San Francisco Swede

Reflections on San Francisco from a Swedish perspective

Archive for the tag “insurance”

First healthcare experience

Healthcare in the US! A hot topic. From the Swedish perspective, on the one hand some parts of the US system are completely unreal (with individual people being liable for huge medical expenses) while in other ways there is the potential for better treatment. If you’ve ever been in contact with the healthcare system in Sweden, it’s very likely you are quite familiar with the seemingly endless queues everywhere, even for simple things. The only time I was not subjected to a crazy queue was when I went to a private practice once (through insurance).

My status at the moment is that while I have insurance in Sweden that is supposed to cover me until the 18:th, I don’t really trust that it will work in practice, so I wanted to be careful before I get signed up with local health insurance. It was unlikely I’d need anything within a week or two of arriving anyway.

As it turns out, I managed to get a pill stuck in my throat within this period, so I figured I’d give healthcare a shot.

Attempt 1: Public healthcare

I went to SF General via bus and did a walk-in into the ER. After about an hour or two I went through triage (which in non-emergencies like this was basically just taking standard vitals and asking some questions to fill in paperwork). After that I had to register and then wait for someone to see me (a matter of hours apparently).

Everyone was extremely non-forthcoming about costs, and wouldn’t even answer seemingly simple questions like “Ok; so suppose I spend 15 minutes with a doctor, I’m not going to get billed $25,000 or something as a matter of course?”. I would have hoped the answer to that would have been a clear “no”, but they mostly just seemed to be unwilling to comment.

While the process was slow, it was convenient in the sense that I could just walk in, sit down, and wait with some minimal identification.

After triage when I registered to see someone, I got various documents about my rights as a patient and information on how to apply for reimbursement of expenses (if eligible).

In any case, I did not want to take the chance with the cost so I decided to bail out and see a private doctor instead.

Attempt 2: Private healthcare

I Googled and found a private doctor with good reviews on Yelp within 30 seconds. He was located within walking distance from SF General.

I called to book an appointment. They were able to quote me price ranges immediately on the phone (after a ~ 10 seconds wait) and I was able to make a booking about 1.5 hours from the time I called (the doctor was one that does house calls and he was out with a patient at the time I called). They were very flexible in dealing with me; for example they reserved an appointment for a few minutes while I confirmed I would indeed be leaving. I then called back and just confirmed to them I was showing up.

They took my credit card information on the phone to make the booking. Expected cost was $350-$600 depending on complexity of care.

I walked there expecting to wait until the allotted time, but he showed up about 50 minutes earlier so I was able to get in much quicker.

In the end, I had to pay $495. According to him (keeping in mind this is hearsay from someone who has a vested interest in me not deciding to use public healthcare in the future) an ER visit is usually $1500 just from being seen – and can easily be inflated by thousands if they e.g. call in specialists for a consult. If I take his word for it, the choice to just go with a private physician was a good one.

It will be interesting whether and how I can get the cost reimbursed through Swedish insurance. Even if it would normally be, I’m half expecting they will reject the claim on some bureaucratic ground like “you can’t go to a private doctor”.

It would be interesting to understand how the pricing the private doctor claimed affects the reported average per-capita health care costs in the US. If a large part of it is $1500+ for a few minutes spent at the ER, they would seem to be extremely inflated to me.

Future healthcare

The expectation is that as soon as I’m signed up with the HMO, the process will be much smoother. As far as I have understood it, you basically call up and make an appointment with a doctor working with the HMO depending on what type of issue you need help with. I expect (based on what I have heard so far) and hope it is similar to the experience I had calling a private doctor directly.


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