Hospitalization and surgery with no insurance

[ajk912]

Whether the housing is on the bus route is irrelevant if the place of employment is NOT.

You answered yourself with the bike. Those that bike to work are in great health. For them, it's great exercise. But what about the rest of the population? The guy with the bad knees that's trying to avoid surgery? Or the lady with lupus that must avoid the sun? Etc, etc, etc...

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As for the hospital bills, our hospital just got this great new program that allows them access to real-time insurance information. For us, it was great news yesterday when DS was stung repeatedly and had an allergic reaction. We've met our OOP max for the year, and they changed their minds about treatment and DS was given the expensive meds that would last several days and reduce the chances that he would have a secondary reaction at a later time.
But it REALLY disturbed me. Would he have not gotten the best treatment option available if they knew they'd be billing me personally for the cost? I'm not for sure that our insurance status was what changed the treatment, but it certainly seems to be.

I am pretty sure I bolded in my original post that there will always be exceptions. Mostly, I just agree with the poster who said there is a crazy disparity, that if you come in uninsured you get more help (or even a write off) than those of us who do have insurance. It doesn't seem right at all. It drives up the cost for everyone..everyone who pays, that is.

 

[My2BabiesLexis&Dill]

Why didn't your co-worker have insurance if he had a job? Just curious.

Because some jobs don't offer insurance. My husbands company cancelled their insurance policy on all of their workers b/c they couldn't afford it anymore. So without notice DH had NO insurance.

My job offers it to us but it's half of my paycheck and I can't afford that. So just b/c you have a job it doesn't mean you automatically get insurance.

 

[disfan07]

"We have insurance, but I know our hospital takes 50% off of the bill for anyone who is uninsured..."


I don't think is fair either. Let me explain...we are very fortunate to have insurance for our family thru DH's job - at a cost of $120 a month. I know this seems cheap but we have a $1250 deductible per person then 80% with 5k oop max. This insurance is so different than what I'm used to...no doctor co-pays period until deductible is met.

So, my doctor's office charges $91.00 for quick visit and offers a discount for paying that day in cash...that comes to $42.00 for the visit. Pretty cheap, right?

Last week Dh was taken to the hospital with chest pains and admitted to the cardiac care unit. After much testing a heart attack was ruled out but they found a pulmonary embolism (blood clot) in his lung. Terrifying to me but he got on medication (don't even ask what the injections cost) and is going to be okay. He was there for 5 days...3 in the cardiac care unit.

The day we got home from the hospital I get a call from the hospital financial office. His bill is over 26K but they have a great offer for us. They figured after the deductible and BCBS paying 80% we would owe almost 5k BUT if we could pay "today" they would give us a 20% discount leaving a balance of a little over 4K. And how would I be paying today to take advantage of this great offer???

Needless to say, I was (and still am) on an emotional rollercoaster and not in any shape to deal with this right now. I'm sure we will have medical bills from various doctors, labs, etc for months to come. I don't even know where we are on our deductible since we have paid some to the doctor's office this year. I told her I would contact them after talking to our insurance company. I know it is their job to collect any money due but I feel like DH's hospital bed was still warm!


So we have insurance and pay our premiums and still can have thousands of dollars we will owe after they have paid. While I am very grateful for the insurance I kind of resent the deep discounts and bills being paid by charities. I have a charitable nature and am all about helping the less fortunate, but we work very hard for what we have and try our best to pay everything we owe and we still struggle at times like this. I guess that 20% discount offer from the hospital was all we are going to get. I guess we are what you would call the working poor. We make to much for any assistance but not enough for any unexpected medical crisis.

Thanks for letting me rant here...and please don't take this as me saying that people in bad circumstances don't deserve a helping hand - I just wish it were more equitable.

But did you read the rest of it? They give the same discount to people who have insurance that is accepted at the hospital (which is probably about 95% of private insurance companies). So I don't see how that is not fair.

We pay $300 month for our insurance. We have a $250 per person deductable plus $8000 OOP per person before coverage. Even after we reach our OOP max, we still pay copays. $20 for internist and $40 for the specialist.

 

[ZachnElli]

Ditto. There are exceptions, but in general, I don't understand not having health insurance in this day and age. I totally get the pre-existing conditions and how some people can be uninsurable through a private policy. This is us, because my daughter has a lot of health problems. One of us HAS to work at a job that has group coverage (where individuals can't be kicked off). My DH would LOVE to start his own business, and I told him...no way, you can't, not until I am done with college and can carry a job with health insurance. No one would insure our family. So I get temporary measures..I am just taking this job to pay the bills for NOW, until I find something with health insurance...but then hopefully you had COBRA from your last job to buy you some time, and I believe that's for 18 months.
To me, insurance is more important that your own house, or even a car. If you can't afford insurance, you don't live on your own, you would bring in a roommate or live with family. You wouldn't have your own car, you would move to a place that offered public transportation so you only have to buy a bus pass (usually reasonable). You would eliminate the extras (and yes, a car is an extra!!!), cable is an extra, etc.. till you can afford health insurance which is a NEED.

Obviously, there are exceptions, and if you are that person don't feel bad. Someone who got fired from their job and has a debilitating illness and cannot work, period...I am so sorry and that's different. I am not talking about those situations. I am talking about the people who just make bad choices and play the "I can't afford it" card.

You do realize that COBRA is around $1000 a month and when you are unemployed, that it is impossible to afford, right? And living in the city to use the very limited public transportation my city has puts you in the center of crime and gangs. Sorry, not raising my kids like that. Riding a bike is not feasible for a large part of the year here, ice, snow, subzero temps, not to mention NO bike lanes and of course there is the kid still in the car seat, where shall we put him? Yeah, we went without insurance recently and we were living with relatives. Do you know how fun it is to live with 10 people and 5 pets under one roof for 8 months is? And we still couldn't afford health insurance because we were still unemployed! Our "extra" (the car) is a Ford Focus for a family of 5, so not a luxury, but a very cramped ride. Some people really have no idea how hard it is out there. My dh has a job now with full benefits, thank God, but I am still looking. Stop telling people what they should do in your opinion until you walk the walk.

 

[Halbleib1]

Why didn't your co-worker have insurance if he had a job? Just curious.

Just because you have a job does not mean that you can afford insurance. It also does not mean that insurance is offered through the employer.
My husband has worked many jobs where insurance was either not offered(usually when he was working through a temp. agency) or if it was it was still not affordable.

I think it is probably safe to say that most of the people that do not have insurance do work but simply can not afford it still.

 

[Halbleib1]

Sure, but many people have bad priorities.

You can not put everyone into a box it is not as simple as that. Sometimes people have the right priorities and still can not afford it. There are a lot of variables that go into why a person does or does not have insurance.

 

[seashoreCM]

To me, insurance is more important that your own house, or even a car. If you can't afford insurance, you don't live on your own, you would bring in a roommate or live with family. .

Neale Godfrey, on Moneytalk (WRKO 680 Boston 6/13/10 9:15 PM, also other stations) 80% of kids come back to the empty nest nowadays compared with 40% a few decades ago.
Howie Carr (WRKO, weekdays 3-7) Kids who come back home to live are losers.

The cheaper housing is on the bus route, more towards the centers of the cities. The cheapest housing would be on the bus route or way out in the rural areas.

Apartments in Boston (and Cambridge and Brookline and other inner communities) rent for a lot more than out in the 'burbs like Billerica and Shrewsbury and Norwood.

Not sure how a bike causes more health risks, biking is great for your health, it keeps your weight down, great exercise!!! Most people who bike to work are in great health.

You forgot bad drivers causing accidents.

 

[DisneyNutMic]

I find this interesting , my daughter was diagnosed with cancer in 2007 and the only thing the ACS gave us was $300 a year for meals and gas. The following year they told me she was not eligible for anything because she was not in "active treatment" because she was no longer getting chemo , but she was still getting physical therapy to learn how to walk again with the implant she got on her knee thanks to cancer , go figure.

Anyway , speak to the hospital's social worker , that is a good way to start.

It was a LOT of paperwork I remember. I do know that someone is still covering his chemo treatments though. He has to go through some red tape each time he gets a treatment but they are still covering it I know. I do remember them saying that once he isn't in "active treatment" that it wouldn't be covered but since it is it still active, it is being covered to this day. I'm happy to say that he only has one treatment left in a few weeks though. It might have to do with the hospital he was admitted to as well. I know it was a teaching hospital. Not sure if that makes any difference but it could.

 

[iheartpeterpan]

Report them to the federal government via your state's insurance commissioner. Just because it is illegal, it doesn't mean that some companies won't try to get away with it. You'll need written proof of denial and your Certificate of Credible Coverage that came when your last policy ended. How long were you uninsured between policies?

Each of the insurance companies you mentioned MUST take you. BCBS is the largest insurance in the US and has reciprocity agreements with almost all states -- it is known as a "Cadillac" plan. It won't be cheap, but they have to insure you. Just like with auto insurance, your premiums are rated based on the number of claims you have made. Depending upon your preex dx, your premiums will go down after a few years. It would be smarter buying a smaller, lesser-known policy first and waiting out the preex waiting period.

Good luck.

You are misinterpreting the law. You have to have had group coverage to get the certificate that allows you to continue coverage without disallowing pre-existing conditions. This law in no way requires any insurance company to write you a new policy if it determines you a bad risk. You will not succeed in a suit against insurance companies that refuse to write you a policy if you are not coming off of a plan with an insurance certificate. You are not eligible for Cobra unless you are continuing a previously written group plan when you leave a job/retire, etc.

I hate the way we handle medical care in this country. My DH is considered "self-employed" because he is considered a partner in what is actually a big company - we are not eligible for the group plan and have to pay over $1,000 a month for a plan for our family that does not even pay one dime until we are out of pocket $6,000. It makes me really mad because we have done all the right things, paid our taxes, paid our bills etc. and because he does not work for a big company with a great group plan then we are hosed on medical expenses. We pay it - but it is our largest monthly expense, and provides nothing unless we have a disaster.

 

[eliza61]

Obviously, there are exceptions, and if you are that person don't feel bad. Someone who got fired from their job and has a debilitating illness and cannot work, period...I am so sorry and that's different. I am not talking about those situations. I am talking about the people who just make bad choices and play the "I can't afford it" card.

Some people can't afford it. If you have to chose between eating and insurance, eating will win out every time.
I know many seniors in this situation. they have to chose between their prescription drugs and eating, and no medicaid does not cover every thing.

Do you really think this country's health care crisis is a result of people making bad choices? gimme a break.

Oh, health care cost is predicted to rise about 9% next year for the average american. How many people do you know got a 9% pay raise? Now add that to the cost of every thing else going up and you really believe people are making bad choices?

http://blogs.wsj.com/health/2010/06...s-to-rise-9-in-2011-higher-deductibles-ahead/


Other details from the report:

More than two-thirds of companies are expanding or enhancing wellness programs.

Some employers are planning to share more of the cost of health care with workers; 42% of employers surveyed say they’ll increase employee contributions, 41% will boost deductibles and co-pays and 26% will increase prescription-drug cost-sharing.

Retiree benefits are dwindling, with one-third of employers with 5,000 or more employees subsidizing coverage for retirees not yet eligible for Medicare and 22% subsidizing coverage for Medicare-eligible retirees. In 2009 those figures were 47% and 37%.

If the economy doesn’t improve and COBRA subsidies are reinstated, the increase in medical costs is likely to be closer to 9.5% in 2011.

The survey covers 700 U.S.-based companies of all sizes

 

[iwrbnd]

You are misinterpreting the law. You have to have had group coverage to get the certificate that allows you to continue coverage without disallowing pre-existing conditions. This law in no way requires any insurance company to write you a new policy if it determines you a bad risk. You will not succeed in a suit against insurance companies that refuse to write you a policy if you are not coming off of a plan with an insurance certificate. You are not eligible for Cobra unless you are continuing a previously written group plan when you leave a job/retire, etc.

I hate the way we handle medical care in this country. My DH is considered "self-employed" because he is considered a partner in what is actually a big company - we are not eligible for the group plan and have to pay over $1,000 a month for a plan for our family that does not even pay one dime until we are out of pocket $6,000. It makes me really mad because we have done all the right things, paid our taxes, paid our bills etc. and because he does not work for a big company with a great group plan then we are hosed on medical expenses. We pay it - but it is our largest monthly expense, and provides nothing unless we have a disaster.

I think we have the same insurance! It's a HUGE expense and one I hate paying! I guess that's why I get a little frustrated when I see people without insurance buying things we couldn't afford. I know many people truly can't afford it or get coverage, but there are SOME who just need a money management/priorities class! (Of course, I said "some", not all, so don't flame me!)

My DH runs a free clinic on his day off (he's a family practice doc). He has a passion for helping those who can't afford insurance. He does laugh a little about the people who come to the free clinic in nicer cars than we have talking on cell phones we could never afford! But, he loves helping those who really do need it so it doesn't bother him. It bothers me a little but I try not to judge because I don't know their whole story.

 

[jodifla]

Some people can't afford it. If you have to chose between eating and insurance, eating will win out every time.
I know many seniors in this situation. they have to chose between their prescription drugs and eating, and no medicaid does not cover every thing.

Do you really think this country's health care crisis is a result of people making bad choices? gimme a break.

Yeah I'd like everyone to go through their budget, subtract ALL their income and then add $1,200 a month for health insurance, and see how long they'd last.

 

[hffmnheidi]

Yeah I'd like everyone to go through their budget, subtract ALL their income and then add $1,200 a month for health insurance, and see how long they'd last.

I don't even make 1200 a month working 40 hrs/full time. Between car ins, gas money, medical collections debt, and student loans-there's very little left over at the end of the month.

 

[PatsMom]

I do know a few people who have gone to work for Wal-Mart or a grocery store just because they offer group benefits to part timers. Stay employed long enough to be on their insurance plan and if you terminate you have the certificate to get a policy that won't exclude pre-existing conditions. Won't help you pay the cost of that coverage though.

If it came down to eating or being insured, I would be seeking public assistance. Food stamps, food pantries, they can help a lot. The one I donate to support sees an increase in people wanting help in the winter when they have fuel bills. Also, seniors who are in the "donut hole" on their prescription drugs. Although every major drug company has a patient assistance program that can help as well if you are truly in need. My Mom volunteers with her local hospital helping to process applications through their medication assistance program. The only low income, no asset people they aren't able to help are those who don't file tax returns as that is their starting point for determining income. And you would be surprised at the people who just don't file - illegal aliens, those living on the underground economy - there are lots of reasons.

 

[angwill]

I know, my job doesn't offer benefits. I was just thinking that if you have a job you would buy insurance. I know it's expensive but it should be a priority.

Sadly there are people who can not get insurance and live in areas where there are very few companies that offer insurance. We live in a tiny town that is mostly factories and a lot of them went out of business so lots of people are out of work and in line waiting for something to open at one of the factories.

If you have a pre-exhisting condition no insurance company will insure you and then there is the state CHIP program by us for the uninsureable which is very expensive and goes up depending on age. Over 35 years of age costs $750-$800 per person. The problem is you can only qualify if you have had insurance within the last 30 days and been turned down by other health insurance agencies. If you loose your work coverage and then wait to be turned down more than likely the 30 days is up.

Not everyone lives in the same areas with the same opportunities and same pay level that would leave $750-$800 left over after living expenses. Not everyone in that position has a Disney trip planned and may be choosing dial up internet for just over $10 a month to have access to job sites vs cable etc. Not everyone has the same health issues either. It really is not wise to only see thing the way they are directly surrounding you and your loved ones and friends and then assume everyone has the same opportunities and privileges. Things are different all over.

If someone comes here for advise for themselves or a friend in a bad situation they don't need someone assuming things and asking questions that are none of their business either.

 

[eliza61]

I do know a few people who have gone to work for Wal-Mart or a grocery store just because they offer group benefits to part timers. Stay employed long enough to be on their insurance plan and if you terminate you have the certificate to get a policy that won't exclude pre-existing conditions. Won't help you pay the cost of that coverage though.

If it came down to eating or being insured, I would be seeking public assistance. Food stamps, food pantries, they can help a lot. The one I donate to support sees an increase in people wanting help in the winter when they have fuel bills. Also, seniors who are in the "donut hole" on their prescription drugs. Although every major drug company has a patient assistance program that can help as well if you are truly in need. My Mom volunteers with her local hospital helping to process applications through their medication assistance program. The only low income, no asset people they aren't able to help are those who don't file tax returns as that is their starting point for determining income. And you would be surprised at the people who just don't file - illegal aliens, those living on the underground economy - there are lots of reasons.

That is the funniest thing I've read. really, do you honestly believe that millions of seniors simply "don't know", that's the reason we complain about the donut hole? Really?

Obviously you have never, ever had to apply from those major drug companies. I have and believe me you will spend more in postage then you ever, ever get from the drug companies. Please, please do not believe that crap you hear on the drug companies commercials about anyone who can't afford their drugs will get help from them. Sure, after two years of applications by which time you will be dead. Go down to the senior citizens center and ask them how willing the drug companies are to help.

My dad was in the drug company propagada for 10 years

 

[angwill]

Not sure how a bike causes more health risks, biking is great for your health, it keeps your weight down, great exercise!!! Most people who bike to work are in great health.

Well if you were my brother you would understand the health risks of biking. He was on his way to work riding his bike as he always done when he was hit by a guy who was texting and in a hurry because he had to get to work.

My brother had a pick up truck parked on his chest for 45 minutes and is now dead. That is why riding a bike is not healthy for everyone.

 

[Calliaz]

You are misinterpreting the law. You have to have had group coverage to get the certificate that allows you to continue coverage without disallowing pre-existing conditions. This law in no way requires any insurance company to write you a new policy if it determines you a bad risk.

Yep. Basically, HIPAA requires that if you get coverage through a new company, they can't exclude treatment for pre-existing conditions. However, that does not prevent any company from refusing to cover you in the first place. I went around with this several years back when my husband moved to a small company that paid for individual private policies. We could not be insured because of pre-existing conditions. I even had my own policy through my employer at the time (since it was free spouse coverage, this would have been a secondary policy for me).

 

[iwrbnd]

I don't even make 1200 a month working 40 hrs/full time. Between car ins, gas money, medical collections debt, and student loans-there's very little left over at the end of the month.

I really don't mean to be rude so please don't be upset, but how are you going to Disney in 2011?

 

[eliza61]

Hey Patsmom,
I must apologize for the tone of my last post. I didn't mean to sound flippant but as a new proud card caring member of "AARP" I am unfortunately find ing out the hard way that if you are a middle income member, health care and drugs are exceedingly expensive. All those wonderful programs that people love to quote, in reality help a very small population.
I do have a problem with the fact that in order to get decent quality health insurance I must either be super rich or live far worse than some 3rd world countries.