My brother needs his knee fixed but can't pay for it.

October 26, 2011 10:35 AM

My brother was scheduled to have knee surgery, but has just lost insurance coverage. How can I help him?

tldr: My 21-year old younger brother needs knee surgery, has no money, and his insurance coverage ended 12 days ago. He lives in MI, USA. How can I make this happen for him?

details:

My younger brother is 21 years old. He has some kind of...thing, in his knee that has been causing him constant pain. I'm sorry I don't know the details - it could be a tumor, bone fragment... I don't know. I do know that doctors don't believe it to be malignant or life-threatening. But it makes it difficult for him to stand or walk or enjoy life, and it's been getting gradually worse for the past few months.

He was scheduled to undergo surgery to fix this problem tomorrow, October 27. Unfortunately, he cancelled his appointment because he recently lost health coverage. He was covered under my father's health plan. But my father lost his job on October 14. For a while it looked like my father's health insurance would continue until the end of the month, but we recently got confirmation that his coverage ended on October 15, the day after he was let go.

My brother is very upset that he will not be able to have this problem corrected. He works part-time at a retail establishment; his job requires him to be on his feet all day. This has become very difficult for him in his current condition. His employer does offer health insurance, and his new insurance kicks in in another week or so. However it is very minimal insurance. It looks like their coverage for surgical procedures is only $400 per year! My Mom estimates that the base cost for the surgury is upwards of $10,000, so my brother's insurance wouldn't make a very big dent in that.

My parents are exploring their options - they mentioned applying for Medicare. My Dad could theoretically get COBRA, but there's no way they could afford it. My parents are in bankruptcy right now and have no money and no income. The family's doing our best to keep them housed and fed while my dad looks for a new job.

I would like to intervene and make this surgery happen for my brother. How can I do that?

I am reasonably stable in my current condition. I am employed full-time and do not live with my parents and the rest of my family. I know there's never any guarantees, but my job looks to be as stable as a job can be right now. I am far from rich, but I have enough money to pay for my own expenses, plus a little extra. I'm already giving my parents all the monetary support my income allows while my dad looks for another job, but I'm willing to get into a little bit more debt if it helps my brother out. I don't think I can get a multi-thousand dollar loan right now though, because I already have a fairly high debt-to-income ratio (the last time I applied for credit I was declined for this reason). I'm willing to try though.

What are my options here? One thing that came to mind is that I could have my brother get an individual insurance policy, and I could pay the premiums. I was looking at this plan, for example. It covers surgery 70% in-network with an annual out-of-pocket maxmium of $3500. It says pre-existing conditions aren't covered for the first 180 days. But my understanding is that you can get around that if the gap between the new coverage and your previous coverage is less than 63 days. Is that correct? However, I realize that we might still be talking about me paying $3500+$200/month for this, and I'm not sure I can come up with that money. Also, I'm not sure how something like this would interact with his work-sponsored plan that has a $400 limit. Do they stack up so that the first plan would pay $400 and the second plan would pay the rest? Can you even have 2 health care plans?

I really don't know what I can do here, but I want to do something. Any suggestions?

My brother lives in Michigan, USA.

Thanks Mefites.

posted by Vorteks to health & fitness (16 answers total)

Pay for one month of your father's COBRA and have him get the operation soonest kind. Also have him talk to the Dr. Maybe he can get a reduced rate and a payment plan. Hospital would have to be onboard too.
posted by JohnnyGunn at 10:45 AM on October 26, 2011 [3 favorites]

Talk to the surgeon and the hospital and see if there's anything they can do to lower the costs. One of my relatives needed some surgery and the hospital was able to enroll her in a special plan for low-income people. She still ultimately ran up several thousand dollars in bills, but the hospital accepted a $50 per month payback plan.
posted by BlahLaLa at 10:46 AM on October 26, 2011

I'm sorry for your family's situation. To help I would try to get the COBRA paid for. That way most of the procedure can get covered. Definitely talk to the doctor's office regarding the situation as they will work to make sure to get the surgery done while in the coverage time. As for the remaining amount due after insurance you will be able to work out a payment plan with the hospital.
posted by Mister Fabulous at 10:59 AM on October 26, 2011 [2 favorites]

I agree that paying for the COBRA is going to be the best way to make this happen for your brother. Especially if that plan had good surgery coverage.
posted by kimdog at 11:03 AM on October 26, 2011 [2 favorites]

Nthing COBRA. I am going through a knee thing right now and have a somewhat uncertain employment outlook. I was just thinking the other day how I would manage if I lost my job and benefits... I'd suck it up and pay for COBRA until I my treatment was done!
posted by FlamingBore at 11:07 AM on October 26, 2011 [1 favorite]

Yes, you picking up a month or two of COBRA costs will absolutely be the easiest way for you to do this.
posted by iminurmefi at 11:10 AM on October 26, 2011 [1 favorite]

Paying for a month or two of your father's COBRA will almost certainly be the cheapest and easiest solution for this. If you try to do payment plans you will need to negotiate separately with every single entity that sends you a bill (and for surgery, this is frequently not just the surgeon, but the anesthesiologist, the hospital that provided the operating room, meds, and nurses, the pathologist who looks at the thing that came out of the knee, etc.) Plus if you pay for COBRA --bonus!--your parents will have coverage too, until they figure out what they're doing for insurance. If they've already declared bankruptcy and one of them has an expensive health emergency in the near future, they will be SOL with the bills from that since they won't be able to declare bankruptcy again for the next 7-10 years. Better to maintain coverage.
posted by The Elusive Architeuthis at 11:23 AM on October 26, 2011 [1 favorite]

Your brother is 21. If his income is low and he doesn't have any valuable assets he may well be eligible for Medicaid. Your parents may too, if they are under 65. Medicare is for people 65 and older. Check out
form for info on eligibility and application procedures.
posted by mareli at 11:44 AM on October 26, 2011

Link disappeared, let me try again. This form.
posted by mareli at 11:45 AM on October 26, 2011

Thanks everyone. Can anyone tell me what the time window is for getting COBRA? I thought I had read somewhere that you had to enroll within 14 days of losing your job, but my Mom tells me that isn't the case.
posted by Vorteks at 11:52 AM on October 26, 2011

Call the employer and ask about COBRA options. Alternatively, google "'COBRA' + your state".
posted by 200burritos at 11:58 AM on October 26, 2011

A quick google indicates that your brother should have 60 days from notification of COBRA availability to submit an enrollment form (here is a helpful site, assuming your father worked in Michigan). Once your brother is enrolled, his coverage will be retroactive to the date the prior policy ended, so any medical expenses incurred now would be covered.

Also note that COBRA is available separately to each qualified individual, meaning that your father does not have to enroll in COBRA for your brother to enroll.
posted by unsub at 12:54 PM on October 26, 2011 [1 favorite]

Also note that COBRA is available separately to each qualified individual, meaning that your father does not have to enroll in COBRA for your brother to enroll.

Yes this. While it's a horrible situation, your brother can get on the Cobra plan by himself, your dad does not need to elect it too. And there is no realistic way getting this surgery can be done cheaper, easier, or quicker than just paying for the Cobra - no worries about waiting times, pre-existing conditions, or not having access to the doctors your brother was seeing before.

But your brother should reschedule the surgery asap while you figure out the Cobra, it's a shame he cancelled it, and it will suck if he can't get in with the surgeon for another six months!
posted by crabintheocean at 1:15 PM on October 26, 2011

Or go abroad. I had knee surgery I'm Europe totally out of pocket for $5K. Including physical therapy. It was removing loose cartilage so it sounds similar.
posted by fshgrl at 2:00 PM on October 26, 2011

If he's low income enough he can also possibly get retroactive Medicaid. Is the surgery going to be done at a hospital? If so, there should be a social worker on the staff there who could help get Medicaid or Cobra sorted out. The HR department at your father's old job might also help too.
posted by mareli at 2:03 PM on October 26, 2011

Thanks everyone. It looks like we have a solution. I just called my family and told them to reschedule the surgery ASAP, and I would pay for a month or two of COBRA to make it possible. I was able to get money to do this by refinancing my car - I didn't owe that much on it and I was able to get a few thousand dollars more out of the loan while keeping the same monthly payment, just extending the length for another 20 months. So the short-term pain will be minimal.

I'm so glad to have a solution! Thanks again!
posted by Vorteks at 2:44 PM on October 26, 2011