Cancer and no health insurance. What to expect?

[poppy]

Being vague for privacy.

 

Family member was diagnosed with stage 4 cancer.  Large tumor, plus the cancer has spread to  other organs.

This person doesn't have health insurance.  He has some mental issues stemming from a head injury (but is not on disability).

He doesn't have a doctor, he went to the ER after a few weeks of feeling very ill and ended up admitted.

So far they are doing scans and tests, and talking about surgery options. They are putting in a port.

But what's next?   The prognosis is grim, but, he is in his 40s.  

Can he sign up at this point?

For the state he went to for treatment, or the state he'll likely end up being cared for?

Will it be challenging to get needed treatments?

I think these are dumb questions but they are something I blessedly haven't had to think about.  Always had a good HMO covering me.

 

[JustEm]

We have a young friend who was recently diagnosed with stage 4 breast cancer who didn't have insurance. Their income level qualified them for Medicaid and the hospital helped them sign up for that and once they were accepted, all their medical expenses from the day they signed up were covered.

 

I don't know about normal insurance though

[creekland]

I suspect he's going to need to check with the hospital.  They should have someone in their financial dept who can see if he's eligible for any programs his state or the hospital has.

[poppy]

We have a young friend who was recently diagnosed with stage 4 breast cancer who didn't have insurance. Their income level qualified them for Medicaid and the hospital helped them sign up for that and once they were accepted, all their medical expenses from the day they signed up were covered.

 

I don't know about normal insurance though

 

Ah, the hospital helped.  That is very good to hear, thanks.

[jewellsmommy]

Help your family member contact a company called Chamberlin Edmonds. They may be able to help him get disability, medicaid, or present another option. They helped us with ds successfully. 

 

 

 

ETA: it looks like they have changed their name. I think this number may get you to the right place Phone: (404) 267-1092

If not, ask the hospital if they can help you reach this company. 

Edited May 16, 2017 by jewellsmommy

[kiana]

Family member of mine had a critical health issue resulting in a hospital stay while uninsured and requiring aftercare. Hospital had a dedicated staff member who helped sort through the nightmare mess of finances. Ended up being responsible for a few thousand which was raised. 

[maize]

When my neighbor was diagnosed with stage IV cancer he was able to get some kind of expedited SS disability approval.

[displace]

The social workers will be all over this in the hospital. If there is any state insurance he can qualify for, he will be signed up (basically they will do all the work for him). If he needs private, they can help him with that too.

[TravelingChris]

I am so sorry you are going through this.  I think everyone here has given good advice.

 

[Guest]

None of this would be an issue if we had single payer insurance. So frustrating.

[MEmama]

None of this would be an issue if we had single payer insurance. So frustrating.

X 10,000,000,000,000,000,000

 

This cannot be said enough.

 

:grouphug: to the OP and her family.

[SKL]

I have had uninsured friends in catastrophic health situations.  They received excellent, life-saving care at no cost to them, because they were considered indigent at that point.

[Scarlett]

I have had uninsured friends in catastrophic health situations. They received excellent, life-saving care at no cost to them, because they were considered indigent at that point.

Same here. My friend who had breast cancer had no insurance. She did not suvived the cancer....she died within 4 years. But it was not for lack of care once she was diagnosed.

[creekland]

I have had uninsured friends in catastrophic health situations.  They received excellent, life-saving care at no cost to them, because they were considered indigent at that point.

 

Perhaps that was due to their income level?  I haven't seen it at "no cost to them" unless they were kids.  I've seen people get some care - probably not the best care out there, but something perhaps a standard or two lower - and end up owing a fair bit that they either beg for (Go Fund Me types of things) or have monthly payments forever, sometimes having to declare bankruptcy.

 

Maybe state matters too.  Or hospital.  Around here (and in NY) there are plenty of donation jars around for folks with illnesses or diseases and not enough $$ to pay for care.  Our school occasionally offers fundraisers for folks too.

 

I'm really wondering where it's found (in the US) "at no cost to them" and rather doubt that applies to the general population.

 

I have a relative with health needs and no health insurance.  Her needs have not come "at no cost to her."  Hers isn't cancer though.  At least we don't think it is.

[SKL]

Perhaps that was due to their income level?  I haven't seen it at "no cost to them" unless they were kids.  I've seen people get some care - probably not the best care out there, but something perhaps a standard or two lower - and end up owing a fair bit that they either beg for (Go Fund Me types of things) or have monthly payments forever, sometimes having to declare bankruptcy.

 

Maybe state matters too.  Or hospital.  Around here (and in NY) there are plenty of donation jars around for folks with illnesses or diseases and not enough $$ to pay for care.  Our school occasionally offers fundraisers for folks too.

 

I'm really wondering where it's found (in the US) "at no cost to them" and rather doubt that applies to the general population.

 

I have a relative with health needs and no health insurance.  Her needs have not come "at no cost to her."  Hers isn't cancer though.  At least we don't think it is.

 

Cleveland Clinic in the cases I'm talking about.  World class, life-saving care.

 

These individuals were not "indigent" before their catastrophic health issues, but the accident / massive heart attack rendered them unable to go back to work anytime soon, so that pushed them into indigent.  If they'd had "money," it would probably be different, but then, if they'd had "money," they would have had insurance.

[marbel]

None of this would be an issue if we had single payer insurance. So frustrating.

 

OK, but we don't, so this is not going to be helpful to the OP.   How about keeping the thread informational, for her sake?

 

Poppy,  :grouphug:  :grouphug:

[creekland]

Cleveland Clinic in the cases I'm talking about.  World class, life-saving care.

 

These individuals were not "indigent" before their catastrophic health issues, but the accident / massive heart attack rendered them unable to go back to work anytime soon, so that pushed them into indigent.  If they'd had "money," it would probably be different, but then, if they'd had "money," they would have had insurance.

 

I can't speak for Cleveland Clinic or the particular cancer, but I know at Johns Hopkins I was told the type of radiation I had - that deemed best for my particular brain tumor - was not available if we couldn't pay for it.  There was a different type - not as good - that was.  Fortunately, our health share covered it.  Supposedly not all insurances do.  Money is required up front, not after the fact.  (With health share, that meant we had to supply the $ first and get reimbursed ourselves - fortunately - something we could do knowing we were getting paid back.  We would not have been able to - without significant debt - if we didn't get paid back.)

 

Just one data point, of course, but I'm definitely not convinced those who can't pay or have insurance pay get the "best" care out there all the time.

[Carol in Cal.]

In addition to all of the excellent advice above, he or his advocates need to watch very carefully for open enrollment dates (assuming that the 'no denial of preexisting conditions' holds) and strongly consider getting him signed up at that point.  I imagine that someone (social worker?) has already assessed whether he qualifies for a special enrollment?

 

https://www.healthcare.gov/glossary/open-enrollment-period/

 

PS Poppy, I'm very sorry.  This sounds absolutely awful.  Hugs to you.

Edited May 16, 2017 by Carol in Cal.

[Anne in CA]

We have a young friend who was recently diagnosed with stage 4 breast cancer who didn't have insurance. Their income level qualified them for Medicaid and the hospital helped them sign up for that and once they were accepted, all their medical expenses from the day they signed up were covered.

 

I don't know about normal insurance though

I have a good friend who had breast cancer with no insurance. She made too much money for Medicaid but got help from different grants, she cashed out part of her retirement, and she coped. 

[PinkyandtheBrains.]

I can't speak for Cleveland Clinic or the particular cancer, but I know at Johns Hopkins I was told the type of radiation I had - that deemed best for my particular brain tumor - was not available if we couldn't pay for it.  There was a different type - not as good - that was.  Fortunately, our health share covered it.  Supposedly not all insurances do.  Money is required up front, not after the fact.  (With health share, that meant we had to supply the $ first and get reimbursed ourselves - fortunately - something we could do knowing we were getting paid back.  We would not have been able to - without significant debt - if we didn't get paid back.)

 

Just one data point, of course, but I'm definitely not convinced those who can't pay or have insurance pay get the "best" care out there all the time.

 

My mother is currently fighting her insurance to cover the cancer med her doctor wants her to take.  She has excellent coverage, and it is still a fight.

 

 

 

 

In the OP's situation, hospitals and cancer clinics have social workers on site. The social workers should be able to help in this situation.  I hope they are able to get the help and treatment they need.

[poppy]

Thank you everyone.   I am feeling better about the logistics of it.  It sounds almost like being indigent is .. not an advantage, that's the wrong word.  But, takes away some barriers, since he has no assets,  and no insurance company to fight, and the hospital has mechanisms in place to help deal with the paperwork.   I am very heartened to hear stories about people who still received good care regardless of financial status.     Much appreciated. 

[trulycrabby]

I think that certain types and stages of cancer get automatic approval for SS disability. The only one I know specifically is stage III ovarian cancer, so you might need to do some research.

 

A family member has a type of oral cancer and was able to get insurance through the ACA marketplace.

Edited May 16, 2017 by trulycrabby

[Catwoman]

Poppy, I don't have any advice for you, but I'm so sorry to hear about your family member. :grouphug:

[Lanny]

I believe there is a chance he can sign up for the ACA on an Exchange. However, I am not sure if he can sign up before the next enrollment period begins later this year. This is not normal insurance, which covers people for an event that has not yet happened.  He should explore the possibility with the Social Worker(s) and Financial Aid people in the hospital where he is being treated.  Good luck to him!

[poppy]

I think that certain types and stages of cancer get automatic approval for SS disability. The only one I know specifically is stage III ovarian cancer, so you might need to do some research.

 

A family member has a type of oral cancer and was able to get insurance through the ACA marketplace.

 

Good to know.  It is colorectal cancer.

[prairiewindmomma]

It depends on the state (Medicaid expansion).

It depends on the treatment.

It depends on the billing codes (global billing v. Per visit billing).

 

We got killed on the co-pays. We got killed on the Rxs that we had to fill at the pharmacy (compared to infusions in office).

 

As an example, even if the $100k radiation is covered by insurance, your 20% co-insurance will mean you have to meet your deductible up front and if you don't have a max out of pocket on copay for dr visits getting hit with a $50 specialist co-pay 30 times during the 6 weeks of radiation really sucks. The fact that it hits suddenly with multiple providers (imaging, oncology, radiology, etc) makes it harder to cope with.

 

IME, our friends who were indigent were better off than those of us with a middle income salary and insurance.

 

TBH, I know of many people who choose to go straight to hospice with stage 4 just to avoid saddling families with debt. Sometimes, statistically, the outcome is no different and the quality of remaining life is much better.

[Guest]

It depends on the state (Medicaid expansion).

It depends on the treatment.

It depends on the billing codes (global billing v. Per visit billing).

 

We got killed on the co-pays. We got killed on the Rxs that we had to fill at the pharmacy (compared to infusions in office).

 

As an example, even if the $100k radiation is covered by insurance, your 20% co-insurance will mean you have to meet your deductible up front and if you don't have a max out of pocket on copay for dr visits getting hit with a $50 specialist co-pay 30 times during the 6 weeks of radiation really sucks. The fact that it hits suddenly with multiple providers (imaging, oncology, radiology, etc) makes it harder to cope with.

 

IME, our friends who were indigent were better off than those of us with a middle income salary and insurance.

 

TBH, I know of many people who choose to go straight to hospice with stage 4 just to avoid saddling families with debt. Sometimes, statistically, the outcome is no different and the quality of remaining life is much better.

Last I checked, medical bills are the #1 cause of bankruptcy and most of those people have insurance. Effing politicians.

[*LC]

There is a fast track program for social security disability coverage for certain conditions. It is called compassionate allowances; here is the list of conditions covered. I don't see colorectal cancer under any names that I know for it. https://www.ssa.gov/compassionateallowances/conditions.htm#C

 

Usually one needs to be on SS disability for two years, before Medicare kicks in. I know there was a fast track program for that also for certain conditions. Searching didn't come up with anything, except for ALS and end-stage renal disease. I know it did apply to more conditions, but my information is old. It had some type of acronym name that started with T, probably for terminal. Someone at the social security office should be able to give guidance, but it may not apply to his cancer since it doesn't seem to be a type that qualifies for compassionate allowance for SS.

 

I had a family member end up in the hospital with a scary diagnosis and no evidence of medical insurance, and the hospital social worker was there immediately after diagnosis to talk about options. So, there should be someone available for your family member. If not, you can call another hospital. Or a national organization for that cancer. Maybe www.ccalliance.org Online support groups may also have information on how others with his cancer have handled no insurance.

[Janeway]

None of this would be an issue if we had single payer insurance. So frustrating.

Not necessarily. My husband has some relatives in Canada and one of them has a chronic health condition and can no longer treated because of age. I think they are in their 70's. I also have a friend who is a doctor and worked in the U.K. for a little while and was prevented from doing more aggressive, but very typical in the US treatment for a heart attack for someone in their late 50's due to age. If the guy is in his 40's and has mental health problems, he might be refused care in some places.

[kroe1]

 

DH was within the single payor system in England. A stage 4 anything would not have gotten a port or any hope for treatment. Hospice would be provided, however.

Edited May 17, 2017 by Minniewannabe

[Guest]

DH was within the single payor system in England. A stage 4 anything would not have gotten a port or any hope for treatment. Hospice would be provided, however.

My sister works for Hospice and this is something we talk about a lot. I know this sounds cold but the amount of money and intervention we spend on people with no hope of survival is insane and cruel. Family doctors don't want to give the bad news so they keep dishing out false hope that "with 12 rounds of chemo Grandma has an extra 6 months". Of course the kids want her around so they convince her to try it and she lives those few extra months in a hospital, in agony. I think we would do well to get a little more comfortable with the reality that no one makes it out alive.

[TechWife]

Cleveland Clinic in the cases I'm talking about.  World class, life-saving care.

 

These individuals were not "indigent" before their catastrophic health issues, but the accident / massive heart attack rendered them unable to go back to work anytime soon, so that pushed them into indigent.  If they'd had "money," it would probably be different, but then, if they'd had "money," they would have had insurance.

 

If they were indigent, they likely qualified for medicaid.  Cleveland Clinic doesn't provide free care. They were paid by someone. 

[Amy in NH]

My sister works for Hospice and this is something we talk about a lot. I know this sounds cold but the amount of money and intervention we spend on people with no hope of survival is insane and cruel. Family doctors don't want to give the bad news so they keep dishing out false hope that "with 12 rounds of chemo Grandma has an extra 6 months". Of course the kids want her around so they convince her to try it and she lives those few extra months in a hospital, in agony. I think we would do well to get a little more comfortable with the reality that no one makes it out alive.

I agree. I'd rather live out my days with palliative care and hospice instead of painful and debilitating procedures that will give me both poor quality of life and prognosis while bankrupting either my family or society. I encourage people to read the book Being Mortal.

[Guest]

My sister works for Hospice and this is something we talk about a lot. I know this sounds cold but the amount of money and intervention we spend on people with no hope of survival is insane and cruel. Family doctors don't want to give the bad news so they keep dishing out false hope that "with 12 rounds of chemo Grandma has an extra 6 months". Of course the kids want her around so they convince her to try it and she lives those few extra months in a hospital, in agony. I think we would do well to get a little more comfortable with the reality that no one makes it out alive.

Read up on the story of cancer..there is a an article in this months popular mechanics mag to get people started. Stage 4 is no longer a death sentence for certain types of cancer. Granny could indeed live to 100 if she could have treatment at 71.

[SKL]

My mom had pretty advanced colorectal cancer diagnosed at 60, and she did go through all that pain and suffering to beat it.  She did beat it.  Today is her 73rd birthday and her family is glad she's here.

 

And because my folks had good insurance, their out-of-pocket was approximately $0.  (But this post is not about people with insurance - good, bad, or otherwise.)

Edited May 17, 2017 by SKL