<story><title>Insurance copays are higher than the cost of the drug about 25% of the time</title><url>https://www.pbs.org/newshour/health/why-a-patient-paid-a-285-copay-for-a-40-drug</url></story><parent_chain><item><author>antjanus</author><text>I had the same situation with multiple services:&lt;p&gt;1. ultrasound cost around $300 with insurance...$150 without&lt;p&gt;2. ER visit cost $4K with insurance....$900 without&lt;p&gt;3. specialist visit with insurance cost around $200...$150 without&lt;p&gt;And don&amp;#x27;t get me started on labs.&lt;p&gt;It&amp;#x27;s really a rip off to use insurance for anything other than:&lt;p&gt;1. general doctor visit (cheap co-pay, pretty expensive cash option)&lt;p&gt;2. really expensive shit (c-section w&amp;#x2F;o insurance runs $25-$30K -- cost me around $5K with insurance)&lt;p&gt;Anything in between seems to be cheaper when you pay individually.&lt;p&gt;As a disclaimer this is &amp;quot;gold-level&amp;quot; insurance coverage which costs around $1200-$1300&amp;#x2F;month for a family of 4.</text></item><item><author>cascom</author><text>I had this experience with imaging (MRI), cost 10% more with insurance than without.&lt;p&gt;I asked a friend in the healthcare industry about this - they said that since insurance companies negotiate all the services at once - the insurance company is trying to lower the total cost for the whole insured pool, this often means that they will marginally overpay for high margin services in order to get big discounts for the really costly things. The hospital makes more gross margin, and the insurance company lowers it’s total spend. The offshoot is that individual people may bear the brunt of this grand bargain...&lt;p&gt;No idea if it’s true, but had a ring of truth to it...</text></item></parent_chain><comment><author>cosmie</author><text>One thing to keep in mind when paying individually is that many insurance providers won&amp;#x27;t count the payments toward your deductible or maximum out of pocket expenses, since it wasn&amp;#x27;t processed through your insurance.&lt;p&gt;If you&amp;#x27;re nowhere near hitting your deductible for the year, and don&amp;#x27;t anticipate hitting it, then looking for cash-only discounts make sense. But &lt;i&gt;if&lt;/i&gt; you anticipate hitting your deductible anyway, sometimes it makes sense to pay the inflated price on that individual item, since you&amp;#x27;ll make up for it later when you hit your deductible and switch to only paying your coinsurance amount (or hitting your max OOP).</text></comment>
<story><title>Insurance copays are higher than the cost of the drug about 25% of the time</title><url>https://www.pbs.org/newshour/health/why-a-patient-paid-a-285-copay-for-a-40-drug</url></story><parent_chain><item><author>antjanus</author><text>I had the same situation with multiple services:&lt;p&gt;1. ultrasound cost around $300 with insurance...$150 without&lt;p&gt;2. ER visit cost $4K with insurance....$900 without&lt;p&gt;3. specialist visit with insurance cost around $200...$150 without&lt;p&gt;And don&amp;#x27;t get me started on labs.&lt;p&gt;It&amp;#x27;s really a rip off to use insurance for anything other than:&lt;p&gt;1. general doctor visit (cheap co-pay, pretty expensive cash option)&lt;p&gt;2. really expensive shit (c-section w&amp;#x2F;o insurance runs $25-$30K -- cost me around $5K with insurance)&lt;p&gt;Anything in between seems to be cheaper when you pay individually.&lt;p&gt;As a disclaimer this is &amp;quot;gold-level&amp;quot; insurance coverage which costs around $1200-$1300&amp;#x2F;month for a family of 4.</text></item><item><author>cascom</author><text>I had this experience with imaging (MRI), cost 10% more with insurance than without.&lt;p&gt;I asked a friend in the healthcare industry about this - they said that since insurance companies negotiate all the services at once - the insurance company is trying to lower the total cost for the whole insured pool, this often means that they will marginally overpay for high margin services in order to get big discounts for the really costly things. The hospital makes more gross margin, and the insurance company lowers it’s total spend. The offshoot is that individual people may bear the brunt of this grand bargain...&lt;p&gt;No idea if it’s true, but had a ring of truth to it...</text></item></parent_chain><comment><author>sandworm101</author><text>Wow.  I used to live in the US but thank you for the reminder.  I am very glad i now work a government job in a country with public health care.  I went to the dentist last week.  Walking out without paying anything, not a single form, feels like stealing.  I cannot understand how anyone in the US can pay such costs.  Simply staying alive seems a constant battle.</text></comment>