Insurance worries...

[redfox]

So, on Monday I go in for the pre-surgery consult; I'm scheduled for a D&C on the 4th to rule out endometrial cancer. I have a private pay policy with a $3500 deductible, 50% after that, stop loss at 10K. This surgey will consume what's left of my deductible.

If I need a hysterectomy & further treatment, that's the realm of OMG I am entering. A 15-20K surgery, plus possible treatment if I do have cancer leads me into thinking about bankruptcy. I am feeling insane right now.

It's scary enough considering the possibilities of a cancer diagnosis. Then the expense... how do people cope with this?

[MamaM]

Have you met your deductible? I would apply for charity with the hospital. You may be surprised. Also, talk to the patient advocate.

[ApatheticNoMore]

I have a private pay policy with a $3500 deductible, 50% after that, stop loss at 10K. This surgey will consume what's left of my deductible.

If I need a hysterectomy & further treatment, that's the realm of OMG I am entering. A 15-20K surgery, plus possible treatment if I do have cancer leads me into thinking about bankruptcy. I am feeling insane right now.

Well I'm interpreting it that the 10k is your "annual out of pocket maximum", so the most it can possibly cost you is 10k (unless you needed treatment *and* it took *multiple* years and yes that's horrible to think about). I guess that's the bright side that the 20k surgery plus any treatment you needed this year will cost you 10k at most (not whatever the ridiculous bill ends up being). Whether you can find a way to pay that off over time or declare bankruptcy is up to you, you might be able to negotiate hardship with the hosptial. Do what almost everyone does ultimately, get whatever you really need medically today and worry about paying for it tommorow.

[redfox]

Oh argh, I hate insurance speak. What is the difference between deductible & out-of-pocket?

Here is the pertinent wording:

Annual Deductible -- $3,500 per calendar year.

Hospital Services
Covered inpatient medical and surgical services -- Covered at 50% after the annual Deductible is satisfied.


Out-of-Pocket Limit
Limited to an aggregate maximum of $10,000 per calendar year. Except as otherwise noted, the total out-of-pocket expenses for the following covered services are included in the out-of-pocket limit:
• Plan Coinsurance. • Oral chemotherapy
• Emergency care.

[ApatheticNoMore]

This is how I think it works (but someone here has to know better than me). The deductable is the amount you pay out of pocket before the insurance company kicks in ANYTHING. Then the insurance company kicks in say 50% for the hospitalization (in your plan) until the total money you have paid for healthcare reaches 10k (I believe this includes the deductable), then the insurance company kicks in 100%. So that the maximum you have to pay for healthcare a year is 10k (plus maybe copays for doctor visits not sure about that). Although it's a little troubling that your plan is specifying what exactly fits into the out of pocket limit because I thought pretty much everything did. This is all assuming you are in network if you are in an HMO etc., but I'd have to assume you are if they are even going ahead with this, just check if your hosptial is.

[rosarugosa]

Redfox, So sorry you are going through this stress! I work in HR, so I'm pretty familiar with the insurance terminology. ANM has it right:
deductible - amount you pay out of pocket before insurance kicks in
out of pocket max - the most you would have to pay out of pocket in a given year
These are both usually per person, so if two people are insured on the policy, the deductible would generally be $3500 per person, if that is your deductible amount.
A lot also depends on the design of the individual plan. My plan does not count prescription med expenditures or emergency room visits towards the OOP max, so it's good to see that if you did need oral chemo drugs, that those would count towards your OOP max. I have employer-sponsored coverage though, so my deductible and OOP are much smaller numbers.
This is a good example of why we need some type of health care reform. When DH had renal cancer/kidney removal last year, it really hit home how lucky we are insurance-wise.

[rodeosweetheart]

I would read it the same way as ApatheticNoMore did; sounds like you pay 3500, then you pay 50% of the surgery up to the out of pocketmax--it might or might not take you to the 10000, and it is good that this is the beginning of the year, so that if you have anything else you need to do after the surgery, then you will have met the maximum and they pay it all after that, but obviously, check with them at insurance.

When I had a massive unexpected medical bill for surgery and ventilator and icu, it ended up being around 89000 back 10 years ago, and I paid 10,000 (our out of pocket max for the year.) Hospital would have taken payment on time, they have to. But the insurance company, when I got home (it was emergency thing) assigned a nurse in charge of my case and I coudl discuss the care with her, and the costs. Can you call your insurance company and get that person now, someone to talk to before this surgery?

Blessings and peace sent your way--life will go on and you will go on, and try to focus on peace and health and light, rather than the terror--it will all honestly be okay, even though it is so scary, what you are going through. Lots of hugs and love your way!!

[MamaM]

Hospitals have case management and financial counselors as well. Make an appointment ahead of time and start the dialogue.

[redfox]

Great advice everyone, thank you. Lots of late night awfulizing going on in my head...

[LilyB]

Redfox, It is terrible that you are going through this when you should be concentrating on your health. You got good advice about working with the hospital. I found that the Patient Advocate was of great help when DH was hospitalized. She even did a conference call with our insurance company at the time to explain why we were out of our coverage area. (UM...because we were 1200 miles from home?). Good thought and prayers for you as you deal with this.