How does a millenial pay for cancer, in Florida, without insurance?
July 31, 2013 8:43 PM   Subscribe

My brother has been diagnosed with an acute form of leukemia, and is currently in the ICU. What we know is that he's not going to die tonight. He's got some life left in him. They're not sure about the precise form yet, that will take some time. But in the meantime, we have a problem: he's 31, recently unemployed, and uninsured. My family is far from being able to afford out of pocket health costs. And from all the doctors, drugs, machines he's been hooked up to in the past 10 hours, I know the bill is already creeping into the many tens of thousands of dollars. So my question to MeFites is: what are our options? How do we pay for this? We have very few assets, although I'm sure we'd sell the family home to keep my brother alive for a few more years. But apart from that, we've got nothing substantial. (I'm a graduate student, and my mother is a self-employed seamstress. My father is unemployed). Are there any gov't programs available? Can he go on Medicaid? Etc. I'm having trouble finding hard info on people in his particular situation (not a minor, not elderly, and diagnosed with cancer). Help!
posted by dis_integration to Health & Fitness (19 answers total) 3 users marked this as a favorite
If he was insured under a group plan with his former employer he may still be eligible to opt in for COBRA.

I am so sorry that you and he and your family are going through this.
posted by janey47 at 8:47 PM on July 31, 2013 [1 favorite]

Ask to talk to a social worker at the hospital. The social worker will be familiar with the various programs (including Medicaid) that he may be eligible for. And he may be eligible for retroactive COBRA, even if he didn't sign up initially.
posted by cushie at 8:51 PM on July 31, 2013 [15 favorites]

2nding talk to the social worker at the hospital. I don't know about Florida specifically but if he has no income or assets Medicaid is a likely solution.
posted by entropyiswinning at 8:53 PM on July 31, 2013 [3 favorites]

3rding: talk to the social worker. A friend of mine got onto Medicaid because of his total kidney failure, and not because of the form of cancer which shut 'em down. There's legitimate ways in, and there's loopholes, and both are useful.

Also, just in case it didn't come up in your post: is your brother a veteran, honorably discharged? If so, get his ass over to the VA forthwith.

Are either of your folks veterans with some degree of service-related disability? The VA *might* cover some of his costs:
posted by ivan ivanych samovar at 9:11 PM on July 31, 2013 [3 favorites]

I don't know for sure if they can help but hope you contact the Leukemia and Lymphoma foundation. Their support for patients and their families is a major reason I ran a fundraiser marathon for and with them.
posted by bearwife at 9:25 PM on July 31, 2013 [1 favorite]

Also call Livestrong, this is what they do and they're really, really helpful.
posted by fshgrl at 10:51 PM on July 31, 2013 [1 favorite]

Talk to the ICU social worker about charity care, as well as how to go about getting paperwork started for disability and Medicare/Medicaid. Most hospitals have some resources to help people get the treatment they need, or at least the resources to get people to where they need to go to get access to low-cost or free care.
posted by honeybee413 at 11:04 PM on July 31, 2013 [1 favorite]

This one kid I mentor, one day he notices that he's got this thing on his neck, and for a couple or three weeks he just is like "Oh yeah" but then his mother got on him and he went to a doc. He was 24, if I recall correctly, no insurance, healthy as a horse. Oh, except for this hodgkins lymphoma thing that he's got.

Though he was making considerably less than thirty grand a year -- 24 grand? 25 maybe? -- that was too much to qualify for any aid programs of any kind. (Austin does have a really, really sweet system to help people in trouble, the M.A.P. thing -- Medical Assistance Program -- it's really something. But he made too much money for that one, too, not by much but whatevs.) None of the cancer hospitals or clinics would help him, and none of the local hospitals. Local hospitals told him -- this is the truth here, honest to god -- hospitals told him to come back once he hit stage four, that they'd give him pain management, and a bed to lay in while he died.

Welcome to the US.

He's a stubborn kid, and was not interested in dying just yet, so he called and called and called. Everyone. One day he's on the line with someone in Houston -- we live in Austin, but he was willing to go even to flippin' Houston for chrisakes, if it meant he could live, which seemed a huge sacrifice to me but whatever -- he's on the phone with someone at MD Anderson cancer center, which is like a super hurray hurray cancer hospital, the woman tells him he fits their profile, he doesn't make too much money, come on in tomorrow and let's get rolling!

And the next morning she called him back, said "Whoops! I read the chart wrong, you make too much money and you're fuct still." except Michael was done being fuct still. He told her fuck you, that he was coming down there to Houston that afternoon as laid out the day before, and they were going to help him.

And he did go there that afternoon, and they did tell him to buzz off, and he said "Nope, not good enough -- you're going to help me." and then the woman’s supervisor told him to buzz off and he said "Nope, not good enough -- you're going to help me." and on up the chain and finally he is talking to the person who can actually click the box on her puter screen and magically make it all better, and *she* told him to buzz off, and he said "Nope, not good enough -- you're going to help me." and she went into her office and thought about it a few minutes and then magically somehow she decided that yes, she *could* by gum check the box on her puter screen, and give him a chance to fight this son of a bitching illness. She clicked the box.

Michael was given the chemo and radiation. I forget the dollar amount, what it would have cost him. Fistfuls. A shit-ton. Big bucks. Mucho dinero.

So I don't know exactly how much but I know that if your brother is sick like Mikey was sick, and needs treatment like Mikey needed, it was so much that you cannot afford it, not unless you really have serious money behind you. Like, capital S Serious money. If your brother fits into the slot that Michael fit into -- he made about two grand more in that prior year than was allowed -- if your brother fits into that sort of slot where he made too much money to be accepted for aid of whatever sort, then you are going to have to fight.

It's completely insane, it's totally bizarre, the money is available, our country has the bread if any country does. But if you don't fit into the right slot, you've got to fight like hell to get someone to click the right box on a stupid computer screen.

Michael will help you. I will help you. We both of us are willing to help anyone caught up in this bullshit, jive-ass, nightmare situation. Michael a better source of help than I -- it was after all him that it all came down on. Though I also have had my own interesting times, too; sometime you get bored, I can tell you neat stories. Anyways, pretty much anyone who has been close to this insane situation will help you.

But mostly the only help we can give is cheerleaders. Telling you do not give up the fight.

Keep telling everyone that no, not helping you is not good enough. Finally get good and tired of it all and get good and mad and start jumping up and down and a door will open somewhere. Doors do open when really angry people start jumping up and down and yelling loudly, howling as if their life depended upon it, because it does. You've gotta come on like a one-armed paper-hanger. You've got to come on like a one-man band. You've got to come on like a bizarro, howling psycho mad-woman, because who cares what anyone thinks, you want to buy your brother a birthday present next year, and the year after that, and, more important, you want him to buy *you* stuff, for your birthday(s).

Contact me if you need to, or want to.

Good luck.
posted by dancestoblue at 2:04 AM on August 1, 2013 [48 favorites]

If your brother does get a huge bill from the hospital, don't just accept the dollar amount owed on the bill. The amount owed will likely be hugely inflated and will have no relationship to the actual cost of things. People wiithout insurance like your brother are usually charged much more than an insurance company would pay for the same service. So somebody needs to negotiate the bill down to a much lower amount on your brother's behalf. There are medical bill negotiation services available, so that would be one thing to look into. Also, you should find out if the hospital has a charity policy of some kind.
posted by Seymour Zamboni at 4:40 AM on August 1, 2013 [1 favorite]

A relative of mine has had to go to the hospital for some semi-serious overnight-stay kind of things without health insurance or a ton of means. The solution for this person was to be forthright with the hospital about how much money she made, and to negotiate a monthly payment amount that worked for her, which I think was $100/month or so. She paid it promptly and on-time for I think two years and the hospital forgave the rest. I don't know if that's going to work for you but I'd talk to the hospital however you can.

Good luck. I'm sorry this is happening to you. Take care of yourself and please check in here if you need some support.

Also, just while I'm thinking about it, this:

IF after a while it came down to selling the family home I'd "sell" it to a relative (aunt, cousin, whatever) so you could stay in it, but on paper it wouldn't be connected to the people's going into debt for the treatment. Murica.

is something you have to be very careful about doing.

I am a lawyer but I'm not your lawyer and this is not legal advice, but this is not necessarily a sure way to protect your home. A court is going to want to know where the money went from the sale of that home, and if it is too soon before bankruptcy the court may even unwind the sale and bring the house into the bankruptcy estate if it comes to that. You should talk to a competent lawyer in your jurisdiction about how to do this before too long, especially if it looks like bankruptcy is in your, or someone's, future.
posted by gauche at 6:10 AM on August 1, 2013

The hospital should have someone to ask about charity care options, in addition to Medicaid. They don't necessarily cover the whole cost, but it can decrease the cost significantly.
posted by Sequence at 6:47 AM on August 1, 2013

You should not take seriously any advice about what effect debt and/or bankruptcy will have on a Florida homestead from anyone who is not a Florida lawyer familiar with this area of law.

The Florida Bar runs an online referral service.
posted by one more dead town's last parade at 6:47 AM on August 1, 2013 [3 favorites]

nthing the recommendation to look into COBRA - depending on how recently he was employed, he may be able to retroactively enroll, and the coverage would extend back to the date of termination of his employment. COBRA can be expensive, but it would certainly be cheaper than completely out-of-pocket care.
posted by bedhead at 8:55 AM on August 1, 2013 [1 favorite]

People who can't afford huge medical bills will often hold benefits, such as chili suppers or such to help with costs.
posted by cass at 10:09 AM on August 1, 2013 [1 favorite]

Use any available cash to pay for stuff that doesn't get billed. Negotiate with the hospital on bills. Apply for every assistance program. And if (when) he ends up with massive bills, he should declare bankruptcy. Obamacare is getting closer to getting things better, but until he can get insurance through the Affordable Healthcare Act, he should not avoid care because of the cost. It's a crazy screwed-up system.

I hope he gets better.
posted by theora55 at 10:13 AM on August 1, 2013 [1 favorite]

This happened to my mom the first time she suffered through breast cancer in her early 30s. Medicaid helped, but since she was a single mother and couldn't work for a few months we did wind up going bankrupt and on foodstamps/welfare/etc. for a while. She recovered and was unable to get quality medical insurance for the next few decades due to the cancer being considered a pre-existing condition. She finally qualified for Medicare last year at 65, just in time to be diagnosed with stage four breast cancer after multiple crappy doctors failed to properly diagnose her symptoms until it was too late. The medical system in the U.S. is shameful, and I lost some friendships during the whole Obamacare debate after realizing how so many people are completely without compassion.

There is some great advice in this thread. I can only add that he could try looking in to clinical trials. Some pay for treatment during the trial. Also, please don't lose hope. There have been some great advances in treating leukemia over the last few decades. Your brother is very lucky to have your support as it can be very difficult to get by when you are sick and scared. Best of luck.
posted by Thoughtcrime at 10:50 AM on August 1, 2013 [3 favorites]

Whatever you don't accept responsibility for your brothers health care costs without the advice of a good attorney and when it comes time to settle your brother's bills DO NOT PAY "LIST" PRICE. People with good insurance don't pay list price, their insurance companies don't pay it either, they don't pay anything close to it. I've had bills where the provider got paid well under 50% of what they billed as a matter of course, with no controversy at all.

The other thing is that once he is stabilized, you should get him to a top-tier national cancer center (like MD Anderson, or Fred Hutchinson).

Good luck to you, your family and your brother.
posted by Good Brain at 10:53 AM on August 1, 2013 [1 favorite]

Response by poster: Thanks everyone for your helpful answers and your compassion. My brother may have let his COBRA expire. We're digging through his apartment for the paperwork. He's still in intensive care, but we're in touch with the hospital social worker about our options, and my father has begun the process of contacting places like the Leukemia & Lymphoma foundation. Thanks again, this really has been a great help to us.
posted by dis_integration at 8:11 AM on August 2, 2013

I'm glad you're in touch with the hospital social worker - that's where things get done. Don't fret about paying for any of this right now - just fret over your brother and his need to get his health back. The fact is that only a bare minimum of people who show up in a hospital ICU with something as serious as this have insurance that will pay any appreciable amount. Most patients are either vastly underinsured - most who are employed at low-level or minimum-wage jobs - or completely uninsured, but they do get the same medical care as the insured. DO NOT consider such things as selling the family home, for heaven's sake; that's not necessary, and would probably backfire all over the place. Understand that your brother's care is not dependent upon your financial contribution - he will be cared for whether you pay your last cent or not (and unless you're in much better circumstances than most, you couldn't pay the total medical bill in a lifetime).

I hope with everything I have that your brother beats this.
posted by aryma at 4:10 PM on August 2, 2013

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