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Notes -
I'm not SSCReader, but for a different example:
I have the low-deductible buy-up plan. Deductible is 1500 per person or 4500 over the whole family, for in-network providers. This is not the same as an Out of Pocket Maximum. When the deductible is hit, insurance starts paying 50% of the costs until the Out of Pocket Maximum is hit. Individual Out of Pocket maximum is $6,850, over the whole family it is 12,000.
I had the ill fortune of reaching my family's Out of Pocket Maximum a couple years back. Three young kids hospitalized with complications from a bad combo of RSV and Parainfluenza. Two of the kids spend 2 days in the ICU, the third spent 9 days in the ICU. Each day in the ICU was $8,140.00 charged to insurance, and that is leaving out all other services that were provided while they were in the ICU. In the end, about $300,000 was billed to insurance and I paid only $12,000 of that. (That doesn't count the hundreds of dollars we spent on the Starbucks in the hospital over the three weeks we were swapping kids in and out, but you can only expect so much from insurance.)
Naturally, when I was sitting in the Emergency room with an unresponsive kid I had no way of knowing how much would get charged to insurance. I think by the time I was bringing my second child we assumed we were hitting our Maximum.
Also, my husband has annual colonoscopies and SSCReader's experience is also our own.
Thank you for sharing your experience.
I definitely did not realize that most people don't just view the deductible as a sunk cost with any significant utilization.
RSV sucks but kids bounce back thank god.
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