r/SipsTea • • Aug 22 '26

WTF Damn

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u/HillarysBloodBoy Aug 22 '26

Really depends on your insurance. I’ve had a bunch of MRIs due to knee surgeries and I don’t think I’ve ever paid more than like $40ish per scan.

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u/coldfusioned Aug 22 '26

In America? Congrats on being the 1%. The rest of us are lucky to have any insurance and even then, 99% will have a large deductible and still have to pay 20% copay.

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u/Aggravating_Bat3618 Aug 22 '26

Damn, I guess Kaiser’s not so bad after all. 

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u/MainStreetExile Aug 22 '26

You're exaggerating. I'm not arguing the US healthcare situation is good, but more than 60% of working age Americans have employer provided health insurance. A large majority of those plans have an annual out of pocket max. 

Let's not act like only the 1% have decent insurance.

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u/Boom-For-Real Aug 22 '26

That’s the work on this website anymore. Lots of bad faith actors in literally every comment section now.

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u/Mysterious-Entry-357 Aug 23 '26

Not bad faith as much as those who are not so easily duped by mischaracterized and out of context statistics used to prop up an oversimplified argument. I don't expect you to re-examine what you believe, but some novice keyboard warrior copy/pastes some tangentially relevant statistics that only reveal a sliver of reality and you just accept their argument? Statistics must be presented in an honest and truthful way. Readers must understand the complexities in issues of these scale.

You cannot just blindly side with those you agree with and label everyone else as "bad faith actors". It robs you of your own ability to question what you think you understand.

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u/[deleted] Aug 22 '26

[deleted]

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u/annnm Aug 22 '26

Out of pocket max can be in excess of 12-15k assuming they approve the procedure or medication and after what has likely been years of premiums.

OOP maxes can range wildly based on state rules. Why not just look at averages rather than made up numbers.

Hawaii is the lowest at ~1.2k/person. And nevada the highest at 2.7k/person. https://www.kff.org/private-insurance/state-indicator/average-annual-deductible-per-enrolled-employee-in-employer-based-health-insurance-for-single-and-family-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Average%20Single%20Deductible%22,%22sort%22:%22desc%22%7D

If we dig further, 12% of workers have no deductible plans (half are from HMOs). Of the reamining 88%, the average deductible is 1.3k. 21% of workers has an OOP max greater than 6k.

Those out of the labor force are often swept up into obamacare (ACA+medicaid) or medicare such that 92% of the USA is insured.

https://files.kff.org/attachment/Employer-Health-Benefits-Survey-2025-Annual-Survey.pdf

The medical insurance industry had lobbied their way into becoming the single greatest detriment to US prosperity.

Everything, including medicine, is more expensive in the US because we're generally much richer in all regards. Household income per person is ~10k/person more in the USA than Canada. I personally prefer to have >10k/yr income here in the USA than lower healthcare costs in Canada.

Alas the only way to win is not to play. Medical tourism, FSBO, and AI financial advisors are just the start

This is mostly a poor man's game. Typically well compensated employees have good packages all around. Including the middle and upper middle. It's typically the lower middle that are in jobs too rich for medicaid (nearly free care) and on horrific workplace plans where the finances make sense for medical tourism. I'm glad that outlet exists for them. But it mostly doesn't make sense for anyone else, which is why basically nobody else needs or does it.

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u/[deleted] Aug 23 '26 edited Aug 23 '26

[deleted]

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u/annnm Aug 23 '26

Everything you said is deliberately deceptive and misrepresented.

"12% of workers have no deductible plans (half are from HMOs)." Well...that's interesting but not the norm...is it.

Yes indeed, I mentioned the 88% in the next sentence.

Does not include copay, coinsurance, and premiums already paid.

OOP maxes were discussed in the third sentence of that 3 sentence paragraph.

"21% of workers have an OOP max greater than 6k". Well, that definitely coincides with the argument that it can be higher...does it not? Like say 12k?

It is relevant to the discussion that it is not even close to the norm.

Indefensibly costly workplace healthcare programs can be found in many workplaces regardless of pay. Household income of 295k and both of us have garbage offerings.

This is as compelling as when the republican senator brought in a snowball to disprove global warming.

Look you have some broad statistics with which you overlay your own characterizations and commentary, but statistics presented without analysis only impress the intellectually lazy.

Should have impressed you then. Weird.

FWIW, one of us works as a medical provider and the other was a licensed medical insurance agent.

Oh neat, I'm a physician. You a midlevel or something?

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u/MainStreetExile Aug 23 '26

295k? You're lying - either about your income or about your insurance.

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u/Mysterious-Entry-357 Aug 23 '26 edited Aug 23 '26

For what is paid to insurance by both us and our employers each month, it is garbage. I'm sure to others it would be fine but they're not paying what we pay.

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u/MainStreetExile Aug 23 '26

I already started above that I think the state of US healthcare is poor. I just don't like bullshit threads like this where people are pretending that an MRI costs 30k.

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u/Mysterious-Entry-357 Aug 23 '26

Of course 30k is an insane figure, but so is 8k and can tell you that is real. Cardiac MRI for the old man. Not typical, but ridiculous nonetheless.

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u/Mysterious-Entry-357 Aug 23 '26

Nope. Dead honest. Sorry friend.

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u/MainStreetExile Aug 23 '26 edited Aug 23 '26

Either lying or you've put zero effort into investigating your options. With a 295k income, you can afford a private PPO plan that is better than my employer-provided plan, where I have a 3k deductible and 6,500 out of pocket limit. You're being very disingenuous.

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u/Mysterious-Entry-357 Aug 23 '26 edited Aug 23 '26

Neither lying nor stupid. Let's be adults, shall we?

Yes, I can afford the plan and do have what most would consider great coverage. That is not the point. Very few people can claim that health insurance is a good value. But let's look at it in reality.

Do you know what your premiums are (whether you pay them or not)?

Let's say they are $800/month or $10,000/year (this is not included in your OOP max of course) Then you have your $3k deductible that you pay. Then there is the coinsurance that eventually leads you to the $6500 OOP maximum (for THAT year only) if something serious happens. Let's say that this incidence is in year 3 of that plan. Which means you have already paid a significant number of dollars in premiums.

The hospital deliberately bills a higher than necessary charge because they know that the insurance company will negotiate it down anyway to hopefully somewhere near the actual cost.

By the time insurance pays, it may very well be less than the $45-50k you have spent in those 3 years (premiums+copays+coinsurance). You think, "Man good thing I have insurance" after lookingat the inflated figures not knowing what was actually paid in the end...if they cover your claim, that is.

Look, insurance is a business and most have very demanding shareholders that insist on growing massive profits. They pay for advertising, lobbying, salaries, commissions, and their own reinsurance...and still turn incredible profits.

It's not because they offer good value to policyholders.

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u/coldfusioned Aug 23 '26

Right? He is obviously a shill for big insurance. It is just a matter of time before the USA finally joins the developed world and offera universal medical care. Spoiler... a LOT of insurance reps will suddenly be unemployed.

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u/Ocelotofdamage Aug 22 '26

If you work at a reasonable company you will have a similar experience.

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u/AshhhCakes Aug 22 '26

Well let's go on over to the job tree so we can get life saving care without bankrupting ourselves! Most regular Americans have no idea how perverse it is to be a wage slave to MAYBE get ok health insurance. The just love keeping Americans poor so no one dares to do anything but bend over for corporations.

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u/LocksmithOk9968 Aug 22 '26

You’d be disappointed at what they’re offering at big well known companies for 6 figure roles.

It’s by no means terrible but not great either. No MRIs for $20 bucks, that’s for sure.

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u/rips_n_chel Aug 22 '26

So which rock do you live under? Nice neighborhood?

I imagine it must be quiet, what with the lack of brain cells living here...

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u/Warbr0s9395 Aug 23 '26

Or be in a union

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u/crenshaw_007 Aug 22 '26

Damn, lucky. With my insurance it’s $600 copay. I needed one on my elbow a while back, before surgery, which then cost me $1,500 with insurance. I wish MRIs were similar to the cost of X-rays from my insurance.

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u/exoticsamsquanch Aug 22 '26

Same. I had an MRI and didn't pay anything. My insurance covered it

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u/Ganjake Aug 22 '26

Bro had a kidney transplant and 5 months of dialysis for the cost your one MRI. Not nearly the same.

It all sucks.

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u/S0RRYMAN Aug 22 '26

Bro if 40$ can pay for a kidney transplant lol.

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u/Ganjake Aug 22 '26

Some people really just are tone deaf.

"Man healthcare must suck in America!"

"Well, it depends...."

🤔

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u/CelebrationFair6887 Aug 22 '26

Well the dialysis (how tf do you write that word) and operations are actually free. Because insurance in germany covers 100%.

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u/HillarysBloodBoy Aug 22 '26

I mean my surgeries cost me nothing beyond a small copay. Again, really depends on insurance.

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u/Ganjake Aug 22 '26

I've had 3 different insurance carriers and am now on ACA insurance, every single one gave me debt. And I never had anything as serious as knee surgery.

It's not "it depends," it's that you're in a very small minority. I was salaried, had a good job that was usually taken by college grads, carefully thought out each plan. And even then, I could never tell the difference.

The ACA is fucking worthless without those subsidies. I have an ortho appointment on Tuesday with someone in network and it's going to cost me almost $300. In network urgent care wasn't much cheaper and they refused to prescribe anything more than 5 days so I'm just hanging out in pain unable to work for over a week.

I just need people reading this to know you are in the minority and that it's not "it depends."

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u/RifewithWit Aug 22 '26

ACA is fucking worthless. It forced prices up for everyone and didn't make up for it in the number of "insured" people.

Not saying we didn't or don't need something to fix insurance/healthcare, but the ACA was a poison pill for sure.

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u/Ganjake Aug 22 '26

I mean that something is pretty easy to say, it's Medicare For All. Make it so that no doctor can turn you away just because of their personal contracts with insurance companies and you have widespread, affordable healthcare.

If you can pay more for a private plan, go for it.

And finally, if it wasn't for Joe Lieberman, we wouldn't be having this conversation right now. That was the something and we almost had it.

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u/PiccoloQuirky2510 Aug 22 '26

Yeah I’ve had several MRIs and the most I’ve paid has been a couple hundred bucks at most. I have 20% coinsurance. BUT I also have a $1000 deductible and a $4000 OOP max.