Help me save money for a self pay surgery.

June 13, 2016 1:11 PM

I need a surgery, which is elective but that my physicians are recommending for me. This surgery will increase my quality of life. My employer based insurance (BCBS HSA Plan) excludes this type of surgery. Not a loop hole in this plan at all. My employer does not offer any plans that cover this surgery. What are your tips/tricks/advice for saving a large sum of cash?

Here is the biggest problem: After countless consults with different area hospitals, surgery costs at LEAST $15k for self pay. I've spoken with financial people at all locations and all of them state they do not do payment plans, and everything must be paid up front before the surgery.

I am 30 years old and married with a 4 year old son. We like mostly paycheck to paycheck and sometimes have a little left over. I make okay money for someone without a college degree, but I have never been able to effectively save money for anything short of a planned upcoming vacation or Christmas. I am not good at saving money at all and I need some advice.

What is the most effective way to save money for something like this? Do you have any tips, tricks, to help me control the flow of the cash in the best way possible?

posted by Sara_NOT_Sarah to Work & Money (19 answers total)

YNAB

When I started using this I started feeling in control of my money for the first time in my life.
posted by Kriesa at 1:15 PM on June 13, 2016 [5 favorites]

Set up auto-transfers to a savings account with every paycheck. Set this account up so that it is difficult to transfer money from it into your other accounts. This method is so painless you won't even notice it after you get used to the initial adjustment in your budget.
posted by something something at 1:17 PM on June 13, 2016 [4 favorites]

Sorry if you have done this, but have you specifically appealed the "no coverage for x surgery, even if physician-recommended" up the chain at your insurance? They may persist in saying no, but you have little to lose but time, and you're not going to be saving $15K overnight.
posted by praemunire at 1:17 PM on June 13, 2016 [12 favorites]

I find it works best to find cheaper solutions for ongoing needs. So, couponing, shopping sales, cooking from scratch, etc. Be creative about getting your needs met for less instead of simply assuming you must just do without. Find cheaper ways to eat well, keep yourself entertained, etc. That way saving is not simply deprivation.

Also, you might be able to pay for it using a home equity line or borrow against your retirement savings: How to Pay For Surgery Costs That Insurance Won't Pay
posted by Michele in California at 1:28 PM on June 13, 2016 [2 favorites]

People have saved a lot on dental surgery costs in Mexico, you might want to research any options there might be for the type of surgery you're looking for.
posted by IpsoFacto at 1:34 PM on June 13, 2016 [3 favorites]

YNAB or *any* kind of tracking system (even if it's just saving receipts and going over them with a calculator) is going to help because at least then you'll know where the money is going.

If you're just not paying attention and sort of spending money on stuff without thinking (no shame here, everyone does it at some point), tracking alone is going to help a lot. On the other hand, if you take a hard look at the numbers and see that your fixed expenses (stuff like housing, car payments, debt payments, day care) are a high percentage of your income, you'll know that you're going to have to make big changes: moving, downsizing your car, etc. The awesome news is that once you stick with those changes for a while (whether it's big stuff or little stuff) you'll be comfortable with them and you'll be able to continue to save even after you've saved enough for your surgery.

Also, you don't have to answer this here, but think about it: what percentage of your annual household income is $15,000? You probably won't be able to go from saving 0% to saving 50% right away (although you might be able to someday!) but shoot for at least saving 10% or even 20%.

You might also want to check out Dave Ramsey's stuff. He has a tendency to oversimplify but if you feel like you're starting from zero in terms of financial knowledge, he can help a lot.

Also, is your spouse on board? You are going to have to cooperate to do this. But you can do it! This internet stranger believes in you.
posted by mskyle at 1:35 PM on June 13, 2016 [1 favorite]

I've linked to this before about appealing (no personal experience though). YMMV of course.

Also, I am not suggesting that you do this, but what others have done in your situation is to go abroad for the procedure.

I suggest having x% of your paycheck deposited into a bank account from a different bank than your usual account.

You've said that you've checked multiple hospitals for cost estimates. Have you tried searching for hospitals that are further away for "hospital name" + "charity care"?
posted by oceano at 1:40 PM on June 13, 2016

Many medical practices accept Care Credit. It's easy to get and interest free for the first year.
posted by myselfasme at 1:40 PM on June 13, 2016 [4 favorites]

Absolutely, positively recommend YNAB. It doesn't change how much money you make, obviously, but if very clearly shows you where it's going and how you're using it. You then make choices based on a very solid understanding of your money. I've tried all sorts of different methods to budget and this is the only one that works for me. If this surgery is something you really want, you may be surprised by how quickly you adapt to saving money once it's easy to see your choices.
posted by VioletU at 1:44 PM on June 13, 2016

I'm sorry to hear that you're in this position. No one should have to play games of brinkmanship with their finances just to get medical care they need.

This probably isn't workable for someone with a child, but I thought I'd mention that one year when I needed to accumulate cash quickly I intentionally started living in my car so that I could re-direct all of the money I'd been spending on rent into savings. I had the substantial advantage of working a job where I traveled for work quite a lot anyways and already spent lots of time in motels and hotels I was reimbursed for, and even when I was at "home" living in my car the owner of my company had just had a shower installed in the basement to use after he took long lunches to go play his favorite sports, which employees were allowed to use.

So maybe the message (which quite possibly, if you're already living paycheck to paycheck, you already know) is that if rent makes up a big portion of your monthly expenses, finding some way to reduce such a singular large expense can give you access to an "extra" revenue stream.

Also, it's just occurring to me, do you have student loans? If so, maybe you could negotiate a deferment or some other accommodation that would free up space in your current monthly budget by moving those expenses into the future.
posted by Sockpuppet Liberation Front at 1:47 PM on June 13, 2016

I would suggest searching around for "medical tourism + [your_surgery_here]." You may find that it's significantly cheaper to travel somewhere else and pay out of pocket there.

Edit: I know that's not directly answering your question, but just in case you haven't heard about it!
posted by nosila at 2:02 PM on June 13, 2016

I second the suggestions to use auto-deposit to save before you get the money in your account, and to try appealing up the ladder with your health care company and/or your state's insurance commission.

Is this a surgery which is typically not covered by most health care plans, or is your plan unusual in not covering it?

If any health care plans typically cover this surgery, and if it's not something you need immediately, I would at least consider trying to seek alternate insurance coverage (whether through your spouse if their job offers family plan coverage, through finding a new job, or even though self-pay insurance).

Good luck -- it's a very shitty situation to be in.
posted by pie ninja at 2:07 PM on June 13, 2016 [1 favorite]

Definitely take advantage of your HSA (Health Savings Account) if you can! Because of the tax benefits of an HSA, you'll effectively be "saving" that tax money by using the HSA -- and of course, if your employer provides a contribution match to the HSA, that's free money too. See this IRS publication for more details on contribution limits and tax benefits, and this IRS publication for a detailed list of what medical expenses can be paid for with an HSA. Make sure you check that you're allowed to use the HSA for the surgery you're planning, and make sure you stay under the yearly limits for contributions to your HSA.

Automatic deductions from your paycheck are very helpful -- you can generally set them up with your employer just like you set up Direct Deposit. In the past, I've found it helpful to auto-deduct money into a separate account that's a little bit difficult to access -- like an internet savings account with no debit card, for instance.

I also nth the YNAB recommendation -- it really works, and they've got great free articles and classes to teach you how to use it. If you feel a bit intimidated like that, you could also try starting with the simpler cash envelope system.

Do you have an emergency fund? If you don't, any little mishap could cause you to raid your savings and set back your goal. Can you put away $25 month? $25 per paycheck? $25 per week? You'll be shocked at how fast it adds up, and you'll be pleasantly surprised at the peace of mind it brings you.

Have you (and/or your spouse) thought about getting a second job to help save up for this? If you can, between the two of you, work 20 extra hours per week for $15/hr and sock all of that money away, then you get to your goal in just a little over a year.

The personalfinance subreddit actually has a great, very concise guide for getting your financial life together. You might find that the guide, and the subreddit itself, offer some useful ideas and support.

Good luck!
posted by ourobouros at 2:16 PM on June 13, 2016

I'm sorry, this is awful. I agree that setting up a budget will help you see light at the end of the tunnel. Paycheck to paycheck is the reality for a lot of us but then again, sometimes we get so used to that, we don't realize there is a little more room for savings than we thought until we really buckle down and look at where the money goes.

Is it time to ask for a raise at your job? Whatever they can throw you, you can have directly deposited into your surgery savings account and you'll never miss it.

Is there some daily vice that you can give up or substitute something cheaper? Expensive coffee, drinks at a bar, lunch out, junk food, cable tv? Then you can deposit the savings into your surgery account.

Are you comfortable setting up a gofundme or similar fundraising site and reaching out to your contacts?

Can you or anyone in your household find part time work? Delivering papers, working at a store where you already shop (paycheck + discount!), something freelance? Then the total income goes to your surgery account directly.

I agree with others that you can shop around for cheaper locations and there is no harm in really pursuing this with insurance or with a medical facility. Wouldn't they rather have say half the $ in a lump sum with more to come in installments, than have to refer you to collections and never get a cent? You can be a squeaky wheel, you might get the right person to listen to you.

Are you comfortable with the idea of taking out a loan or running up credit card debt? You would of course have to pay interest and there are a lot of bad deals out there but at least you would be paying in installments. This seems stressful and like digging yourself deeper, but might be a last resort if you can't quite save enough and can resign yourself to being in debt if you feel the results of the surgery outweigh that stress.
posted by kapers at 2:26 PM on June 13, 2016

I had 2 surgeries in the last few years that were charged at about $15K each. My insurance (also BCBS) approved and paid about $6K for each one. The rest somehow disappeared. I know you wrote that you've already talked to the financial people at the hospitals, but you also wrote that the surgery costs at least $15k for self pay. It might be worth asking them what insurance would pay, if they paid. If the hospitals are willing to settle for 40% of their billed price from insurance companies, which they clearly are, you might be able to talk someone into accepting 50% from you.

I don't understand why this is the case, but since I started reading my BCBS statements, it's true in so many cases. Doctors, dentists, hospital costs, drugs: BCBS pays much less than I paid myself when I was underinsured.
posted by still_wears_a_hat at 2:40 PM on June 13, 2016 [6 favorites]

Another idea: Check around and see if there are any reality TV shows that might be interested in this type of surgery. They'll pay for it if you're suitable for the show.
posted by Coffeetyme at 5:10 PM on June 13, 2016

Oh yeah, make sure you talk to the hospital and find out if they would be able to write off the difference between the list price and the insurance price. As still_wears_a_hat mentioned, medical providers never get the "full price" from insurance. It's criminal that they charge patients that amount!
posted by radioamy at 5:24 PM on June 13, 2016

Even if it's not covered you may be able to get the BC/BS discount by running it through the insurance company.
posted by COD at 5:29 PM on June 13, 2016 [2 favorites]

If moving in with family is an option, even if it's uncomfortable, it may be worth it. Rent is a huge expense.
posted by metasarah at 7:05 PM on June 13, 2016