Help with Health Insurance/Medical Bills

I am currently working on outlining a novel in which one of the characters develops a life-threatening illness (most likely going to be a brain tumor at this point). I want to make it so that the character is unable to have the surgery done on them because they cannot afford this. How can I make it so that my character cannot afford to pay the costs of this surgery?
Thank you so much!

 

If money must be the sole reason for not having the surgery, maybe you can give to the character another overwhelming responsibility that absorbs all his funds: another sick relative, an inherited debt, an addiction towards gambling, drugs or buying. There are many possibilities to make your characters financially miserable, even by just looking at real life. Maybe could be a global event, like a recession, or a war, or a lawsuit against him. Or just ineptitude, bad management, unlucky choices for investment, being heisted, blackmailed, amid others.

 

It’s incredibly easy to be unable to pay for surgery in the US, yep. However, you need to research what will be flat-out denied, and what will still be done but will saddle the person with bankrupting debt forever. I think that something immediately deadly will be done even if you lack both insurance and money, but I may be wrong.

 

Yeah, you're going to need to specify jurisdiction for this question to be answered.

(My non-scientific observations are that the vast majority of people who don't specify jurisdiction are, in fact, Americans, but possibly this thread will be the exception!)

 

In the US, generally there are options for people who cannot afford care. Clearly many people have gone bankrupt from medical bills.

But something that would make it simpler would be for the character to have medical insurance but the insurance doesn't cover the treatment. This is often the case with promising treatment that is worth trying but the insurance company has it listed as experimental and not covered.

I have a medication (I'm not on it yet) that is more than $4000/month. I can't afford that, no way. But if you are on Medicare (I will be next month) one of the drugs in that class of drugs is given IV and that's covered because it's considered a hospital treatment. Go figure.

It's new treatments that are the issues. While they are still undergoing studies, insurance companies often don't cover the treatment or drug. And that's true with the national health services and insurances as well. It's not always one of those 'everyone in a country with a national health system doesn't have to worry about financing health care' things. New drugs are ridiculously priced under the claim the drug company has to recoup R&D.

 

The other option that a lot of people go is to sell their pain medication. I know a lot of people who are prescribed powerful painkillers after surgeries, but can't afford their bills. They chose to be in pain and risk the law rather than lose their house or become burdens to their families. It's a contributor to the opioid crisis in this country for sure.

Definitely set your story in the USA though, lots of people die here simply because they can't afford medical treatment. Hell, most people can't even afford one ambulance ride.

 

If it's in the US, simply having a job that doesn't provide insurance can do it. For myself, it's literally cheaper for me to die than to seek medical treatment of any kind. Life insurance is less than $30 a month whereas the cheapest health insurance is $300 a month.

Individual hospitals may also have programs to help people with little to no money, but will disqualify you if you have a decent income even if your income is eaten up by other bills.

 

Thank you, thank you, thank you for saying this. [Raises hand]

Depends on where you live, and how sympathetic doctors in the person's area are. Immediate ER care for a heart attack? Yes. Followup care? No. Other types of care or surgery for a deadly illness? Iffy. Before Obamacare got me insured with the preexisting condition clause, I couldn't get a neurologist in Los Angeles for potentially deadly symptoms. One had the nerve to tell me, "You must see someone. These symptoms are very serious" but wouldn't see me. ETA: So if someone can't afford their premium, they're probably still SOL

Depends on where you live in the US. Obamacare made it better than it was, because more of us can get insurance now, but if you live in a state that didn't accept the Obamacare subsidies, you're still screwed. Also, doctors and hospitals still are not required to take medicare or medicaid patients, so having medicare / medicaid doesn't mean the person will be able to find care. And yes, the medication problem is still a thing. Every time I pick up my prescription there's someone in line who has to make a tough decision about which med they can afford.

Very true. Thank you for saying that.

So, yeah, set in in the US, OP. No problem not affording surgery. Before President Obama was elected, and during the period when he was trying to get a healthcare bill through, I did a lot of volunteer work trying to get a healthcare bill on the table, (Op-Eds, letters, calls, talking with members of Congress) because I was considered uninsurable and couldn't afford care but live with a chronic illness. Feel free to P.M. me with questions (although it's been long enough ago that I've finally purged my brain of numerical stats).

ETA: Ha-- I just thought of another way the character might have difficulty. I'm out of my home state right now and need to refill a prescription for a medically necessary med (blood pressure stabilizer), and my insurance won't cover it unless I'm in my home state. I'm willing to bet they wouldn't cover a surgery out of my home state, either, unless I was in an accident or something.

 

Sorry, Homes, we really did try to get better insurance coverage in Obamacare, I swear... (I know you meant the insurance company fuckwads.)

 

I went in for potential appendicitis. The bill for the two hour ER visit was over $7,000. My insurance paid less than $2,000 (this was back when I could afford insurance due to the Affordable Care Act and having an okay job). It left me with over $5,000 to pay on an income of where I had less than $100 of "disposable" income (see: it needed to pay for groceries and gas for a month). Thank goodness the hospital had a financial aid department and because I was making little more than the poverty level they paid off all of it except for $700.

The insurance companies are turds. Now all I can do is pray I don't get sick (though the hospital in the area, supposedly, will take great care of people who aren't insured or are under-insured).

 

So when the hospital pays it off, where does that money come from? Are they charging other patients more in order to subsidize those who can't pay, or is there a pool of private donations, or...?

 

It depends on the hospital, and whether the hospital is a private hospital, a public hospital (such as a county hospital), or a religious entity hospital, such as a Catholic hospital.

Some hospitals have a fund for this (Catholic hospitals often do), and if it's a private hospital, other patients are charged more to make up the difference. But if it's a private hospital, they're choosier about which patients they will accept income-wise. Many times after they stabilize you they'll send you via ambulance to County.

ETA: I also forgot a category called Teaching hospitals. Those are university affiliated (UCLA Medical Center, for example) and are supposedly a bit less costly. But not free, and not low income like County would be.

ETA: And again, all this depends on what state and what county you live in. Health care really is the luck of the draw in the US.

 

I believe there is state and federal assistance available in some cases. In other instances, the hospital may simply write down the bill (which could, I suppose, contribute to higher costs for those who are able to pay).

 

As I said above, it depends a lot on which state we're talking about. Also, Federal budget cuts in any given time period alter those programs' availability significantly.

 

My vibe is that there is no single bill, either. There’s what they charge if you don’t have insurance. There’s the usually much smaller amount that they charge if you do have insurance, because the insurance companies have usually negotiated rates. There’s the pay-now discount.

My guy fell and hit his head, and we couldn’t immediately find his insurance card. So the different possible bills were, as I recall:

- self-pay over time: 1 gazillion
- pay cash within 30 days: .5 gazillion
- after we found the insurance card: .1 gazillion, on which he paid about .001 gazillion copay.

I think the gazillion was around ten thousand dollars, possibly more like twenty. He was in the hospital for about six hours.

 

So foreign to me. I've been in the hospital for days, been transported to a different city for surgery, gotten a bajillion tests and scans and whatever... I've never seen a bill. I have no idea how much all that cost. I'm not sure they even keep track of it. Maybe, so they can get reimbursed from the gov't? I really don't know how it works on their end.

 

Makes sense.

 

This.

The hospital in Wyoming had funds given to them to help with financial help for people. Despite being a pretty awful state to live in, the state and its people tried to take care of one another. The one here in Virginia is Christian-based (might be Catholic) and their entire mission is taking care of people; they have donors and funds specifically to help others. They offer all sorts of free workshops, too, for check-ups and dental health along with low-cost to free vaccines.

 

I have to say that I am happy to be a Canadian. Getting old sucks especially when you start to get sick. I think everyone deserves medical attention without worrying about how they will pay the medical bills. Then financial worrying and stress can only made a bad situation worse. I really feel for you guys..

 

When I got sick and couldn't find a neurologist, one doctor seriously suggested that I renounce my US citizenship and move to Canada. I'm dead serious. That's what was offered as a potential alternative to me.

 

Do you have duo-citizenship? 'Cause, we're thinking of building a great big wall along our southern border...

 

LOL. Nope, I was going to have to find a sponsor and do whatever one does. But it was never a question because it was so stupid to have that as my only choice. That's when I got involved in lobbying for healthcare.

 

My mom is a Dutch citizen. If she had a major health issue that Medicare couldn’t take care of financially she can travel to Holland for it.