What did you/do you find confusing about US health insurance?

That one came from sister’s experience and me being so worried she had to deal with The System and then she was like oh yea it was easy and the coverage is good/fine/adequate. But like if you’ve been on parents’ employer insurance your whole life, you have zero reference of how that works up front. :woman_shrugging:

By the way @anomalily what a great book idea :two_hearts: I hope we can do the “get one give one” type thing when it’s done. :blush:

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This one is going out to a publisher (I have a co-author as well) not self-published, but we included that in the marketing plan in the proposal!

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What to do if your doctor says you need a treatment or procedure but your insurance says it is not necessary?

How to be absolutely sure that you’re using in-network providers and aren’t going to get dinged later for “the doctor was in network but the facility isn’t” or vice versa. Or, like, if you’re in the hospital and can’t control whether or not some out of network doctor is going to stick their head in your room for 2 minutes and then send you a huge bill.

I feel like outside of the hospitalization/cannot speak for yourself scenario, this should be pretty straightforward, but once my work switched to insurance that has zero out of network coverage even for the PPO, I started encountering things like “Cigna’s website says the doctor is in network but the doctor’s office says they don’t take Cigna” or vice versa.

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HSA vs FSA and what things you can use them for.

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Discussing informed consent models versus WPATH for trans access and care. Might be niche but :man_shrugging:
Insurance often follows one and sometimes clinics follow the other.

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include with that the possibility that you may have to pose as transitioning binary to binary in order to access care.

my new provider didn’t require it but did have to put it on my records for my insurance (Medicaid) to approve.

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How do I know when something I get will be on me to pay even if I hit my deductible and/or OOP max?

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Thought of another one: how to write off medical costs on taxes, not just functionally in the moment but also how to keep track of the costs as you go throughout the year.

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To add to this, the difference between HSA and FSA deadlines for reimbursements.

Oh this a huge one! And for me it really was just about trial and error. But knowing that a “good” doctor was actually possible made a huge difference.

Also the average time to diagnosis for some types of illnesses - eg with my autoimmune disorder it takes on average 12 years to get a diagnosis, last I checked. I wish someone had told me that when I started trying to figure out wtf was happening, it would have been good to expect a long term journey.

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Oh another one - how can you tell what a particular plan will cover, before you actually sign up for the plan? I found it really hard to predict which plans would cover which medications, or what types of “alternative” medicine, etc. And I remember you dealt with a bunch of copay accumulator shenanigans.

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How to navigate the ACA system, how / what subsidies are, you have to buy in the marketplace to get a subsidy. If you qualify but did not buy through the marketplace you are SOL. That you can but don’t have to use a navigator and the navigator may be on commission and not have your best interest at heart. That you can’t buy certain plans when working with a navigator. That the folks at the state helpline (at least mine) were very helpful. That the application process closely follows your taxes (the online application made no sense to me until I spent a season doing taxes).

Income limits for ACA, the cliff, I think the cliff was lifted for 2021 and maybe 2022 but I’m not sure going forward.

That you can continue to contribute to / invest in an HSA even if you are not working and the requirements. HSAs as an investment strategy, when distributions are taxable.

That it is often much cheaper to self-pay rather than going through insurance if you don’t think you will meet your deductible for the year.

If you really want to be complete, explain Medicare, Medicare Advantage, Supplemental B and D and god knows what else about the Medicare system.

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Oh Yea this is great stuff but since it changes so much we won’t get into specifics in a published book just general

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So much this.

I was shopping for an ACA plan for Kiddo at one point and saw a BCBS plan that looked like a good fit. I adore his doctor so I called the insurance company to try to make sure the doctor was in network. I checked with the doctors office when I had them on the phone too but they couldn’t speak to a specific plan of course. Turned out I picked a plan that didn’t actually include that doctors office. I was beyond livid. I’m still mad about it years later. Luckily I was able to change it for the following month because we were still in the open enrollment window in winter.

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What exactly is an HMO? Because I’ve seen people say an HMO is just things like Kaiser, where everything is in one big system, but I’ve also had/been offered HMO plans under, say, CareFirst (local BCBS) that are not one big system.

Also how to contact your lawmakers and tell them to pass single-payer legislation :joy:

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Also I assume you will tell us when this book is for sale? Because I want one.

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Yes but no rush :joy: it is a graphic novel and traditionally publishes so it will be a few years

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Patience is a virtue I possess :wink: good luck with it! Sounds like quite an undertaking.

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Maybe a section on rights? I’ve heard of hospitals doing things like suing people who can’t pay, garnishing wages, etc. Are these things true? What can on do to protect one’s self upfront? What recourse does one have after the fact? Or is that the kind of stuff you want to stay away from because it will scare people away from getting health care?

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Oooh yeah a mention of what a hospital ombudsperson does and what they can help you with.

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