4mo ago

For the first time in my life, I have hit my deductible AND reached my out-of-pocket maximum. I now have three months of actual free healthcare, which is unheard of in the US. What should I get done?

Biologically male procedures only. EDIT: If the two people who downvoted this question could explain their reasoning, I would be super interested. No judgements. This is a safe space!

176 comments

Do you snore? Get a sleep study and a CPAP - thats pricy! Need a colonoscopy? Gel shots in your knees? Any family histories that would warrant testing for cancer markers?
- Just had Inspire surgery. How do you think I hit my maxes lol! What I do think I have also is arthritis.
  
  If you're beginning to struggle with joints, get on the PT, MRI route while it's free.
  
  I was curious so I looked up the inspire website.. this has got to be the best accidentally hilarious medical video I have ever seen:
  https://m.youtube.com/watch?v=BOnZjPD6n5Q
  Who directed this monstrosity!?
- +1 for cpap. You might not like it at first but seriously try out different options. There’s different mask types. My wife’s blood pressure dropped to normal very quickly once she started using it. Mood and energy levels improved by a lot. Sleep is super important

This is the perfect opportunity to recreationally infect yourself with rare short term diseases. Try breaking your arm or nose so you have a story. Self harm has never been so cheap.
Edit: See evasive_chimpanzee's comment here, as the following seems to be incorrect information
Seriously though get checked for prostate cancer. Especially if you're over 25 it's very possible and catching it early will be a massive difference.
Same for everyone reading this. I doubt it's that expensive so please look into it and get checked if affordable where you are.
- Checking for prostate cancer is super easy now and doesn't even require a finger in your bum. It's a simple blood test that is far more accurate than the traditional manual method. I get one done every time I have a physical since they just add it on to the other stuff they check my blood for.
  
  -doesn’t even require a finger in your bum
  Then what the heck am I paying these deductibles for?? >:(
  
  PSA sucks, it has both low sensitivity and low specificity.
- I would talk to your doctor about it for your case specifically rather than advocating broadly for prostate cancer screenings.
  https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/prostate-cancer-screening
  
  Huh, I'm always happy to proven wrong. thank you for bringing this up.
  Is this still relevant however with blood testing becoming more prevelant? The main reasons listed are due to harms caused by probing both physical and psychological along with false positives which out-weigh the positives of a 0.128% life saving outcome. It's been 6, nearly 7 years now and prostate testing is both more accurate and non-invasive
  Either way, this body is currently in the final research plan stage of updating the recommendation.
  https://www.uspreventiveservicestaskforce.org/uspstf/draft-update-summary/prostate-cancer-screening-adults
  I'd agree we should stand by the current assessment though until it changes. Thank you for the correction
- I was actually told by my doctor that unless you have a history of colon or prostate cancers in the family, advisory boards are pushing testing to past 40.
  
  Yeah, as an early 30s AMAB having to go in for annual checkups for insurance, two different doctors told me there really isn't shit to do for someone my age
  
  Idk. When I worked oncology all our prostate patients were very young men way before 40.
  But thats anecdotal. I don't have any numbers. But whats the worst thing that can happen when you get a prostate check? That they don't find anything?

Do every test available for prevention and prophylaxis.
Get your general practitioner to do a full health check, ECG, EEG, cardiac ultrasound, a full blood panel, bloodpressure, pulmonary function, skin cancer prevention ect.
Schedule a gastroscopy and colonoscopy.
Check in with an urologist to get your prostate and urinary tract checked.
If you can, get a full body scan. Either PET or MRI.
Nearly every serious disease or health issue is easier prevented or treated when caught before it casues real issues.
Every cancer there is, has a better outcome and is easier treated when found early. Most of them are silent until very late in the game.
This is something I would recommend to anyone: Take advantage of every preventative messure or examination that is available to you!
There is no illness that you can detect too early.
- Until the insurance decides they're not covering it for some reason and OP is stuck with the bill.
- The kicker is that I just moved here and don’t have a PCP (primary care physician) yet. AND my company is switching health plans next year, so I basically need to find someone who takes BOTH health plans.
- Omfg, don't get a PET-scan 'just because'. You would literally have to be injected with radioactive particles. The other stuff, while not necessary, will atleast not kill you faster.
  Last paragraph is also massively oversimplified. Getting a 'you have cancer'-speech and treatment for a superslow growing prostatecancer will fuck with your mind and body more than the cancer itself. That's why most health care systems advise against general PSA screening.
  
  Just to provide some data on the radiation dose. It’s everyone’s own decision whether a ‘willy-nilly’ PET scan is worth it.
  From the English Wikipedia:
  FDG, which is now the standard radiotracer used for PET neuroimaging and cancer patient management, has an effective radiation dose of 14 mSv.
  The amount of radiation in FDG is similar to the effective dose of spending one year in the American city of Denver, Colorado (12.4 mSv/year). […T]he whole body occupational dose limit for nuclear energy workers in the US is 50 mSv/year.
  https://en.wikipedia.org/wiki/Positron_emission_tomography#Safety
  From the German Wikipedia:
  Es ist bei einer Strahlendosis von 1 Sievert (Sv), der 100 Menschen ausgesetzt sind, mit 5 Todesfällen durch Strahlenkrebs zu rechnen […]. Man müsste also 100.000 PET-Untersuchungen durchführen, um 35 Todesfälle an Strahlenkrebs (nach einer mittleren Latenzzeit von etwa 15 Jahren für Leukämie und etwa 40 Jahren für solide Tumoren) zu verursachen, das heißt etwa eine auf 3000 Untersuchungen
  If 100 people received a radiation dose of 1 Sievert (Sv), one would expect 5 deaths due to radiation-induced cancer […]. One would need 100,000 PET scans in order to cause 35 cancer deaths (after a median wait duration of 15 years for leucemia and 40 years for solid tumors), which is about 1 in 3000 scans.
  https://de.wikipedia.org/wiki/Positronen-Emissions-Tomographie#Strahlenexposition
- Guess I'll die

Vasectomy if you don't plan on having kids. Also consider mental healthcare. Everybody could use a little bit now and then.
- Yes! Mental healthcare!!
  
  OP editing their post cuz they got put off by 2 whole downvotes is a sign that, yes, it’s time to consider mental health
- Vasectomy is probably free anyway.
  
  Or crazy cheap (like copay), since it prevents lots of expenses for the insurance company.
- May not be the same in all cases, but with my insurance mental healthcare is its own separate thing through a completely different company, much like dental and vision usually is. So if OP is in the same situation it's a different bucket and would have its own costs not associated with the medical deductible being met.

I say blow your free healthcare on something frivolous and fun.
See if they'll swap your left kidney with your right one.
- Frivolous? Yes. Fun? 😬😬😬
  
  The surgeon deserves a little fun too

Snip snip
- I don't think you need health insurance to play Gwen
  
  Not Gwen specifically, but I’d recommend seeking mental health resources to anyone who has been exposed to League of Legends.
- snibbedy snip, put in more than the tip

To your "edit" point: Don't take a handful of downvotes personally; it's pretty easy to do accidentally on mobile so they may have been unintentional
- To add to that downvotes have no serious negative effect on this platform
  In reddit as soon as a few people downloaded you, you disappeared
  Here people can brigade you and unless you're reading top, who cares, your stuff still gets seen.
  
  Oh I know. I am genuinely curious what anyone found so objectionable. They are welcome to their opinion, I’m just very eager to know what it is.
- Some people also use downvotes as way to say they dislike something. Unlikely, but some people might be down voting to indicate they don't like the insurance industry.
- I downvote anyone that whines about or asks why they're getting downvotes. Otherwise I don't up/downvote anything at all (except that guy that is posting triangles for upvotes)
  Seriously, who cares?

What you mean is, your HMO has had to dust off the "not medically necessary" stamp.

If you're on any expensive meds, now'd be a good time to get them refilled. ...and 'my backpack got stolen!' them and get them refilled again if that's covered.
If you've got anything you think needs to be addressed with any urgency at all, skip the normal process and go to the ER to complain about your symptoms, especially if you've got ANY pain in your abdomen or tenderness in your lower back (which could mean kidney stones).
Infact, even if you don't have pain, go in and tell them you feel nauseous after eating anything greasy or fatty, and you'll get a free ultrasound of your gallbladder to see if there's any stones in there. ...don't actually accept surgery to remove it unless there are stones that look like they're for sure going to be problematic, cuz you WILL have symptoms once it's gone (eating will make you feel like shit... your body should adjust eventually, but that's not a guarantee, and it can take anywhere from a few months to years).
So, if they offer a scan or any diagnostic, do it. If they offer surgery, have a long think about whether it's actually worth doing.
- Not only refill your meds, but there are places where you can get 90 day prescriptions filled, so you can go into the new year with several months of pills already ready.
- The ER idea is brilliant, especially because I just moved here and don’t have a PCP yet. Even better, I can hit up urgent care every day!
  
  Yeah your biggest obstacle right now is going to be "our next available appointment is in 4 months", so ER is the way passed that. It's not super ethical, but neither is the way our healthcare system operates, so do what you gotta do.

I'd double- and triple-check the small print.
They'll find a way to still charge you.

Do you have any persistent pain or discomfort when doing things? Get that checked out.
Another +1 for colonoscopy.
Also if there's a family history of anything nasty, see if there's a test for it my maybe? (E.g. heart attacks, get blood work done for cholesterol).
Get a full physical including blood work.
- Fun fact: for people over 45, colonoscopy screening for cancer is always free. If your insurance tries to make you pay for it, report them to your state insurance commissioner or the Center for Consumer Information and Insurance Oversight. ACA made a lot of preventative medicine & screenings free.
  
  in my experience the first one was free. the followup a few months later wasn't.
  
  This is great, except in my case, where I have regional insurance that no one takes where I live. Everyone is out of network.

Idk? Boob job? Dental work? Extra set of arms? I wouldn’t know
- It's the US, so dental isn't included
  
  Wait, what? You guys are paying all that for insurance and it doesn't always include dental? Like the main reason I wanted to be on health insurance here in Canada was for dental and prescriptions. I've been on some of the crappiest insurance plans here and they all include dental.
  
  Oh then get a quadruple bypass since you’re in America

My health insurance denied covering my vasectomy so i put it off. Later that year i was in an accident and hit my max out of pocket pretty quick. I called up my doctor and had them resubmit the preauthorization. got it covered at 100%
I'm still pretty pissed that sterilization for women is covered at 100% under my plan but not for men. (It should be both 100% imo)
- It goes the opposite way for wanting to reproduce, too. That is, myself and my wife decided we would try to start a family, and she's apparently fine, but something isn't working on my side of things. (Her doc even said "Don't worry about it, men tend to be an easy fix.")
  There's a million programs and special coverages and stuff for women's fertility, but all I asked is "Hey can we just diagnose what's wrong with me? I don't want super-swimmer-syrum or something I just wanna know."
  They refuse to consider it urology or any kind of "men's health", and keep wanting to rule as "fertility treatment" which conveniently isn't covered.
  Men's reproductive rights aren't even on the radar.

Get all your injuries out of the way. Do a bunch of dumb shit to build character

Similar boat. Getting my snoring looked into. Got a sleep study done and now I'm having an ent do a scoping to see what's actually vibrating and what can be done.
- This is a major one!
  Sleeping is a third of your day. There's a lot of health issues that result from bad sleep/snoring. and the worse is that you'll never even know it.
  My wife had a sleep specialist provide helpful strategies after her pregnancy and her back pain stopped.
- I tried Cpap and just could not tolerate it. I just got the Inspire surgery last month, which I think is the only other viable option in existence right now.
  
  Mandibular advancement splint is another option.

Get prohibitive dental work. My teeth are fucked from no fluoride in the water when I was a kid, so I always have more work needed.
- Lol dental work isn't covered under health insurance. Teeth are luxury bones that only the rich are allowed to keep!
  
  Aw, but all my other bones are so low maintenance.

Dentistry. This shit is always hard to get for free so you should do everything you can.
- Not covered by my health insurance, or even most health insurances in the US. We have special horrible dental insurance for that.
  
  Ew, i'm not even surprised, this seems to be trend in all capitalist countries, in Poland dentistry also went to shit after 1989 and even worse after 1999 healthcare reform.
- Chewing bones and seeing orbs are not covered in US health insurance
  
  Seriously not even eyes?
  
  I think seeing orbs are still mostly covered for medical issues

Any minor physical pains? Could see a physical therapist. If you use a computer a lot, your posture might be bad and it helps a lot!

My wife is there.
She's gotten two knee replacements this year and is scheduled for a hip replacement before the end of the year. And last night I reminded her she's been meaning to go to a dermatologist.
- Here I am with acceptably functional knees and hips. I just can’t win!
  
  Yes but how’s your skin
- Ooh! Dermatologist! That's a good one!

Find a excuse to get physical therapy.
- My ‘bone spurs’

Talk to your primary doctor if they can get you a referral for an MRI. Insurance loves to try and deny MRIs, so I think a referral is probably required due to how expensive they are. IMO, they should be included in annual physicals since it's one of the only (if not the only) ways to detect brain tumors early, which is critical given how difficult it is to treat brain tumors and the earlier the better.
- Medical authorities usually don't advocate for getting imagery like that as a screening tool without any relevant risk factors or symptoms. Everyone has stuff that is unique and weird about their bodies but completely benign, and chances are, it turns up in an MRI or CT. This can end up leading to unnecessary invasive procedures to remove or biopsy something. The odds (in the literal sense) are that not-called for screening leads to either worse outcomes or the same outcomes as people who didn't get the screenings.
  I didn't look up a source for MRI specifically, cause that's pretty broad, but here's a report that does a good job explaining it for prostate cancer screenings. The logic is the same.
  https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/prostate-cancer-screening
  
  I mean, sure, but if it detects something and there's no reason to suspect it's necessarily cancerous, then I'd hope doctors would recommend just keeping an eye on it and possibly scheduling periodic checkups to ensure it doesn't continue growing. No competent doctor is going to recommend invasive surgery right off the bat.

I don't know what's covered under US "healthcare", and I think it also depends on your age. Probably should talk to your doctor and ask them. Maybe a bunch of blood tests, dental work, cancer screenings, prostate check, colonoscopy, and upper endoscopy.
- I work in American healthcare. Your doctor is actually one of the worst people to ask about coverage.
  Unfortunately, the only solid way to be 100% sure of coverage is to call your insurance company and make them guarantee your planned procedures in writing. Every doctors office has a department to deal with insurance—after you talk to the insurance company you will want to talk to the insurance department at the doctors office and give them the written statement from the insurance company.
  After your procedures, your bill will be processed by a medical coder at the doctors office, and a clearing house coder who gets things ready for your insurance company, before it potentially gets double checked again by coders who actually work for the insurance company. Those people will not have any clue about the arrangement made prior to your procedure, and this is the series of steps where something might happen that would cause your insurance company to not pay.
  If you did your due diligence and got everything in writing beforehand, then the insurance company will kick the bill back to the doctor, at which point it will be reviewed by a payment specialist who will be able to see and use the written commitment to force the insurance company to process the bill.
  This whole process takes anywhere from weeks to months, so you may not know there is a problem until a while after your appointment.
  Welcome to American healthcare. Good luck getting whatever you can.
- Unfortunately, dental is typically separate from health care in the US. (It's stupid).
  
  This isn't always the case, technically. Dental can be considered for normal health insurance if it's directly impacting your health (like an emergency surgery). That being said, your insurance may fight the shit out of this and will still most likely require you to list your dental insurance as the primary for billing.

Get an MRI for, idk, back pain.

When this happened for me, I went and refilled my sumatriptan injections as fast as I could and actually used those for two years afterwards, it did save me money. If you need any extra dermatologist stuff, mental health, physical therapy, do it now.

Get your ears cleaned at an ent. Go to a dermatologist and get a facial. Go to a pediatrist and get a mani/pedi.
Really sucks that dental doesn’t count as medical.
- Get my ears cleaned by an ent?
  
  I’m so soryy. I couldn’t resist.
  _I’llsee_myselfto_thedoor~
  
  Why does it look like the Ent is feeding him 😂

Colonoscopy!

Emigrate.

Colonoscopy

Shop around if you don't like your GP. Tell them your situation and ask them for a referal to every specialist under the sun. Get tested and innoculated for absolutely everything they suggest.
- Referrals AND a new patient appointment in less than 3 months? You're dreaming.
  
  Fortunately i do not need referrals on my plan. So I can definitely get to the specialists. Ortho and Gastro are first up.
  
  Yea that's a good point. I guess I'm living in fairy tale land considering meeting mandatory minimum and deductible 🤣 A boy can dream

I'd say colonoscopy, esp if you're over 45, but those are required by law to have no out-of-pocket costs, regardless.

oh. go get a therapist--not physical; mental. they're insanely expensive, but you can spend the next three months shopping around and by the new year you'll have found someone you like!

Start a fist fight with a random stranger!
(not me please)
- That…can have other consequences besides medical.

Is anything cracking or sore more than it should be? Time to go get that treated.

Some kind of general fitness testing?
You know, involving heart, lung capacity, performance?
- This is interesting, although my results will be awful, thanks to long COVID, recovering from surgery, and vaping weed.
  
  Outs there anything you can get done to address the long Covid symptoms?
  
  Having the data could still be helpful for tracking your progress towards recovering from some of those things in the long term. 🤷

Tape worm weight loss, or if you are already at a healthy weight start roids for a couple months
- 😂
- Can I keep abusing stimulants while I do those?
  EDIT: Where can I get roids? I want to drop 25 pounds and it’s taking too long.
  
  Maybe! Let’s see how far that free healthcare can take you!
  
  ...the stimulants should be helping with that though already.

Go to all the specialists! And if therapy is covered, indulge in that, too.
- Therapy is covered, thank you for reminding me

Mole map

Physical therapy if you have any physical issues at all, massage therapy if you have any chronic pain, occupational therapy if you have specific life skills or mobility needs.
Any preventative screening or vaccines. There are various generic cancer screenings, etc. Get a referral to a dermatologist to do a once over your skin and document any spots of concern.

Get a Dietician and physical trainer. Use this opportunity to get yourself into healthy shape and never look back. I did something years ago and had no clue just how bad I was actually feeling before the improvement. Both physically and mentally. We are not designed to sit at desks all day.
Do your feet crack sometimes? Consider testing for athletes foot.
Blood, STD and Cancer screenings, as many as they’ll give you. Hell, depending how old you are, maybe a colonoscopy.
Sleep study. MRI, ECG, EKG. Allergy test. Dermatology/mole screening.
IQ test, find out your best skills and then learn how to use them to your advantage.
DNA testing, if you really want to know some things you may be perceptive to…though personally i don’t know if I would want to know if Huntingtons is in my future.

Knee brace.

Not a medical procedure, but take the time to reevaluate your medical plan before open enrollment! Look at the cheaper plans and see how much you'd save in premiums. It might be greater than the difference in max out of pocket. And if you get a qualified "high deductible" plan you can even contribute the savings to an HSA that you get to rollover and keep forever into retirement, without ever paying taxes on it.

Gender reassignment surgery?

Get on Ozempic or Mounjaro
- Oh they do NOT cover that unless you are diabetic. No way. (I looked into it.)
  
  Wegovy might be covered if you’re just fat. You might also find a doctor willing to prescribe it on the basis of pre-diabetes, although it’ll be a long argument with your insurer.
  But if you respond well to the drug it’s worth it. Trust me

Down vote because this is an American specific thing in a global community. It excludes the rest of the world.
- The rest of the world has health care too. The situation is america specific, but anyone can chime in to say what health care is probably worth getting.
- Upvote for your honesty, mate!
  
  ♥️
- While the prices arent insane, I still spend nearly double my insurance each month due to "eigen bijdrage". I think it's 400 per 3 months, though I'm not sure.
  So I understand wanting to catalogue all treatments he could do whilst not needing to pay for'm.
  The situation is mostly America specific, the question isn't.

176 comments