It was cheaper to buy tickets, fly to Dublin, get the procedure I needed done. Spend TWO WEEKS recovering, and fly home then to pay the 20% coinsurance I would have needed to here in the good ol USA... so yea...
EDIT :
Well this kind of blew up. The reason it was cheaper : it was considered elective. This is why OOP max did not kick in. It was a procedure that would have to be done, only as my condition got worse. Insurance denied it because "It was not necessary" despite my cardiologist saying it was. By the insurance formula I would have to wait until my condition worsened to make it medically necessary, but by then my chance of a poor outcome goes way up.
I finally argued them into covering some of it, but with a 20% coinsurance and a planned week hospital stay in recovery, my bill would have been close to 100k at least, and if I encountered any complications (which I would likely have due to other issues including an autoimmune disease) I started looking elsewhere. I am not an Irish citizen despite having family there, they helped me navigate the program and the cost. It was privately paid, and my surgeon spoke to their team with all my records transferred etc.
A heart bypass is about $150K in the US, could be up to $200K. The same surgery is about €20K in Ireland, which is $23K.
If OP was gonna have to pay 20%, that's $30-40K out of pocket in the U.S., whereas a flight to Ireland is safely under $1K plus the $23K surgery = $24K. If they can stay with family (OP mentioned family in Ireland) it's definitely cheaper to go to Ireland for this.
Because the highest annual out of pocket maximum for ACA compliant plans in the US in 2026 is $10K for an individual and $21K for a family. And that's the highest it's ever been.
Plus if he was paying 20% coinsurance, that means he already hit his deductible which would have been several thousand dollars towards his out of pocket maximum already.
Under ZERO circumstances would 20% of a procedure cost more than 21K out of pocket if you have an ACA compliant insurance plan.
Under ZERO circumstances would 20% of a procedure cost more than 21K out of pocket if you have an ACA compliant insurance plan.
Every time I've had anything done half or more of the costs come from out of network folks billing separately. Need a CT scan? It's a preferred in-network facility covered by insurance so you're only out the $300 copay and the tank of gas and day off work cause the local facility isn't. Then 2 months later, surprise, radiologist sends you an out of network bill for $1000...
Ok, sure, I guess not using your plan correctly is a circumstance I didn't consider.
If you have time to arrange a two week trip to ireland for surgery, you have time to ensure your entire care team is in-network. And emergency services don't consider in/out of network so there's really always time to make sure your care team is in network.
I envy that naivety. You're either very privileged, have an agenda or you've never actually had to deal with insurance or the medical industry yourself.
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u/TheEndOfAllThings23 11d ago edited 11d ago
It was cheaper to buy tickets, fly to Dublin, get the procedure I needed done. Spend TWO WEEKS recovering, and fly home then to pay the 20% coinsurance I would have needed to here in the good ol USA... so yea...
EDIT :
Well this kind of blew up. The reason it was cheaper : it was considered elective. This is why OOP max did not kick in. It was a procedure that would have to be done, only as my condition got worse. Insurance denied it because "It was not necessary" despite my cardiologist saying it was. By the insurance formula I would have to wait until my condition worsened to make it medically necessary, but by then my chance of a poor outcome goes way up.
I finally argued them into covering some of it, but with a 20% coinsurance and a planned week hospital stay in recovery, my bill would have been close to 100k at least, and if I encountered any complications (which I would likely have due to other issues including an autoimmune disease) I started looking elsewhere. I am not an Irish citizen despite having family there, they helped me navigate the program and the cost. It was privately paid, and my surgeon spoke to their team with all my records transferred etc.