Ongoing medical bills, no insurance, and location complications.
November 16, 2014 11:05 PM   Subscribe

Young couple living out their dream came to an abrupt halt in October. He was diagnosed with a particularly aggressive form of melanoma. They had not signed up for Affordable health care insurance, since they were planning on traveling and working around the country. And hey, they are young and healthy, right??

My daughter and her husband are living in Wyoming, working seasonal jobs that ended in October. They have done this for the last 4 years. This year they decided to stay for the winter, and he has already gotten a job that starts in January 2015. Daughter has been applying for jobs also; they are both dedicated hard working people. She has a biology degree and he has a business degree. He is a chef. She is 28, he is 30.

She noticed a mole on his shoulder looked different, and long story short, he just had his second surgery. The good news is that the full body scan and biopsies are all clear and for the time being, he's OK. He will probably be looking at some sort of chemo, to kill any cancer cells that the surgeries missed. They are going to Huntsman Cancer Institute in Salt Lake City, which is 6 hours from where they live, in Jackson Hole. The doctor who is treating them and the facility are discounting the costs somewhat, but they went from being debt free to owing many thousands of dollars, with more to come as his situation unfolds. They have both paid off their college loans and had been living in an RV that they bought and renovated, to be able to save more money during the summer. They are now renting an apartment for the winter in Jackson.

His upcoming job will offer insurance after 3 months. Yes, he told them about the medical issue when he applied. What they are trying to figure out is what financial course of action to take. They have looked into affordable health care option, which looks like it will cost them in excess of $500 a month. Should they look into private insurance? The magnitude of the mounting medical bills is staggering. He will be looking at yearly scans and near constant monitoring to catch any new cancer. The doctor told them that this will almost certainly happen. We just don't know where to start to unravel this and get a handle on how to deal with the crushing debt.

So, first, how to get insurance, based on all the complications involved? Second, are there sources of financial aid or assistance for medical bills of this magnitude? Any other helpful advice is more than welcome. We are trying to help them by finding resources and asking questions, hence this plea to AskMe! And I forgot to mention, we the parents,both his and hers, are in Ohio. This all played out in just over a one month span of time.
posted by anonymous to Work & Money (11 answers total) 1 user marked this as a favorite
$500 per month barely covers an office visit and a lab test or two if you're paying out of pocket, and depending on the physician and/or the tests might not even cover that.

Of course they should do whatever they can to get insured until his employment-linked insurance kicks in in three months and you should find out the details of that plan to find out whether it will meet their needs or whether they need a better plan than the employer offers.

I'm sure it seems like a lot of money.. because it is. But the option not to spend a lot of money is pretty much gone at this point. The choice is now between spending a lot of money or spending a mind-boggling amount of money.

I'm very sorry to hear about their misfortune but happy to hear that they apparently discovered it early. Good luck to your daughter and son-in-law.
posted by Nerd of the North at 12:12 AM on November 17, 2014 [12 favorites]

They should immediately apply for Medicaid. I have no idea if they'd qualify or not, as it'll depend on income and location and a bunch of other stuff, but if they do, they can apply to have three (if I remember right) months of bills covered retroactively.

In the event that they don't qualify for Medicaid, they're probably out of luck regarding whatever debt they've already incurred--this is why medical bankruptcy is such a big deal in this country. They can apply for charity care from the hospital, or they can attempt to negotiate reduced bills, and that could get them some relief, but it's a case-by-case thing done by the hospital itself. Sometimes it works, sometimes it doesn't.

If they don't qualify for Medicaid, they should immediately sign up for the most comprehensive medical plan that they can. $500 a month is pocket change compared to what cancer treatment or a hospital stay will cost out of pocket, and they can drop the coverage when his job's coverage kicks in.

In the event that insurance can't be acquired, for whatever reason, they should brace themselves for an uphill battle, and round up as much cash as they can to be used to facilitate access to services. I've had major but non-cancer health issues while uninsured, and it really, really sucks. Getting insurance ASAP will make everything so much easier--few things are as defeating as knowing that you need follow-up care and being unable to get it because you don't have the cash to pay up front for your tests/appointments/etc. I found it comforting to remind myself that bankruptcy was an option, and that even if it came to that, it'd fall off in seven years--that may not be a helpful thing for everyone, but feeling like I had a plan made things a lot easier for me.
posted by MeghanC at 1:58 AM on November 17, 2014 [8 favorites]

Make sure to coordinate with his doctors to ensure the plan he signs up for is one they're in-network with. I would suggest calling the office with plan names to run by the staff. And definitely do check on the Medicaid option; with Wyoming not expanding Medicaid they're probably SOL on that option but it's worth a shot.
posted by ThePinkSuperhero at 2:05 AM on November 17, 2014 [3 favorites]

I'd strongly encourage them to keep calling the ACA people and see if there's something that can be worked out. It may well be that if they keep calling and keep asking, somebody somewhere in the system can help them. They shouldn't take the first few no's for an answer. They need to plead their case to a supervisor's supervisor.

This year I was diagnosed with colon cancer and got it treated at UCLA, and the whole thing was paid for by Medi-Cal, all thanks to Obamacare. The level of care I received was amazing. It was a huge pain to get covered and stay covered all through my treatment, there was a lot of red tape. But it literally saved my life.

I found that having cancer has a way of making bureaucrats take your questions and complaints more seriously. If you're just some schmo with agonizing arthritis, they'll put you on hold and probably forget about you. But tell people you've got cancer, and that gets their interest.

Maybe I've just been absurdly lucky. But I'm poor and I had cancer, and this year I got a big hunk of my colon hacked out and I stayed in a lovely room with nice nurses and an amazing view, and Obamacare paid for the whole damn thing. So, please tell your daughter and your son-in-law to keep working on their ACA coverage. I've got my fingers crossed that they'll reach somebody who takes this seriously, punches a few buttons and moves a few mountains.
posted by Ursula Hitler at 4:28 AM on November 17, 2014 [7 favorites]

I'd strongly encourage them to keep calling the ACA people and see if there's something that can be worked out. It may well be that if they keep calling and keep asking, somebody somewhere in the system can help them. They shouldn't take the first few no's for an answer.

I'm not sure where you got the idea that these people have been "denied" by ACA. No one said no, someone said "$500", which as noted above sounds like it's far less than the monthly cost of the actual cancer treatment.

They can buy their own insurance now and it will cover costs incurred until his work insurance kicks in, at which time he can cancel the other policy. This doesn't sound like a borderline situation where the actual medical costs might not exceed the cost of the insurance policy -- it is most likely overwhelmingly favorable to have insurance as soon as possible than to not.
posted by telegraph at 5:21 AM on November 17, 2014 [6 favorites]

Seconding the importance of applying for insurance immediately due to the ability to get retroactive coverage. There are financial counselors at the hospital whose sole job is to help them navigate whether they qualify for Medicaid or what other options they have and help them get their application started immediately. Hospitals have an interest in doing this, obviously, because they know you cannot squeeze blood from a stone and that people with no money can't pay hospital bills.

Even more critical is to get the ball rolling on coverage prior to chemo. If you think what has been done so far is expensive, wait til you see how much chemo costs. Best of luck to them, thank god it was caught early, melanoma kills too many young people. And thank you for asking this question so that I can link to it when people ask if they should go temporarily without insurance because they are "young and healthy."
posted by treehorn+bunny at 6:06 AM on November 17, 2014 [5 favorites]

Just to clarify a few items:

No health care plan is allowed to charge more due to pre-existing conditions anymore, so don't even make that a worry.

Insurance plans listed on the website are private insurance plans. The website, if they enter their expected annual income, will tell them if they are eligible for federal subsidies on their premium (that's the "affordable" part), so make sure that they've entered their expected household income correctly when they're shopping there.

If they have entered their income correctly, it looks like $500+ means they make (or will make) too much money for federal subsidies. This implies they will make more than 400% of the poverty level, which looks like it's about $60,000 for a two-person household. If it seems right that they will make $60,000 or more, then assume the $500+ is about right for private insurance.

Medicaid will not be an option if they are applying in a state that did not expand Medicaid coverage, as Wyoming did not, because they do not have children or disabilities. This also screws them over if they are making below $15,730, it seems, because then the federal government thinks they should qualify for expanded Medicaid but Utah did not expand Medicaid, leaving a huge gap.

If they make less than $21,707, I would look into whether the state where his new job is has expanded Medicaid coverage, or any state within reasonable commuting distance has expanded Medicaid, and ask them to consider moving there immediately. As others have said, Medicaid will cover a lot of treatment retroactively.
posted by jaguar at 7:16 AM on November 17, 2014 [4 favorites]

Some types of cancer (or maybe all?) immediately qualify you for disability and Medicaid.
posted by bleep at 8:31 AM on November 17, 2014 [2 favorites]

Some types of cancer (or maybe all?) immediately qualify you for disability and Medicaid.

Here are the Medicaid eligibility guidelines for Wyoming. Breast and cervical cancer are the only cancer-related categories listed. Other disabilities seem to require that the patient meet the Social Security guidelines for disability, which generally include not being able to work due to the condition.
posted by jaguar at 8:41 AM on November 17, 2014

Second, are there sources of financial aid or assistance for medical bills of this magnitude?

To be blunt, bankruptcy is the option for relief of medical debt.

Your basic guide posts are:
  • Get him insurance as soon as possible. I'm sorry but 30 is not a kid living out a dream. This is exactly the reason you need health insurance. He can not be denied coverage for his existing condition. You can apply for medicaid at anytime and have coverage be retroactive, but in WY he may not qualify. (Republican Governor blocked expansion.) You can only get a Marketplace plan during open enrollment. Which is NOW. The plans won't start until 2015, but thats still 3 months of coverage. Get on it. Feel free to get quotes from non-marketplace plans but don't expect them to be cheaper or equivalent coverage. Do keep in mind they may qualify for subsidies. Once he is covered by his new employer he can cancel the old plan.
  • Collect all medical bills. Keep negotiating for self-pay discounts where possible. Total the debt owed. It can be difficult but you need a clear picture of what you're working with. You may not get the final bill from surgeries for several months afterwards. Hopefully with insurance, you'll stem the future and ongoing costs.
  • What will their future income be? Can she take on a second job? Can he work now? It sounds like they have very low expenses. Calculate total yearly expenses, and a total yearly income.
  • If their income is such that their debt cannot be repaid in 5 years, with no assets and no jobs, consider filling Chapter 7 bankruptcy. Retain a bankruptcy lawyer and seek their council.
Best of luck.
posted by fontophilic at 11:32 AM on November 17, 2014 [2 favorites]

I'm not sure where you got the idea that these people have been "denied" by ACA.

I wasn't assuming they'd been denied. But...

Some types of cancer (or maybe all?) immediately qualify you for disability and Medicaid.

I was thinking of something like that, or the possibility that they could get a lower monthly premium, or that something could be worked out that's much better than the situation they've got.
posted by Ursula Hitler at 1:06 PM on November 17, 2014

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