move is to not play. Hospital prices are highway robbery, pure and simple. Everybody plays the blame game between suing patients, hospitals, drug manufacturers, and insurance companies when the reality is that prices (yes, even the pre-negociated insurance rate) are completely made up.

Vote with your dollars and avoid the hospital at all costs. Medical tourism FTW.

[beltim]

I (like 90% of people?) don't understand medical insurance. So, as far as I understand, once you hit your out-of-pocket maximum will the insurance company will pay 100% of the cost. Does this apply to out of network charges, like these, as well?

After ACA the OOP max is $6,350, so would I never have a medical bill larger than this?
per http://www.consumerreports.org/cro/news/2013/12/what-s-the-difference-between-a-deductible-and-an-out-of-pocket-limit/index.htm

Yes, that's correct.  And you'll note that even in this story, the insurance company paid the claim.  To me, the real story is these extortionate out-of-network billings.

I don't understand why states don't simply legislate that if a hospital accepts a given insurance, all providers in a hospital must accept that insurance.  It seems like common sense to me.

[Freedom2016]

I don't understand why states don't simply legislate that if a hospital accepts a given insurance, all providers in a hospital must accept that insurance.  It seems like common sense to me.

+1000

[Captain and Mrs Slow]

I wish I had the link now, but I think it was The Atlantic about billing on medicare, basic gist they compared two US counties and one was double or triple the other one but the health out comes where the same. Secondly they talked about how the Mayo Clinic expanded the salaried doctor concept to Florida and it took 10 years but eventually they established a huge presence.

From a political point of view Canada will never (offically anyways) private healthcare and neither will the US adopt  single payer coverage for the simple reason each sees the faults in the other. For the US the best place to look is Europe where you have universal coverage along with private healthcare. It varies from country to country but so far Germany has the best healthcare I've seen, miles better than Canada

For example my sister in law put out her back, went to the doctor and told under no circumstances would she get an MRI, I did the same in Germany in less than a week I had an MRI done. Also as far as I know there is no option in Ontario for a private MRI.

[Emilyngh]

I (like 90% of people?) don't understand medical insurance. So, as far as I understand, once you hit your out-of-pocket maximum will the insurance company will pay 100% of the cost. Does this apply to out of network charges, like these, as well?

After ACA the OOP max is $6,350, so would I never have a medical bill larger than this?
per http://www.consumerreports.org/cro/news/2013/12/what-s-the-difference-between-a-deductible-and-an-out-of-pocket-limit/index.htm

Yes, that's correct.  And you'll note that even in this story, the insurance company paid the claim.  To me, the real story is these extortionate out-of-network billings.

I don't understand why states don't simply legislate that if a hospital accepts a given insurance, all providers in a hospital must accept that insurance.  It seems like common sense to me.

+2

We actually had this happen a couple of years ago.   DH got into a bike accident and had to go to the ER.   The hospital was in network, and we had an ER copay that we paid before leaving.   Later, I got a bill from one of the ER doctors who was not in network.   Before this I felt very ontop of things for knowing that the hospital was in our network and never imagined they then could have Dr's who were out of network.  And even though I now know it, there's very little one can do to make sure that everyone who they see is in network in these type of sitches.

The bill was for a few hundred dollars, so I almost just paid it.   Luckily, I thought to call the hospital (who were not helpful) and then the insurance company before just paying it.   The insurance company was super helpful and right away said they'd send me a check, since it was an emergency.   Within days I had a check for the out of network amount, which I cashed and paid the bill.

So, in our case, it worked out fine.   But, patients have to know to call their insurance in this type of sitch (and hopefully all insurance companies are as accommodating as ours was).

[retired?]

Stories like this make me wonder why Americans are so protective of their present system - it sounds like a horror show.  Dealing with this paperwork when you are already sick and stressed is right up there with planning a funeral when you are sick with grief - not the best time for the brain to make good decisions.

Americans are not protective of the current system.  It is a mess that lacks any transparency.  Rather, most Americans don't want the federal government having power over this aspect of life.  The federal govt is inefficient at most things since there is no incentive to watch the bottom line.  And, replacing a bad system with another poor system isn't the answer.

Back to the OP - I can recall dealing with this sort of issue for the first time in 2005.  This stuff has been going on a long while.  In an open market, prices are what help consumers make decisions.  With healthcare, the insurers and hospitals have somehow gotten away with not having to (easily) provide prices. 

Consumers are also to blame.  With $20 copays, how many people think twice about visiting a doctor?

[Freedom2016]

Stories like this make me wonder why Americans are so protective of their present system - it sounds like a horror show.  Dealing with this paperwork when you are already sick and stressed is right up there with planning a funeral when you are sick with grief - not the best time for the brain to make good decisions.

Americans are not protective of the current system.  It is a mess that lacks any transparency.  Rather, most Americans don't want the federal government having power over this aspect of life.  The federal govt is inefficient at most things since there is no incentive to watch the bottom line.  And, replacing a bad system with another poor system isn't the answer.

Back to the OP - I can recall dealing with this sort of issue for the first time in 2005.  This stuff has been going on a long while.  In an open market, prices are what help consumers make decisions.  With healthcare, the insurers and hospitals have somehow gotten away with not having to (easily) provide prices. 

Consumers are also to blame.  With $20 copays, how many people think twice about visiting a doctor?

I have trouble squaring your first paragraph with the second. The entire health care industry benefits from information asymmetry (some players more than others), at the ultimate expense of sukkas like you and me. What is the nefarious result we would have to live with if government mandated price and coding disclosures, or required hospitals' providers to be within the hospital's network? These seem like fairly minimal requirements.

I'm certainly open to a market solution to this; I just have a hard time seeing how that will be possible. How did car buying information become so ubiquitous online? (genuine question, not rhetorical) That arena used to be a black box as well, but obviously some actors found a way to learn and then publicize that information and now consumers have much more negotiating power. Could something similar happen with health care?

[CanuckExpat]

struck fear into my heart about the impending birth of my second child:

I've had similar questions/fears, but I think no matter what, you can't end up owing more than your out of pocket maximum , if as in this case, it is an non-network provider, there might be a higher maximum, but I think there is still a defined ceiling on what you can pay.
Someone please correct me if I am wrong, I hope I am not.

Edit, I was wrong, see below.

[GuitarStv]

Stories like this make me wonder why Americans are so protective of their present system - it sounds like a horror show.  Dealing with this paperwork when you are already sick and stressed is right up there with planning a funeral when you are sick with grief - not the best time for the brain to make good decisions.

Americans are not protective of the current system.  It is a mess that lacks any transparency.  Rather, most Americans don't want the federal government having power over this aspect of life.  The federal govt is inefficient at most things since there is no incentive to watch the bottom line.  And, replacing a bad system with another poor system isn't the answer.

Well, you know what they say . . . If something doesn't work the first time, don't ever try again.


The large purchasing power that a government has related to medical supplies drastically reduces cost.  The US system as it stands right now is the most expensive in the world - so clearly it's not being run in a remotely efficient manner.  Most other countries are able to leverage their purchasing power to run far less expensive health care.  I don't share your view that Americans are too incompetent to do the same.

[retired?]

Stories like this make me wonder why Americans are so protective of their present system - it sounds like a horror show.  Dealing with this paperwork when you are already sick and stressed is right up there with planning a funeral when you are sick with grief - not the best time for the brain to make good decisions.

Americans are not protective of the current system.  It is a mess that lacks any transparency.  Rather, most Americans don't want the federal government having power over this aspect of life.  The federal govt is inefficient at most things since there is no incentive to watch the bottom line.  And, replacing a bad system with another poor system isn't the answer.

Back to the OP - I can recall dealing with this sort of issue for the first time in 2005.  This stuff has been going on a long while.  In an open market, prices are what help consumers make decisions.  With healthcare, the insurers and hospitals have somehow gotten away with not having to (easily) provide prices. 

Consumers are also to blame.  With $20 copays, how many people think twice about visiting a doctor?

I have trouble squaring your first paragraph with the second. The entire health care industry benefits from information asymmetry (some players more than others), at the ultimate expense of sukkas like you and me. What is the nefarious result we would have to live with if government mandated price and coding disclosures, or required hospitals' providers to be within the hospital's network? These seem like fairly minimal requirements.

I'm certainly open to a market solution to this; I just have a hard time seeing how that will be possible. How did car buying information become so ubiquitous online? (genuine question, not rhetorical) That arena used to be a black box as well, but obviously some actors found a way to learn and then publicize that information and now consumers have much more negotiating power. Could something similar happen with health care?

I don't see any contradiction.  I'd love govt mandated price transparency.  Can be done at the state level via DOI.  What I don't want is the govt managing healthcare.  I think people are becoming more aware of their options, e.g. $4 Rx at Walmart.  By now, people should realize that they have to ask if a specialist that their PCP recommends is in-network, ask how a test will help him/her make decisions, ask if their is a generic alternative, etc.

It's a big mess.  It would be nice if a single large insurance company stepped up and started doing things in a transparent manner.  They wouldn't need to rely on info asymmetry since they'd have so many new customers.

[cacaoheart]

My wife had the maddening experience of trying to find an in-network physical therapist that would tell her their fee before the appointment. Each office acted like she was insane for expecting such data and that they had no idea what the cost would be. Ultimately she went to one that seemed like it would be ok, and their initial price was ~$100 per appointment with insurance, but then a couple months later after multiple appointments she was sent a 2nd bill that made each appointment more like $400.

I had a milder experience going to an in-network ENT (ear nose throat) doctor. Our insurance card specified a set rate for the appointment, $25, which I paid, but then a month later I got another bill for an additional $130. Insurance had paid about half of the $280 bill. It's crazy that we can't know what we'll be billed going in even for a very specific, routine service such as a hearing assessment or basic physical therapy.

[rocksinmyhead]

Consumers are also to blame.  With $20 copays, how many people think twice about visiting a doctor?

I know this is a thing, but I don't get it. who are these people going to the doctor all the time? yeah, the copay is cheap, but who has the fucking time? it's a hassle, you have to leave work and deal with insurance, ugh.

[MayDay]

Who even had 20$ copay insurance anymore?  We have had only HSA options for the last 5 years at a combined 3 different employers. 

This complaint brought to you by the 400$ bill we got to remove splinters from DD's foot. 

[bacchi]

I've received unexpected/mysterious charges for an ER visit. Did they mix me up with a heart patient? Why was I being charged for an EEG for stitches on my hand?!? Some of the line items didn't even have a code.

I asked, I begged, I implored. They refused to tell me what was what. After many calls and letters to both the hospital and insurance company, I finally got a lawyer to send a letter -- "Tell me or no money! Oh, and if you continue, this is a notice to sue." The hospital backed down in a hurry, apologized, and that was that.

Fuckers.

[mollyjade]

[quote author=course11 link=topic=24372.msg411074#msg411074 date=1412030849

Would be interested in peoples' experiences along these lines, and even more so, in successful strategies for fighting surprise charges. I could imagine that peoples' FIRE plans could be significantly thrown off by a big enough surprise...
[/quote]

I had a high risk hospital birth three months ago. I can't count the number of people I saw, including three different lactation consultants. Thankfully, there were only about six bills. One for the OB, one for the anesthesiologist, one for the hospital, and a few for lab work. My son also had a small handful. All but one ended up being in network, and the one that wasn't was my son's mandatory hearing exam. But it was only $30 or so, so that didn't matter.

The new healthcare laws really favor the patient for a lot of this. That one bill for my OB, less than $1000 no matter what kind of birth I had, covered every single visit and all lab work that was part of that visit. Which in my case was at least 15 visits and sets of lab work. And I only paid one $35 copay for my many visits to the perinatologist.

A few years ago, my husband had surgery on his nasal passages. We jumped through the hoops to get preauthorization. Except, oops, the surgeon forgot to include both nostrils (which of course you don't find out until weeks later). So insurance would only cover one. It took months of talking to insurance and the doctor's office, and in the end the doctor ate the cost. Thankfully it never had to go to court or a collection agency.

My practical advice about your upcoming birth is to call your insurance company now to ask about what you need to do to get them to cover a breast pump, which should be covered 100% for all mothers. They can make rules about what brand you get and where you buy them from and whether you need a doctor's prescription. Even if you don't plan to need one, find out because you never know what problems will arise. I ended up buying one a few days after my son was born because he was having trouble latching on. And of course, sleep deprived and worried, I just drove to the store and bought one. Insurance reimbursed me $14.

As long as you're on the phone with them, you might as well ask if there are any other out-of-network costs you should be looking for.

[Emilyngh]

struck fear into my heart about the impending birth of my second child:

I've had similar questions/fears, but I think no matter what, you can't end up owing more than your out of pocket maximum , if as in this case, it is an non-network provider, there might be a higher maximum, but I think there is still a defined ceiling on what you can pay.
Someone please correct me if I am wrong, I hope I am not.

You are wrong (at least with my insurance, and I highly doubt it's a rare exception).   My insurance does have an in-network and out-of network out-of-pocket max.   But, as a result of this thread, I went and read the details (hoping that I'd be relieved).   And, instead what I found was that the out-of-pocket max for out of network only applies to covered amounts for services.   It has absolutely nothing to do with balance billing.

This means that if I see an out of network Dr for a procedure that my insurance usually pays $400 for in-network, but the out-of network charges $1,000 for, before meeting my out-of-network-out-of-pocket max my insurance will kick in 70% ($280) and once I've met my out-of-pocket-out-of-network max, my insurance will kick in their full $400, but in both cases the Dr would send my the bill for the extra $720 or $600 (balance billing) and my insurance will have nothing to do it with this portion, regardless of whether or not I've hit my out-of-pocket max.   

The insurance states this very clearly, and I have insurance that otherwise provides a lot of coverage (no deductibles, low out-of-pocket maxes, low copays, etc).

[Freedom2016]

On point to this conversation - and relevant to my exact situation - is an article on Slate today: Why Can't States Do More to Protect Patients from Surprise Medical Bills?

http://www.slate.com/articles/business/moneybox/2014/10/surprise_out_of_network_hospital_bills_why_it_s_so_hard_for_states_to_protect.html

Patching up these network gaps is complicated, and the most straightforward solutions are nonstarters. For instance, we could demand that all doctors in a hospital accept the same suite of insurance plans. But hospitals fear that such a requirement would make it harder to recruit physicians, especially in parts of the country where doctors are in short supply. Another idea: We could ask hospitals themselves to make sure, whenever possible, that patients are treated by in-network doctors. But when a Texas commission considered this seemingly straightforward concept, it concluded that technological limitations and the rapid mutations of doctors’ schedules from hour to hour would make it impossible.

[MrsPete]

. Do you think we will see a lot more of this in the coming years? Is it inevitable unless there is even more reform/change in the health care system?

Keep in mind that we only hear the negative stories.  Here's what I personally have experienced over the years:

- When my first child was born, we paid a couple hundred dollars total for all my pre-natal care and care for both of us in the hospital.
- When my second child was born, we paid nothing. 
- When they had all their well-child visits, vaccinations, and occasional sick visits, I paid just a co-pay.  A couple times I had mistakes in billing, which was frustrating.
- When my oldest broke her arm (had to be across a "growth plate"), it cost almost 2K, but I only paid a couple hundred out of pocket.
- When my husband was sick and spent one night in the hospital, the total cost was 8K, but we only paid a couple hundred.  I searched for billing mistakes -- none.
- When I had outpatient surgery -- three procedures on the same day -- the total cost was more than I bring home in a year, but I paid somewhere between $600-700.  Again, I searched for billing mistakes -- none. 

Yes, we pay a large price for insurance, but what I've paid out of pocket has been fairly reasonable, and I can't say that they've surprised me with unexpected bills.  Nor do I know anyone in real life who's ever told me about something like an extra surgeon in the operating room.  I think it's easy to read these things and get the idea that every third person is billed outrageously -- and while even one is too many, this isn't particularly common. 

Americans are not protective of the current system.  It is a mess that lacks any transparency.  Rather, most Americans don't want the federal government having power over this aspect of life.  The federal govt is inefficient at most things since there is no incentive to watch the bottom line.  And, replacing a bad system with another poor system isn't the answer.

Yes, this is it exactly.

I don't think anyone loves our current system -- but we fear that something else might be worse.  Specifically, we fear being made to wait for treatment /being denied treatment, or being told what doctors we can/can't see.  Think these are unrealistic fears?  What have we been hearing in the news lately about VA hospitals?  They're run by the government, and some shameful things have been happening in those facilities. 

[rocksinmyhead]

Americans are not protective of the current system.  It is a mess that lacks any transparency.  Rather, most Americans don't want the federal government having power over this aspect of life.  The federal govt is inefficient at most things since there is no incentive to watch the bottom line.  And, replacing a bad system with another poor system isn't the answer.

Yes, this is it exactly.

I don't think anyone loves our current system -- but we fear that something else might be worse.  Specifically, we fear being made to wait for treatment /being denied treatment, or being told what doctors we can/can't see.  Think these are unrealistic fears?  What have we been hearing in the news lately about VA hospitals?  They're run by the government, and some shameful things have been happening in those facilities.

yeesh, good point about the VA hospitals. but what I don't get is aren't we already at the mercy of our insurance companies with regard to what treatment we can get, and which doctors we can see? Why does it matter if it's Big Government or Big Insurance? (I haven't really figured out what my opinion is either way, just trying to play devil's advocate/get some thoughts)

[Pooperman]

Americans are not protective of the current system.  It is a mess that lacks any transparency.  Rather, most Americans don't want the federal government having power over this aspect of life.  The federal govt is inefficient at most things since there is no incentive to watch the bottom line.  And, replacing a bad system with another poor system isn't the answer.

Yes, this is it exactly.

I don't think anyone loves our current system -- but we fear that something else might be worse.  Specifically, we fear being made to wait for treatment /being denied treatment, or being told what doctors we can/can't see.  Think these are unrealistic fears?  What have we been hearing in the news lately about VA hospitals?  They're run by the government, and some shameful things have been happening in those facilities.

VA issue comes down to being underfunded. People without FU money calling the shots wanted their jobs more than standing up to say they couldn't possibly give the level of care required with the given budget. I sincerely hope we end up with a public-private system where you are covered by govt for necessary things but can get private insurance for other stuff.

[beltim]

yeesh, good point about the VA hospitals. but what I don't get is aren't we already at the mercy of our insurance companies with regard to what treatment we can get, and which doctors we can see? Why does it matter if it's Big Government or Big Insurance? (I haven't really figured out what my opinion is either way, just trying to play devil's advocate/get some thoughts)

We're at the mercy of someone else paying for it, but payment is only required after service.  In countries where the government runs the healthcare system, they deny treatment to start with.

Most people figure it's better to have lifesaving treatment and worry about cost later.

[Thegoblinchief]

I've been following this thread for a while but until Mrs Pete's comment I didn't feel inspired to comment.

My family's been lucky. I have close to zero complaints about the health insurance situation, though I remember being surprised at the size of the bill a doctor I barely recall during child #3's delivery submitted, so the "drive by doctoring" trend doesn't surprise me too much.

My first child had a two week stay in the NICU. The cost billed to insurance was in excess of $30K. Our portion? About $3K, which was our OOP max, so health care the remainder of the year was "free".

[jordanread]

We're at the mercy of someone else paying for it, but payment is only required after service.  In countries where the government runs the healthcare system, they deny treatment to start with.

I only have anecdotal evidence in regards to this, and I do a lot of blood work that is not considered preventative, so I pay out-of-pocket. However, my experience with people with gov't sponsored health care haven't had many issues with this. I have read many things about waiting lists and the like, but haven't seen any actual evidence. Nothing I've seen (and granted, I haven't looked very hard) and no hard numbers. Do you have anything regarding that?

Don't get me wrong, I haven't seen much evidence that the gov't would do better (VA stuff aside), but most articles I've seen don't have anything behind them either. Personally, I hate having the gov't involved, but I try to always look at the actual case being made. I can't see that 'the people' have done a good job actually making the system work. This shit is insane!!! My new(ish) job is designing software for the health care industry, and I can say that this shit is convoluted, and there has to be a better way.

[beltim]

We're at the mercy of someone else paying for it, but payment is only required after service.  In countries where the government runs the healthcare system, they deny treatment to start with.

I only have anecdotal evidence in regards to this, and I do a lot of blood work that is not considered preventative, so I pay out-of-pocket. However, my experience with people with gov't sponsored health care haven't had many issues with this. I have read many things about waiting lists and the like, but haven't seen any actual evidence. Nothing I've seen (and granted, I haven't looked very hard) and no hard numbers. Do you have anything regarding that?

Don't get me wrong, I haven't seen much evidence that the gov't would do better (VA stuff aside), but most articles I've seen don't have anything behind them either. Personally, I hate having the gov't involved, but I try to always look at the actual case being made. I can't see that 'the people' have done a good job actually making the system work. This shit is insane!!! My new(ish) job is designing software for the health care industry, and I can say that this shit is convoluted, and there has to be a better way.

Well, this sort of depends on what you're asking.  Are you asking about countries with government-run healthcare denying treatment?  Then look at http://www.telegraph.co.uk/health/healthnews/9706918/50000-denied-treatment-to-save-NHS-cash-claims-Labour.html and http://www.ombudsman.org.uk/about-us/news-centre/press-releases/2011/nhs-is-failing-to-meet-even-the-most-basic-standards-of-care-for-older-people,-warns

Are you asking about delays in care?  Then look at http://www.oecd-ilibrary.org/sites/health_glance-2011-en/06/08/index.html?contentType=&itemId=/content/chapter/health_glance-2011-59-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2011-en&mimeType=text/html  The US rates much better at waiting times (how quickly you can see a specialist) than Canada, France, Australia, New Zealand, and the UK.  It performs similarly to Switzerland and Germany.

Then, of course, there are cracks in the system, most notable recently illustrated by the VA debacle.

Also, it's possible I missed what you were actually asking, in which case just let me know and I'll do my best.  I'm actually a big proponent of universal health care, but I also encourage people to know the advantages and disadvantages of each particular implementation of universal health care.

[jordanread]

We're at the mercy of someone else paying for it, but payment is only required after service.  In countries where the government runs the healthcare system, they deny treatment to start with.

I only have anecdotal evidence in regards to this, and I do a lot of blood work that is not considered preventative, so I pay out-of-pocket. However, my experience with people with gov't sponsored health care haven't had many issues with this. I have read many things about waiting lists and the like, but haven't seen any actual evidence. Nothing I've seen (and granted, I haven't looked very hard) and no hard numbers. Do you have anything regarding that?

Don't get me wrong, I haven't seen much evidence that the gov't would do better (VA stuff aside), but most articles I've seen don't have anything behind them either. Personally, I hate having the gov't involved, but I try to always look at the actual case being made. I can't see that 'the people' have done a good job actually making the system work. This shit is insane!!! My new(ish) job is designing software for the health care industry, and I can say that this shit is convoluted, and there has to be a better way.

Well, this sort of depends on what you're asking.  Are you asking about countries with government-run healthcare denying treatment?  Then look at http://www.telegraph.co.uk/health/healthnews/9706918/50000-denied-treatment-to-save-NHS-cash-claims-Labour.html and http://www.ombudsman.org.uk/about-us/news-centre/press-releases/2011/nhs-is-failing-to-meet-even-the-most-basic-standards-of-care-for-older-people,-warns

Are you asking about delays in care?  Then look at http://www.oecd-ilibrary.org/sites/health_glance-2011-en/06/08/index.html?contentType=&itemId=/content/chapter/health_glance-2011-59-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2011-en&mimeType=text/html  The US rates much better at waiting times (how quickly you can see a specialist) than Canada, France, Australia, New Zealand, and the UK.  It performs similarly to Switzerland and Germany.

Then, of course, there are cracks in the system, most notable recently illustrated by the VA debacle.

Also, it's possible I missed what you were actually asking, in which case just let me know and I'll do my best.  I'm actually a big proponent of universal health care, but I also encourage people to know the advantages and disadvantages of each particular implementation of universal health care.

Just judging from the URLs, this definitely applies to what I was asking. Thanks for that. I'll research and come back with any thoughts. Much appreciated.

[Paul der Krake]

various links dissing the NHS

Of the 9000 complaints against the NHS last year cited in one of the articles, I can guarantee you that 99% have never seen another system at work. I have yet to meet a single Brit living in the US who hasn't come to love the NHS after experiencing a hospital visit here.

Yes, there are some delays and some fuckups. But for a system that cares for some 60 million people where you can litterally walk in a hospital with some broken bones and get treated without anybody asking you anything beyond your name and address, it works great. Or you know, give birth to your child not knowing whether your bill is going to be 2, 3, 4, 5, or 6 figures because of complications or out of network policies.

[tracylayton]

I was very nervous because I went to see the closest physician with good reviews that was on my HMO (thru the ACA exchange). I loved him, but he ordered blood work that was more than the ordinary profiles I've had in the past...including Vitamin D and all of the Hepatitis markers. I felt like he was being thorough, but was worried what my policy would cover (I have a $6500 deductible). The girl that drew my blood said it looked like I would owe a $45 copay on the $1310 total. I just got my email from BCBS and I will only owe $10.80  but I can tell you that I was worried I might get stuck for the full amt. It really would be nice if you knew ahead of time exactly what you were going to owe.

[firelight]

I just had a baby and the bills are starting to come in.... We have good insurance and as far as I can tell, we've hit the deductible max already and I still see a number of physician bills that we owe... Starting to be stressful already :( not sure what the final amount would be.... For all this, I had a normal delivery and the allowed two day stay at hospital.. Can't imagine the bills that would come in if I had had ac section or any complications.

[rocksinmyhead]

Americans are not protective of the current system.  It is a mess that lacks any transparency.  Rather, most Americans don't want the federal government having power over this aspect of life.  The federal govt is inefficient at most things since there is no incentive to watch the bottom line.  And, replacing a bad system with another poor system isn't the answer.

Yes, this is it exactly.

I don't think anyone loves our current system -- but we fear that something else might be worse.  Specifically, we fear being made to wait for treatment /being denied treatment, or being told what doctors we can/can't see.  Think these are unrealistic fears?  What have we been hearing in the news lately about VA hospitals?  They're run by the government, and some shameful things have been happening in those facilities.

VA issue comes down to being underfunded. People without FU money calling the shots wanted their jobs more than standing up to say they couldn't possibly give the level of care required with the given budget. I sincerely hope we end up with a public-private system where you are covered by govt for necessary things but can get private insurance for other stuff.

yeah, that sounds pretty good to me too.

beltim, thanks for the links (and Paul der Krake, thanks for your comment, that's interesting to hear too!)

I too just wish everything was more transparent. it's completely absurd that you can go into a transaction where you may end up being charged thousands of dollars, yet no one can give you the slightest idea ahead of time what your charges will be.

[GuitarStv]

yeesh, good point about the VA hospitals. but what I don't get is aren't we already at the mercy of our insurance companies with regard to what treatment we can get, and which doctors we can see? Why does it matter if it's Big Government or Big Insurance? (I haven't really figured out what my opinion is either way, just trying to play devil's advocate/get some thoughts)

We're at the mercy of someone else paying for it, but payment is only required after service.  In countries where the government runs the healthcare system, they deny treatment to start with.

Most people figure it's better to have lifesaving treatment and worry about cost later.

This has never, ever been my experience in Canada.  If you arrive in ER, cases are triaged . . . It's quite possible that you might wait a really long time to see a doctor about your sore throat if a big car accident just rolled in and they need surgery.  Actual life threatening shit is attended to immediately.  Denial of treatment is a pretty foreign concept for most Canadians . . . I don't ever even recall hearing someone mention the term.

[hybrid]

yeesh, good point about the VA hospitals. but what I don't get is aren't we already at the mercy of our insurance companies with regard to what treatment we can get, and which doctors we can see? Why does it matter if it's Big Government or Big Insurance? (I haven't really figured out what my opinion is either way, just trying to play devil's advocate/get some thoughts)

We're at the mercy of someone else paying for it, but payment is only required after service.  In countries where the government runs the healthcare system, they deny treatment to start with.

Most people figure it's better to have lifesaving treatment and worry about cost later.

This has never, ever been my experience in Canada.  If you arrive in ER, cases are triaged . . . It's quite possible that you might wait a really long time to see a doctor about your sore throat if a big car accident just rolled in and they need surgery.  Actual life threatening shit is attended to immediately.  Denial of treatment is a pretty foreign concept for most Canadians . . . I don't ever even recall hearing someone mention the term.

Oh GuitarStv, stop, stop, stop already with your real world experiences that contradict the stories conservatives in the US spread around like crazy to keep 'Muricans scared of Gubmint health care.

Why, next thing you'll be telling me something cockamamy like how Canadian doctors don't actually work for the Gubmint, they simply bill the Gubmint. And that malpractice suits are practically non-existent in Canada. Poppycock and balderdash I say. You sir can keep your clearly inferior Socialized medicine, what we really need in the US is more competition (among equally expensive and bureaucratic health care providers) to bring down our costs. Yeah, that'll fix everything!

[beltim]

yeesh, good point about the VA hospitals. but what I don't get is aren't we already at the mercy of our insurance companies with regard to what treatment we can get, and which doctors we can see? Why does it matter if it's Big Government or Big Insurance? (I haven't really figured out what my opinion is either way, just trying to play devil's advocate/get some thoughts)

We're at the mercy of someone else paying for it, but payment is only required after service.  In countries where the government runs the healthcare system, they deny treatment to start with.

Most people figure it's better to have lifesaving treatment and worry about cost later.

This has never, ever been my experience in Canada.  If you arrive in ER, cases are triaged . . . It's quite possible that you might wait a really long time to see a doctor about your sore throat if a big car accident just rolled in and they need surgery.  Actual life threatening shit is attended to immediately.  Denial of treatment is a pretty foreign concept for most Canadians . . . I don't ever even recall hearing someone mention the term.

Yes, it does seem that this is not a significant problem in the Canadian health care system.  To be fair, no one ever said it was.  I pointed out a particular problem with one implementation of universal healthcare and gave specific examples.  One would expect different implementations of universal health care to have different advantages and disadvantages.  Canada's health care system is quite different than the NHS and the VA.

[beltim]

yeesh, good point about the VA hospitals. but what I don't get is aren't we already at the mercy of our insurance companies with regard to what treatment we can get, and which doctors we can see? Why does it matter if it's Big Government or Big Insurance? (I haven't really figured out what my opinion is either way, just trying to play devil's advocate/get some thoughts)

We're at the mercy of someone else paying for it, but payment is only required after service.  In countries where the government runs the healthcare system, they deny treatment to start with.

Most people figure it's better to have lifesaving treatment and worry about cost later.

This has never, ever been my experience in Canada.  If you arrive in ER, cases are triaged . . . It's quite possible that you might wait a really long time to see a doctor about your sore throat if a big car accident just rolled in and they need surgery.  Actual life threatening shit is attended to immediately.  Denial of treatment is a pretty foreign concept for most Canadians . . . I don't ever even recall hearing someone mention the term.

Oh GuitarStv, stop, stop, stop already with your real world experiences that contradict the stories conservatives in the US spread around like crazy to keep 'Muricans scared of Gubmint health care.

Why, next thing you'll be telling me something cockamamy like how Canadian doctors don't actually work for the Gubmint, they simply bill the Gubmint. And that malpractice suits are practically non-existent in Canada. Poppycock and balderdash I say. You sir can keep your clearly inferior Socialized medicine, what we really need in the US is more competition (among equally expensive and bureaucratic health care providers) to bring down our costs. Yeah, that'll fix everything!

It's fun watching people argue against straw men.

[Jack]

I don't understand why states don't simply legislate that if a hospital accepts a given insurance, all providers in a hospital must accept that insurance.  It seems like common sense to me.

+2

We actually had this happen a couple of years ago.   DH got into a bike accident and had to go to the ER.   The hospital was in network, and we had an ER copay that we paid before leaving.   Later, I got a bill from one of the ER doctors who was not in network.   Before this I felt very ontop of things for knowing that the hospital was in our network and never imagined they then could have Dr's who were out of network.  And even though I now know it, there's very little one can do to make sure that everyone who they see is in network in these type of sitches.

The bill was for a few hundred dollars, so I almost just paid it.   Luckily, I thought to call the hospital (who were not helpful) and then the insurance company before just paying it.   The insurance company was super helpful and right away said they'd send me a check, since it was an emergency.   Within days I had a check for the out of network amount, which I cashed and paid the bill.

So, in our case, it worked out fine.   But, patients have to know to call their insurance in this type of sitch (and hopefully all insurance companies are as accommodating as ours was).

I had the same kind of thing happen to me (went to ER for food poisoning, paid $200 copay, then got billed for $800 for the services of some random doctor I have no memory of). I knew damn well it wasn't legitimate and I refused to pay it out of principle, but I didn't understand how to deal with the hospital/doctor/insurance to convince them of that, so now I'm waiting for the resulting collections action to age off my credit report.

My new(ish) job is designing software for the health care industry, and I can say that this shit is convoluted, and there has to be a better way.

I also work in the health care software industry, and I find myself struggling with job satisfaction because most of what I do is only "necessary" because American medical billing is such a goddamn clusterfuck!

I just had a baby and the bills are starting to come in.... We have good insurance and as far as I can tell, we've hit the deductible max already and I still see a number of physician bills that we owe... Starting to be stressful already :( not sure what the final amount would be.... For all this, I had a normal delivery and the allowed two day stay at hospital.. Can't imagine the bills that would come in if I had had ac section or any complications.

My wife and I our at that stage in life where we ought to be starting a family, but I'm anxious and hesitant mostly because I have no idea what the pregnancy-related medical bills might cost, and terrified to find out (despite the fact that I have "good[1]" insurance).

([1] and by "good" I mean I don't really understand all the coverages, but it had better be good since my job pays for half of my wife's premium but the other half comes to something like $500/month! I would have considered getting her an Obamacare plan, but during last year's open enrollment the ACA website didn't work yet...)

[jordanread]

My new(ish) job is designing software for the health care industry, and I can say that this shit is convoluted, and there has to be a better way.

I also work in the health care software industry, and I find myself struggling with job satisfaction because most of what I do is only "necessary" because American medical billing is such a goddamn clusterfuck!

Have you seen the ICD10 coding? I sometimes struggle with the job satisfaction of it, but since I'm writing software that helps navigate this cluster, it's kind of making things better. Treating the symptom it may be, but without our tools, it'd be much worst.

[Jack]

My new(ish) job is designing software for the health care industry, and I can say that this shit is convoluted, and there has to be a better way.

I also work in the health care software industry, and I find myself struggling with job satisfaction because most of what I do is only "necessary" because American medical billing is such a goddamn clusterfuck!

Have you seen the ICD10 coding? I sometimes struggle with the job satisfaction of it, but since I'm writing software that helps navigate this cluster, it's kind of making things better. Treating the symptom it may be, but without our tools, it'd be much worst.

Only obliquely -- I wasn't on the "main" ICD10 implementation team, but I did have to modify some of the bits in my part of the app to accommodate it (mainly adding data fields to hold -10 codes alongside the -9 ones, and switch between them). I do get the impression that some higher-ups were pretty upset when the Feds decided to delay the switchover, since our company was ready.

Considering how incredibly specific ICD10 codes are, I'm not at all convinced they have any benefit compared to just writing out the text of the condition.

My points of annoyance are more things like 837 or NCPDP claims, the prescription monitoring program (both its existence in general as an affront to my civil liberties and the fact that every other damn state has slightly different reporting requirements), etc.

There's so many other codes -- HCPC, proc codes, SIG codes -- that I don't even know what they're all for. And don't get me started on the vagaries of Medicare / insurance pricing schemes!

Ameliorating the symptoms is all well and good, but I'd much rather fix the underlying problem and move on to something more useful. I mainly took this job because I'd learn web development and the company wasn't too picky on prior experience... I'll move on to something in an industry I'm actually interested in (e.g. engineering) reasonably soon.

[Emilyngh]

My wife and I our at that stage in life where we ought to be starting a family, but I'm anxious and hesitant mostly because I have no idea what the pregnancy-related medical bills might cost, and terrified to find out (despite the fact that I have "good[1]" insurance).

([1] and by "good" I mean I don't really understand all the coverages, but it had better be good since my job pays for half of my wife's premium but the other half comes to something like $500/month! I would have considered getting her an Obamacare plan, but during last year's open enrollment the ACA website didn't work yet...)

Oh, don't let this interfere with your family planning!   Just check into the plan and be aware of potential issues and do your best to look into/avoid them and probably, it'll be just fine.

And maybe a happy story will help to counter your fears.   I too was very worried about surprise bills.   Our plan has a hospital copay of $350 a night for any overnight stay, and then everything else is supposed to be covered with no extra costs.   I didn't believe them about this (worried that there were charges, from other Dr's or other things like anesthesia, not included), and called the hospital before the birth of our daughter to get clarification regarding what would be included.   The woman on the phone said that it should all be included according to our insurance and that I could even prepay the expected cost of $700 (average 2 night's stay for birth) and would get a 10% discount.

I prepaid the $700, wound up actually having to be there 3 nights (well arriving in the middle of the first), and never was billed for anything beyond the prepayment.   I did not have to pay one penny more than the $700 (with discount, so really $630) for anything, even the extra half a night; my insurance just took care of it all.  So, it's not all horror stories.