Americans Share Their Health Insurance Horror Stories

It's no secret that the American healthcare system is flawed and expensive for the people who need to rely on it to receive care.

But there are some situations that Americans have found themselves in that could easily qualify as horror stories.

Already cringing, Redditor Old-Arachnid77 asked:

"Americans, what is your insurance horror story?"

Not Sick Enough

"My father got hospitalized for a week from heart failure. He was literally guaranteed death without getting medical help, his lungs were filled with fluid, and he was effectively drowning."

"Insurance decided that the entire stay was completely unwarranted because, according to them, it didn't seem like he was sick enough. They didn't want to cover ANYTHING relating to it."

"While we were eventually successful, it took years to fight. The bill was in the six figures."

- alequey-itj

No Max To Out-Of-Pocket

"I had a cardiac event this year that scared the h**l out of me. My blood pressure and heart rate crashed. I didn't really understand what was going on, but I knew I didn't feel good, so I had family drive me to a small local hospital."

"I felt fine for a bit, but while I was chatting with the ER doc my heart rate crashed down to 35 BPM and my blood pressure was 49/35. It was funny, the ER doc was calmly talking to me while they were wheeling in the crash card 'just in case'. ER doc says I need to see a cardiologist ASAP and guess what, I'm going on a helicopter ride."

"They flew me to a larger hospital with a cardiologist and watched me for 24 hours before determining it must have been a one-in-a-million drug interaction between two medications I took."

"Insurance paid for the small hospital ER. Insurance paid for the big hospital stay. Insurance first said that I had to prior auth the life flight, then realizing that wouldn't fly given it was an 'emergency' argued that it wasn't actually needed because I wasn't in active cardiac arrest, and now I'm sitting on the sidelines while the provider and the insurance fight it out over a ~ $60k bill."

"Previously, when budgeting for healthcare, I always assumed that the out-of-pocket max was the most I'd ever pay. I'm now realizing that is woefully naive when your insurance can just not decide to pay a bill."

- alpacaMyToothbrush

A Real Catch-22

"Far less severe than what I'm sure will populate this thread, but a terrific example of the nonsense that is American Health Insurance."

"During the pandemic, I was working for a Hawaii-based organization, but on the East Coast. Someone in my office popped positive for COVID, so everyone in the office went to a testing site to get tested."

"My claim for the test was denied, because I didn't go to one of the approved testing sites for my insurer. All of the approved sites were in Hawaii. At the time, you couldn't travel to Hawaii without proof of a negative test."

"So. The only way I could get the cost of a test covered was if I went to an approved testing site, but in order to travel to any of the approved testing sites, I needed to show a negative test."

- WatchTheBoom

A Terrible Waiting Game

"My dad is an oncologist and he says there has been an uptick in the number of arbitrary denials, by insurance companies, for claims that should absolutely be covered under the patient's plan."

"When they're appealed, they'll often eventually be approved. But the whole process moves really slowly, which can be a death sentence given early treatment is critical when dealing with cancer."

"It almost seems like the insurance companies are delaying sh*t on purpose, in the hopes that the patient will die before they have to pay for treatment."

- midnightsunofab***h

"And you might think that providers could just push forward with treatment when they are 100% sure it is necessary and just worry about getting insurance to pay later."

"But that’s exactly why insurers require prior authorization. So that even when they’re wrong, you can’t forge ahead with treatment to save or preserve quality of life, or the insurer won’t pay."

- GlassBelt

A Needed Scan

"Not me, but someone I know was diagnosed with cancer in her early thirties. Her oncologist found cancer cells in her lymph nodes, indicating that it had metastasized, so he ordered a full body MRI to assess where it had spread to."

"Her insurance denied it because they said she was too young to be considered at risk, despite her actively having cancer. They did eventually approve it, but not without a lot of pressure from her doctor."

- MyFullNamels

No Time To Relax

"My wife had an emergency surgery for a spontaneous retinal detachment. Literally minutes away from going blind. Insurance tried not to pay because she had not gotten pre-authorization, and then after that, claimed a SPONTANEOUS event was a pre-existing condition."

- therevspecial

"I had a retinal detachment in 2023, and it has been frustrating to deal with. I should be worried about preserving my vision, not if work will approve my time off or cover it. Several thousand out of pocket."

- Fit-Whereas5661

Too Expensive

"My girlfriend had kidney failure as a child and had been on dialysis for over 15 years. She graduated college and was working as a teacher. She had to stop due to complications with her condition and go on disability."

"This was prior to Obamacare, so we tried to get coverage from all the insurance companies since it’s impossible for anyone to afford dialysis without insurance."

"Every single company declined to cover her due to her pre-existing condition. They essentially told her that she was too expensive to live."

- Myst031

"This is an extraordinarily good example of why healthcare should not be a for-profit business. It's necessary for society. My work is related to medical billing. Your partner is a contributing member of society, living their best life."

"That best life could cost upwards of $300,000 USD/month. Perhaps 100 people in the world can pay out of pocket for that, which is a different conversation."

"I was at a seminar for investing in healthcare. Chew on that one for a moment, let's just say "ethics" was not a tract. There was a session on investing in drug research and what the reasonable expected returns could be, on a genetic drug costing $8-9 million per treatment."

- RedReina

Possible Affordability

"I work for a DME company. We exist solely for the shareholders in hopes of packaging and selling the company to a larger company like Medtronic."

"Our income is largely, perhaps mostly, based on overbilling Medicare. We waive patient costs all the time on the basis that we will still make record profits year over year if medicare pays their part less than half the time they're asked to."

"This is happening at scale across the entire healthcare industry, the system is utterly vampiric. Healthcare could be so much cheaper if there wasn't an entire for-profit industry dedicated to exploiting our poorly constructed state health system."

- PositiveChi

A Non-Elective... Elective... Surgery

"My surgery to remove ovarian cancer surgically was deemed, ELECTIVE. The type I had wouldn't respond to chemo or radiation therapies, but since it wasn't going to immediately kill me it was just cause I wanted it apparently. Had to pay 6k out of pocket."

- Bubbly_Ad_8072

"The problem is the vernacular. At least near me, any surgery that you come in for through the outside (meaning not in ER or already admitted) is considered elective."

"For example, if someone comes in through the ER with hand numbness, found to have stenosis in the neck, they get surgery, it’s considered urgent, doesn’t need insurance approval."

"That same patient comes into our office, we book for surgery, it’s considered elective."

"Makes zero sense."

"For a personal example, my heart ablation times two were both considered elective. Like yes, for funsies, I am choosing to ablate my heart."

"I do peer-to-peer all the time, and the “medical” staff I have to deal with from the insurance companies are probably the dumbest, lowest IQ staff I ever deal with. Don’t even get me started. Trying to explain to one of those donuts why a patient with a benign brain tumor needs yearly MRI screening (“but they had one last year already”) is enough to make my pull my own teeth out."

- GoddessOfWarAres

Overly Consistent Sugar

"So, I am a diabetic. My doctor wanted Lantus insulin, but insurance wanted another, cheaper insulin that's not as effective (Basaglar**)**. So my doctor doubled the dosage. So my insurance decided to make the dosage two times 14 days worth (two weeks a month) instead of 30 days worth so I had to pay the copay twice a month."

"That meant 28 days a month, and most months except February have more than 28 days. I ended up having to ration my insulin, and the copay went from $25 for 14 days to $65 for 14 days in less than two years."

"That meant I had to go to the pharmacy, stand in line, and get refills, every 14 days. And the pharmacy ran out a lot, so I had to come back. I can't drive, so I had to walk a mile to CVS down the road for this (and other medicines)."

"I just started 'buffering' a week at a time just so I could deal with this inconsistency."

"'How come your blood sugar never goes down?' the doctor asked. I told him, and he shook his head, saying this was so common. He tried swapping insulin types, or increasing the dosages, but insurance said no. My A1C was like 10."

"Then I ended up on Tricare, because I married someone in the military. I got Lantus, Trulicity, and BOOM, my A1C dropped to 6 in less than a year. I know the military has efficiency issues, but I pay nothing out of pocket in Tricare: no copay, no prescriptions, and no fees. It's like $58/month from my wife's pension for the both of us. I mean, socialized medicine WILL work in this country, The companies just don't want it to."

"When my first wife died (the military officer was my second marriage), her insurance dropped her because she was dead. Then they sent her a $230,000 hospital bill for her last week of life because she was on a ventilator in critical care. No, I don't live in a communal property state, but they sent her to collections, and heavily implied (illegally) that I had to pay. I didn't."

"Let me repeat this: they sent my dead wife to collections. Then lied that I had to pay because she was dead. Bill collectors called me, called me at work, called our son, and even MY sister. Not her sister, MY sister."

"I had legal notices and bills for her, in her name, coming as late as eight years after her death. In fact, twice, she had a summons to go to court. Then a summons for arrest for failure to appear in court, however THAT sheriff had common sense and took her death certificate. He even said he was sorry for bothering me."

"F**king crazy."

- punkwalrus

A Cruel Rejection

"My wife just got her third denial for authorization (from UHC) for an MRI on her hip that her doctor has been trying to get her for over a year."

"The first reason: she didn’t submit X-rays. Submitted X-rays, reapplied."

"The second reason: she hadn’t done PT before the request. Submitted evidence that she has done PT on and off for seven years, to no improvement, reapplied."

"The third reason: she needs to have X-rays done first."

"This AI auto-rejection cruelty is par for the course."

- therevspecial

When It's Time To Focus On The Baby

"My daughter was born early and spent seven weeks in the NICU. When she got out we got a bill for something like $400,000 and it took months to get the hospital and insurance company to sort it out."

"We have stacks of paperwork showing that everything has been settled but every so often we get a letter or a call from one of them because they randomly decided that we still owe them $100,000."

- e36

On-Site Troubles

"I got hurt at work suffered an amputation on site with no pain meds. They slowly pulled my toes off with my crushed boot."

"My family lost our health insurance at the end of the month because I wasn't working. But it's okay; Cobra was only $2500."

- Designer_Situation85

"Cobra is such bulls**t, when I left my employment previously they sent a letter in the mail that I could maintain health insurance through cobra the monthly cost was 350 and they only cover you for 12 months. So 4,200 for a year of insurance that only covered preventative care? F**k that."

- medusalynn

Retirement Deserved

"I got super sick when I was 7, and had an extended hospital stay. Unfortunately, it happened during a brief lapse in my Dad’s employment history, so we were briefly between insurance."

"I later found out my parents went bankrupt, and my dad had to take on higher-paying jobs he hated in order to pay it off."

"He eventually worked himself to death - almost literally; he worked so many hours of overtime he fell asleep at the wheel and drove off the road and crashed into a tree. Worst day of my life."

"He should have been enjoying his retirement by now; instead he’s been gone for years, and my mom still struggles with depression and being a widow."

"America needs universal healthcare."

- Baelish2016

Remembering What Mattered

"My father was a doctor with a pre-existing condition before Obamacare, which meant the only health insurance he could get was through his state's pool of last resort."

"It took 30% of his income as he was self-employed and working in a very rural area. He was the only physician in his specialty for 75 miles, and when things got desperate for his patients, he would allow them to 'pay' in piano lessons, vegetables, whatever instead of cash if they needed to."

"He had a stroke and 'died' on his bathroom floor but lived on life support for four more days. $350,000 later, including a 70k helicopter flight for 30 miles, a man who dedicated his life to medicine and donated all of his organs to science died less than broke because of healthcare costs."

- Misschiff0

It's horrible enough to go through a medical crisis and to have to depend on people you don't know during your most vulnerable moments to save you.

But the fact that all of these Redditors had to worry about how they would afford their care when they actually needed to be recovering was all the worse.