What happens when you can't afford care? Need a reality check.

Catsme

Hi,

I have a question that to many of you may seem very naive.  What happens, in the US in the following scenarios?

1. No health insurance - are you completely denied care?  Are you denied access to hospitals, doctors or treatment?
2. You have health insurance but can not make more than a minimum ($10., $20.) per month toward any unpaid balance?  Are you denied further care and treatments?

I guess what I want to know is, can and do medical professionals and institutions allow people to go without treatments or follow-up care, or delay these, and risk more advanced disease, based on their ability to afford needed care?

Thanks

vlnrph

No, you are not denied (except at for profit institutions like Cancer Treatment Centers of America which does all that advertising) but it may be more difficult to access. There is charity care available. I seem to hear about hospitals originally founded by religious organizations having a stronger history of offering this - think Catholic facilities named after saints...

If a person qualifies for a state program like Medicaid, they will have coverage however might experience delays.

It helps to have a patient advocate, perhaps a nurse navigator or social worker assist in getting appointments scheduled. That person could also talk to the finance department to set up a payment program and/or intervene in the event of billing errors. Unbelievable how many times those occur. In other words, a woman should not give up and wait for things to become worse.

Catsme

Thank you vlnrph!  I get nervous, not just for myself but also others with cancer diagnosis, anytime I see or hear changes to health care being discussed.  I do appreciate your quick response.

Moderators

Hi Catsme!

You may want to visit the recently updated main Breastcancer.org site's section on Paying for Your Care

Hope this helps!

The Mods

Catsme

Thanks Mods, I'll check that resource.

NancyHB

When I was first diagnosed I had insurance with a decent-sized deductible, and quickly discovered the copay for chemo and Neulasta was also high. I was unemployed but my husband worked and I knew we’d be okay, even if it was a struggle. I asked my MO the same question - what’s happens to your patients who don’t have good insurance? He told me our center offered some Compassionate Care (free or reduced treatment); some people qualified for Medicaid which covered some - but not all - treatments. Others did GoFundMe campaigns, or sold their homes and cars. And some, he said, simply stopped treatment because they couldn’t afford it.

Since that time I’ve met two Stage IV women who’ve done just that - stopped treatment because they couldn’t afford the copays for their meds. They made too much to qualify for any programs but the cost over a long period of time took its toll and so they.....stopped. One died last year. A mutual friend in the medical field had the audacity to chide her (after her death) for not “doing more” to stay alive. It’s an easy comment to make when you’re not the one having to decide between food and rent, or cancer care - living without having a life.

We should not have to make these decisions. It’s not about fairness, it’s about humanity. Our lives should not be valued by our bank accounts. I often call it fiscally medical Darwinism - only the rich will survive.

MelissaDallas

My hours had just been cut to part time and no insurance a couple of months before I was diagnosed with ovarian cancer. The hospital that diagnosed me did not do charity cancer care. They wrote my week in the hospital bills down ninety percent based on my income, but I still had to pay out around $6000.00 over two years. I was referred from there to our county hospital that had a special program for people making 200% or less of the poverty level-I just paid a minimal deductible for each procedure/appointment. It was great, but I couldn’t go back to full time work for close to 3 years or I would have lost my eligibility for the program while still in treatment. I had just turned 50 and that forced part time work (while my parents helped me financially) seriously hurt my retirement savings at the time I should have been socking away lots of money. Now the problem is such high deductible/copay/premium that I have no idea how I could manage

Catsme

My sister passed away after a 40 day battle with leukemia and its associated treatment in 2014. She was in the hospital for all 40 day, diagnosis to death. Everything was through the University of Kentucky Cancer Center. The hospital took what her insurance paid as payment in full, but she didn't know this as she went through the treatments and spending 2 weeks in ICU. She worried the entire time about the bills mounting.

It's just so sad that the decision you've described, between food and treatment, have to be made.

buttonsmachine

You ask a good question, although there is no simple answer. These are some of the scenarios I've seen since hanging around with people who have cancer:

- Try to get more adequate insurance coverage after diagnosis (this can be tricky).

- Sell your house and belongings and move in with relatives to help pay for care (often this is done when insurance coverage is still inadequate).

- Live in an RV or other vehicle.

- Participate in a charity program through a hospital (nice, but not always available).

- Get another job and work yourself almost to death during cancer treatment (or have your spouse do this).

- Qualify for Medicaid (this can also be tricky).

- Stop treatment and let nature take its course.

You might be interested in this article from last year, it discusses this problem: https://www.amjmed.com/article/S0002-9343(18)30509-6/fulltext

edwards750

What a sad commentary it is when you have to decide between treatment or food / that's just reprehensible. I know elderly patients who do often decide between the two and they don't have cancer but have medical issues that require expensive monthly meds.

We had BC/BS with a $5000 deductible. Needless to say we met that deductible in a few months. We also used our flex plan from my husband's job and still had to make monthly payments on medical bills. The fortunate thing though was when we reached our deductible I had to have radiation treatments and it covered them 100%. Idk what we would have done if we had had to pay for those treatments.

There are places here like the Church Health treatment center that discount procedures but there is still out of pocket expenses to be paid. I know women who have wiped out retirement funds and savings to pay their bills.

That is beyond disheartening that those Stage IV ladies discontinued treatment and one had already passed away as s result. To judge her though is despicable. As they say walk a mile in her shoes. No one is prepared for the financial drain this disease causes and for many women it has bankrupted them. Imagine adding financial issues to the physical and emotional ones you are already dealing with. It is blantly unfair. We didn't ask for this.

I agree about talking to a social worker or if you have one a patient advocate. I had a patient advocate who was awesome.

Surely women in need are not turned away from treatments because of their inability to pay. When we made payments we paid the minimum. It took forever to pay it off but so what. It got paid.

Don't feel awkward about asking for help. It's your life and you deserve assistance however and wherever you can get it.

Btw I'm sick of those CTCA commercials. All that love and compassion comes at a very high price tag with no guarantees.

Diane