This is big. Once they have to explain each (often absurd) charge, they usually decide they don't NEED to charge $800 for an IV and will usually leave that off. Has saved some people I know
I’m not in the USA but we have a Medicare / insurance system. My wife had an elective surgery. The first round of quotes were $12,000.00+ estimates. After asking for a itemised bill the quote went down to $4,000.00~ estimate. We decided to go ahead after being told that we could not claim against our insurance by the company. Also Medicare said that they would not give rebates. After checking our insurance policy and Medicare rebates etc... against our bill and then putting in claims after the surgery, we ended up paying $300.00 final bill. The success rate for this type of surgery in the UK is 12%, in the USA it’s 72% and where we live our surgeons had a 92% success rate.
That is shocking. I'm speechless. I'm originally from the UK, and what I got in my accident in China I thought I was f**ked because the Chinese health system isn't as good as the UK. However, my super cheap Chinese health insurance covers 80% of all costs. Being taken to hospital, staying in 2 different hospitals for about 2 weeks, having a titanium plate put in my leg, and a bunch of nails (all imported from Switzerland at medical prices) came to a total of about $13,000 USD. That's a far, far cry from $250,000. My insurance will cover 80% of that, and the other party will cover the 20%. I'll be $0 out of pocket. This is CHINA. Again, people will criticize that the quality of health care here isn't as good as America... maybe, maybe not - but how can you have an inferior healthcare system to China, a country many people still think of as a 2nd world nation. America - you do so many things amazingly, but please fix your healthcare system.
@@the.communist China is second world. USA and west = first world. (Former) USSR+allies and other communist countries = second world. Non-aligned and usually poor nations = third world. The term is obviously now out of date.
@@rkan2 the term does not refer to level of development, it is a cold war term used to categorize countries in the west (1st) vs the eastern bloc (2nd), and all others (3rd). it is misused often today to imply level of development. that is not correct.
China's farmer medical insurance will only cover 30% of the cost. What's more serious is that a large number of civil servants in China can enjoy medical insurance without paying premiums. There is too much medical waste. Many cancer patients cannot use better drugs because of the deficit in the medical insurance system. Unfair is more desperate than broken bones.
My wife was interviewed on one of those segments, regarding a $1000 bill for a few stitches in my daughter's foot. We have excellent coverage, but a scam of contract doctors in the ER landed us with that bill. That is such a world of difference from what Phil is going through. I tore my face off (literally) mountain biking while in graduate school, and I was fortunate that my graduate student insurance covered it, otherwise I would have been crushed by the nearly $150K cost that incident ran. It is insane what happens in the US.
"If you think your insurance is the right one, it's just because you havnt experienced it" Oh man is that real. I learned this the hard way when looking for a sleep specialist for my sleep disorder. For anyone who's skeptical about him saying that trust me hes telling the truth. Both of us had to learn it from experience.
altandrew I've got a bad back. I went to a doctor to have it looked at thinking it was covered. This was for just a regular, non-surgical consultation. $2500. So, now I have a bad back because I'm not going to go to the doctor and incur more expenses. The reality of our healthcare system. I'm an attorney, make a good living, etc., but that money can be better spent on my kids. It's a shame our system encourages people to stay out of it and be in pain or be sick rather than take the chance of getting a bill that blows the budget. We should demand better.
I’m skeptical. I was in the hospital for 2 weeks. Received my bill for 98k once I got out. A couple weeks later my insurance kicked in and I paid 3k total. Most insurance plans have a max out of pocket per year. For example mine is 5k so no matter what happens to me I won’t pay more then 5k in a given year.
Zach Grabill bad insurance then. My insurance still pays out of network. Granted in network is 80/20, out of network is 50/50 but they still pick up 50% and I still only have to pay up to the max out of pocket. I guess maybe the difference is he’s using covered California and mine is provided from my work. Still though I wouldn’t be paying $500 a month for coverage that doesn’t have a max out of pocket in network or not.
Zach Grabill bad on the hospital for telling him he would be covered in the first place as well. A lot of places will do that. My cousin had dental work done that she was told was covered. After the work was done they informed her it wasn’t and demanded payment. It was only a 3k bill but she walked out and never went back. She received bills and threatening letters for about a year and then they just stopped. This was 5 years ago and she never received another and was never sent to collections.
My husband subscribes to you and told me about you and want to help. I work in the insurance industry (behavioral health side) but I think I can help you. Firstly, you need to check what your yearly out of pocket and is and you would be responsible for that only. Secondly, you need to call the insurance and explain your bills and ask what the claims were denied and tell them that you want to appeal the denial. Thirdly, you need to request a single case agreement for the out of network provider and that they need to be able to prove that no other in network options were available at the time of your treatm ent. Fourthly, you need to request an ombudsm an for your insurance to advocate on your behalf. Do not pay anything until you exhausted all of your appeal options and you want to file a complaint with your insurance if they can't help you. Fifthly, file a grievance with the insurance as well. Believe me, corporate doesn't like complaints and they will try to handle yours quickly. Good luck
I guess the problem is that USA is built on the notion that you make your own opportunities. Therefore there is a reluctance for the individual to pay for the greater good. I.e like we do, pay for healtcare for all through taxes. I simply do not understand why people should be punished, just because they can not afford healthcare insurance.
Yes, most what I paid for doctor was 200€ for the dentist visit, my biggest injury costed me 10€ for registration to free rehabilitation facility. I can’t even fathom what kind of lunatic system this is.
After 18 years working in the US healthcare system and seeing this story everyday, people forced into bankruptcy because they found themselves abandoned by their insurance, , I moved to New Zealand to work in a socialised medical system. Can’t imagine being back in the US to work in that environment. Single payer Govt run systems are not prefect by any stretch, but we just get to worry about what is best for the patient with no concern for cost.
@@bpperk Charlie Gard was not treatable by any tested standard. An experimental treatment was being trialed in New York and the lead Physician said he would be willing to enroll Charlie (this was in late fall), *but* the Physician never inspected Charlie. The following January, before treatment had begun, Charlie suffered massive seizures resulting in severe brain damage. When the US Physician did finally visit and assess Charlie, he agreed that there was little hope even with treatment and advised palliative care (the same position as NHS). Charlie Gard would have been left to suffer in the US and his parents would have been saddled with thousands upon thousands in medical debt. This is in addition to losing their child anyway.
Had a similar issue when I was hit by a car, Cycling Australia were so difficult to deal with, 6 months later I gave up trying to recover lost wages. MAIB Motor Accident Insurance Board, were fantastic, within two weeks my surgery was covered as well as rehab. I have separate insurance for my bike, they paid out on my claim within 72hrs. And then went after the driver who denied responsibility. twelve months later it was settled in court.
@@danjo1967 If I'm reading it right, the only complaint is with Cycling Australia. Seems everything else was pretty smooth, states that surgery was covered and performed within two weeks.
Yeah it's a shame we all have to pay CA a hefty fee for insurance as part of the licence system. Insurance that's meagre and rarely of benefit to anyone. It should be optional and then people can use that money to self- insure and get better cover.
I was not too sure about you Phil; and then you said “I could’ve set up a go fund me, but there’s people far worse off then me, so donate to no kid hungry”. Now I’m converted.
I had a pretty similar situation 7 broken ribs, collapsed lung, unconscious, broken collarbone. I was airlifted and transported to 2 different hospitals. I ended up paying less than $100 after my insurance covered the rest. My wife and I refer to insurance as trash money because it just feels like we are throwing money away: health, life, auto, home, earthquake, umbrella, etc. However, after having experiences like this it really does feel wise to pay a premium for the best insurance you can afford. I received fantastic care at all of the hospitals I was in. My story does not fix Phil Gaimon’s situation, but just provides another perspective.
The American voter/taxpayer is the gift that keeps on giving. Refusing to vote the healthcare-bought politicians has consequences. So sorry for your problems!
Total sympathy for you, Phil. I’ve worked years in a medical office, often hamstrung by insurers’ arcane rules and gotchas. If even my coworkers and I find the system confusing (or plain broken), how can patients like you hope to fare better? Sucks. G’luck, man. Strength.
All great points, Phil. And 100% agreed. The thing is, too. You can be in low-risk categories and still be screwed by this stuff. I didn't have health care coverage and then got pneumonia. That thing messes you up. And inhalers are not cheap.
I had heard about this story Phil and wanted to hear it directly from you - what a horrible story about how the person (with insurance) gets screwed by the big money insurance companies. It's amazing that you were responsible, had insurance, yet, everyone is denying it. Best wishes in your battle with the companies and I'm glad you are still here to speak about it!
We're American expats living in one of those "god-forsaken countries with socialized medicine." I get private insurance through my work that gives me choices if I want them, but I've never seen the need to use it. We pay $280 per year ($40 per person) to have access to nationalized health services and we have never gone to the doctor, emergency or otherwise, where he bill and the medicine exceeded the cost of the gas we burned to drive there. We want to live in the US again, but we can't live in a world where a minor medical issue routinely wipes out your savings and a major event equals bankruptcy. I'm so sorry Phil is going through this, but after seeing a bill for 3.5 million when our twins were born in the US, I know of what he speaks when he says our system is terribly broken.
Gareth Ogden twins born at 30 weeks, one with Down syndrome. If they hadn’t have stayed past 30 days in the NICU we’d have been on the hook for 20% with our insurance. They were discharged at 35 and 68 days respectively, but when you get hit with a medical crisis, it doesn’t help to know that a financial apocalypse is waiting as well.
It's very sobering to hear stories like this, but I've never heard a good word about the American health system. I hope you are able to get through it all with not too much further trouble. Here in Australia everything you've described would be covered. When I came off my mtb out on a trail three years ago I very badly broke my shoulder and was taken to hospital in an ambulance. It took two surgeries to get me fixed up - the first surgeon said he was not the right person for something that complicated and recommended another. I was told the new one was among the best shoulder surgeons in the country. I got through that and eight months of physiotherapy before I was allowed back on a bike or drive a car. Everything was covered. No bills came to me for the whole thing. I have never understood why national health care is so scary for the US.
fenderperry I earn in the $60k range and pay about $12k in tax. For that we get healthcare, both my kids were born free of charge in public hospitals, my wife’s pre-natal care was all free, the kids now attend free public school, we’re right near lots of beautiful local parks, our roads are well maintained, our bridges etc don’t collapse etc etc. We also can opt to pay for additional private health care, prices vary and it can cut wait times for elective surgery or get you a private room rather than shared etc but many Aussies are dumping it as they find they never get their money’s worth and are happy with the public system. No system is perfect, and the introduction of our public healthcare system in the 70s came with all the same corporate predictions of doom gloom and communism as you hear in the USA but we wouldn’t be without it.
@@fenderperry How much of your pay check do you have to spend on health insurance and other services which would otherwise be provided by the government? The actual amount taken out of my income for medicare is only a couple of percent. I am more than happy to pay that to ensure health care is available when I need it without a life changing invoice.
Much sympathy for your situation Phil. I think you are handling it in the best way that you can. And much character for forwarding donations to the kids fund. Real stand up (out of the saddle) guy. :)
I'll tell you what happens next from experience: They will send all of those bills to collection agencies, it'll happen soon, about 8 months after the accident, and then you will have to deal with that.
I've heard its pretty brutal in the states ehen it comes to debt recovery. Phil needs to start hiding his possessions and put others names on vehicles. If he owns property they'll take it.
Damn Phil, I'm sorry that you are having to deal with this. It sucks. Thank you for opening up and sharing something that is this personal. I appreciate you sharing this because people do need to know the pitfalls of our health insurance system. We all need to highlight the inequities that plague the system so that, hopefully, one day we can come up with something better that works for everyone.
It's ridiculous you work your whole life just to try and get a little ahead then you have one mishap or just get old and have some issue and bam there goes everything you worked for. Things have gotten way out of hand. I feel you tho. I broke my collar bone last year and had a slap tear in my shoulder. One 10K later I have a plate that now has to be removed and a slap tear that is unrepaired.
What would reform look like? In Australia we have a public health care system and a private health care system. You have to go on long waiting lists for non life-threatening surgery for the public system, whereas the Private system the que is short but you pay $$$. I don't really know what the answer here is.
@@gumzster Denmark has some of the world's highest tax rates. I would challenge your "costing zero to patients" there. Taxpayers pay for that and that is fine. I'd prefer it was that way than being landed with $250k worth of bills for an accident.
Agh that sucks... sorry to hear. A few years back i went down during a training ride and broke my hip. I was in the hospital 1 week, got surgery and rehab. Plus was out of work for three months because my job requires me to be mobile. Fortunately, I live in Canada. Our health care system is far from perfect, but I can hardly complain. Everything was covered.
God bless America :/ Lived there for a few years and it was great but the health insurance was definitely one of the negatives...now happily back in a civilized country where everybody, no matter how much money you've got, is covered by health insurance ...and you can't just walk into Walmart and buy a Semi-Automatic rifle...
Stephen Swanson I think the point being made would be about the insanity that the rest of the world sees when you look at a country that bankrupts its citizens over health care but actively promotes their “right” to tool up and kill each other.
@@chinboy66 it's not to tool up and kill each other. It's the right to protect against a tyrannical government. If you're trying to say more guns equals more killing each other then you're wrong. All crime has been decreasing over the past 30 years. You know what hasn't been decreasing? Number of guns. There is millions and millions of guns in the US and crime rates have never been lower. Aside from other things. Its interesting... For some reason as supposedly terrible as the insurance is here (and supposedly terrible the gun crime is even though its actually a very safe country). People spend their whole lives trying to get here. Some, literally dying to get here. It's almost as though people love freedom and want that because its a means to success and true happiness. I was recently in Ukraine and if there is one thing I have learned it's that guns should not be something surrended to the government. During Maidan of 2014, there is nothing more Ukrainians wish they had other than guns. Their government wasn't allowing them to protest and was going against what the majority of people wanted. Many people died standing up to the government in part because they had no way to defend themselves (look up the "heavenly one hundred"). Also as a little bonus, each Ukrainian I asked said that if they had guns when Russian annexed Crimea and began their war in eastern Ukraine, they would not have been successful. On to healthcare. If you look how healthcare is changed over the past 25-30 years, the reason that people go bankrupt is because we have a proxy system of socialized medicine. It's psuedocapitalism combined with pretend socialism due to the fact that people who are able to pay (aka not living under the poverty line and above) are the ones who end up being on the line for their own cost which in reality is set at certain prices due to the insurance companies negotiating with hospitals and lobbying congress. Understanding direct primary care is an integral part of understanding how healthcare was originally designed and how insurance companies have failed us (Google it). This is mostly due to the government stepping in and essentially telling insurance companies they must cover everyone regardless of their willingness to pay combined with them lobbying to increase their role in the delivery of the healthcare process. Your response to this only displays the fact that you are creating a strawman argument, while essentially misrepresenting the problem. Trying to bait and switch the actual problem and is dishonest to yourself as well as your school of thought.
@@tecnociclista5342 www.google.com/amp/s/www.businessinsider.com/walmart-gun-buying-review-virginia-store-2019-8%3famp since you put out the claims it's so easy to buy a gun just by walking into any Walmart....
Are you in a Bernie Sanders ad? Would love to see that. We need him as president. We had a much less traumatic situation and my wife ended up in a hospital in NC, out of network (were from MA) and we owed $12k for an overnight and bunch of tests. Insurance wouldn’t (and never did) pay despite appeals. Really sucks. So sorry you’re going through this too. Please vote for Bernie and Medicare for all!!
Best public service announcement ever. It's truly a broken system when you're forced by law to pay for health insurance, but the health insurance you buy most of the time refuses to pay and gets away with it.
@@gregkane8635 What about the 250.000 pounds a week you will save after leaving the EU? That should be enough to fund the NHS and also have free chocolate fountains on every street, right? Oh, the humanity!
At first I wasn't sure about this guy, but now seeing this and his attitude towards life and others...well lets say you got yourself another sub and supporter. hoped everything worked out Cookie man!
This breaks my heart to hear. The US needs some sort of universal healthcare for this very reason. You shouldn't have to pay to have your baby be delivered in a hospital, have cancer treatments, emergency heart surgery or an unfortunate accident riding your bike. You also shouldn't have to pay for some physio after surgery. Come on america, wake up and do something about this.
Let us help you!!! You don't deserve this!! If you have left over money, give that to no kid hungry. But let us help pay this crap. It's not your fault. It's America.
As someone who has been on a journey of discovering I have AFib last year I know the pains of medical debt all too well. So sorry to see you going through this and hope it all gets sorted out for you. You are a class act and a great cyclist!
God Bless Canada, where you are taken care of when you are most vulnerable. They should invent a word for this great concept for a social structure that ends in ism, I'd bet that would really scare the top 1% - insurance companies, banks corrupt politicians, etc...
This sucks mate, and I"m sorry you're going through it. Thanks for sharing and for citing the issues for what they are. I hope for you a fair, reasonable and even favorable outcome. With aloha, Will
I feel your pain Phil, a couple years back we had a similar fight with our insurance company. Keep your head up, talking to the right person on the right day is (maddeningly) the only way we were able to resolve things. Best of luck
Anyone in the UK who has the nerve to complain about the NHS and free health care to all should be locked in a room and watch stories like this until they agree to STFU and wait politely and be respectful
@@rgjdk Only 5.79 M people in Denmark, 53% - 67% tax rate - not going to work in the USA! Nothing again Denmark, love to visit, my grandmothers Danish, but we can't afford socialized medicine based on the other models in the world. We need to come up with a different model. Sure hope we can and we do.
@@pbarr1935 No, surely it's not going to work in the states. We also have some high salaries in order to pay all that tax. A minimum wage job in the states will probably leave you with not enough money to live after taxes. Tax avoidance is a Danish national sport.
The UK tax is not too different from the US and we get free healthcare. Just moved to the US and we now pay more in health insurance (by a long way) than we did in UK taxes
I don’t get this insistence that the US can’t do it because there are too many of us. That also means there are more of us paying into the system, you know. That’s how insurance works: you have more people in the insurance pool, the insurance pool is able to handle more stuff. Besides, what happened to American exceptionalism? We can put a man on the moon but we can’t ensure the same quality of life for our citizens that every other major nation on earth does? Strange the things we have money for and don’t have money for. Phil should do a Bernie rally. Or at least an NNU rally. He’d be a big hit.
Best medical advice I received from a doctor-- know what ERs are covered prior to visiting. The sad part of health care is you could offer a course on navigating the contract. You pay the insurance companies than need to give up a weekend reading the contract to explain it in plane terms -- then you forget it all. Remember this as well,our system penalizes people b/c of the abuses of greedy individuals and companies -- the bad 1%.
Have you ever considered what level of care you would have received under a federally managed healthcare system... perhaps something like the Veterans Healthcare System? The probability that you'd have to live with ongoing discomfort and pain, or even a disability, is considerably likely. It's almost certain that you wouldn't ever ride your bike competitively again. That you were able to fly to New York and see a specialist could not have happened under a system like the UK's NHS. It's precisely because you have choices that allowed you to seek out care that would have otherwise been unavailable to you under a nationalized single payer system. Unless of course you're one of the elite that receive VIP treatment... but wait, I thought everyone is treated equally under single payer systems? I truly am sorry for you. The US healthcare system does need overhaul. But, it does not need to go to a single payer system. Queue the "thumbs down" and negative replies... arguments about the myths of rationed care, unequal health outcomes, wait times.... blah blah blah.
@@benspeller8635 No thank you. I'd rather die from a thousand paper cuts than get into a healthcare debate in the comments section on RUclips! I'm glad you're happy with the NHS.
wow. hope you get the bills covered in the end. i'm from Denmark, and don't envy you. once your on your feet. it should not be a fight over bills. that's crazy. best of luck man
Keep up the good fight....Kudos to you for taking a difficult situation and thinking outside of yourself. The happiness that will bring is worth a million dollars.
Thank you Phil for posting this cautionary tale. I had a motorcycle accident 2 weeks after I graduated college, not realizing that that was the trigger to make me no longer covered under my parents military health insurance. I died in the hospital and wound up with 'only' a 100k bill. Thankfully family worked 'in the system' and advocated heavily on my behalf when all I wanted to do was to give up breathing. Every political system has its faults, but I think a large portion of the population is blind to the risk they are running here. That policy is worthless unless companies do the right thing, you follow every line of the contract AND have a team of lawyers to back you up. Hope it all works out for you.
I just had a great idea Phil..... you should do a new series where you not only go after KOMs, but you do it WHILE on hold with insurance companies. Would be downright hilarious.
Americans continue to believe having private insurance and choosing your own primary doctor is more important than universal health care. What we don't realize is every visit to ER means another doctor is in charge. And when a specialist is needed, its not your primary care doctor. Most of routine office visits are staffed by capable nurse practitioners or physician assistants. So much for your choice of doctor. I see so many burned out people trapped to specific jobs, unable to switch careers because the costs of health care.
Listening to this I am so glad that in Germany we don't have to worry about stuff like that. So sorry to hear that, dude. Also amazing how you still worry about other people more than about yourself. If everyone was more like you, you wouldn't even have that problem. Lots of love!
Insurance here in the US is a scam.
insurance everywhere is a scam, trust me.
GNiessen how much does it cost?
Horia Pintilie In some countries it is necessary to have at least one insurance and they are subsidized by the country. This makes them more reliable
This is why I left the US.
Get government out of it and it will be less of a scam.
Just a tip: ask the hospitals for an itemised bill, just that request can cut your bill by a lot
This is big. Once they have to explain each (often absurd) charge, they usually decide they don't NEED to charge $800 for an IV and will usually leave that off. Has saved some people I know
Crazy
This is a good tip from what I've read!
Hospitals are definitely willing to negotiate bills down. My brother did after cancer surgery.
I’m not in the USA but we have a Medicare / insurance system.
My wife had an elective surgery.
The first round of quotes were $12,000.00+ estimates.
After asking for a itemised bill the quote went down to $4,000.00~ estimate.
We decided to go ahead after being told that we could not claim against our insurance by the company. Also Medicare said that they would not give rebates.
After checking our insurance policy and Medicare rebates etc... against our bill and then putting in claims after the surgery, we ended up paying $300.00 final bill.
The success rate for this type of surgery in the UK is 12%, in the USA it’s 72% and where we live our surgeons had a 92% success rate.
That is shocking. I'm speechless. I'm originally from the UK, and what I got in my accident in China I thought I was f**ked because the Chinese health system isn't as good as the UK. However, my super cheap Chinese health insurance covers 80% of all costs. Being taken to hospital, staying in 2 different hospitals for about 2 weeks, having a titanium plate put in my leg, and a bunch of nails (all imported from Switzerland at medical prices) came to a total of about $13,000 USD. That's a far, far cry from $250,000. My insurance will cover 80% of that, and the other party will cover the 20%. I'll be $0 out of pocket. This is CHINA. Again, people will criticize that the quality of health care here isn't as good as America... maybe, maybe not - but how can you have an inferior healthcare system to China, a country many people still think of as a 2nd world nation. America - you do so many things amazingly, but please fix your healthcare system.
Almost as if..... Capitalism/commodification of basic needs sucks
@@the.communist China is second world. USA and west = first world. (Former) USSR+allies and other communist countries = second world. Non-aligned and usually poor nations = third world. The term is obviously now out of date.
Great comment, USA wtf, sort it out.
@@rkan2 the term does not refer to level of development, it is a cold war term used to categorize countries in the west (1st) vs the eastern bloc (2nd), and all others (3rd). it is misused often today to imply level of development. that is not correct.
China's farmer medical insurance will only cover 30% of the cost. What's more serious is that a large number of civil servants in China can enjoy medical insurance without paying premiums. There is too much medical waste. Many cancer patients cannot use better drugs because of the deficit in the medical insurance system. Unfair is more desperate than broken bones.
I felt bad when you got hurt, now I really feel bad.
NPR has a "Bill of the Month" segment. You should contact them.
My wife was interviewed on one of those segments, regarding a $1000 bill for a few stitches in my daughter's foot. We have excellent coverage, but a scam of contract doctors in the ER landed us with that bill. That is such a world of difference from what Phil is going through. I tore my face off (literally) mountain biking while in graduate school, and I was fortunate that my graduate student insurance covered it, otherwise I would have been crushed by the nearly $150K cost that incident ran. It is insane what happens in the US.
I second this suggestion. NPR does a good job with that segment.
"If you think your insurance is the right one, it's just because you havnt experienced it"
Oh man is that real. I learned this the hard way when looking for a sleep specialist for my sleep disorder.
For anyone who's skeptical about him saying that trust me hes telling the truth. Both of us had to learn it from experience.
altandrew I've got a bad back. I went to a doctor to have it looked at thinking it was covered. This was for just a regular, non-surgical consultation. $2500. So, now I have a bad back because I'm not going to go to the doctor and incur more expenses. The reality of our healthcare system. I'm an attorney, make a good living, etc., but that money can be better spent on my kids. It's a shame our system encourages people to stay out of it and be in pain or be sick rather than take the chance of getting a bill that blows the budget. We should demand better.
I’m skeptical. I was in the hospital for 2 weeks. Received my bill for 98k once I got out. A couple weeks later my insurance kicked in and I paid 3k total. Most insurance plans have a max out of pocket per year. For example mine is 5k so no matter what happens to me I won’t pay more then 5k in a given year.
xlayedoutx that's if it's covered. Phil's point is that he wasn't, even though he has insurance.
Zach Grabill bad insurance then. My insurance still pays out of network. Granted in network is 80/20, out of network is 50/50 but they still pick up 50% and I still only have to pay up to the max out of pocket. I guess maybe the difference is he’s using covered California and mine is provided from my work. Still though I wouldn’t be paying $500 a month for coverage that doesn’t have a max out of pocket in network or not.
Zach Grabill bad on the hospital for telling him he would be covered in the first place as well. A lot of places will do that. My cousin had dental work done that she was told was covered. After the work was done they informed her it wasn’t and demanded payment. It was only a 3k bill but she walked out and never went back. She received bills and threatening letters for about a year and then they just stopped. This was 5 years ago and she never received another and was never sent to collections.
My husband subscribes to you and told me about you and want to help. I work in the insurance industry (behavioral health side) but I think I can help you. Firstly, you need to check what your yearly out of pocket and is and you would be responsible for that only. Secondly, you need to call the insurance and explain your bills and ask what the claims were denied and tell them that you want to appeal the denial. Thirdly, you need to request a single case agreement for the out of network provider and that they need to be able to prove that no other in network options were available at the time of your treatm ent. Fourthly, you need to request an ombudsm an for your insurance to advocate on your behalf. Do not pay anything until you exhausted all of your appeal options and you want to file a complaint with your insurance if they can't help you. Fifthly, file a grievance with the insurance as well. Believe me, corporate doesn't like complaints and they will try to handle yours quickly. Good luck
Eva A thank you for helping
Incredible. As an outsider, I certainly do appreciate my health care system more after reading this!
thank you
Third, abolish private healthcare.
_-_ Agreed! Healthcare is not a business. Capitalism works for widgets but not for those things which are human rights (ie healthcare, education etc)
Richest country on Earth should have ZERO stories like this one.
a big part of why it is the richest country is the way they don't look after the poor, or provide free health care
@@xantg6931 and this guy is not even poor...
@@OliverBatchelor well, he might be soon
Vote for Bernie
I guess the problem is that USA is built on the notion that you make your own opportunities. Therefore there is a reluctance for the individual to pay for the greater good. I.e like we do, pay for healtcare for all through taxes. I simply do not understand why people should be punished, just because they can not afford healthcare insurance.
Come to Sweden, we pay taxes that cover ALL medical expences. I hope it get solved out for you🙌🏼
Americans will say u are communist 😂
Same in malta
@johan correction: come to literally any other vaguely developed country in the civilised world, except for the US.
Yes, most what I paid for doctor was 200€ for the dentist visit, my biggest injury costed me 10€ for registration to free rehabilitation facility. I can’t even fathom what kind of lunatic system this is.
After 18 years working in the US healthcare system and seeing this story everyday, people forced into bankruptcy because they found themselves abandoned by their insurance, , I moved to New Zealand to work in a socialised medical system. Can’t imagine being back in the US to work in that environment. Single payer Govt run systems are not prefect by any stretch, but we just get to worry about what is best for the patient with no concern for cost.
THANK God I live in the uk
Charlie Gard never got the chance to live long enough to voice his opinion of UK health care.
So jealous that you don’t have to live with this fear.
True
@@bpperk
Charlie Gard was not treatable by any tested standard. An experimental treatment was being trialed in New York and the lead Physician said he would be willing to enroll Charlie (this was in late fall), *but* the Physician never inspected Charlie. The following January, before treatment had begun, Charlie suffered massive seizures resulting in severe brain damage. When the US Physician did finally visit and assess Charlie, he agreed that there was little hope even with treatment and advised palliative care (the same position as NHS).
Charlie Gard would have been left to suffer in the US and his parents would have been saddled with thousands upon thousands in medical debt. This is in addition to losing their child anyway.
Had a similar issue when I was hit by a car, Cycling Australia were so difficult to deal with, 6 months later I gave up trying to recover lost wages. MAIB Motor Accident Insurance Board, were fantastic, within two weeks my surgery was covered as well as rehab. I have separate insurance for my bike, they paid out on my claim within 72hrs. And then went after the driver who denied responsibility. twelve months later it was settled in court.
@@danjo1967 If I'm reading it right, the only complaint is with Cycling Australia. Seems everything else was pretty smooth, states that surgery was covered and performed within two weeks.
Yeah it's a shame we all have to pay CA a hefty fee for insurance as part of the licence system. Insurance that's meagre and rarely of benefit to anyone. It should be optional and then people can use that money to self- insure and get better cover.
I was not too sure about you Phil; and then you said “I could’ve set up a go fund me, but there’s people far worse off then me, so donate to no kid hungry”.
Now I’m converted.
Sadly, this type of story is only possible in America among all developed nations.
wichersham - that’s what makes the US a developing nation.
I’ve never heard anyone say anything positive about the hospital or heath care system in the US.
Edit: now someone has told me.
I work in the health care system in the US and I completely agree
@@Two-StrokeLife and how much does that cost you per month?
@@Two-StrokeLife I hope you've healed well! I'm actually an ER nurse and your remarks warm my heart. Ride safe
Two-Stroke Life in australia that would be free. No need for private insurance. The problem isn’t the staff. The problem is the system.
It’s only something rich Americans ever say
After watching this I'm gonna think twice about taking that blind corner at 25mph.
Thanks for putting up this video. I'm going through a similar insurance battle. It's ridiculous,
I had a pretty similar situation 7 broken ribs, collapsed lung, unconscious, broken collarbone. I was airlifted and transported to 2 different hospitals. I ended up paying less than $100 after my insurance covered the rest. My wife and I refer to insurance as trash money because it just feels like we are throwing money away: health, life, auto, home, earthquake, umbrella, etc. However, after having experiences like this it really does feel wise to pay a premium for the best insurance you can afford. I received fantastic care at all of the hospitals I was in. My story does not fix Phil Gaimon’s situation, but just provides another perspective.
The American voter/taxpayer is the gift that keeps on giving. Refusing to vote the healthcare-bought politicians has consequences. So sorry for your problems!
Total sympathy for you, Phil. I’ve worked years in a medical office, often hamstrung by insurers’ arcane rules and gotchas. If even my coworkers and I find the system confusing (or plain broken), how can patients like you hope to fare better? Sucks. G’luck, man. Strength.
All great points, Phil. And 100% agreed. The thing is, too. You can be in low-risk categories and still be screwed by this stuff. I didn't have health care coverage and then got pneumonia. That thing messes you up. And inhalers are not cheap.
I had heard about this story Phil and wanted to hear it directly from you - what a horrible story about how the person (with insurance) gets screwed by the big money insurance companies. It's amazing that you were responsible, had insurance, yet, everyone is denying it. Best wishes in your battle with the companies and I'm glad you are still here to speak about it!
We're American expats living in one of those "god-forsaken countries with socialized medicine." I get private insurance through my work that gives me choices if I want them, but I've never seen the need to use it. We pay $280 per year ($40 per person) to have access to nationalized health services and we have never gone to the doctor, emergency or otherwise, where he bill and the medicine exceeded the cost of the gas we burned to drive there. We want to live in the US again, but we can't live in a world where a minor medical issue routinely wipes out your savings and a major event equals bankruptcy. I'm so sorry Phil is going through this, but after seeing a bill for 3.5 million when our twins were born in the US, I know of what he speaks when he says our system is terribly broken.
Hang on - $3.5 million for a birth? Are you being serious?!
Gareth Ogden twins born at 30 weeks, one with Down syndrome. If they hadn’t have stayed past 30 days in the NICU we’d have been on the hook for 20% with our insurance. They were discharged at 35 and 68 days respectively, but when you get hit with a medical crisis, it doesn’t help to know that a financial apocalypse is waiting as well.
Thanks for putting this out there, Phil. Important for people to see.
It's very sobering to hear stories like this, but I've never heard a good word about the American health system. I hope you are able to get through it all with not too much further trouble.
Here in Australia everything you've described would be covered. When I came off my mtb out on a trail three years ago I very badly broke my shoulder and was taken to hospital in an ambulance. It took two surgeries to get me fixed up - the first surgeon said he was not the right person for something that complicated and recommended another. I was told the new one was among the best shoulder surgeons in the country. I got through that and eight months of physiotherapy before I was allowed back on a bike or drive a car. Everything was covered. No bills came to me for the whole thing.
I have never understood why national health care is so scary for the US.
Kim Miller how much of you paycheck goes to taxes?
fenderperry I earn in the $60k range and pay about $12k in tax. For that we get healthcare, both my kids were born free of charge in public hospitals, my wife’s pre-natal care was all free, the kids now attend free public school, we’re right near lots of beautiful local parks, our roads are well maintained, our bridges etc don’t collapse etc etc.
We also can opt to pay for additional private health care, prices vary and it can cut wait times for elective surgery or get you a private room rather than shared etc but many Aussies are dumping it as they find they never get their money’s worth and are happy with the public system.
No system is perfect, and the introduction of our public healthcare system in the 70s came with all the same corporate predictions of doom gloom and communism as you hear in the USA but we wouldn’t be without it.
I broke my humerus in my right arm 3 years ago. The $50,000 surgery only cost me a $75 co pay. There’s one good story for you.
@@joegsoccer91 But how the f does a broken arm cost $50,000 unless they're turning you into the bionic man?!?!?
@@fenderperry How much of your pay check do you have to spend on health insurance and other services which would otherwise be provided by the government? The actual amount taken out of my income for medicare is only a couple of percent. I am more than happy to pay that to ensure health care is available when I need it without a life changing invoice.
Thanks for being so open and sharing your situation about the US healthcare system. I wish you the best.
Insurance plans and how they use billing codes makes it that much more confusing and it’s all done on purpose, for their business revenues.
Business medicine
Yes, and those codes should be universal and the pricing published--insurers should have no right to secrecy.
They do the codes to easily identify what they did to you. Those codes tell how long the doctor treated you
Much sympathy for your situation Phil. I think you are handling it in the best way that you can. And much character for forwarding donations to the kids fund. Real stand up (out of the saddle) guy. :)
I'll tell you what happens next from experience:
They will send all of those bills to collection agencies, it'll happen soon, about 8 months after the accident, and then you will have to deal with that.
I've heard its pretty brutal in the states ehen it comes to debt recovery. Phil needs to start hiding his possessions and put others names on vehicles. If he owns property they'll take it.
Really sorry to hear about this. Hope it goes viral and your insurance company catches a lot of flack.
Come to the U.K. it’s shit weather but no medical bills. Keep up the good work
Thank you very much for sharing. Keep going strong 👍
We love you Phil!
What a horrible situation to be in. You are very resilient. Good luck with it.
Glad to live in Canada. Stay strong Phil.
44 people downvoted this vid? Seriously? Power to you Phil, your grit is a source of real inspiration.
US health care just makes me maaaaaad!🤬🤬🤬 glad I live in Canada 🇨🇦
Damn Phil, I'm sorry that you are having to deal with this. It sucks. Thank you for opening up and sharing something that is this personal. I appreciate you sharing this because people do need to know the pitfalls of our health insurance system. We all need to highlight the inequities that plague the system so that, hopefully, one day we can come up with something better that works for everyone.
It's ridiculous you work your whole life just to try and get a little ahead then you have one mishap or just get old and have some issue and bam there goes everything you worked for. Things have gotten way out of hand. I feel you tho. I broke my collar bone last year and had a slap tear in my shoulder. One 10K later I have a plate that now has to be removed and a slap tear that is unrepaired.
Wow, this is amazing. Thank the lord I live in Canada. My son had a collapsed lung, surgery, total cost $100 for a private room in the hospital
This is why I love the NHS
Agree pity we voted to shoot ourselves in the face though give it 5 hears this story will be familiar in the UK
Thank you for sharing this story and putting our health care system into perspective
Phil, this is exactly why we need healthcare reform in our country.
What would reform look like? In Australia we have a public health care system and a private health care system. You have to go on long waiting lists for non life-threatening surgery for the public system, whereas the Private system the que is short but you pay $$$. I don't really know what the answer here is.
@@gumzster Denmark has some of the world's highest tax rates. I would challenge your "costing zero to patients" there. Taxpayers pay for that and that is fine. I'd prefer it was that way than being landed with $250k worth of bills for an accident.
@@gumzster that's how I'd prefer it but a 58% income tax in America has as much chance of happening as you or I living on Mars. :P
Agh that sucks... sorry to hear. A few years back i went down during a training ride and broke my hip. I was in the hospital 1 week, got surgery and rehab. Plus was out of work for three months because my job requires me to be mobile. Fortunately, I live in Canada. Our health care system is far from perfect, but I can hardly complain. Everything was covered.
God bless America :/ Lived there for a few years and it was great but the health insurance was definitely one of the negatives...now happily back in a civilized country where everybody, no matter how much money you've got, is covered by health insurance ...and you can't just walk into Walmart and buy a Semi-Automatic rifle...
Tecno Ciclista Good God someone finds a way to relate this to guns. Gold star for you!
Stephen Swanson I think the point being made would be about the insanity that the rest of the world sees when you look at a country that bankrupts its citizens over health care but actively promotes their “right” to tool up and kill each other.
@@chinboy66 Thanks, I think this is a pretty accurate assessment :)
@@chinboy66 it's not to tool up and kill each other. It's the right to protect against a tyrannical government. If you're trying to say more guns equals more killing each other then you're wrong. All crime has been decreasing over the past 30 years. You know what hasn't been decreasing? Number of guns. There is millions and millions of guns in the US and crime rates have never been lower. Aside from other things. Its interesting... For some reason as supposedly terrible as the insurance is here (and supposedly terrible the gun crime is even though its actually a very safe country). People spend their whole lives trying to get here. Some, literally dying to get here. It's almost as though people love freedom and want that because its a means to success and true happiness. I was recently in Ukraine and if there is one thing I have learned it's that guns should not be something surrended to the government. During Maidan of 2014, there is nothing more Ukrainians wish they had other than guns. Their government wasn't allowing them to protest and was going against what the majority of people wanted. Many people died standing up to the government in part because they had no way to defend themselves (look up the "heavenly one hundred"). Also as a little bonus, each Ukrainian I asked said that if they had guns when Russian annexed Crimea and began their war in eastern Ukraine, they would not have been successful. On to healthcare. If you look how healthcare is changed over the past 25-30 years, the reason that people go bankrupt is because we have a proxy system of socialized medicine. It's psuedocapitalism combined with pretend socialism due to the fact that people who are able to pay (aka not living under the poverty line and above) are the ones who end up being on the line for their own cost which in reality is set at certain prices due to the insurance companies negotiating with hospitals and lobbying congress. Understanding direct primary care is an integral part of understanding how healthcare was originally designed and how insurance companies have failed us (Google it). This is mostly due to the government stepping in and essentially telling insurance companies they must cover everyone regardless of their willingness to pay combined with them lobbying to increase their role in the delivery of the healthcare process. Your response to this only displays the fact that you are creating a strawman argument, while essentially misrepresenting the problem. Trying to bait and switch the actual problem and is dishonest to yourself as well as your school of thought.
@@tecnociclista5342 www.google.com/amp/s/www.businessinsider.com/walmart-gun-buying-review-virginia-store-2019-8%3famp since you put out the claims it's so easy to buy a gun just by walking into any Walmart....
Sorry you are going through this. No one should have to. Good luck to you.
Are you in a Bernie Sanders ad? Would love to see that. We need him as president. We had a much less traumatic situation and my wife ended up in a hospital in NC, out of network (were from MA) and we owed $12k for an overnight and bunch of tests. Insurance wouldn’t (and never did) pay despite appeals. Really sucks. So sorry you’re going through this too. Please vote for Bernie and Medicare for all!!
So sorry, Phil, it really sounds terrible. Stay strong!
Best public service announcement ever. It's truly a broken system when you're forced by law to pay for health insurance, but the health insurance you buy most of the time refuses to pay and gets away with it.
nightmare dude. Sorry you're going through this. Good luck.
NHS
Same mate. Thanks to brexiteers...
Greg Kane completely 😭
@@gregkane8635 What about the 250.000 pounds a week you will save after leaving the EU? That should be enough to fund the NHS and also have free chocolate fountains on every street, right? Oh, the humanity!
@@aaesteve I'd imagine what we will loose is a hell of alot more than we will save 👍 unless anyone can conjure a unicorn out
Just re-watched this video. The fact that you didn't blow a gasket on someone and destroy it all is a testament to your character.
It's sad that this is happening in a great country like the US.
yeah, such a great country.
Wishing you the best of luck! Stay strong Phil!
vote Bernie
The whole country needs to hear this story. Thank you for sharing. It’s time for Medicare for All. Enough of this nonsense.
Abolish private healthcare
Abolish private ~everything~
At first I wasn't sure about this guy, but now seeing this and his attitude towards life and others...well lets say you got yourself another sub and supporter. hoped everything worked out Cookie man!
This breaks my heart to hear. The US needs some sort of universal healthcare for this very reason. You shouldn't have to pay to have your baby be delivered in a hospital, have cancer treatments, emergency heart surgery or an unfortunate accident riding your bike. You also shouldn't have to pay for some physio after surgery. Come on america, wake up and do something about this.
Oh God! So sorry to hear about this!
Let us help you!!! You don't deserve this!! If you have left over money, give that to no kid hungry. But let us help pay this crap. It's not your fault. It's America.
As someone who has been on a journey of discovering I have AFib last year I know the pains of medical debt all too well. So sorry to see you going through this and hope it all gets sorted out for you. You are a class act and a great cyclist!
We can use you in Canada. Ontario Health care 4 lyfe. (Unless the current government destroys it more than it already has)
Yeah sucks for him, Here in canada I wouldn't pay a single cent for all of those injuries...
@Brady Lacko If I get hurt at work my job even covers the ambulance.
God Bless Canada, where you are taken care of when you are most vulnerable. They should invent a word for this great concept for a social structure that ends in ism, I'd bet that would really scare the top 1% - insurance companies, banks corrupt politicians, etc...
@@bobslaman8578 when you're most vulnerable, couldn't be more correct. It's shameful
Ebhkkc E yeah, dying because you cant afford to go to hospital or going bankrupt even with insurance is way better
So sorry to hear this Phil! Hope it works out you deserve better
Phil is one hell of a stand up guy!
This sucks mate, and I"m sorry you're going through it. Thanks for sharing and for citing the issues for what they are. I hope for you a fair, reasonable and even favorable outcome. With aloha, Will
I'm moving to Canada ASAP
Your true character is evident in this video Phil. Still directing donations to needy kids when you’re in this shit storm. You’re a good man.
Phil go to social Worker.
They will help . Dont let then intimidate you.
Keep fighting💪💪💪💪🙏
I been in similar situación.
Wow.
Thank God we have the NHS here in the UK.
sweet to live in Canada
Mike Lalonde didn’t you guys have problems for year with lines to just get think like MRIs. 6 month lines I believe it was.
Sure beats rationing insulin
Man, sorry to hear about this. So much time and energy to this negative thing. Good luck!
maybe go ahead and start that "go fund me" deal? seriously thought dude, good luck.
Good luck. I hope you are feeling better.
vote for bernie baby
I feel your pain Phil, a couple years back we had a similar fight with our insurance company. Keep your head up, talking to the right person on the right day is (maddeningly) the only way we were able to resolve things. Best of luck
Anyone in the UK who has the nerve to complain about the NHS and free health care to all should be locked in a room and watch stories like this until they agree to STFU and wait politely and be respectful
a sad reality, sorry you had to go through this.
Come to Canada? We have healthcare. Because profiting off of people's accidents is wrong lmao
Canada doesn't take us Yanks. ;) You got to have a relative, or an employee sponsor. I always wanted to retire there, so I did some checking.
very sorry to hear all this mate.
Come to Canada!
But actually I'm sorry you have to go through this
Very sorry to hear about your situation, hope you can find a solution with your insurance company.
Phil, move to Denmark. We don't have to pay if this happens to you. This is all payed for through your taxes.
Which is among the highest in the world. But it's stories like this, that makes one appreciate the benefits we get from paying high taxes.
@@rgjdk Only 5.79 M people in Denmark, 53% - 67% tax rate - not going to work in the USA! Nothing again Denmark, love to visit, my grandmothers Danish, but we can't afford socialized medicine based on the other models in the world. We need to come up with a different model. Sure hope we can and we do.
@@pbarr1935 No, surely it's not going to work in the states. We also have some high salaries in order to pay all that tax. A minimum wage job in the states will probably leave you with not enough money to live after taxes. Tax avoidance is a Danish national sport.
The UK tax is not too different from the US and we get free healthcare. Just moved to the US and we now pay more in health insurance (by a long way) than we did in UK taxes
I don’t get this insistence that the US can’t do it because there are too many of us. That also means there are more of us paying into the system, you know. That’s how insurance works: you have more people in the insurance pool, the insurance pool is able to handle more stuff. Besides, what happened to American exceptionalism? We can put a man on the moon but we can’t ensure the same quality of life for our citizens that every other major nation on earth does? Strange the things we have money for and don’t have money for.
Phil should do a Bernie rally. Or at least an NNU rally. He’d be a big hit.
Best medical advice I received from a doctor-- know what ERs are covered prior to visiting. The sad part of health care is you could offer a course on navigating the contract. You pay the insurance companies than need to give up a weekend reading the contract to explain it in plane terms -- then you forget it all. Remember this as well,our system penalizes people b/c of the abuses of greedy individuals and companies -- the bad 1%.
BERNIE 2020
good luck, hope things get sorted out.
I hope your presidential election changes things
Can't wait for stories like this to arrive in the UK...
Have you ever considered what level of care you would have received under a federally managed healthcare system... perhaps something like the Veterans Healthcare System? The probability that you'd have to live with ongoing discomfort and pain, or even a disability, is considerably likely. It's almost certain that you wouldn't ever ride your bike competitively again. That you were able to fly to New York and see a specialist could not have happened under a system like the UK's NHS.
It's precisely because you have choices that allowed you to seek out care that would have otherwise been unavailable to you under a nationalized single payer system. Unless of course you're one of the elite that receive VIP treatment... but wait, I thought everyone is treated equally under single payer systems?
I truly am sorry for you. The US healthcare system does need overhaul. But, it does not need to go to a single payer system.
Queue the "thumbs down" and negative replies... arguments about the myths of rationed care, unequal health outcomes, wait times.... blah blah blah.
Where are you from M D? What you describe doesnt sound like UK health care to me.
@@benspeller8635 No thank you. I'd rather die from a thousand paper cuts than get into a healthcare debate in the comments section on RUclips! I'm glad you're happy with the NHS.
So sad your having to go through this. I do live in a country where this doesn’t happen, and listening to your story makes me appreciate it even more.
wow. hope you get the bills covered in the end. i'm from Denmark, and don't envy you. once your on your feet. it should not be a fight over bills. that's crazy. best of luck man
Keep up the good fight....Kudos to you for taking a difficult situation and thinking outside of yourself. The happiness that will bring is worth a million dollars.
this is sad, I hope you find a solution, I just had a bit of a hospital stay in canada and it was covered, Im greatful. Get well soon keep posting
Thank you Phil for posting this cautionary tale. I had a motorcycle accident 2 weeks after I graduated college, not realizing that that was the trigger to make me no longer covered under my parents military health insurance. I died in the hospital and wound up with 'only' a 100k bill. Thankfully family worked 'in the system' and advocated heavily on my behalf when all I wanted to do was to give up breathing. Every political system has its faults, but I think a large portion of the population is blind to the risk they are running here. That policy is worthless unless companies do the right thing, you follow every line of the contract AND have a team of lawyers to back you up. Hope it all works out for you.
I just had a great idea Phil..... you should do a new series where you not only go after KOMs, but you do it WHILE on hold with insurance companies. Would be downright hilarious.
Americans continue to believe having private insurance and choosing your own primary doctor is more important than universal health care. What we don't realize is every visit to ER means another doctor is in charge. And when a specialist is needed, its not your primary care doctor. Most of routine office visits are staffed by capable nurse practitioners or physician assistants. So much for your choice of doctor. I see so many burned out people trapped to specific jobs, unable to switch careers because the costs of health care.
Listening to this I am so glad that in Germany we don't have to worry about stuff like that. So sorry to hear that, dude. Also amazing how you still worry about other people more than about yourself. If everyone was more like you, you wouldn't even have that problem. Lots of love!
Damn man, true respect for posting this. Keepin it real
this is an incredibly frustrating story. really sorry phil
Hope you get this sorted Phil, this shouldn't happen. Definitely makes me thankful for the healthcare system where I live.