Umbrella Insurance

[neophyte]

I tried to get umbrella insurance recently and was surprised to find that they wouldn't sell it to me since I don't have car insurance/ don't own a car. Apparently they would require a non-owners car insurance policy first. I already get supplemental liability whenever I rent a car, but it upped the cost significantly to need to add on non-owners car insurance for the whole year. You'd think I'd be more attractive to them since I rarely drive!

I ran into the same thing several year ago. Haven't owned a car or driven in years, but I would like to have the assurance of having some additional liability coverage.  You would think they could specifically exclude liability due to automobile injuries or something. Maybe that would mean it's not an umbrella policy.

[ROF Expat]

I tried to get umbrella insurance recently and was surprised to find that they wouldn't sell it to me since I don't have car insurance/ don't own a car. Apparently they would require a non-owners car insurance policy first. I already get supplemental liability whenever I rent a car, but it upped the cost significantly to need to add on non-owners car insurance for the whole year. You'd think I'd be more attractive to them since I rarely drive!

I ran into the same thing several year ago. Haven't owned a car or driven in years, but I would like to have the assurance of having some additional liability coverage.  You would think they could specifically exclude liability due to automobile injuries or something. Maybe that would mean it's not an umbrella policy.

A non-owner's policy should be cheap, and even pay for itself if it means not buying the supplemental Liability Insurance when you rent a car.  I think my policy costs me $25 per year and it meets my insurance company's requirement for an umbrella policy. 

[evme]

Business owners should be 2x-3x value of business

Why is that?

[Shane]

Recently, CarMax paid us almost as much for our car as it cost brand new in 2019. Since we barely used the car, anyway, we decided to take the cash. Moving forward, we're planning on renting cars occasionally and/or just using Uber/Lyft to travel distances further than can be easily covered on foot or by bike. When I called to cancel our auto insurance policy, we ended up accepting GEICO's offer of a "Named Non-Owner" policy that will cover me and DW as drivers of rental or borrowed cars, at a cost of $208/year. Just checked, and the policy includes $300K of both under/uninsured motorist coverage. Our umbrella liability policy, also with GEICO, costs $102/year for $1MM in coverage.

Just curious, wasn't able to easily tell by looking at GEICO's website, anyone know if the Under/Uninsured motorist coverage will cover us if we are hit by a car while walking or riding our bikes, or do auto insurance policies typically only cover you if you are driving a car?

[FIREby35]

Recently, CarMax paid us almost as much for our car as it cost brand new in 2019. Since we barely used the car, anyway, we decided to take the cash. Moving forward, we're planning on renting cars occasionally and/or just using Uber/Lyft to travel distances further than can be easily covered on foot or by bike. When I called to cancel our auto insurance policy, we ended up accepting GEICO's offer of a "Named Non-Owner" policy that will cover me and DW as drivers of rental or borrowed cars, at a cost of $208/year. Just checked, and the policy includes $300K of both under/uninsured motorist coverage. Our umbrella liability policy, also with GEICO, costs $102/year for $1MM in coverage.

Just curious, wasn't able to easily tell by looking at GEICO's website, anyone know if the Under/Uninsured motorist coverage will cover us if we are hit by a car while walking or riding our bikes, or do auto insurance policies typically only cover you if you are driving a car?

It SHOULD cover you as a pedestrian. I'd need to read a policy to say for sure and that is beyond my internet posting boundaries :) You could show it to a local PI lawyer if you really want to know.

[aetheldrea]

Recently, CarMax paid us almost as much for our car as it cost brand new in 2019. Since we barely used the car, anyway, we decided to take the cash. Moving forward, we're planning on renting cars occasionally and/or just using Uber/Lyft to travel distances further than can be easily covered on foot or by bike. When I called to cancel our auto insurance policy, we ended up accepting GEICO's offer of a "Named Non-Owner" policy that will cover me and DW as drivers of rental or borrowed cars, at a cost of $208/year. Just checked, and the policy includes $300K of both under/uninsured motorist coverage. Our umbrella liability policy, also with GEICO, costs $102/year for $1MM in coverage.

Just curious, wasn't able to easily tell by looking at GEICO's website, anyone know if the Under/Uninsured motorist coverage will cover us if we are hit by a car while walking or riding our bikes, or do auto insurance policies typically only cover you if you are driving a car?

14 years ago Geico underinsured motorist coverage paid when my son was hit by car as a pedestrian, so I would assume they still would.

[Shane]

It SHOULD cover you as a pedestrian. I'd need to read a policy to say for sure and that is beyond my internet posting boundaries :) You could show it to a local PI lawyer if you really want to know.

14 years ago Geico underinsured motorist coverage paid when my son was hit by car as a pedestrian, so I would assume they still would.

What is Extraordinary Medical Benefits Coverage?

Extraordinary Medical Benefits coverage pays medical, dental, hospital and funeral expenses for you, household relatives and guest passengers injured in a motor vehicle accident. Also protects you and household relatives if injured while in other vehicles or if injured when struck as a pedestrian.

Payments under this coverage begin only when covered medical expenses exceed $100,000 and are capped at the lifetime limit of $1,000,000. In choosing whether to carry this coverage, you may want to consider your ability to meet your medical expenses and other financial obligations if you were injured in a vehicle accident. This material is intended for general information only. It does not expand coverage beyond the policy contract. Please refer to your policy contract for any specific information or questions on applicability of coverage.

The only thing I've been able to find on GEICO's website that mentions possible coverage in the event one of us is hit by a car as a pedestrian (not sure if bicyclists are considered 'pedestrians'?) is under 'Extraordinary Medical Benefits' section. There's nothing in the 'First Party Benefits' section that mentions whether the policy would pay if we were hit by a car while walking or riding a bike.

Tried using GEICO's virtual assistant, but it didn't understand my question. I can't figure out where my actual policy is on GEICO's website. All I'm looking at is, basically, a synopsis. There must be an actual legal document somewhere. Just haven't found it yet. Guess I'll need to give GEICO a call. Since our main means of transportation is walking and riding our bikes, it would be nice if some insurance (homeowners?, auto?) covered us in the event we were hit by a distracted driver with no/not enough insurance.

[jac941]

Since our main means of transportation is walking and riding our bikes, it would be nice if some insurance (homeowners?, auto?) covered us in the event we were hit by a distracted driver with no/not enough insurance.

Yes, definitely check this. It’s especially important to have uninsured / underinsured motorist if you bike and walk a lot. It is much more common for collisions with people walking and on bikes to be hit and runs whether the driver is insured or not. And the level of injuries and potential costs are dramatically higher if you’re not in the protective bubble of a car. So minimal liability policies are cleaned out pretty quickly.

If Geico doesn’t cover it, many others do. Shop around.

[afox]

Great thread although it kept me up too late reading @FIREby35 's posts which read like a John Grisham novel!

I still dont understand the case for carrying auto insurance that covers medical expenses for the insured like UIM, Medpay, etc for the well health insured individual. From the avoiding medical bankruptcy thread we've established that the ACA change things so there are no lifetime out of pocket (OOP) max's on covered services which appear to include just about everything that could be considered "conventional medicine" due to the standards established by ACA and the annual OOP max's are reasonable (8k individual, 17k family) for someone with savings. Perhaps these coverages made more sense pre-aca when most plans had lifetime limits, you could be screwed for life due to pre-existing conditions, etc?

I get that these coverages can cover lost work, expenses related to travel to appointments, etc and @jac941 's experience has good info, but maybe that experience was pre-aca when plans didn't have to cover things like mental health? UIM seems like double coverage in many ways which would be a waste of money. Dealing with one insurance company for healthcare costs seems simpler that dealing with 2. I'm sure the insurance companies (health and auto) would fight over who pays for what. In general I want to pay deductibles for one policy not two, etc and medical expenses paid by the auto insurer would not count towards health insurance deductibles, OOP max, etc. It just doesn't make much sense to me and certainly adds alot of complication to an already complicated scenario, if it is really necessary that is really too bad.

[jac941]

Great thread although it kept me up too late reading @FIREby35 's posts which read like a John Grisham novel!

I still dont understand the case for carrying auto insurance that covers medical expenses for the insured like UIM, Medpay, etc for the well health insured individual. From the avoiding medical bankruptcy thread we've established that the ACA change things so there are no lifetime out of pocket (OOP) max's on covered services which appear to include just about everything that could be considered "conventional medicine" due to the standards established by ACA and the annual OOP max's are reasonable (8k individual, 17k family) for someone with savings. Perhaps these coverages made more sense pre-aca when most plans had lifetime limits, you could be screwed for life due to pre-existing conditions, etc?

I get that these coverages can cover lost work, expenses related to travel to appointments, etc and @jac941 's experience has good info, but maybe that experience was pre-aca when plans didn't have to cover things like mental health? UIM seems like double coverage in many ways which would be a waste of money. Dealing with one insurance company for healthcare costs seems simpler that dealing with 2. I'm sure the insurance companies (health and auto) would fight over who pays for what. In general I want to pay deductibles for one policy not two, etc and medical expenses paid by the auto insurer would not count towards health insurance deductibles, OOP max, etc. It just doesn't make much sense to me and certainly adds alot of complication to an already complicated scenario, if it is really necessary that is really too bad.

I just want to clarify that my experience is current. In fact, I live and have health insurance in California which has numerous consumer protection laws around healthcare and health insurance that far exceed US requirements.

Health insurance and healthcare in the US are broken. We have “excellent” health insurance with extensive coverage. It covers substantially more physical therapy, mental health therapy, and home healthcare than most policies. It even covers things like acupuncture, etc. Our in network and out of network out of pocket maximums per person are $4,000 each - so $8,000. As of Dec 31, 2021, my “patient responsibility” as shown by my health insurance company was $45k for the year - and every single facility I went to including the trauma center was in network (though not all physicians were). That balance doesn’t include the extra physical therapy I did, any durable medical equipment, balance billing from the ambulance companies, any of the gardening, housekeeping, and childcare help we paid for, my lost wages … I could go on and on.

Medical bills are a top cause of bankruptcy for a reason. Motor vehicle accidents are the most common form of accidental injury for most age groups in the US (because our transportation system is broken too). You can rely on your health insurance instead of paying for UIM, but it’s a risk. And it’s a risk for a very common type of incident.

If you choose to not have coverage, just make sure you understand the risk you’re taking.

[afox]

Great thread although it kept me up too late reading @FIREby35 's posts which read like a John Grisham novel!

I still dont understand the case for carrying auto insurance that covers medical expenses for the insured like UIM, Medpay, etc for the well health insured individual. From the avoiding medical bankruptcy thread we've established that the ACA change things so there are no lifetime out of pocket (OOP) max's on covered services which appear to include just about everything that could be considered "conventional medicine" due to the standards established by ACA and the annual OOP max's are reasonable (8k individual, 17k family) for someone with savings. Perhaps these coverages made more sense pre-aca when most plans had lifetime limits, you could be screwed for life due to pre-existing conditions, etc?

I get that these coverages can cover lost work, expenses related to travel to appointments, etc and @jac941 's experience has good info, but maybe that experience was pre-aca when plans didn't have to cover things like mental health? UIM seems like double coverage in many ways which would be a waste of money. Dealing with one insurance company for healthcare costs seems simpler that dealing with 2. I'm sure the insurance companies (health and auto) would fight over who pays for what. In general I want to pay deductibles for one policy not two, etc and medical expenses paid by the auto insurer would not count towards health insurance deductibles, OOP max, etc. It just doesn't make much sense to me and certainly adds alot of complication to an already complicated scenario, if it is really necessary that is really too bad.

I just want to clarify that my experience is current. In fact, I live and have health insurance in California which has numerous consumer protection laws around healthcare and health insurance that far exceed US requirements.

Health insurance and healthcare in the US are broken. We have “excellent” health insurance with extensive coverage. It covers substantially more physical therapy, mental health therapy, and home healthcare than most policies. It even covers things like acupuncture, etc. Our in network and out of network out of pocket maximums per person are $4,000 each - so $8,000. As of Dec 31, 2021, my “patient responsibility” as shown by my health insurance company was $45k for the year - and every single facility I went to including the trauma center was in network (though not all physicians were). That balance doesn’t include the extra physical therapy I did, any durable medical equipment, balance billing from the ambulance companies, any of the gardening, housekeeping, and childcare help we paid for, my lost wages … I could go on and on.

Medical bills are a top cause of bankruptcy for a reason. Motor vehicle accidents are the most common form of accidental injury for most age groups in the US (because our transportation system is broken too). You can rely on your health insurance instead of paying for UIM, but it’s a risk. And it’s a risk for a very common type of incident.

If you choose to not have coverage, just make sure you understand the risk you’re taking.

Thanks for the explanation, your insurance does indeed sound like it is top notch. I just dont understand how its possible to end up with $45k in costs with a plan that has an 8k out of pocket max while only seeing in network providers? Is it due to some of the medical services not being covered at all by insurance? Maybe I dont understand what "out of pocket maximum" means?

Sounds like a just awful ordeal to have to go thru, i commuted by bike every day from 2001 until covid, many many close calls, this could have easily happened to me.

[Raenia]

Thanks for the explanation, your insurance does indeed sound like it is top notch. I just dont understand how its possible to end up with $45k in costs with a plan that has an 8k out of pocket max while only seeing in network providers? Is it due to some of the medical services not being covered at all by insurance? Maybe I dont understand what "out of pocket maximum" means?

Sounds like a just awful ordeal to have to go thru, i commuted by bike every day from 2001 until covid, many many close calls, this could have easily happened to me.

From healthcare.gov:

The out-of-pocket limit doesn't include:

Your monthly premiums
Anything you spend for services your plan doesn't cover
Out-of-network care and services
Costs above the allowed amount for a service that a provider may charge

My interpretation of that is, if the insurance company says that a surgeon should charge $1000 for a certain procedure, and your surgeon actually bills $2000, you are responsible for the additional $1000 - and it doesn't count toward your out-of-pocket max.  If your plan covers 5 physical therapy appointments, but it actually takes 10 appointments to regain function, you pay for those extra 5 appointments yourself - and they don't count toward your OOP max.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

[afox]

Thanks for the explanation, your insurance does indeed sound like it is top notch. I just dont understand how its possible to end up with $45k in costs with a plan that has an 8k out of pocket max while only seeing in network providers? Is it due to some of the medical services not being covered at all by insurance? Maybe I dont understand what "out of pocket maximum" means?

Sounds like a just awful ordeal to have to go thru, i commuted by bike every day from 2001 until covid, many many close calls, this could have easily happened to me.

From healthcare.gov:

The out-of-pocket limit doesn't include:

Your monthly premiums
Anything you spend for services your plan doesn't cover
Out-of-network care and services
Costs above the allowed amount for a service that a provider may charge

My interpretation of that is, if the insurance company says that a surgeon should charge $1000 for a certain procedure, and your surgeon actually bills $2000, you are responsible for the additional $1000 - and it doesn't count toward your out-of-pocket max.  If your plan covers 5 physical therapy appointments, but it actually takes 10 appointments to regain function, you pay for those extra 5 appointments yourself - and they don't count toward your OOP max.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

I thought that as an in-network provider a surgeon has to charge the agreed upon covered rate for a procedure, thus they could not charge $2000 for a procedure that the agreed upon rate is $1000. They could perform an additional surgery for $1000 that is "not covered" by the insurance plan though but I have not been able to find good examples of conventional medicine not covered by aca compatible plans.

The limit on physical therapy # of visits may be a valid concern for some people with especially stingy plans such as your example of 5 physical therapy visits per year. I just checked my plan and it covers upto 60 physical therapy visits per year of a combined physical therapists, occupational therapists, speech therapists. The example of a plan covering 5 physical therapy visiits sounds extremely stingy.

[Raenia]

Thanks for the explanation, your insurance does indeed sound like it is top notch. I just dont understand how its possible to end up with $45k in costs with a plan that has an 8k out of pocket max while only seeing in network providers? Is it due to some of the medical services not being covered at all by insurance? Maybe I dont understand what "out of pocket maximum" means?

Sounds like a just awful ordeal to have to go thru, i commuted by bike every day from 2001 until covid, many many close calls, this could have easily happened to me.

From healthcare.gov:

The out-of-pocket limit doesn't include:

Your monthly premiums
Anything you spend for services your plan doesn't cover
Out-of-network care and services
Costs above the allowed amount for a service that a provider may charge

My interpretation of that is, if the insurance company says that a surgeon should charge $1000 for a certain procedure, and your surgeon actually bills $2000, you are responsible for the additional $1000 - and it doesn't count toward your out-of-pocket max.  If your plan covers 5 physical therapy appointments, but it actually takes 10 appointments to regain function, you pay for those extra 5 appointments yourself - and they don't count toward your OOP max.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

I thought that as an in-network provider a surgeon has to charge the agreed upon covered rate for a procedure, thus they could not charge $2000 for a procedure that the agreed upon rate is $1000. They could perform an additional surgery for $1000 that is "not covered" by the insurance plan though but I have not been able to find good examples of conventional medicine not covered by aca compatible plans.

The limit on physical therapy # of visits may be a valid concern for some people with especially stingy plans such as your example of 5 physical therapy visits per year. I just checked my plan and it covers upto 60 physical therapy visits per year of a combined physical therapists, occupational therapists, speech therapists. The example of a plan covering 5 physical therapy visiits sounds extremely stingy.

I picked the numbers at random for illustration purposes, not trying to represent any particular real plan.

If it wasn't possible for a provider to charge more than the "allowed amount," why would healthcare.gov bother listing it?

I know I've heard from plenty of people about an ambulance ride being agreed to be medically necessary and preapproved by insurance (i.e. moving from one hospital to another) but insurance will only pay $500 while actual billed cost is $3000.  If that happens, you are on the hook for $2500 which doesn't count toward OOP.

You say you don't understand how someone can generate costs in excess of OOP, so people are giving examples.  You said you might not understand what OOP meant, so I found you the official definition.  Not really sure what you're looking for?

[afox]

Thanks for the explanation, your insurance does indeed sound like it is top notch. I just dont understand how its possible to end up with $45k in costs with a plan that has an 8k out of pocket max while only seeing in network providers? Is it due to some of the medical services not being covered at all by insurance? Maybe I dont understand what "out of pocket maximum" means?

Sounds like a just awful ordeal to have to go thru, i commuted by bike every day from 2001 until covid, many many close calls, this could have easily happened to me.

From healthcare.gov:

The out-of-pocket limit doesn't include:

Your monthly premiums
Anything you spend for services your plan doesn't cover
Out-of-network care and services
Costs above the allowed amount for a service that a provider may charge

My interpretation of that is, if the insurance company says that a surgeon should charge $1000 for a certain procedure, and your surgeon actually bills $2000, you are responsible for the additional $1000 - and it doesn't count toward your out-of-pocket max.  If your plan covers 5 physical therapy appointments, but it actually takes 10 appointments to regain function, you pay for those extra 5 appointments yourself - and they don't count toward your OOP max.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

I thought that as an in-network provider a surgeon has to charge the agreed upon covered rate for a procedure, thus they could not charge $2000 for a procedure that the agreed upon rate is $1000. They could perform an additional surgery for $1000 that is "not covered" by the insurance plan though but I have not been able to find good examples of conventional medicine not covered by aca compatible plans.

The limit on physical therapy # of visits may be a valid concern for some people with especially stingy plans such as your example of 5 physical therapy visits per year. I just checked my plan and it covers upto 60 physical therapy visits per year of a combined physical therapists, occupational therapists, speech therapists. The example of a plan covering 5 physical therapy visiits sounds extremely stingy.

I picked the numbers at random for illustration purposes, not trying to represent any particular real plan.

If it wasn't possible for a provider to charge more than the "allowed amount," why would healthcare.gov bother listing it?

I know I've heard from plenty of people about an ambulance ride being agreed to be medically necessary and preapproved by insurance (i.e. moving from one hospital to another) but insurance will only pay $500 while actual billed cost is $3000.  If that happens, you are on the hook for $2500 which doesn't count toward OOP.

You say you don't understand how someone can generate costs in excess of OOP, so people are giving examples.  You said you might not understand what OOP meant, so I found you the official definition.  Not really sure what you're looking for?

Sure, to clarify i was looking for examples of how someone could exceed their OOP max + premiums for the year since I like to think of this combined figure as a worst case scenario for healthcare expenses for a year. Since @jac941 is the only one Ive ever heard of who had tens of thousands of dollars in bills in excess of premiums + OOP max I am wondering what services incurred those costs. I want to make sure I'm not making a mistake by budgeting for premiums + OOP max for my early retirement and not paying for UIM so I'm looking for evidence that I need to save more or purchase UIM to pay for medical care.

Your examples of the in network surgeon charging twice as much for a procedure as the agreed upon rate and a plan only covering 5 physical therapy visits  havent convinced me that it is easy to go over my OOP + premiums budget.

The published prices mandated by healthcare.gov or whatever are "out of pocket" rates assuming someone had no health insurance/not a member of any group. The negotiated rate your insurer pays the provider could be more/could be less than that amount, I think the negotiated rates are often less than that amount. Its irrelevant for people with insurance looking at prices for in-network services. Insurance companies dont publish the negotiated rates for services.

I just checked my health insurance for ambulance coverage and its very good. There is basically no situation where I could end up with tens of thousands in ambulance bills unless I voluntarily used an ambulance where one was not needed or used an air ambulance when it was not a necessity. Basically ambulance coverage counts towards OOP max as long as its necessary and not what I would consider taking an ambulance for joy ride. Ironically if Im injured badly enough to require air/ground ambulance my injuries are likely to cost more than the OOP max for the year so all that really matters is that the ambulance services count toward the OOP, ie it does not matter to me if I spend the full OOP amount on an ambulance or on the hundreds of other expenses that Im likely to incur, it would actually be more convenient to pay the ambulance company a large amount that way I have less bills to deal with for the rest of the year. Last year I exceeded the OOP max due to birth of my son and it was quite nice to go the rest of year not worrying about paying for any medical services other than checking to see if the provider was in network.

[Raenia]

Sure, to clarify i was looking for examples of how someone could exceed their OOP max + premiums for the year since I like to think of this combined figure as a worst case scenario for healthcare expenses for a year. Since @jac941 is the only one Ive ever heard of who had tens of thousands of dollars in bills in excess of premiums + OOP max I am wondering what services incurred those costs. I want to make sure I'm not making a mistake by budgeting for premiums + OOP max for my early retirement and not paying for UIM so I'm looking for evidence that I need to save more or purchase UIM to pay for medical care.

Your examples of the in network surgeon charging twice as much for a procedure as the agreed upon rate and a plan only covering 5 physical therapy visits  havent convinced me that it is easy to go over my OOP + premiums budget.

The published prices mandated by healthcare.gov or whatever are "out of pocket" rates assuming someone had no health insurance/not a member of any group. The negotiated rate your insurer pays the provider could be more/could be less than that amount, I think the negotiated rates are often less than that amount. Its irrelevant for people with insurance looking at prices for in-network services. Insurance companies dont publish the negotiated rates for services.

I just checked my health insurance for ambulance coverage and its very good. There is basically no situation where I could end up with tens of thousands in ambulance bills unless I voluntarily used an ambulance where one was not needed or used an air ambulance when it was not a necessity. Basically ambulance coverage counts towards OOP max as long as its necessary and not what I would consider taking an ambulance for joy ride.

If actual examples from actual people who have gone through it can't convince you it happens, I don't know what can.  No one is trying to convince you that you personally need more coverage than you get through your health insurance.  If your coverage is that amazing, then good for you.  But insisting it can't happen to anyone just because you don't think it can happen to you feels disingenuous.

Also, you do know that even if you're at an in-network hospital with an in-network surgeon, you can still wind up with a big non-covered bill from an out-of-network specialist, right?  A good friend of mine had this happen with a planned surgery that was pre-approved through insurance, and verified with the hospital that everything was covered ahead of time.  Day of the surgery comes, no one thinks to tell her that the scheduled, in-network anesthesiologist is out that day, and the replacement is out-of-network.  Bam, multi-thousand dollar non-covered bill.

[afox]

Sure, to clarify i was looking for examples of how someone could exceed their OOP max + premiums for the year since I like to think of this combined figure as a worst case scenario for healthcare expenses for a year. Since @jac941 is the only one Ive ever heard of who had tens of thousands of dollars in bills in excess of premiums + OOP max I am wondering what services incurred those costs. I want to make sure I'm not making a mistake by budgeting for premiums + OOP max for my early retirement and not paying for UIM so I'm looking for evidence that I need to save more or purchase UIM to pay for medical care.

Your examples of the in network surgeon charging twice as much for a procedure as the agreed upon rate and a plan only covering 5 physical therapy visits  havent convinced me that it is easy to go over my OOP + premiums budget.

The published prices mandated by healthcare.gov or whatever are "out of pocket" rates assuming someone had no health insurance/not a member of any group. The negotiated rate your insurer pays the provider could be more/could be less than that amount, I think the negotiated rates are often less than that amount. Its irrelevant for people with insurance looking at prices for in-network services. Insurance companies dont publish the negotiated rates for services.

I just checked my health insurance for ambulance coverage and its very good. There is basically no situation where I could end up with tens of thousands in ambulance bills unless I voluntarily used an ambulance where one was not needed or used an air ambulance when it was not a necessity. Basically ambulance coverage counts towards OOP max as long as its necessary and not what I would consider taking an ambulance for joy ride.

If actual examples from actual people who have gone through it can't convince you it happens, I don't know what can.  No one is trying to convince you that you personally need more coverage than you get through your health insurance.  If your coverage is that amazing, then good for you.  But insisting it can't happen to anyone just because you don't think it can happen to you feels disingenuous.

Also, you do know that even if you're at an in-network hospital with an in-network surgeon, you can still wind up with a big non-covered bill from an out-of-network specialist, right?  A good friend of mine had this happen with a planned surgery that was pre-approved through insurance, and verified with the hospital that everything was covered ahead of time.  Day of the surgery comes, no one thinks to tell her that the scheduled, in-network anesthesiologist is out that day, and the replacement is out-of-network.  Bam, multi-thousand dollar non-covered bill.

The surprise medical billing rules that went into effect Jan 1, 2022 have put an end to the situation you describe with your friend in surgery for everything but ground ambulances. Prior to this, I believe this was a valid concern.
https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills

It could be that I have just have excellent insurance but sounds like @jac941 has excellent insurance too so I am really curious how he/she and others could have ended up with $45k in costs after meeting an OOP max. It puzzles me and keeps me up at nite. I was looking for specific examples of actual services/charges that did not quality towards the OOP max, the general reports of "i paid more than my OOP max" dont help me understand the situation. Im interested in the details/nuance.

[Dr Kidstache]

If actual examples from actual people who have gone through it can't convince you it happens, I don't know what can.  No one is trying to convince you that you personally need more coverage than you get through your health insurance.  If your coverage is that amazing, then good for you.  But insisting it can't happen to anyone just because you don't think it can happen to you feels disingenuous.

^^^This.

I feel like @afox is being willfully obtuse. I'm truly thrilled for them that they haven't suffered significant ill health or injury and that their health insurance has always been generous coverage for their needs. But most people in the US - regardless of even the cadillac insurance plans - have 5 or 6 figure medical bills when they have the misfortune of getting really sick or injured. Yes, balance billing aka surprise bills should become a thing of the past thank goodness. But the insurance plans, not your doctors, determine what is "medically necessary" and they often determine that after the fact. Maybe you don't think you were joyriding in that ambulance when you thought you were having a heart attack, but United or Aetna or Humana or whoever can decide you were when you're sent home from the emergency room with a non-emergent diagnosis.

I was running about $20,000/year in uncovered medical bills before I became Medicare eligible and that was just for routine care and no hospitalizations for my medical condition because the insurance company determined that not a single medical treatment or imaging test that I required qualified under the plan. And that's even with me being a doctor and chasing every billing code.

[afox]

If actual examples from actual people who have gone through it can't convince you it happens, I don't know what can.  No one is trying to convince you that you personally need more coverage than you get through your health insurance.  If your coverage is that amazing, then good for you.  But insisting it can't happen to anyone just because you don't think it can happen to you feels disingenuous.

^^^This.

I feel like @afox is being willfully obtuse. I'm truly thrilled for them that they haven't suffered significant ill health or injury and that their health insurance has always been generous coverage for their needs. But most people in the US - regardless of even the cadillac insurance plans - have 5 or 6 figure medical bills when they have the misfortune of getting really sick or injured. Yes, balance billing aka surprise bills should become a thing of the past thank goodness. But the insurance plans, not your doctors, determine what is "medically necessary" and they often determine that after the fact. Maybe you don't think you were joyriding in that ambulance when you thought you were having a heart attack, but United or Aetna or Humana or whoever can decide you were when you're sent home from the emergency room with a non-emergent diagnosis.

I was running about $20,000/year in uncovered medical bills before I became Medicare eligible and that was just for routine care and no hospitalizations for my medical condition because the insurance company determined that not a single medical treatment or imaging test that I required qualified under the plan. And that's even with me being a doctor and chasing every billing code.

Was that pre-aca or did you have a plan that got around the ACA requirements (healthcare ministry, temporary insurance, etc)? THe ACA put minimum standards of coverage in place, in hindsight prior to the ACA it was the wild west and many people bought health insurance that was useless.

I think it is necessary to appeal your health insurance rulings when claims are denied and this happens often. Denying valid claims is part of the business model for health insurance companies. I am in the process of appealing a denied claim right now, I consider that just part of the process for dealing with healthcare in the U.S. The more appeals I file, the better I get at the process.

I promise im not being purposefully obtuse, i really am just trying to understand examples of the circumstances in which one could end up with tens of thousands in expenses for medically necessary conventional medicine even after meeting their OOP max.

ALso, if health insurance companies behave this badly and routinely wrongfully deny medically necessary conventional medicine why would an auto insurer behave better and cover those things???

Maybe there is no good answer and the only solution is to work longer and have massive savings for healthcare expenses or move to another country that values human health more than profits.

[afox]

Sounds like ambulances are a major problem so don't use one unless it's life or death. This is a good example of the kind of healthcare expense loophole everyone should be aware of. My brother had an injury at a ski area and patrol wanted to put him in an ambulance, he refused the ambulance and saved a lot of money. I think I will at least find out if my local ambulance service is in network. The thing is though, ambulance rides are not going to result in tens of thousands of dollars in bills do this doesn't explain the extremely high non covered healthcare expenses being reported here. Lots of info on how to deal with ambulance billing here: https://www.consumerreports.org/medical-billing/your-ambulance-ride-could-still-leave-you-with-a-surprise-medical-bill-no-surprises-act-a2373503204/

[Dr Kidstache]

If actual examples from actual people who have gone through it can't convince you it happens, I don't know what can.  No one is trying to convince you that you personally need more coverage than you get through your health insurance.  If your coverage is that amazing, then good for you.  But insisting it can't happen to anyone just because you don't think it can happen to you feels disingenuous.

^^^This.

I feel like @afox is being willfully obtuse. I'm truly thrilled for them that they haven't suffered significant ill health or injury and that their health insurance has always been generous coverage for their needs. But most people in the US - regardless of even the cadillac insurance plans - have 5 or 6 figure medical bills when they have the misfortune of getting really sick or injured. Yes, balance billing aka surprise bills should become a thing of the past thank goodness. But the insurance plans, not your doctors, determine what is "medically necessary" and they often determine that after the fact. Maybe you don't think you were joyriding in that ambulance when you thought you were having a heart attack, but United or Aetna or Humana or whoever can decide you were when you're sent home from the emergency room with a non-emergent diagnosis.

I was running about $20,000/year in uncovered medical bills before I became Medicare eligible and that was just for routine care and no hospitalizations for my medical condition because the insurance company determined that not a single medical treatment or imaging test that I required qualified under the plan. And that's even with me being a doctor and chasing every billing code.

Was that pre-aca or did you have a plan that got around the ACA requirements (healthcare ministry, temporary insurance, etc)? THe ACA put minimum standards of coverage in place, in hindsight prior to the ACA it was the wild west and many people bought health insurance that was useless.

I think it is necessary to appeal your health insurance rulings when claims are denied and this happens often. Denying valid claims is part of the business model for health insurance companies. I am in the process of appealing a denied claim right now, I consider that just part of the process for dealing with healthcare in the U.S. The more appeals I file, the better I get at the process.

I promise im not being purposefully obtuse, i really am just trying to understand examples of the circumstances in which one could end up with tens of thousands in expenses for medically necessary conventional medicine even after meeting their OOP max.

ALso, if health insurance companies behave this badly and routinely wrongfully deny medically necessary conventional medicine why would an auto insurer behave better and cover those things???

Maybe there is no good answer and the only solution is to work longer and have massive savings for healthcare expenses or move to another country that values human health more than profits.

What now? As I said, I was a doctor. I was also a researcher in health outcomes. I was on state-level advisory councils for healthcare. Are you explaining to me that I perhaps didn't know what to look for in insurance plans (and, yes, all post-ACA)? Or that I don't understand how to appeal a claim? Do you believe that you are smarter than allllllllll the people in this thread that have shared their experiences and so, therefore, are immune to our misfortunes? I thought that you were just being intentionally obtuse. Now I think you're just trolling.

[afox]

If actual examples from actual people who have gone through it can't convince you it happens, I don't know what can.  No one is trying to convince you that you personally need more coverage than you get through your health insurance.  If your coverage is that amazing, then good for you.  But insisting it can't happen to anyone just because you don't think it can happen to you feels disingenuous.

^^^This.

I feel like @afox is being willfully obtuse. I'm truly thrilled for them that they haven't suffered significant ill health or injury and that their health insurance has always been generous coverage for their needs. But most people in the US - regardless of even the cadillac insurance plans - have 5 or 6 figure medical bills when they have the misfortune of getting really sick or injured. Yes, balance billing aka surprise bills should become a thing of the past thank goodness. But the insurance plans, not your doctors, determine what is "medically necessary" and they often determine that after the fact. Maybe you don't think you were joyriding in that ambulance when you thought you were having a heart attack, but United or Aetna or Humana or whoever can decide you were when you're sent home from the emergency room with a non-emergent diagnosis.

I was running about $20,000/year in uncovered medical bills before I became Medicare eligible and that was just for routine care and no hospitalizations for my medical condition because the insurance company determined that not a single medical treatment or imaging test that I required qualified under the plan. And that's even with me being a doctor and chasing every billing code.

Was that pre-aca or did you have a plan that got around the ACA requirements (healthcare ministry, temporary insurance, etc)? THe ACA put minimum standards of coverage in place, in hindsight prior to the ACA it was the wild west and many people bought health insurance that was useless.

I think it is necessary to appeal your health insurance rulings when claims are denied and this happens often. Denying valid claims is part of the business model for health insurance companies. I am in the process of appealing a denied claim right now, I consider that just part of the process for dealing with healthcare in the U.S. The more appeals I file, the better I get at the process.

I promise im not being purposefully obtuse, i really am just trying to understand examples of the circumstances in which one could end up with tens of thousands in expenses for medically necessary conventional medicine even after meeting their OOP max.

ALso, if health insurance companies behave this badly and routinely wrongfully deny medically necessary conventional medicine why would an auto insurer behave better and cover those things???

Maybe there is no good answer and the only solution is to work longer and have massive savings for healthcare expenses or move to another country that values human health more than profits.

What now? As I said, I was a doctor. I was also a researcher in health outcomes. I was on state-level advisory councils for healthcare. Are you explaining to me that I perhaps didn't know what to look for in insurance plans (and, yes, all post-ACA)? Or that I don't understand how to appeal a claim? Do you believe that you are smarter than allllllllll the people in this thread that have shared their experiences and so, therefore, are immune to our misfortunes? I thought that you were just being intentionally obtuse. Now I think you're just trolling.

I never said any of those things, typical Strawman b.s. on your part.

I was just looking for examples of services that could be incurred that would not qualify toward OOP max's, that does not make me a troll.

[RyanAtTanagra]

FWIW I'm with afox in this.  I don't think they're trolling, just looking for specifics.  Generalized 'someone i know got injured and now has a lot of medical bills' and 'It happened to me it can happen to you too!' isn't super useful.  This is MMM, we dig into the weeds on everything, and healthcare coverage in the US is fucked up in every way, so it's a lot of weeds to dig through.

[lutorm]

I think there is some value to UIM even with excellent medical coverage, because it covers pain and suffering, which your health insurance will most definitely not cover you for. True, there's never coverage for pain and suffering for injuries for which you yourself are liable, but you are more able to have an influence on those events than those for which another party is liable.

It's also a false choice to say that if you're exposed to two risks, A and B, you can only either insure against both or none. It's total risk reduction that matters, so eliminating A while deciding the residual risk posed by B is acceptable is perfectly rational.

Insurance is only one facet of personal risk management, so it's a perfectly valid decision to carry UIM to insure against acts of others over which you have little control while simultaneously being satisfied with minimizing risk for injuries you would be liable for by just not doing stupid stuff. There will always be some residual risk and it's up to you to decide what you're comfortable with. Insurance policies have limits and force majeure, too.

[DaMa]

I'm with afox, too.  I do not UIM coverage and don't see where I need it.  I am lucky to be in Metro Detroit and have mostly had Blue Cross so almost everyone is in-network.  I am interested to hear what jac941 was paying for. 

I have an example of uncovered claims.  I had coverage with BCBS of Alabama until recently.  I use a CPAP.  Alabama covered CPAP supplies at about 1/2 the rate of every other plan I have ever had (4), and Medicare and Medicaid.  I was shocked, and filed an appeal fully expecting to have them covered.  The appeal was denied.  (This is a relatively small cost, ~$200 a year.)

Afox has contributed to a similar discussion in another thread.  He is not a troll.

[Paul der Krake]

Yeah I don't really get the "medical bills will bankrupt you" trope either. I'm sure that was true 20 years ago.

Maybe that was true before my time. Nowadays it seems like every time there is a sob story in the news, there's a very clear reason once you dig in the story.

The article often reads like this:

1. Mr and Mrs Jones were a stable middle class family with two kids and a picket fence
2. Everything is going according to plan
3. Something happens and insurance coverage is lost
4. Let's ride this out lol
5. A really bad thing happens during that coverage gap
6. Bills bills bills
7. A dubious conclusion is drawn

[seattlecyclone]

It's also a false choice to say that if you're exposed to two risks, A and B, you can only either insure against both or none. It's total risk reduction that matters, so eliminating A while deciding the residual risk posed by B is acceptable is perfectly rational.

I don't really agree with this bit. Suppose you have two options for insurance: Option A) a $1,000 deductible in any case, or Option B) $7,000 deductible on Tuesdays but no deductible any other day of the week. If you engage in similar levels of risk every day, you're reducing your total risk the same amount either way, but if you go with Option B you're exposing yourself to a much wider distribution of possible events. The point of insurance is to smooth out this distribution so that no one event will cause you great financial hardship. If a $7,000 loss on a Tuesday is something you can afford to pay without causing undue hardship, then why are you paying the insurance company to assume that $7,000 risk for you on the other days of the week? Surely you'd be better off with Option C: $7,000 deductible every day but lower premium than Options A or B.

I view underinsured motorist insurance in a similar light. You're paying for a policy that limits your risk in one scenario while leaving a pretty big hole in another. The area under your risk curve goes down, yes, but you're not doing anything about the height of the tail end of that distribution. That's a problem.

Insurance is only one facet of personal risk management, so it's a perfectly valid decision to carry UIM to insure against acts of others over which you have little control while simultaneously being satisfied with minimizing risk for injuries you would be liable for by just not doing stupid stuff. There will always be some residual risk and it's up to you to decide what you're comfortable with. Insurance policies have limits and force majeure, too.

Why buy liability insurance at all then? If "just not doing stupid stuff" is good enough to bring the risk from hurting yourself down to a level that you can self-insure, why then would you want to pay for insurance for when you hurt others? Shouldn't "just not doing stupid stuff" be sufficient there as well?

[jac941]

There seems to be a lot of curiosity on how I racked up $45k in “patient responsibility”. I don’t want to do detailed accounting here - I have 125 Explanation of Benefits statements from last year. So I’ll pull out a few examples with approximate costs.

I do want to start with a few of points of clarification that people seem to be debating:
-I’m in California which has had consumer protection from surprise billing since 2017. The insurance and healthcare companies are well versed in the law and there are loopholes. I’m not sure how things would have been different under the new national law, but I assure you that if there are any loopholes, they will be utilized.
-I filed several grievances, appeals and complaints with the hospital, insurance company, and the CA Dept of Insurance. I won a few, I lost or was denied a few - typically due to some convoluted or unexpected exception in the law.
-The out of pocket maximum is calculated based on the insurance company’s ‘allowed amount’ for the bill. Not based on the actual billed amount. So if the insurance company allows $1,000 for an ambulance ride and pays 80%, they would pay $800 and the amount counted toward the out of pocket max is $200. But if the actual bill was $2,200, then the patient actually pays $1,200 with $1,000 not counting towards the out of pocket maximum.
-The amount I ended up paying was not the $45k that the insurance company calculated. Some bills I negotiated down. Others never hit the insurance list because I had maxed out benefits. I haven’t finished the final accounting, but things that most people would consider medical bills probably landed pretty close to $50k.
-I was extremely lucky to not have a brain injury - in fact my neurosurgeon said that he didn’t want to call it a miracle, but it was kind of unbelievable that I didn’t have a stroke. If I had a brain injury, the costs absolutely would have been more because I wouldn’t have had the cognitive capacity to argue as much as I did.

With that out of the way, here are a few examples.
-Ambulance bills: I had 2 of these. One for the original transport to the trauma center and one for a pre authorized transfer from the trauma center to an inpatient rehabilitation hospital. Between the two, my cost was ~$2,200 with none of that counting towards my out of pocket maximum.
-Neurological monitoring during surgery: By far the biggest cost. Insurance company said the equipment provider was out of network. And this is apparently one of those funny loopholes like the ambulance - somehow doesn’t count as surprise billing. Hopefully that loophole is closed in the national law. ~25k
-Post discharge follow up appointments: 2 surgeons and physician that coordinated inpatient care. This is a little complicated, but while the trauma center was in network, the physicians were not. Even more confusingly, these physicians were in network if seen at a different facility. I was assured each time at check in that there was no copay / insurance covered it. Unfortunately that was wrong. Oops. ~$2,000
-Physical Therapy: Not surprisingly I exceeded my annual limit for this. Now that it’s 2022, I’m back to covered visits again. ~$2,500
-Mental Health: This isn’t in network. My therapist charges a fair price that’s about double what insurance will reimburse. ~3,000

There are a few others as well. Mostly smaller amounts, but they add up. As I mentioned in my earlier post, medical equipment isn’t included in that $45k number - walker, shower chair, ice packs, special pillows and things for positioning at home, home equipment for PT, etc. Nor is the extra private physical therapy I’ve been doing on my own.

And back to the do you need it or not UIM. It’s totally up to you. I walk and bike a lot more than I drive. I think in this scenario I’m much more likely to need UIM than liability. Personally, we insure for very high cost, high impact things and set deductibles pretty high. I’m not insuring against a $20k loss, I’m insuring against a $100k+ loss (which this definitely was). Most other people carry $25k/50k car insurance in CA (the minimum). That’s not enough for what we are insuring against. So for us it makes sense to carry it.

[Shane]

GEICO is only charging us $2/6mo for Uninsured Motorist coverage, and $7.16/6mo for Underinsured Motorist coverage, at $300K each, the maximum offered in our state. Given what Jac941 is reporting, as well as other nightmare stories I've heard, those small amounts seem more than worth it to me. I get what others in this thread have been bringing up about how if you have enough health insurance, which we do, you shouldn't need to worry about UM/UIM coverage on an auto insurance policy, but for <$20/year for the maximum allowable UM/UIM coverage, it doesn't seem worth it, to me, to scrimp. Every time I read or hear about the ridiculous adversarial system of private, for-profit healthcare/insurance in our country, it makes me feel sick to my stomach. For what possible reason are we allowing this to continue? It makes no sense. I don't even think Medicare for All goes far enough. We should have Medicaid for All. Patients shouldn't have to deal with negotiating with insurance companies, when they're already suffering from an accident or illness. Everything should just be covered. No bills to patients. No OOP max bullshit. Just full coverage for all expenses. Any negotiations should be strictly between the insurance company (Medicaid) and the providers, which should be a complete non-issue for patients and their families.

[DaMa]

There seems to be a lot of curiosity on how I racked up $45k in “patient responsibility”. I don’t want to do detailed accounting here - I have 125 Explanation of Benefits statements from last year. So I’ll pull out a few examples with approximate costs.

I do want to start with a few of points of clarification that people seem to be debating:
-I’m in California which has had consumer protection from surprise billing since 2017. The insurance and healthcare companies are well versed in the law and there are loopholes. I’m not sure how things would have been different under the new national law, but I assure you that if there are any loopholes, they will be utilized.
-I filed several grievances, appeals and complaints with the hospital, insurance company, and the CA Dept of Insurance. I won a few, I lost or was denied a few - typically due to some convoluted or unexpected exception in the law.
-The out of pocket maximum is calculated based on the insurance company’s ‘allowed amount’ for the bill. Not based on the actual billed amount. So if the insurance company allows $1,000 for an ambulance ride and pays 80%, they would pay $800 and the amount counted toward the out of pocket max is $200. But if the actual bill was $2,200, then the patient actually pays $1,200 with $1,000 not counting towards the out of pocket maximum.
-The amount I ended up paying was not the $45k that the insurance company calculated. Some bills I negotiated down. Others never hit the insurance list because I had maxed out benefits. I haven’t finished the final accounting, but things that most people would consider medical bills probably landed pretty close to $50k.
-I was extremely lucky to not have a brain injury - in fact my neurosurgeon said that he didn’t want to call it a miracle, but it was kind of unbelievable that I didn’t have a stroke. If I had a brain injury, the costs absolutely would have been more because I wouldn’t have had the cognitive capacity to argue as much as I did.

With that out of the way, here are a few examples.
-Ambulance bills: I had 2 of these. One for the original transport to the trauma center and one for a pre authorized transfer from the trauma center to an inpatient rehabilitation hospital. Between the two, my cost was ~$2,200 with none of that counting towards my out of pocket maximum.
-Neurological monitoring during surgery: By far the biggest cost. Insurance company said the equipment provider was out of network. And this is apparently one of those funny loopholes like the ambulance - somehow doesn’t count as surprise billing. Hopefully that loophole is closed in the national law. ~25k
-Post discharge follow up appointments: 2 surgeons and physician that coordinated inpatient care. This is a little complicated, but while the trauma center was in network, the physicians were not. Even more confusingly, these physicians were in network if seen at a different facility. I was assured each time at check in that there was no copay / insurance covered it. Unfortunately that was wrong. Oops. ~$2,000
-Physical Therapy: Not surprisingly I exceeded my annual limit for this. Now that it’s 2022, I’m back to covered visits again. ~$2,500
-Mental Health: This isn’t in network. My therapist charges a fair price that’s about double what insurance will reimburse. ~3,000

There are a few others as well. Mostly smaller amounts, but they add up. As I mentioned in my earlier post, medical equipment isn’t included in that $45k number - walker, shower chair, ice packs, special pillows and things for positioning at home, home equipment for PT, etc. Nor is the extra private physical therapy I’ve been doing on my own.

And back to the do you need it or not UIM. It’s totally up to you. I walk and bike a lot more than I drive. I think in this scenario I’m much more likely to need UIM than liability. Personally, we insure for very high cost, high impact things and set deductibles pretty high. I’m not insuring against a $20k loss, I’m insuring against a $100k+ loss (which this definitely was). Most other people carry $25k/50k car insurance in CA (the minimum). That’s not enough for what we are insuring against. So for us it makes sense to carry it.

Thanks for sharing!  Those are definitely things that could happen to me, too.

[afox]

Thanks for sharing that info @jac941 . I love to hear stories like these because I think it helps others avoid the same pitfalls (such as the neurological monitoring out of network). I think it is analogous to pilots studying accident reports. Pilots learn from each others mistakes and the sharing of information makes everyone safer. In the same way we can use this information to save each other money and have better health outcomes.

In that vein, I really like the NPR "Bill of the month" series and when I searched for information about insurance issues with neurological monitoring, this story came up which sounds like an even costlier experience than yours:
https://www.npr.org/sections/health-shots/2019/06/17/732497053/a-year-after-spinal-surgery-a-94-000-bill-feels-like-a-backbreaker

It does sound to me like the new surprise billing rules would have helped you significantly. Was your surgery an emergency surgery in which you had no opportunity to check to make sure that all providers were in network? If so it is criminal and inhumane that the insurer would not pay the provider or the provider would not accept the insurers rate.

Also, this story is interesting, apparently auto insurers have medical networks as well. I wonder if the surprise billing rules apply to auto insurers as well:
https://www.npr.org/sections/health-shots/2021/04/22/989209329/surprise-the-charge-for-his-spine-surgery-after-a-car-crash-topped-700-000

I do wonder how much complexity having two insurers paying for healthcare adds to an already complex scenario. Of course each insurers has to do everything it can to make sure that the other insurer pays as much as possible. I am concerned that if I used something like UIM to pay for medical bills those costs would not count towards my OOP max and if I had enough medical expenses to meet the OOP max then the auto medical insurance would not have any benefit, I dont know if this is a valid concern or not.

One other note: by law FMLA can be invoked by an employee in the case of a serious accident.

[Paul der Krake]

@jac941 Any chance you would consider naming and shaming the Bay Area hospital that pulled this fast one on you?

[jac941]

@Paul der Krake I’m not going to name and shame. Too personally identifiable. And I did receive excellent life saving care there for which I will be forever grateful (despite the shitty billing practices). Besides you don’t get to shop around for your trauma center, so it doesn’t help folks avoid the place. I will say that it was NOT SF General who used to be infamous for awful billing practices until they were publicly shamed in Vox. I understand they’ve improved in the last year or two.

It does sound to me like the new surprise billing rules would have helped you significantly. Was your surgery an emergency surgery in which you had no opportunity to check to make sure that all providers were in network? If so it is criminal and inhumane that the insurer would not pay the provider or the provider would not accept the insurers rate.

I got hit by a car. There were no options to shop around or make an informed decision. It was surgery or possibly die and almost certainly have a stroke and be paralyzed from the chest down. I am lucky to be alive - really really lucky. The insurance is a hassle and borderline criminal. But I’d rather be dealing with it that have my kids grow up without me.

I don’t regret carrying UIM or think that coordinating with insurers is worse than having no insurance at all. The biggest benefit to UIM is that if things get really bad you can hire a personal injury lawyer to fight with everyone for you and they only get paid out of what they collect from the insurance company. You can’t get that with heath insurance. That bit alone is with the peace of mind.

[afox]

So my auto insurer (state farm colorado) offers several  different kinds of healthcare coverages:
-bodily injury: basically healthcare liability for others in the event of an accident you cause, i would never go without this and pretty sure its required.
-UIM bodily injury: we all know what this is but state farm seperates out UIM property and UIM medical/bodily injury.
-Medical Payments: apparently this is medical coverage for the insured (drivers only) in the event that you cause an accident or no other vehicle is involved so you could not make a medical claim via UIM or other drivers liability ins.

So, I assume the proponents of UIM would also have "Medical Payments" coverage by the same logic that you carry UIM coverage, is that correct? Note that "medical payments" coverage does not cover lost wages, there is no option for lost wages coverage for an accident you cause as far as I can tell. Lost wages coverages appear to be a reason for some to carry UIM. So, do people with good health insurance also carry "medical payments" coverage, why or why not?

Medical payments coverage only goes upto 25k coverage and costs about $40 per year per vehicle. I can understand why its cheap, it doesnt cover much.

UIM Bodily(medical) goes upto 500k in coverage and costs about $460 per year per vehicle.

I guess there are no deductibles for these types of auto medical insurance. Sounds like they do have networks, coverage limits by procedure, etc and out of network expenses are a thing with auto insurance medical insurance though. Good luck to anyone trying to go down that rabbit hole to find information.

I still dont understand the case for paying for auto medical coverage (insurance) that overlaps with one's health insurance coverage. I do understand the case for insurance that covers lost wages for those that need/want it. The only coverage for lost wages that you can buy appears to be UIM and that could only be used in the case of an accident with another driver who does not have insurance, for accidents caused by another driver with insurance I assume that the other drivers liability insurance will pay lost wages. Even in @jac941 's unfortunate and terrible ordeal all of the medical services he/she needed with the exception of some physical therapy that went over his plans limits were technically covered by his/her's health insurance, it was just some out of network snafu's (uhm legal stealing from a person at their most vulnerable point in their life) and his/her personal preference for some out of pocket providers (absolutely nothing wrong with that) that caused the high out of pocket costs. All of those out of network excess expenses except the ambulance charge would have had no cost once meeting the OOP/deductibles for the year if the surprise billing rules work as intended.

Maybe its too early to tell how the surprise billing rules will play out in reality but from the personal stories, reporting such as NPR's bill of the month series etc it sounds like the vast majority of the high healthcare costs incurred by patients are coming from surprise billing. This could really change things for the U.S. healthcare situation.

Weird tidbit: if a bad accident or health issue occurs in december/late in the year you're likely to have to pay OOP/deductibles for 2 years vs. possibly one if the accident occurred in january/early in the year.

[jac941]

@afox The advantage of medical payments over UIM is that it’s no fault, first payer, and immediately available. So it can be used for ambulance bills, copays / meeting your out of pocket expenses, etc. And you can use it for yourself even if you’re liable for the crash.

The UIM has to be settled all at once, so if you’re badly injured and have a complicated settlement, it can take a year or two to see the money. It also only covers you if you’re not liable.

Confirm that’s what you’re looking at with the policy options, but that’s how I’ve always understood it.

I really hope that the US surprise billing law is better than the CA one. The CA one protected me from a lot (but not all) of out of network charges. Especially things like anesthesiologist and radiologists. If the surprise billing law works as intended it would massively reduce the risk of big medical bills.

[afox]

@afox The advantage of medical payments over UIM is that it’s no fault, first payer, and immediately available. So it can be used for ambulance bills, copays / meeting your out of pocket expenses, etc. And you can use it for yourself even if you’re liable for the crash.

The UIM has to be settled all at once, so if you’re badly injured and have a complicated settlement, it can take a year or two to see the money. It also only covers you if you’re not liable.

My understanding is that the UIM would only cover you if the accident is the other drivers fault AND the driver at fault did not have liability insurance (they had no insurance). If the other driver had insurance my medical claims would be paid by their liability insurance.

It could be helpful for people to look up percent uninsured for their state to help decide if UIM is worthwhile. In my state (CO) 16% of drivers have no insurance. Mississippi has highest percent uninsured at 30%, NJ has lowest percent uninsured at 3%. Quite a big difference between states. One would assume that UIM would be dirt cheap in NJ. Its shocking to me that all states dont have methods in place to nearly eliminate uninsured drivers from the road as NJ has.

It is nice that MedPay pays coverage towards expenses that go towards health insurance deductibles/OOP max's. In my case my health insurance premiums for family of 4 are $2500, I have a $3000 deductible, and $10k OOP max. Its not likely that I would not have paid any healthcare expenses at the time of a MedPay claim and the coverage is of limited value once the OOP max has been met. Its pretty cheap coverage but its just not a lot of benefit and goes against my philosophy of using insurance to pay for losses that would be catastrophic.

[jac941]

Yes, you should get both uninsured and underinsured motorist insurance if you’re going to bother at all. Not just uninsured. Having a minimum policy is extremely common - if you combine underinsured and uninsured your percent of drivers in the combined categories is going to be high. Some states have no fault insurance which also changes the equation.

If the other driver provides false insurance information to the police (which happened to me), and you have UIM, I guarantee that your insurance company will find any open policy that applies to the liable party or vehicle on your behalf.

I agree regarding medpay. It’s cheap to get and marginally useful. I was glad to have it, but it’s not nearly as useful as the underinsured motorist coverage. The uninsured / underinsured motorist is definitely the catastrophic coverage.