In the US, what happens if you sustain a life threatening injury and you don't have insurance?
In the US, what happens if you sustain a life threatening injury and you don't have insurance?
Assuming nobody else is at fault
They'll fix everyone at the ER.
But you get a ridiculous bill, then likely "settle" for a much lower amount of if you're truly pennyless, you just never pay it and eventually the hospital gives up and uses it as a tax write off.
It's a shit system
It’ll also wreck your credit, and if you’re unlucky they’ll sell your debt off to debt collectors to harass you and your family. Even if they’ve died. And then the truly desperate will sometimes commit heath insurance fraud making the system even more immensely fucked for everyone except for the hospitals and insurance companies
The big story in my city a while back was a shitty debt collector that stole money from a guy's bank account.
‘It is like robbery’: A debt collector wrongly wiped out an Oregon man’s entire bank account
According to court records, the debt collector said Salazar owed money for treatment at Providence Portland Medical Center in late 2007 and 2008. Providence claimed it sent 26 billing statements and six financial assistance applications to the home address provided by the patient. The unpaid bills for six emergency room visits originally totaled $4,750 but have since ballooned to more than $14,000 after costs, fees and interests associated with the debt collection.
Salazar tried explaining to Professional Credit Service that he didn’t have the money to pay, but a customer service representative seemed unsympathetic.
“They did not care if my brother is sick and this is going to put us on the street,” explained Salazar. “They did not care.”
In April, Salazar filled out court papers challenging the garnishment. It temporarily froze his bank account, preventing the debt collector from taking any more money. At the same time, it kept Salazar from accessing much needed funds, including his paycheck, which is electronically deposited into the account.
I feel like a lot of people ignore collection agencies when they advise others to "just not pay." Yeah you could probably get away without paying, but you and your entire family will be harassed nonstop. There's been few things more chilling to me than a stranger calling me out of the blue with my sister's name and info telling me to get her to settle up (thankfully just a small amount).
I’ve been telling people that the notion that the ER lets poor people die in the US is false; instead, they make you wish you did.
The ER might not let you die but fuck you if you need some sort of medication you can't afford.
Part of the reason it's like this is because insurance companies try their very hardest to avoid paying, but that means you have to do the same if paying yourself.
ER patches you up, you get a large bill, you declare bankruptcy, life goes on.
The question you should ask is, what happens if you have no insurance and you develop a serious chronic illness.
How does "life go on" with a bankruptcy and health issues?
The point of a bankruptcy is to move on. You start off at zero again, but you can start building up assets again.
As far as the health issues go, because of the bankruptcy and the ACA you probably qualify for medical care under one of the programs.
Yeah, you get fucked over pretty good. Life goes on because you’re not dead. But everything you had, everything you worked for, is gone. You are left literally with life, not with your life.
My parents went bankrupt like 4 times and it never seemed to make any difference to them. They'd just move on with life and have new credit debt racked up within a few months.
For some, it can be an unbearable long and leasurely spin around the drains perimeter.
Emergenty rooms in hospitals are legaly required to help all patieints, so you would recieve care. Usually until you are able to leave the hospital. You would not receive followup care without going to the emergecy room, or paying cash. You would be billed for all services, usually at a higher rate than insured patients
What kind of care is the question. Often times stabilize and terf em is the name of the game.
My wife worked in the ER for a few months and had to change departments because of a mental breakdown.
Understaffed, abused, and a huge chunk of people who are in the ER are desperate and came there as a last resort because of our fucked up healthcare system.
Not to mention the unstable. Say what you want, but I can count a dozen times where patients threatened to harm my wife for providing care.
Holy shit what the actual fuck is your health care system America. This thread is nightmare fuel.
It's like reading dystopian sci-fi
welcome to our personal hell
We're a cruel people, and the majority think you're not entitled to anything you can't pay cash for.
It's certainly not the majority.
This is what voting right wing does to a country, but hey let's all stick our heads in the sand and blindly hate immigrants.
If someone calls an ambulance and you’re unconscious they will take you the hospital for treatment. You will be responsible for the bill. Including the thousands of dollars for the ambulance ride.
And no, even though you were unconscious and not able to consent to treatment willingly you will still be responsible for the bill. There are ways of dealing with it, but one accident is all it takes for a ruined credit score for some people. It is as fucked up as it sounds.
There are ways of waiving bills, getting financial assistance etc but it’s a total nightmare dealing with hospital billing departments
If I’m unconscious indoors in a safe place then leave me alone I’ll wake up eventually
Ah yes. Healthcare Rape. More terrors to my collection.
Something nobody else has mentioned her eis that even if a hostpital is required to provide care regardless of your insurance, in practice you're not unlikely to get a lower standard of care if you have no insurance or even if you have insurance that's seen as "inferior" like Medicaid.
Folks without insurance or with "lesser" insurance tende to be poorer. More likely to be seeking pain meds to use recreationally. More likely to be disabled, overweight, etc. More likely to be racially discriminated against or, if white, seen as "white trash". So, having no insurance or inferior insurance itself may get you written off as "probably lying" or otherwise somehow undeserving of the same level of care.
And if that's an issue for life-threatening injuries, it's... probably much more so an issue for more routine kinds of medical care. It's literally not even an option to self pay in some cases. And I don't just mean because it's so expensive. Even if you did say "I don't have insurance, but my bank account has $100 million in it and I can use my debit card," you may be told you're not allowed to self pay.
Poor people without insurance are often sent to alternative care facilities specifically for poor people without insurance. And as you might expect, those places are often very understaffed. So you can expect longer wait times and more rushed care.
Poor people without insurance also often don't get treated early when a problem isn't a huge deal for fear of accruing medical debt. So they're also more likely to end up unexpectedly needing a trip to the ER because that minor infection that, had they gotten it treated a week ago, would have been taken care of with a round of antibiotics has now spread to some much more vital organ.
Folks without insurance or with "lesser" insurance tende to be poorer. More likely to be seeking pain meds to use recreationally.
Do you have a source for this? This sounds wrong, pain pills are rich/middle income people drug as I perceive it. You can't really get hooked up on pills if you never got them by a doctor first.
There are definitely pill mills in the poorer parts of town. And usually poor populations receive Medicaid, which will typically pay for the stuff. Just anecdotal evidence as a pharm tech in a rough part of town during college, but after a while we had to actually stop taking scripts for most pain meds (still got a ton of people using trazadone and stuff, though) because the pharmacist just didn't think it was worth his license if the scripts were tied back to a pill mill.
You're assuming doctors are the only source for these.
Adding to this, there is no requirement that hospitals ensure that you are safe when they release you from their care so sometimes people who can't pay for care and have dementia, uncontrolled or poorly controlled mental health issues, or are otherwise vulnerable get left at the nearest bus stop. It even makes the news sometimes because someone got dropped off only wearing a hospital gown at night in winter.
Edit to add link to an example: https://www.cnn.com/2018/01/11/health/baltimore-hospital-patient-video-bus-stop-trnd/index.html
I can't speak for every hospital since I've only worked at a few but this is rare. Some places might still be doing it, dumping people who can't be placed or don't have insurance, but EMTLA was put in place to combat that stuff and the lawsuit and probably fines would make this a bad move. We've kept people where I work for months because we can't place them or psych won't take them. At minimum they're going to a nursing home.
The having money to pay for something and being turned down is such nonsense. I've run into something similar with some procedures I need done. Place would let people without insurance self pay, I have insurance but the wrong kind, they were apparently legally required to bill my insurance but they couldn't. So I was denied service entirely even though I could have paid in full out of pocket. I spent two months getting my insurance to negotiate a contract with them but by then I was/am running into a time constraint and had to switch where I'm going to be an out of state place that can do the same thing but faster. Things are so broken over here.
When I was younger and made next to nothing, I ended up in the emergency room with a bill I couldn't possibly afford to pay. I called up the billing dept and told them about my financial situation and they told me to contact Health Quest so I qualify for a discount. It was relatively easy and not only did it erase my previous debt but it gave me a 0% liability for any hospital fees for the next 6mos. The funny thing was that the hospital ended up selling my my debt to collections by that point so every time they called id fax them a copy of a letter and id never hear from them again and after a few times of them selling this debt to other collectors it just got dropped. This was in upstate NY in like 2010 so YMMV.
It can vary heavily like you're saying. By law, all hospitals must treat all patients who arrive at the ER.
Most hospitals have programs so they can provide care for those who can't afford it, though. Usually around 20-25% of their revenue is used to cover those patients.
If you qualify for Medicaid, they can backdate your enrollment so you'd be covered even before you arrived at the hospital. Coverage can vary, but this usually should cover all medical bills at no cost.
The big issue usually isn't people who have no insurance or are too poor. It's from hospitals treating you while your insurance refuses to pay. Normally this is because the bill was miscoded, but it can also be due to an uncovered treatment, high deductibles and OOP limits, or the insurance just being greedy.
Sometimes the hospital or doctors can work things out to minimize your bills, other times they can't.
A lot of the protections above came about because of the Affordable Care Act (Obamacare). Before then, there were common horror stories of people who had hundreds of thousands in medical debt because they reached their lifetime maximum coverage - something that's illegal now. Insurance could (and often would) just tell people they're on their own from now on because it's too expensive to keep them alive. Your coverage could be changed whenever the insurance company felt like it. And up until last year, they could make you pay for treatment if an out-of-network doctor decided to pop on by while you're at an in-network facility.
You tell the hospital to pound sand when they send a five or six figure bill. Very few in the US have $20,000 or so just lying around. The hospital knows that, the court knows that, even the latest version of FICO knows that.
You can ask for an itemized bill, amd usually a bunch of stupid charges go away. You can try and arrange a payment plan.
But really, after a certain point, it doesn't matter if the bill is $10,000 or $1,000,000, there's just no money, and there will not ever be that money, and they can cry wage garnishment until their ears bleed but it almost never happens - because there's no money.
But what happens if someone has a savings and happens to have say $50k in there and then they're hit with a health issue that incurs a $25k hospital bill? Can they then come after you for payment if you have the money in savings?
In that case, yes they could. But things are different for a person who has 50k in savings, I wasn't talking about them.
Yes, you're punished for saving while those spend all they earned are rewarded. It's a messed up system.
In short? Medical debt. Emergency rooms will treat you, and in some cases might offer discounted rates for patients without insurance, but at the end of the day you are still responsible for the bill, however large it may be.
Worth noting that those discounted rates are still significantly higher than what insured patients pay, and astronomically higher than what people in actually sane countries pay.
Don't forget the possibility of refusing to identify yourself. Without an identity there is no way to bill you. So you just leave and the hospital has no way to contact you. This is the path taken by many, especially the poor.
Hmm....
You go to the hospital and get a bill that puts you into debt for the rest of your life. Maybe you do a crowdfunding campaign to cover part of it
You get care, and then bills and then bankrupt.
So that's why you guys don't save?
And even if you do have insurance, the larger companies are being caught auto denying claims (supposed to be an instance company employed doctor reviewing your case and medical history to make determination on if treatment was medically necessary).
They deny first and automatically put patients at a disadvantage. If you do have the skill/time to fight, you'll likely still only get to a point where you partially pay - and most are too polite/afraid to even appeal a denial in the first place (which is exactly what they are counting on).
Go into enough debt that you wish you just died
What happens if I'm a foreigner? Let's say I travel there as a tourist, break an arm hiking, they put me in plaster. Let's assume I'm careless and made no travel insurance. Are they going to stop me on the border?
You get billed, but you can just go home and not pay it. That doesn't necessarily mean that the issue won't still be waiting for you if you come back, though. I can imagine a situation where a foreigner left behind substantial medical debt and the State Department refuses to allow them back in. So if you're a frequent visitor, or need to visit here again in the future, it would be a problem.
A one-time visit? Fuck it. Go home, back to your more civilized country, and leave it behind.
Someone else will need to answer on the border bit (though I doubt it), but I know from a friend who visited without travel insurance that he did have a bill for something like 30 thousand USD for a broken leg and rib. I think he just never paid it. He's back in the UK now, and says he'll never visit here again because of the experience with our hospitals
Nah, you'll have no problems going home. But if the collectors are smart, they'll pursue you in your home country.
The hospital will keep sending you bills. Every month, and if you don’t pay that or set up a payment plan with them… they absolutely send it to a collection agency. That law agency will hound you all day every day, phone calls… text messages… Mailing threats and lawyer fees on top of the OG bill.
Eventually, I know from personal experience… they will take you to debtor’s court. Where you sit in a room full of strangers till your name is called. Then you have to prove how poor you are and they can pause the collection efforts for a period of time… or if the judge believes you can afford something… then your court ordered to pay… or else.
The bells of freedom!
Eagle screech
Emergency rooms are legally required to provide treatment, and will do so even for non-life-threatening conditions.
If you don't have insurance coverage but can pay, you will get a bill. If you can't pay, in most cases the hospital will write off the debt.
They absolutely will not write off the debt in most cases. They'll get you on a payment plan.
Also quite often charities step in to help with the bill.
Most hospitals are setup as non-profit entities and use medical debt write-offs to exhibit their charity. In all truth, they intentionally drive their own expenses sky high to increase revenue to astronomical levels so to give executives running these organizations excessively high compensation. These write-offs are just part of the gig.
They'll fix you... They fix everything..
If you're lucky you'll be a kid on CHIP. Otherwise you're financially fucked
life threatening means no insurance will be necessary so why bother