# Do you know anyone who needs a medical procedure but can't afford it (or the co-pay)? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [January 2, 2010, 3:08am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365 "2010-01-02T03:08:17Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [December 16, 2015, 9:14pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/81 "2015-12-16T21:14:31Z")
> [@stillownedbysetters](#): > > I am having a knee replacement next March. I should have had this knee replacement at least a year ago, but even though my insurance pays for a goodly chunk of the expense, all the peripheral expenses, on top of the co-pay, required some scrimping and saving in advance. > > What do I mean by peripheral expenses? > > Cabs to and from physical therapy and doctor appointments (right knee being replaced, won’t be able to drive safely for a while) > > Loss of wages (even with STD available, it only pays at 60% of regular salary) > > Co-pays for such things as the PT, medications, crutches, walkers, etcs, as needed > > Pay for dog walker, house cleaner, laundry doer, grocery shopper, etc., as needed > > All of these somewhat hidden expenses, added to my co-pay for the doctor/hospital/etc. will be about 7k. And although I have an FSA, I am only allowed to contribute $2.5k each year, so the rest has to come from somewhere. > > So I have dragged myself around on this painful knee (and I’m active, so it’s been a lot of dragging) for over a year past the time when I truly needed the surgery. > > So although this doesn’t necessary qualify as not being able to afford the surgery, I’m still including it for you anyway. Things like this are a major reason for medical bankruptcies; it’s not so much the medical bills themselves as all the other incidentals that aren’t covered by any insurance plan, although some disability policies may pay for them. It also includes lost wages, child care, restaurant meals, hotel bills, etc. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [December 16, 2015, 9:19pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/82 "2015-12-16T21:19:47Z")
> [@Grrlbrarian](#): > > My uncle lives in Illinois. His vision is very severely limited by cataracts, and he too had the surgery set up to go - and I believe it was, indeed, in an outpatient center. My aunt was told they had to cough up $3,000 before the surgery or he could not have it. They don’t have $3K, nor credit cards upon which they could charge such a sum, and so the surgery was cancelled. My uncle sees only light and dark, so he’s pretty much blind - can’t dress himself, etc. He’s not old enough for Medicare. So these sorts of things do happen other places than Louisiana. ☹ That’s Illinois for you. I take it they aren’t eligible for Illinois Public Aid? Illinois health care entities are often teetering on the brink, because Illinois is perpetually broke and Public Aid is often a year or more behind in their payments. When I worked at the big hospital in Illinois, they were in need of some quick cash, so they sent letters to everyone who owed them money and told them that if they paid the balance in full by a certain date, they would get a 50% discount. It didn’t matter if the balance was $100 or $100,000; it was 50% off. Don’t know how many people were able to pay up, but it was during a time when our 403(b) wasn’t being matched. ---
**Author:** ![stillownedbysetters](https://avatars.discourse-cdn.com/v4/letter/s/41988e/32.png) [@stillownedbysetters](https://boards.straightdope.com/u/stillownedbysetters)\ **Post date:** [December 17, 2015, 5:35pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/83 "2015-12-17T17:35:32Z")
I’ll add my experience to the hospitals requiring payment in advance. As I was doing my research toward my knee replacement next March, I was told by both the hospital and the surgeon’s office, that I would have to pay my estimated deductible IN ADVANCE or the surgery could not be scheduled. I will have to pay the surgeon’s portion prior to my admission to the hospital and I will have to pay the hospital’s portion when I am admitted for the surgery. If I incur expenses beyond the estimated deductible, I can pay those at my leisure, but for all surgeries that are considered non-emergency or elective (and a knee replacement is one of them), estimated deductibles must be paid in advance. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [December 18, 2015, 12:53pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/84 "2015-12-18T12:53:07Z")
Most of this thread pre-dates Obamacare. Has anyone who could previously not afford a procedure, now be able to get it? Regards, Shodan ---
**Author:** ![AbbySthrnAccent](https://avatars.discourse-cdn.com/v4/letter/a/eb9ed0/32.png) [@AbbySthrnAccent](https://boards.straightdope.com/u/AbbySthrnAccent)\ **Post date:** [December 19, 2015, 8:33am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/85 "2015-12-19T08:33:29Z")
> [@GrumpyBunny](#): > > Reputable hospitals should not demand payment before a service is rendered. > > If they are in your network, report this to the insurance company. > > Also speak to the patient advocate at the hospital. We’ve had to prepay for a surgery as well. It was a knee surgery and he wasn’t able to walk or work without it so I presume it was considered medically necessary. We’re in Texas. I know someone that needs cataract surgery and cannot afford the copay. We’ve tried to help out with a cash gift and groceries, which was no small amount to us, but not nearly what she needed for the copay. I suspect she is no closer to that surgery than she was before we gave the gift. She does have some kind of Obamacare mandated coverage but the premiums and copays are so high that she still puts off what I would consider necessary visits, like chest wracking bronchitis. She also receives help with food debit some months depending on how many housekeeping jobs she pulls in. I don’t know yet how to help her get it done. I let her kids and grand daughters know. She hadn’t told them, but none of them seemed concerned, willing or able to help which I found infuriating because she’s 76 and they use her all the time for free babysitting. They “give” her internet so the great grands can have it when they bring their tablets, but aren’t willing to contribute to cataract surgery. Wonder if they will continue to drop off the children when she is legally blind? ---
**Author:** ![SenorBeef](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/senorbeef/32/2220_2.png) [@SenorBeef](https://boards.straightdope.com/u/SenorBeef)\ **Post date:** [December 19, 2015, 9:25am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/86 "2015-12-19T09:25:57Z")
> [@GrumpyBunny](#): > > Reputable hospitals should not demand payment before a service is rendered. Is this true? For emergencies, sure. But do hospitals regularly do non-emergency treatment without any verification that the patient can pay? ---
**Author:** ![robyns15](https://avatars.discourse-cdn.com/v4/letter/r/ebca7d/32.png) [@robyns15](https://boards.straightdope.com/u/robyns15)\ **Post date:** [May 20, 2016, 9:25pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/87 "2016-05-20T21:25:13Z")
I am one of those individuals who is desperate for surgery but can’t find the money to pay for it. I was a teacher for 35 years and became disabled. I couldn’t afford the health care coverage the teachers association was offering. So my husband quit his job to find a job with benefits. He was a restaurant manager and at age 59 it was very difficult. He now cooks at a senior care center and pays a third of his salary for health care coverage that has a $10,000 deductible. Last year, we made less than $30,000. With hospital stays and medications eating up our savings, we are down to nothing. I need hip replacement surgery desperately. I can hardly walk. The pain is like no other. Bone-on-bone pain feels like a knife is going through your joint and then it radiates down your leg and foot until you are going out of your mind. We are below the poverty rate in income, but can’t get any help because we have a health coverage policy that costs a third of my husbands income and pays nothing. What can we do? We are caught in a very horrible place where I continue to suffer, my husband watches me suffer and feels helpless, and there seems to be no one listening! ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [May 30, 2016, 10:22pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/88 "2016-05-30T22:22:47Z")
> [@SenorBeef](#): > > Is this true? For emergencies, sure. But do hospitals regularly do non-emergency treatment without any verification that the patient can pay? No they don’t. We’ve been fortunate that we have the resources to cover up-front costs - because both my husband and I have well-paid jobs. Even with decent insurance, however, those up-front costs can be steep - we paid something like 1,100 bucks upon checking for my gallbladder surgery. With a high deductible plan - often the only option at a job - we’d have had to shell out 2500 or more that morning. We actually have a high-deductible plan right now and have to be able to fork out about 5,500 dollars in the first few months of the year before insurance pays much (well, 2750 for one person, the 5500 is the family deductible). A friend of mine went without medical care for a number of months despite several chronic conditions, because her income was high enough before a job loss that she was not eligible for a subsidy from the Affordable Care Act. Without that subsidy, there was absolutely no way she could afford even the marketplace guaranteed insurance. ---
**Author:** ![Kaio](https://avatars.discourse-cdn.com/v4/letter/k/c68b51/32.png) [@Kaio](https://boards.straightdope.com/u/Kaio)\ **Post date:** [May 31, 2016, 6:00pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/89 "2016-05-31T18:00:29Z")
> [@Mama\_Zappa](#): > > A friend of mine went without medical care for a number of months despite several chronic conditions, because her income was high enough before a job loss that she was not eligible for a subsidy from the Affordable Care Act. Without that subsidy, there was absolutely no way she could afford even the marketplace guaranteed insurance. 😕 Why was she applying based on her previous income? If she made so much less then the current income is the relevant number. You’re allowed to estimate your yearly income – you’ll need to provide documentation (like unemployment docs), but it makes no sense to base it on a non-existent prior income. ---
**Author:** ![Mean\_Mr.Mustard](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mean_mr.mustard/32/3865_2.png) [@Mean\_Mr.Mustard](https://boards.straightdope.com/u/Mean_Mr.Mustard)\ **Post date:** [November 9, 2016, 1:32pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/93 "2016-11-09T13:32:29Z")
Heads up - zombie alert. OP has not posted since March 2015 FWIW. mmm ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [November 11, 2016, 10:43pm UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/94 "2016-11-11T22:43:46Z")
> [@Kaio](#): > > 😕 Why was she applying based on her previous income? If she made so much less then the current income is the relevant number. You’re allowed to estimate your yearly income – you’ll need to provide documentation (like unemployment docs), but it makes no sense to base it on a non-existent prior income. I’m not 100% sure but the job loss was about halfway through the year, giving an annual income much greater than any cutoff for assistance. So, total income for the year was too high even though _current_ income was basically zero. And this was in a state without the Medicaid Expansion rule. Yeah, if you have a small income you can get help. If you have _zero_ income, you’re screwed. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [November 12, 2016, 1:15am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/95 "2016-11-12T01:15:52Z")
I’m slowly trying to come up with $5000 (my dentist works cheap) to get more post/crown and/or bridge so I can eat a sandwich again. I have “Dental Insurance”, but it is a piddling amount that won’t cover the extractions of what is left of the 5 teeth which have rotted off to the gum line. I could also use some ortho surgery - if I could afford it, I would. Medicare will not cover it until ???. Then we can talk about kidney transplant/dialysis. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [November 12, 2016, 1:20am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/96 "2016-11-12T01:20:33Z")
The rabbit hole of US health care cannot be fully appreciated unless/until you are facing ruinous medical situations. I strongly recommend NOT finding out for one’s self. ---
**Author:** ![Trinopus](https://avatars.discourse-cdn.com/v4/letter/t/2bfe46/32.png) [@Trinopus](https://boards.straightdope.com/u/Trinopus)\ **Post date:** [November 12, 2016, 1:45am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/97 "2016-11-12T01:45:49Z")
I used to…but he died. (Very good friend, with congestive heart failure, and the emergency room was his only available medical care. They did what they could, but he couldn’t get therapeutic treatment, only emergency care. He couldn’t see the specialists he needed, only E.R. doctors.) ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [November 12, 2016, 3:34am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/98 "2016-11-12T03:34:31Z")
Two cases outside the US whom I know. A 50ish year old female diagnosed with glaucoma. Cannot afford the prescribed eye drops, about $50 per month in a country where monthly wage is about $150. May go blind as a result. Maybe just go blind faster. And another 50ish female diagnosed with a tumor in her abdomen. Cannot afford the $190 in medicine (which her insurance does not cover) needed as a part of the surgery she needs (which is mostly covered by insurance). ---
**Author:** ![kopek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kopek/32/337_2.png) [@kopek](https://boards.straightdope.com/u/kopek)\ **Post date:** [November 12, 2016, 3:36am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/99 "2016-11-12T03:36:19Z")
The bad news is that both my wife and I had enough health issues to go well over our deductible. The good news is that since we did there are a bunch of things we were putting off we got plans of getting in now. ---
**Author:** ![Gatopescado](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gatopescado/32/5711_2.png) [@Gatopescado](https://boards.straightdope.com/u/Gatopescado)\ **Post date:** [November 12, 2016, 3:53am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/100 "2016-11-12T03:53:47Z")
> [@usedtobe](#): > > The rabbit hole of US health care cannot be fully appreciated unless/until you are facing ruinous medical situations. > > I strongly recommend NOT finding out for one’s self. Dyin’s easy, Boy. It’s livin’ thats hard. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [November 15, 2016, 5:23am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/101 "2016-11-15T05:23:26Z")
> [@kopek](#): > > The bad news is that both my wife and I had enough health issues to go well over our deductible. The good news is that since we did there are a bunch of things we were putting off we got plans of getting in now. If you’re really lucky (?), you’ll hit your out of pocket limit too, then fun times can ensue… or something. We actually hit our OOP every year now - we’re on a high-deductible plan, which is dandy if: 1. You can afford to max out the health savings account 2. you’re very healthy OR very unhealthy. If you’re very healthy you’ll never hit the deductible. If you’re very unhealthy you’ll zoom through that and hit your out of pocket pretty quickly. As my daughter and I are both on somewhat expensive medication, we tend to get there about 2/3 of the way through the year. ---
**Author:** ![starwarsfreek42](https://avatars.discourse-cdn.com/v4/letter/s/e56c9b/32.png) [@starwarsfreek42](https://boards.straightdope.com/u/starwarsfreek42)\ **Post date:** [November 15, 2016, 8:22am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/102 "2016-11-15T08:22:08Z")
Oooh, zombie thread. Friend of mine has uterine cancer, no insurance. Makes too much money to qualify for Medicaid, but for whatever reason has been denied for any subsidies through the ACA. Has been bleeding continually for about two months but can’t afford surgery. And I mean that not in the sense that it’s not in her budget, but that she literally does not have the money. She makes minimum wage cooking at a nursing home that doesn’t offer insurance and has two kids to feed and a house payment. The money does not exist, she barely has food and lights. She’s made a couple trips to the ER and received fluids and blood transfusions, but it’s ruined her credit because she can’t pay the bill. Obamacare has done a lot of good, but it hasn’t fixed everything. She literally might die from lack of medical care and there are zero options available to her. ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [November 15, 2016, 9:21am UTC](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365/103 "2016-11-15T09:21:41Z")
I had a friend whose eyelids–well, actually the area right under her eyebrows–was very puffy and began drooping down, affecting her vision. Under her health plan this was considered cosmetic surgery and her insurance would not pay. And she was running her own business, and things were tight for her. Last year she finally got old enough for Medicare though, and, wonder of wonders, suddenly the surgery was no longer considered cosmetic. Yes, Medicare paid for her eyelift–so she can see again. (It was ridiculous. She had to tape her eyelids up in order to see well enough to pass the test for her driver’s license. Cosmetic.) [Previous page](https://boards.straightdope.com/t/do-you-know-anyone-who-needs-a-medical-procedure-but-cant-afford-it-or-the-co-pay/523365.md?page=4)