urgent health insurance purchase: how fast can it be bought?
May 5, 2014 10:23 PM Subscribe
My friend "Rita" is gravely ill. She wants to go see an out of state doctor ("The Specialist") who is maybe the last person who could help her, but her current insurance doesn't cover his office. She needs to buy some new insurance as soon as possible. How?
Details and more specific questions:
--Rita got married two weeks ago. She has Health Insurance A.
--Rita's husband has Husband's Health Insurance. It does cover The Specialist. Husband could add Rita, BUT
--Rita was in Stupid Hospital on May 1st, Husband's Health Insurance doesn't cover Stupid Hospital, and Husband's Health Insurance says that if they retroactively add Rita for the month of May, she will retroactively be DROPPED from Health Insurance A and be "on the hook" for all costs incurred during her May Day hospitalization ($$$). They say that they can add her mid-month, but her health is so bad that it might not be relevant by then.
Sorry that this reads like an algebra equation. My question is, is there any way to buy Rita some insurance which would start today? And if nobody here knows for sure, who should I try to talk with? Thanks AskMe.
Details and more specific questions:
--Rita got married two weeks ago. She has Health Insurance A.
--Rita's husband has Husband's Health Insurance. It does cover The Specialist. Husband could add Rita, BUT
--Rita was in Stupid Hospital on May 1st, Husband's Health Insurance doesn't cover Stupid Hospital, and Husband's Health Insurance says that if they retroactively add Rita for the month of May, she will retroactively be DROPPED from Health Insurance A and be "on the hook" for all costs incurred during her May Day hospitalization ($$$). They say that they can add her mid-month, but her health is so bad that it might not be relevant by then.
Sorry that this reads like an algebra equation. My question is, is there any way to buy Rita some insurance which would start today? And if nobody here knows for sure, who should I try to talk with? Thanks AskMe.
I don't know the answers, but it may depend where she lives, if you feel like you can share that info.
posted by LobsterMitten at 10:30 PM on May 5, 2014
posted by LobsterMitten at 10:30 PM on May 5, 2014
Has she asked yet how much seeing The Specialist would cost to pay out of pocket, for at least this initial visit? A lot of plans do cover out of network but at less preferable rates, and then there's always the option to just ask how much it would be to pay in cash.
posted by Sequence at 10:32 PM on May 5, 2014 [2 favorites]
posted by Sequence at 10:32 PM on May 5, 2014 [2 favorites]
Oh, and I guess one more angle on this would be: If Rita were to die owing Stupid Hospital money, would Husband and/or Child inherit Rita's health care debt?
Spouse, yes. Child, possibly. A lot depends on circumstances and local laws. My dad nearly lost everything when stepmom died from cancer complications. Even if the patient is unable to be saved, the hospital has still expended significant resources and labor in the attempt, and that doesn't just go away.
posted by xedrik at 10:37 PM on May 5, 2014
Spouse, yes. Child, possibly. A lot depends on circumstances and local laws. My dad nearly lost everything when stepmom died from cancer complications. Even if the patient is unable to be saved, the hospital has still expended significant resources and labor in the attempt, and that doesn't just go away.
posted by xedrik at 10:37 PM on May 5, 2014
Call Health Insurance A to see if she would really be dropped. When my husband and I both worked, I was covered under both my insurance and his. When there was a bill, my insurance paid first and what ever was left over would be paid by his insurance (more or less). So I'm wondering if that was bad information.
posted by metahawk at 10:49 PM on May 5, 2014
posted by metahawk at 10:49 PM on May 5, 2014
Since you say "out of state" in the tags and use a dollar sign, I'm going to assume US.
Rita's marriage probably qualifies as a qualifying event that would allow her to buy insurance on the Affordable Care Act Health Insurance Exchange, even though the open enrollment period has ended. ("Open enrollment" means anyone can enroll; only people with qualifying events like a marriage, divorce, new job, job loss, birth, etc. can enroll at other times.)
So depending on what state Rita lives in, she or you should go to either HealthCare.gov or her state's insurance exchange.
posted by jaguar at 10:49 PM on May 5, 2014
Rita's marriage probably qualifies as a qualifying event that would allow her to buy insurance on the Affordable Care Act Health Insurance Exchange, even though the open enrollment period has ended. ("Open enrollment" means anyone can enroll; only people with qualifying events like a marriage, divorce, new job, job loss, birth, etc. can enroll at other times.)
So depending on what state Rita lives in, she or you should go to either HealthCare.gov or her state's insurance exchange.
posted by jaguar at 10:49 PM on May 5, 2014
This sounds like a nightmare. I'm so sorry. My only advice is to confirm with Rita's HR and insurance co. that the dropping would be retroactive. Get as much in writing as you can. Reach out to the doctor too and make sure they are aware of the entire situation.
posted by bleep at 11:05 PM on May 5, 2014
posted by bleep at 11:05 PM on May 5, 2014
Going through the exchange will likely be too slow--policies won't start until (probably) next month.
Seconding Metahawk about checking if she'll really be dropped.
Husband's insurance won't cover Hospital A at all, or won't cover it in network? Because the latter is much more common, in my experience--they'll cover it, but it's out of network and the patient is on the hook for 20/35/50% of the bill. But that's better than nothing. Depending on how much money Rita and her husband make, the hospital may be willing to negotiate the balance with them, whether that's been partially covered by insurance or not. Calling and saying "ok, my insurance has paid $x, and I can't afford the remainder--can we discuss payment plans or charity care?" has pretty consistently yielded good results for me.
posted by MeghanC at 11:07 PM on May 5, 2014 [1 favorite]
Seconding Metahawk about checking if she'll really be dropped.
Husband's insurance won't cover Hospital A at all, or won't cover it in network? Because the latter is much more common, in my experience--they'll cover it, but it's out of network and the patient is on the hook for 20/35/50% of the bill. But that's better than nothing. Depending on how much money Rita and her husband make, the hospital may be willing to negotiate the balance with them, whether that's been partially covered by insurance or not. Calling and saying "ok, my insurance has paid $x, and I can't afford the remainder--can we discuss payment plans or charity care?" has pretty consistently yielded good results for me.
posted by MeghanC at 11:07 PM on May 5, 2014 [1 favorite]
Sorry to hear about this.
In re: to debts being passed on to survivors, the answer is usually "no." California, Arizona, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington and Wisconsin are Community Property states (source), where a spouse can be held responsible, but I don't know of any case where a child can be held responsible.
posted by drjimmy11 at 12:23 AM on May 6, 2014
In re: to debts being passed on to survivors, the answer is usually "no." California, Arizona, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington and Wisconsin are Community Property states (source), where a spouse can be held responsible, but I don't know of any case where a child can be held responsible.
posted by drjimmy11 at 12:23 AM on May 6, 2014
Response by poster: Her original health insurance doesn't cover The Specialist, full stop, and Husband's Health Insurance doesn't cover Stupid Hospital, full stop. It is a really dumb and unfortunate situation, and yes, we are in the States, I should have said that at the outset.
We should call her insurance in the morning. It was Husband's Health Insurance who said that she would be retroactively dropped once she started with them, but it would be great if they were wrong.
posted by sockanalia at 1:08 AM on May 6, 2014
We should call her insurance in the morning. It was Husband's Health Insurance who said that she would be retroactively dropped once she started with them, but it would be great if they were wrong.
posted by sockanalia at 1:08 AM on May 6, 2014
It is very unusual that an out of state specialist is "the last person who can help" unless she has an exceedingly rare disease or condition. Medicine doesn't really work like that for your more common situations, anyway. Yes there are better and worse docs, but unless you are talking about a clinical trial or very rare condition, you should be able to find someone with the same approximate expertise, probably in network, at any major teaching hospital in most US cities. Have you exhausted the search for a competent specialist more locally, including asking Out of State Doc for her recommendations among docs covered by your friend's policy now?
Most medical treatment is not secret knowledge. It can seem like that to a gravely ill person and her family and it's tempting to believe in the One Great Doc hypothesis (and I admit I've seen it work that way). But I would not give up seeking the same expertise and approach to care as Out of State Doc offers in your own network.
If the care she needs really is not available in her current network, I'd also look at hiring a lawyer to make her current insurance chip in.
posted by spitbull at 5:44 AM on May 6, 2014 [4 favorites]
Most medical treatment is not secret knowledge. It can seem like that to a gravely ill person and her family and it's tempting to believe in the One Great Doc hypothesis (and I admit I've seen it work that way). But I would not give up seeking the same expertise and approach to care as Out of State Doc offers in your own network.
If the care she needs really is not available in her current network, I'd also look at hiring a lawyer to make her current insurance chip in.
posted by spitbull at 5:44 AM on May 6, 2014 [4 favorites]
Is paying cash to teh specialist fo rhte initial visit cost prohibitive. In times when I had shitty insurance, I found it was often cheaper to pay out of pocket circumventing insurance all together than to pay my share of the insurance cost becuase the doctor's offices had reduced cash rates compared to what they charged insurance companies for their services. This was all pre-ACA.
posted by WeekendJen at 6:57 AM on May 6, 2014
posted by WeekendJen at 6:57 AM on May 6, 2014
Is her insurance through an employer or a State Exchange? You also need to say which state Rita is in. A social worker is the person who can help you navigate this. Ask the hospital to connect the family with a social worker.
In short, no, there is no insurance you can buy in the morning and take to a doctor by lunch hour. That is not really the point of insurance. Insurance is a long bet on someone's health.
In the US, health insurance is conflated with access to health care. Rita does have access to health care, through her current insurance. She also has access to "THE Specialist" through her current insurance, it will just cost her dramatically more. If the worst comes to it, what is her out of network out of pocket maximum? Is it something you could afford to pay or is it bankruptcy territory?
Has she seen "A Specialist" in her network? Has she seen 2 or 3 of them? What is the provenance of "THE Specialist"?
Seconding spitbull, medicine doesn't really work that way. Sure you can have one or two doctors who aren't awesome, but no one doctor has mystic healing power.
I would treat any doctor claiming to be the ONE source of true information or treatment of gravely ill patients with high levels of suspicion. Thats the song of a quack and charlatan taking advantage of vulnerable people, not a doctor.
posted by fontophilic at 7:01 AM on May 6, 2014 [2 favorites]
In short, no, there is no insurance you can buy in the morning and take to a doctor by lunch hour. That is not really the point of insurance. Insurance is a long bet on someone's health.
In the US, health insurance is conflated with access to health care. Rita does have access to health care, through her current insurance. She also has access to "THE Specialist" through her current insurance, it will just cost her dramatically more. If the worst comes to it, what is her out of network out of pocket maximum? Is it something you could afford to pay or is it bankruptcy territory?
Has she seen "A Specialist" in her network? Has she seen 2 or 3 of them? What is the provenance of "THE Specialist"?
Seconding spitbull, medicine doesn't really work that way. Sure you can have one or two doctors who aren't awesome, but no one doctor has mystic healing power.
I would treat any doctor claiming to be the ONE source of true information or treatment of gravely ill patients with high levels of suspicion. Thats the song of a quack and charlatan taking advantage of vulnerable people, not a doctor.
posted by fontophilic at 7:01 AM on May 6, 2014 [2 favorites]
So it's possible that this specialist is doing a drug or treatment trial for which Rita is eligible. If this is the case and that is why Rita needs to see this particular specialist, you may be able to get her insurance to cover it even though it is out of network. It will take a lot of time on the phone to get it approved but it can happen. Call the specialist's office and see if they have suggestions about this.
posted by sockermom at 7:11 AM on May 6, 2014 [1 favorite]
posted by sockermom at 7:11 AM on May 6, 2014 [1 favorite]
Sorry, I need to add that you need to confirm if her health insurance does have out of network coverage or not. Some budget/ACA plans do not, and this is because adequate care should be able to be provided by in network providers.
Just looked this up, if she does have an ACA "Bronze" plan, her maximum out of pocket in a given year is $6,350 for an individual plan. Some do or do not have out of network coverage. If she does have out of network coverage, she needs to ask the question if $6,350 is worth it to see The Specialist.
posted by fontophilic at 7:12 AM on May 6, 2014 [1 favorite]
Just looked this up, if she does have an ACA "Bronze" plan, her maximum out of pocket in a given year is $6,350 for an individual plan. Some do or do not have out of network coverage. If she does have out of network coverage, she needs to ask the question if $6,350 is worth it to see The Specialist.
posted by fontophilic at 7:12 AM on May 6, 2014 [1 favorite]
Ask the specialist if they are willing to consult with a doc in Rita's area/insurance through telemedicine. Usually a doc who is the "only one" who can treat a disease is more than willing to consult with other docs to share knowledge and save lives. If the doc refuses to do that on grounds of him/her not making money on his/her knowledge, well....think about that.
Have you Googled Rita's diagnosis? Found any journal articles or research done on it? That could help you find docs in the area or in her insurance who has some knowledge of the condition. Also ask her insurance for docs in their network who treat her disease and the. Google them to see if they are writing/researching.
Where did the hospital refer her to for aftercare?
posted by MultiFaceted at 7:12 AM on May 6, 2014 [1 favorite]
Have you Googled Rita's diagnosis? Found any journal articles or research done on it? That could help you find docs in the area or in her insurance who has some knowledge of the condition. Also ask her insurance for docs in their network who treat her disease and the. Google them to see if they are writing/researching.
Where did the hospital refer her to for aftercare?
posted by MultiFaceted at 7:12 AM on May 6, 2014 [1 favorite]
Has anyone spoken to The Specialist's office? His billing staff, who work with the insurance companies all day long, may have some good advice.
posted by vignettist at 8:41 AM on May 6, 2014 [2 favorites]
posted by vignettist at 8:41 AM on May 6, 2014 [2 favorites]
I would treat any doctor claiming to be the ONE source of true information or treatment of gravely ill patients with high levels of suspicion. Thats the song of a quack and charlatan taking advantage of vulnerable people, not a doctor.
This is unfortunately all too true. Gravely ill patients and their families are very often (and understandably) victims of false promises from docs pushing outlier treatments at best, quackery at worst.
posted by spitbull at 9:22 AM on May 6, 2014 [3 favorites]
This is unfortunately all too true. Gravely ill patients and their families are very often (and understandably) victims of false promises from docs pushing outlier treatments at best, quackery at worst.
posted by spitbull at 9:22 AM on May 6, 2014 [3 favorites]
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posted by sockanalia at 10:26 PM on May 5, 2014