This came up in conversation with a couple of friends yesterday:
Person goes for mammogram. She has no insurance and does not qualify for any of the low-income programs (Medicaid, state or county aid, etc.)
She has advanced breast cancer and her only hope is a masectomy/chemo/radiation STAT. What does she do, without insurance or being low-income enough to get help? Curl up and die? Wait until she is sick enough to go to the ER? How does this person get medical (and disability if necessary) help? Clearly I am talking about people in the U.S., most other countries are evolved enough that this isn’t a huge concern.
Insert any cancer or chronic condition you think applicable - but how does someone who falls through the cracks of “not low-income enough to qualify for aid” and “makes just enough money not to qualify but for xy or z reasons does not have private health insurance” deal with such a situation?
The frist thing to do would be to call the state’s department of health and find out what the options are. There may be a pool-of-last-resort available, but not all states have such a thing. And those that do likely have pre-existing condition exclusions.
Just one insane effect of the fact that insurance is state-regulated is that a person facing this situation has a very different outlook if the state of residence is Arizona or New Jersey. There is no “national healty system” of any kind.
If no insurance can be had then yes, she should go to the ER and seek treatment. And then be prepared to pay every spare cent she has for the rest of her life to the hospital that treated her.
No cite, but I believe the system is mostly unfortunately self-correcting in that sense. Such people will typically will become poor enough and lose their jobs and qualify for some state program.
Some people just rack up the bills to get treatment and then declare bankruptcy. This works because most health care providers require only a little payment up front and will usually offer payment terms for larger procedures.
Another option. Become a ward of the state. Easiest way to do that is commit a felony and go to prison. Then the state is obligated for your health care.
As I understand US law, a hospital has a duty to treat immediate conditions - but not longer-term conditions that will not kill you in the next 24 hours. From what I read on a different thread, many hospitals have programs to help pay for indigent patients. After the first few nights in the hospital, you will be one. They also will work out some sort of payment scheme, so that you will spend as much disposable income as you have, for the rest of your life, paying your bill.
If the hospital is cooperative about payment schedules, can you really declare bankruptcy? After all, if they tell the judge “we will accept whatever he can pay each month as sufficient” then you are not in a situation where you cannot pay your debts unless you also have a whack of other debts?
Maybe I shouldn’t have said that most health care providers work that way. But I do have personal experiences with people who have accumulated large amounts of medical debts (50k, 15k, 12k and 10k for the top four). Many of them were permitted payment plans that would have taken 5+ years to pay off the debt.
It may be as md2000 says, that this only works for emergency-level issues.
I do know that bankruptcy cleared the debt for the person who owed 50k. A bankruptcy usually clears out all debts except for those that have special treatment (like tax debts). The medical debts were just lumped in with all the credit cards and other forms of debt.
I can’t answer for everyone, but I know of one special case like what the OP describes.
A friend was working two low-paying jobs and had no insurance. She went in for a routine gyno exam, and found out that her kidneys were not functioning. She was forced to quit her jobs to get treatment, and receive Free Care, which I believe that the hospital paid for. (Or maybe it was the state.) That covered 100% of her visits, dialysis, and transplants. She never owed anyone for it.
I got testicular cancer this year, Jan 2011. For surgergy, my insurance provider paid some and I was stuck with a $2000 bill. My urologist let me pay the $2000 off over time & they set up a nice payment plan for me. For chemo- I had one round -cost around $4000- my insurance company refuesd to pay it and Texas Oncology cut the bill in half and allowed me to pay it off over time. They didn’t even tell me how much to pay every month. The financial person at Texas Oncology just told me to send in each month what I could and as long as I was sending in something I would not be sent to collections. They were really great about it.
My friend had a part time job, no insurance. One morning, she absentmindedly put a pen in her mouth, started coughing, and inhaled the cap of the pen into her lung! She called an ambulance that took her to the emergency room, and they treated her (removed the cap of the pen with some kind of tongs while she was under anesthesia). She spent some time recuperating in a room and went home that afternoon. Total cost: Around $10,000. The financial office and a worker at the hospital told her to write a letter explaining why she couldn’t pay $10,000, and they wrote off most of the bill. She still had to make payments to the anesthesiologist and the ambulance company, on a monthly basis, for a total of less than $1,000. The payments were low and I think after she paid some, they wrote off the rest of it. This was 2-3 years ago.
I have a diabetic friend who was laid off from a good job with benefits, but had a relationship with a few doctors who let her make tiny payments on various treatments until she got another job with health benefits. Then she got extremely sick, almost died, spent over a month in hospital and is now on full disability (not that it pays much; just enough to get by on) and cannot work. So she is, I suppose, now a “ward of the state” and all her health costs and very basic living expenses are taken care of.
But apart from her, everyone I know who’s had to deal with chronic or ongoing illnesses are either already low-income and qualify for medicaid/medicare, has health insurance through work or spouse, or lives in a country where health care is a given. However, I know there are people out there who have no insurance and don’t qualify for the low-income stuff.
But how does one rack up bills for something like cancer, if one can’t afford the presumably very expensive treatment to begin with? How does a person like that even get care?
we have a pharmacy where the owner offered to charge a longtime patient who got laid off and could not afford cobra and was an MS patient to pay what he could for his meds and supplies. He found a home health nurse who offered the cheapest rates (instead of $50 per visit,she dropped it to $20/visit). It was for cortisone IV meds, not the costly MS meds that just came out. Just to relieve symptoms.
His doctor could have dropped him for not having insurance, but since he had been his patient for ten-plus years, his doc still saw him and prescribed meds for him (not sure for free or not). It was fortunate the patient developed long relationships with one local pharmacy and doctor.
Some doctors have stockpiled samples of medications from pharmaceutical reps that they will hand out free to patients in need. My own doctor once gave me handfuls, a month’s worth, of some pill. Can’t hurt to ask. And some patients are eligible for a pharmaceutical patient assistance program, either free or low-cost medications. Gotta ask your doctor about that, too.