Health insurance dilemma: What would you do?

In My Humble Opinion (IMHO)
#1

So I have a problem with health insurance and I’ve been thinking it over so much that I don’t trust myself to see things clearly anymore. I’m hoping that in posting this, I can get some perspective from some other people.

The situation in brief is this: My fiance needs to see a doctor. Probably a number of doctors. This is going to be expensive and he’s uninsured. He works two part-time jobs and so neither of his employers will pay for insurance (but see option #4), and he makes too much to qualify for state aid. We have a number of options, but no clear best answer that I can see:

Option 1. We could just pay for everything ourselves, but we’re pretty broke. And not just regular broke. Totally broke. All his expenses would have to go on the ol’ credit card. We’re looking at at least $2000-3000 and that would really hurt us.

Option 2. We could buy some ok insurance from one of his employers (paying the entire premium ourselves). However, we did some calculations and discovered that the number of things they don’t cover plus the deductible make this only a marginally better option than #1, financially speaking. We would save some money, but still be out at least $1000 (which we don’t have).

Option 3. We could just go down to the courthouse and get married to put him on my insurance, which covers everything he needs. We’ve been together happily for years and plan to get married next year anyway. However, we’re both concerned that a “fake” marriage would take the sweetness, romance, and sense of commitment out of the actual ceremony next year. However, we also recognize that his health must be taken care of and this is the cheapest way to do it.

The other concern with #3 is that I may be changing jobs in the next 3-6 months, and if I go somewhere else and get on another plan, we may run into pre-existing conditions clauses that preclude him from treatment altogether and stick us with the full bill anyway. We’re thinking maybe we should just wait and see what happens on the job front, but I don’t like the idea that his health has to wait on a job that may or may not be in our future.

Option 4 (maybe). I have a small, unprofitable sole proprietorship that he works for and that I could maybe run his health care through, but he works as an independent contractor and not an employee, so I’m not even sure if that’s an option worth pursuing. Plus I can’t see how it would be any more affordable than #2.

So, Dopers: if it were you, what would you do? How would you get this man to the doctor?

#2

fuffle - wouldn’t pre-existing exclusions apply with your current insurance too? If you got married tomorrow and put him on your insurance, wouldn’t they exclude pre-existing conditions since he has been uninsured for a while? Have you already looked into the way it will work with your current health insurance plan?

I would recommend a high risk pool (provides health coverage through the state for adults who can’t get insurance due to pre-exsiting conditions) but it doesn’t appear that there is one in Arizona at the moment.

#3

Hi, me again -

One thing to look into is this: Go to the hospital or provider that your boyfriend would want to go, plead his case, and see if they will work out a discounted rate and a payment plan for his treatment. Then hopefully he can get treatment at a discounted rate and be able to pay over time, and could possibly use the credit card if he needs help with the payments.

His health is the most important thing so I think you should do whatever it takes to get him treatment.

The health insurance situation in this country SUCKS!!! I really like the new laws that are being passed in some states recently where the state penalizes, in various ways, employers who don’t provide health insurance. I think that is a good approach.

#4

ANY of the insurance options you mention may run you into pre-existing condition issues.

I agree with nyctea scandiaca. Go to a “normal” provider and ask for assistance. If there is a not-for-profit hospital around, call it and talk to a social worker. Or call your city or county social services office.

#5

I should be more clear about the pre-existing condition. He hasn’t been to a doctor in years, and therefore technically hasn’t been diagnosed yet (although we’re almost certain as to what’s wrong with him). The way I see it, since he’s received no care, treatment, or advice, I figure legally, ethically, morally, it doesn’t count. He’s sick and we think we know with what, but we’re not doctors, so there’s no pre-existing condition.

He broke his ankle years ago and we were able to plead with hospital to let us pay over time, but that was clearly an emergency and they took some pity on us. I have a harder time believing that even a not-for-profit hospital would enter into an agreement like that for planned treatment, but then again I don’t have a lot of experience with these things.

#6

Well, Jeez, get to a doctor — TOMORROW! Unless you can go somewhere and sign papers, TOMORROW, to get him immediate coverage.

There are doctors and clinics and hospitals that budget to treat the poor. Believe it.

It’s ridiculous to be “pretty sure” you know what is wrong. No medical professional I know, and I work in a hospital, would assume they had any specific medical condition without tests.

#7

Believe me, Boyo Jim, I (and he) consider this an urgent matter and are working very hard to figure out the best solution. I understand that he needs treatment; I just don’t know the best way to do that (I don’t mean that defensively, I just mean that I’m hearing what you’re saying).

I’ve been calling around looking for doctors or facilities that will work on a sliding scale and haven’t found any (or any that will admit to it). The county and state programs have all turned us down. I wouldn’t even know where to take him tomorrow.

And I can see where you would think it’s silly to assume that we know what’s wrong; I know that we don’t for sure, but rather than be coy about it, I’ll just say straight out that he has all the symptoms of sleep apnea. And if it’s not apnea, it’s some kind of sleep disturbance. Treating it is probably going to involve a sleep study and maybe a CPAP machine. Expensive stuff. Again, I’m not a doctor, but it’s not like he has a nonspecific pain in his back or something. These are specific symptoms that point to a particular problem. The “non-urgency” of the condition (as opposed to a broken ankle) is what makes me think we’ll have trouble making a deal with any doctor or facility.

#8

Oh, hey, I live in Pima County, too. And I just had a thread about this very subject. Sorry, no link, I’m bone tired and on the way to bed.

Arizona’s state health insurance system, AHCCCS, may kick in and start covering 100 percent of medical bills, if his income isn’t too high. You’ve checked on that?

It’s sickening how many people I know fall between being too “wealthy” to get state assistance for healthcare, and yet too poor to buy individual coverage. I feel so lucky to have my insurance for what I pay.

ETA: I just caught your last post, so my advice would be to have him go on and see a sleep specialist MD. There won’t necessarily be any diagnosis at the first visit, more likely the suggestion for a sleep study. It would be helpful to speak candidly to the doctor about his financial concerns and just see what the options are. Also, I could be wrong, but I don’t think preexisting conditions count when someone is brought into a group health insurance coverage, such as at your work.

#9

What is AZ law on Common law marriages and Domestic Partners?

In some states you can put your SO on your insurance even if not “married”.

#10

Arizona does not recognize common law marriages initiated within its borders. This couple would not under any circumstances qualify as married under the common law anyway, which among other things requires the couple to hold itself out as married through their conduct.

Arizona does not recognize domestic partnerships.

fuffle, instead of asking here, you should be asking your benefits administrator what your insurance coverage says about pre-existing conditions for new spouses. None of the group policies I worked, back when I worked insurance, had pre-ex exclusions for spouses added to the policy. IIRC, the job change issue should not be an issue either as long as there is no lapse in coverage of 61 days or longer.

As far as the potential loss of “sweetness” next year should you marry now, which would be sweeter: having a public ceremony re-affirming your marriage with a healthy groom or holding out for the “sweetness” and having your groom be gravely ill on your wedding day?

#11

Go to the courhouse and get married.

#12

Definitely check on your insurance before you take route #3 - and get it in writing. I speak from experience. The definition of “pre-existing condition” on my insurance changed from “haven’t seen a doctor for this” to “never had symptoms prior to coverage” when we married to get my spouse on my insurance. We ended up having to pay for the visit. (The problem turned out to be minor and the insurance came in handy later, so it was all fine.)

On the other hand, changing jobs shouldn’t be a problem - HIPAA fixed that.

I understand your hesitation - I didn’t get checked for sleep apnea for years, just because I didn’t want to deal with the CPAP. It’s not generally an emergency condition. However, you seem to think it’s an urgent situation (i.e., needs to be treated now, not next year after you marry), so you’ll have to make the call on how important this is.

There are lots of doctors around here that will set up payment plans and even give cash discounts. I think the hospitals will do it too, especially if you start making payments first and then get the treatment. (I’ve got a friend that hasn’t had insurance for years - she pays all her bills out over time, including major dental surgery and a pregnancy/birth.)

If you don’t want to (or can’t) get him covered on your insurance, then schedule an appt with a sleep specialist physician and discuss financing with them. They may not do discounts, but they’ll probably take payments. You’ll still be out the bills, but at least you won’t have to pay exorbitant interest on them.

#13

I feel for you… The US health care system is terrible. After 9/11 I became unemployed when my empoyer went out of business. I was unable to get any private insurance (having tried every insurer licensed in my state) due to a pre-existing condition. I ended up leaving the United States and I now have excellent insurance from an overseas private insurance company. The only catch is that is not valid in the US, so now I am effectively excluded from my own country.

It is a drastic measure, but if you have any options to leave the US, you might consider it.

#14

That’s exactly the situation we’re in–he comes in just over the income limit for AHCCCS and PCAP, but that doesn’t mean we have an extra $200 month for his premium.

You’re right that the state of Arizona does not recognize common law marriages, although we could register as domestic partners under Tucson city law. Not that that really matters, since the insurance company wouldn’t honor a partnership anyway.

That’s good advice; I’ll do that.

I admit that I don’t really know what HIPAA is, but I assume it’s some sort of portability law? I’ll look it up this morning.

The apnea isn’t really urgent urgent, but it’s gotten bad enough recently that no, I don’t think it can wait until next year. Otto’s right that I would much rather have a healthy groom than an unhealthy one; it just feels like such a letdown to even be considering early marriage for insurance. Like we’ve failed somehow.

But it seems maybe I was premature in thinking that no doctor would agree to let us pay over time; I’m used to feeling like a nobody being uninsured. I’ll talk over everything everyone has suggested here with him and come up with a plan. At this point, even paying out a large bill over time would be preferable to nothing.

Funny you should mention that; working overseas is actually kind of a dream of mine. If I could find a good librarian job overseas, I would take it in a heartbeat. Luckily the organization I work for now has very good insurance, so at least that much is taken care of for now.

#15

I wouldn’t see it that way at all. Setting aside any romantic or cultural ideas you might have about marriage, realize that there are some legal rights that are at least as important. Maybe I’m misunderstanding your post, but you sound as if you have no problems with being a ‘domestic partner’ if it would help with those legal rights. Getting married to get those same rights could hardly be considered a failure, in fact avoiding crushing debt and maintaining your health would be elements of a successful marriage.

#16

One option to look into is whether there is an opportunity for him to get diagnosis and/or treatment as part of a research study. It is something of a long shot, but it works out for some people sometimes.

#17

I second the Get Married Now option. Waiting a year to have Barbies Dream Wedding* doesn’t make you any more married, and real live marriage is about the sickness & health, richer & poorer, better & worse stuff, not the white dress and cake. Take care of your health and finances up front - they are huge priorities in a marriage.
*I am in no way accusing you of actually planning such a monstrosity.

#18

That’s a good idea; I’ve actually taken that route myself before. I’ll try calling the university, although I know their main guy in charge of sleep research is on sabbatical this semester.

Well, gee, when y’all put it that way, it sounds so obvious. :slight_smile:

It’s not so much that I’m hung up on the wedding or having My Perfect Day, it’s just that we’ve been together and have been living together for a very long time and really wanted to mark our change in status with something formal and meaningful. But maybe we should just consider this a legal necessity and still hold the ceremony next year as planned. No need to tell any of the guests that we’re already hitched. :slight_smile:

#19

If I were in your situation, I’d get married. To me, the marriage would then be even sweeter than it would be otherwise.

#20

Insurance company? I thought it was your employer that decided whether or not thety’d add your SO to a policy as “spouse”? :confused: