okay i am listening to this episode and it is unfortunate how naïve Americans are to how terrifically fucked our own insurance system actually is. Like you might think it’s bad, and you might know things that prove it’s bad, but you truly have no fucking idea until you’ve grappled with the gnarliest, most inhumane parts of it.
It is, wildly, not fraud for the insurance company to turn around and say “actually no”, and it is totally normal for the provider to say “well this is not what we expected! anyway here’s the bill.” Typically you sign a waiver saying you understand you will be responsible for the cost of the procedure if your insurance is not approved in advance of the procedure, but even then…not always! Worse, the insurance company can legally retroactively cancel coverage under certain circumstances, back to the beginning of a month that you were previously covered under, and they (the insurance company) can then bill YOU for the things that they previously approved coverage for.
Additionally, the amounts they will bill you for, which are astronomically fucking large - like, say, $10,000 for a CT scan - are wholly invented. They are a product of what the hospital billing department (the true dark bane of the existing US healthcare system) has determined it to be in coordination with the insurance companies based on bureaucratic nonsense unrelated to the actual procedure, much of which is actually the cost of paying for the billing department itself and those who work it!
You can effectively negotiate with the provider and say to them, “I can’t pay $10,000. I can pay the actual cost, which is [for the sake of argumentation] $800.” and they may just say “okay sure”, knowing they will never get $10,000 out of you. It is an imaginary number. The lower, “true” cost is typically what medicare/medicare recipients pay for the procedure when they/those covered by it receive the procedure.
If you ever find yourself stuck with a fucking enormous medical bill, you DO have options. You can default on it after 7 years, at which point I believe it is finally scrubbed from your credit score (this means never making a single payment, as each payment resets this clock); you can negotiate a lower cost with the provider because you know for a fact the procedure does not cost as much as they say it does, that is just what they’ve convinced insurance companies to pay for it; or you can appeal the coverage rejection by your insurance company. If your coverage is through work and that coverage is somehow fucking you, you can also contact the department of labor agency in your area. Companies do not like receiving calls from them, and they may be convinced to resolve an issue they are legally in the right about just because it’s easier to do so than to keep fighting you.
All of it fucking sucks, all of it is deeply, deeply dehumanizing, all of it will cost you many hours a day, every weekday, for months on hold on the phone, but…it is possible.