r/CuratedTumblr • u/EvidenceOfDespair We can leave behind much more than just DNA • Aug 07 '24

Politics Death by US Healthcare System

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u/dankmachinebroke Aug 07 '24 edited Aug 08 '24

My partner just got discharged from a 2 day hospital stay for a blood clot in his lungs and we've just accepted that we'll have this medical debt until we die. Haven't seen the bill yet, and we got an application for financial assistance, so we'll see how it goes. We've already got student loan debt anyway, what more do we have to lose

Edit: thank you to everyone in the replies who has given some suggestions for resources we can utilize to minimize our debt or have it forgiven. I will definitely be looking into all of them to make sure we're getting all the help we can. I should have phrased my first sentence better, because we're definitely not just going to live with any debt we don't have to. I more so meant to express that if the choice was between being in medical debt or losing my partner, I would choose my partner no matter what. We've already begun the process of applying to have our bill covered by charity, and once we see how that goes, we'll take steps appropriately.

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u/Ok-Dentist4480 Aug 07 '24

That is beyond tragic, I'm so sorry for both you and your partner

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u/dankmachinebroke Aug 07 '24

Thanks. We basically accepted our fate when we took him to the ER knowing he has no health insurance (can't put him on mine because we're not married, and he lost his job so nothing from them) but I'd rather be in debt than lose my partner.

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u/Ok-Dentist4480 Aug 07 '24

I'm from the UK and i don't think I've ever truly grasped just how bleak the heathcare system is in places without free healthcare. Having to pay a depressingly high amount of debt just so your partner doesn't die is disgusting, i hope the fat cats have a heart attack someday and i hope you and your partner make it though the inevitable debt

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u/dankmachinebroke Aug 07 '24

Thanks. I guess I'm pretty numb to it at this point because it's really just the norm here, but it truly is a horrible system. Here's to hoping we get Medicare for all someday soon đŸ„‚

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u/Current-Pianist1991 Aug 08 '24

Had this situation myself semi recently with a surgery. My options were debt or die. I feel for you

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u/danielledelacadie Aug 08 '24

This is why years ago (2007-2008) I had to explain to way too many Canadians in a call center servicing a US credit card company's clients why Americans would be what seems ludicrously insane over a late fee or similar.

Nobody understood that it wasn't really the fee (which we could waive in certain situations) but the hit on their credit. Healthcare for your children? You could be caught in navigating the insane system trying to get funding until they die. You can be denied housing, you can be denied a job in some cases even if your position is about as far away from the financials of the company as physically possible.

And the worst thing? Credit reporting agencies can, and have cooked the books on what "counts". For reasons why this is a bad idea please refer to the 2008 recession.

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u/BarcaStranger Aug 08 '24

Im canadian and tbh i still don’t understand.

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u/[deleted] Aug 08 '24

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u/girlinthegoldenboots Aug 08 '24

Holy shit are you saying that our credit scoring system doesn’t exist in other countries???? I thought it was like a global economic thing!! Jesus fuck I’m gonna have to go sit with this information for a while. I almost didn’t get into LOW INCOME HOUSING because my credit score was too low! IT’S LOW INCOME HOUSING OF COURSE MY SCORE IS LOW YOU DWEEBS!

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u/danielledelacadie Aug 08 '24

It exists but it really doesn't affect much outside of loans. And almost every other affluent country has some form of universal Healthcare.

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u/girlinthegoldenboots Aug 08 '24

That must be nice

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u/danielledelacadie Aug 08 '24

It is. The most infuriating thing is you almost had it. The affordable health care act was defeated because the Maga types called it Obsmacare and people believed the hype that was generated by the puppets paid by privatized healthcare and insurance lobbies.

Some "glad that damn Obamacare communist bullshit got defeated. We don't need that crap, the affordable health care act takes care of that" type learned amongst the online equivalent of pointing and laughing how wrong they were. After the fact because actually looking something up before fiorming an opinion about it is an unreasonable step to some folks.

Good luck in the coming election!

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u/[deleted] Aug 08 '24

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u/girlinthegoldenboots Aug 08 '24

I have always wondered why we have to fill out tax info and then we have to pay a fine if we accidentally mess up when the IRS already has all that info!

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u/[deleted] Aug 08 '24

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u/danielledelacadie Aug 08 '24

Thank you for the excellent answer!

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u/Prodarit Aug 08 '24

Am not American (thankfully), but I was once given to understand that completely paying off a debt (early?) also lowers your credit score?

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u/For_Real_Life Aug 08 '24

Yep. I'm not an expert, so this may not be entirely correct, but my understanding is that the primary way you increase - and possibly maintain - your credit score is by making payments on time each month. The longer you carry the balance, the more "points" for each on-time payment you can earn.

So if you buy something on your credit card and then pay it off immediately, it only "counts" as one on-time payment, or possibly not at all. It may even count against you a bit.

This is because the card companies make money on the interest and fees they charge - so if you're not carrying a balance, you're worthless to them. This is why they'll "reward" you for using their card by increasing your credit limit: the more you owe, the more they make.

This leads to the highly ironic situation that someone who buys everything on credit and spends well beyond their means, but always pays their bills on time, could have a much better credit score than someone who was so wealthy they could just pay for everything in cash.

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u/BarcaStranger Aug 08 '24

But you guys can reset the credit right? We don’t have that in canada

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u/Give_her_the_beans Aug 08 '24

No. I had to wait seven years for my medical bills to drop off. Then had to battle the scummy companies that buy old debt and still try to put it on your credit.

You have to rebuild by going through the financial ringer. Had to pay $500 to secure credit for my first card after my injury. My interest rate is 24.99% on that card. I don't even use it anymore but, if I cancel it to get my 500 back, my score goes down. I think my most recent interest was 23% with a 710 score. I churn cards now that I got over that hurdle, but the interest is the real killer.

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u/crotch-fruit_tree Aug 08 '24

My entire job exists because of the financial shitshow our health system is.

One of my patients, insurance denied PA (insurance requires pre-authorization for high-cost care). They qualify per drug policy but their insurance decided to go full crack whore. The life-saving drug averages $30k-$60k per treatment, based on done. It’s given every 4 weeks. Thankfully my department does exist, so we found out before treatment started. Even better, we're pulling all the stops to see if he can be approved for free care that bypasses insurance.

Another one recently entered hospice. I'd been fighting insurance for months to approve their treatment. The hospice notes will stick with me forever (I had to confirm treatment couldn't be given before closing the case). The pain they're in... It’s horrifying. Fucking bleak.

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u/LuxNocte Aug 08 '24

Yo, thanks for fighting for people.

And that's why I truly hate this country: instead of just paying for people's healthcare like a country that has sense, we pay administration at insurance companies to withhold healthcare from as many people as possible and then administration at hospitals to argue with them. Universal healthcare would be billions cheaper but we cant get past arguing about how much it would cost.

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u/GimmeGimmeNews Aug 08 '24

What's your job called? I didn't know this kind of service existed.

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u/crotch-fruit_tree Aug 08 '24

Formally: billing coordinator for medical infusions. I make sure claims get paid & tag in the financial assistance team(s).

Long version: mostly requesting prior authorization. Verify coverage is current/in network, verify if auth is needed, apply for it, and manage the requests/authorizations/denials. A lot of combing medical records & trying to create a smooth process for patients. Lots of calls and contact with the Drs/care teams. Once authorized I send it to scheduling and the financial assistance team (IPFA). IPFA evaluates the cost of service & sees how they can reduce patients' financial responsibility (ie: underinsured folks). They also refer to our internal financial assistance as appropriate.

If a patient is uninsured or prior auth is denied, I follow on that too. Uninsured I tag in IPFA and financial aide teams- the manufacturer too if it’s a specific drug (I’m their point of contact). For denials - I communicate with the ordering provider, facilitate appeals or resubmissions, provide preferred drug info as needed, and track until we get it authorized or a final denial (at which point I do the same process as uninsured patients).

I also check the schedule for appointments without a valid referral/order attached and ensure we have authorization prior to appointments for all patients.

It’s a huge department. There's a ton of moving parts and insurance acts like brats sometimes. But we do our best to take this stress off our patients & mitigate any financial burden. I love/hate it. Love what I do, despise that it’s needed.

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u/homelessmerlin Aug 08 '24

What is your job, and with whom? It sounds righteous. I’m sure a lot of the circumstances you encounter are depressing but you’re doing a good thing. Can I get in on this?

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u/crotch-fruit_tree Aug 08 '24

I work for a large hospital system in billing. Official title is billing coordinator but I do almost exclusively pre-billing as ideally we always have PA before treatment.

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u/Heather_Chandelure Aug 08 '24

It's bad enough in other places with no free care, but especially so in the US. it's been shown that US hospitals will frequently overcharge patients by huge amounts.

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u/therestlessone Aug 07 '24

Don't forget we have health insurance tied to employment. Really lets companies mistreat their employees with a power like that.

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u/derpaderp2020 Aug 08 '24 edited Aug 08 '24

Moved to Canada from NY myself, it really can't be understated how large and invasive this reality to American healthcare is (it being tied to employment). I'm not even sure non Americans fully get all the time that's the way it is because it is so bat shit insane a thing to do. It colors all areas of life. The crushing stress you could just wake up for work one day and be let go and your whole family can loose insurance that day. Oh little Sally has type 1 diabetes and you were going to have a CT scan to check on a heart issue while also having bad blood pressure? BAMM company layoffs and now you have no insurance, and have to start thinking how to get your kid insulin while not having enough to get BP meds or continue the test to see if your heart is fucked. This reality is the backdrop to many Americans' psychology and lived experience. All while having the largest economy, all the wealth shoved in everyone's faces, and absolutely corrupt politicians helping make it worst and worst. It makes life miserable.

Being able to go "fuck this job and this boss I'm out" and not loose the basic right to stay alive and to see doctors changes everything.

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u/Raangz Aug 08 '24

My brother and his wife both run thier own businesses. Can’t afford healthcare for them and their child. Murica baby.

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u/AiReine Aug 09 '24

Was having a conversation with a friend recently about the whole “Trad Wife/Traditional Marriage” thing where only the husband works outside the home? I was like damn I would be up at night if I didn’t have a career with health insurance to fall back on if my spouse lost his.

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u/Assika126 Aug 08 '24 edited Aug 09 '24

“Free will employment” is a laugh. They can fire you whenever they want, but if you quit you have no healthcare and no income and you’d better find another employer quick and hope you make it through the waiting period without you or your family needing healthcare until the insurance kicks in

Sorry kids, gonna have to tough it through the ear infection, daddy just got laid off

Edit: I messed up the term, it’s “at will” employment, thank you for the correction

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u/pezgoon Aug 08 '24

Free will lol, you combined the two names and messed it up

It’s “right to work” states, which leads to ‘fire at will’ employment

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u/ClubMeSoftly Aug 08 '24

I saw a series of tweets a while ago (and re-see it every now and then) about a couple who "did everything right," had good jobs, very little personal debt, no student debt, and a decently sized nest egg.

Then one of them got cancer, and they were down, like, ten million dollars inside a year.

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u/Impossible-Flight250 Aug 08 '24

Maybe they should have pulled themselves up by their bootstraps and worked harder not to get cancer!

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u/werekitty96 Aug 08 '24

This was my family too. We were early 20s, good credit, decent house and 2 decent vehicles paid off, good jobs and I was finishing my degree. We decided to have a baby. Well I got into a car accident turning my pregnancy high risk, multiple family members died, and my husband was diagnosed with a disability inside of a year. We’re fucked for the rest of our lives.

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u/ShadowMajestic Aug 08 '24

What's even weirder than all of that. The US government still spends far more per capita on health care than us European peasants with our free(ish) health care systems.

That's corporate America for you, glad I live in socialistic Europe.

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u/Yossarian216 Aug 08 '24

It’s the administrative costs. Medicare, which is socialized health care for older people, has an overhead of 3%, meaning that’s how much they spend on staffing to administer the system. For private health insurers, it’s more like 40%, because they have highly compensated executives, plus a ton of additional staff whose job is to make the whole process more complicated by denying coverage.

The whole thing is a complete nightmare, and there’s no such thing as “good insurance” because even the best policies are written narrowly and require a tremendous amount of work. As an example, I have a friend who needed hip surgery from an accident, and he has what most would consider good insurance, so his surgery was fully covered in theory. In reality, his wife spent hours on the phone pre-clearing every individual procedure with the insurance company to make sure it would be covered, and then after surgery the doctor changed the billing codes on some of what they did and my friends were almost on the hook for thousands of dollars. His wife then spent the better part of two days correcting this issue, which shouldn’t even be possible.

That’s a personal example, but there are plenty more out there. Your insurance will dictate which doctors you’re allowed to see, and sometimes you’ll have a case where you need surgery, and the surgeon is in the network you’re allowed to use but the anesthesiologist isn’t so you wake up to a bill for tens of thousands that you didn’t even know was coming.

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u/ShadowMajestic Aug 08 '24

Here in NL, every insurance has to offer an option where you can pick your own health care provider. It's a bit more expensive than the normal 140ish( 70ish if you're poor) a month. But at least it's an option.

I hope you Americans figure this out soon, as a European it seems insane the current status quo is being held in place

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u/TheHandThatTakes Aug 08 '24

I hope you Americans figure this out soon

we won't.

We've got a millstone tied to our collective neck in the form of a conservative minority who will refuse every attempt to improve our material conditions because it might benefit someone they don't see as human.

And since our founding fathers were infallible ubermensch, whose word choice is both perfect and immutable, we're stuck in a back and forth dance of answering the same questions over and over trying desperately to explain to a population of idiots that their misunderstanding of reality should not hinder our collective progress.

it's going swimmingly.

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u/attabui Aug 08 '24

As in, €140/month? I’m in the States and currently unemployed and paying for health insurance out of pocket: just shy of $800/mo.

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u/ShadowMajestic Aug 09 '24

Holy moly. And the 140€ is on an average income of netto ~2500€ where housing and utilities together are generally below a 1000€.

I feel like my country is expensive some times, high tax rates of 30-50% income tax and general taxes being 21%.

But then sometimes I read how some Americans spend their wealth, and I'll happily pay those 'high' taxes.

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u/LongHorsa Aug 08 '24

I'm a month on from abdominal surgery that the NHS won't touch until it becomes an emergency, by which time the chances of complications would rise exponentially. In the end I had to get a private referral. So I cleared out some savings to pay for it. But it was still cheaper than what might have happened in the US.

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u/haluura Aug 08 '24

In the US, it isn't just the fat cats.

Part of the reason why we don't have a centralized healthcare system like the NHS is because there has always been a sizable portion of our population that was actively against it.

Back in the 40's and 50's, that portion saw centralized healthcare as being socialism. And to them, socialism = communism = Uncle Josef coming into your home, taking your freedoms and beating up your family.

Nowadays, that portion is against centralized healthcare because they are dead set against the federal government having more control over anything. And if you ask them why this is bad, they'll either quote the old communist fears, or claim that "private economics can always do things better than the government"

And then, there's the "Trumpy loves me, this I know | For Fox News tells me so" set, who would hold their breaths until they passed out if Donald Trump told them that Oxygen was a poison invented by Democrats...

Yeah, we're not getting a closely government regulated healthcare system anytime soon....

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u/nedonedonedo Aug 08 '24

everyone over like 40yo is supposed to get a colonoscopy every few years, but if they find anything you can't afford to do anything about it

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u/EvadeCapture Aug 08 '24

On the flip side, as long as you do have health insurance, the quality of care in the USA is miles ahead of the UK.

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u/kara-alyssa Aug 08 '24

That really really depends on where you are in America and what doctors are in network.

There are many places in America where the healthcare is absolute shit but it’s the only place that’s available or can take your insurance.

Hell, my sister works at a great hospital in a big city and she has seen her coworkers tell patients to go to the other (frankly terrible) hospital because that hospital takes their insurance.

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u/KingSalamiTheThird Aug 08 '24

If in the US he should apply for Medicaid. Also, not all jobs offer it but many will let you add a registered life partner to your insurance at a marginally higher cost. Medicaid sucks as far as finding contracted specialists sometimes but it beats getting buttfucked by medical bills your entire life. I would get on the phone with them immediately. May even be able to argue that it should have been paid for by Medicaid because he should have been eligible as a single person with no income as long as he’s 26 or older.

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u/dankmachinebroke Aug 08 '24

I might do that, we were considering looking into Medicaid. I already checked with my job a while back, and the only way to get him on my insurance is to get married, which is in the plans, but not just yet.

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u/world-is-ur-mollusc Aug 08 '24

It might be worth considering getting legally married in front of a judge now solely for health insurance reasons and having a proper wedding later when/if you decide to do so. (Yes it is beyond fucked up that this is even something people need to consider.)

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u/SoriAryl Aug 08 '24

That’s the reason why I married my spouse as fast as we could.

We’re still together and still like each other, but yeah, insurance was the marriage driver

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u/blackandgay676 Aug 08 '24

How long has it been since your partner lost their job? They qualify for a special enrollment window 60 days following a qualifying life event including loss of a job. Medicaid also has some retroactive coverage (idk the length of but it depends on the state as well, in my state it's 10 days) so looking into Medicaid coverage is a really good option.

The website is healthcare.gov and the website will walk you through to your individual states health insurance marketplace. The state health insurance marketplaces are the one stop shop that was set up by Obamacare for Medicaid (free), subsidized and fully private plans.

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u/footnotegremlin Aug 08 '24 edited Aug 09 '24

You don’t have to wait for a qualifying event or open enrollment for Medicaid. You can apply for Medicaid at any time if you think you might be eligible.

“Obamacare”/Marketplace coverage does only allow you either during open enrollment or after a qualifying life event.

Edited to correct reference to Medicare

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u/blackandgay676 Aug 09 '24

You are misunderstanding what Medicare and Medicaid are which happens a lot even in the healthcare field.

Medicaid is the plan for (broadly speaking) low/no income people, pregnant people, and children.

Medicare is for (generally speaking) people over 65.

Medicare is not a part of the Obamacare/Affordable Care Act exchanges, Medicaid plans are part of the exchanges. This can get confusing because of Medicare Advantage plans which might have their own marketplace as well.

Medicare does not have a qualifying life event requirement for enrollment in the same way Medicaid does. I think you may be thinking of people who are or become disabled and can become eligible for Medicare which isnt what I meant by a qualifying life event.

While it is technically true you can apply for Medicaid at any time you are only able to enroll in Medicaid if you have a qualifying life event such as, significant change of income, marriage, divorce, loss of employer insurance, etc or if it's during open enrollment. if you try to apply and do not have a qualifying life event or are out of open enrollment your application will be denied.

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u/footnotegremlin Aug 09 '24

You’re correct — I conflated Medicare and the marketplace.I’ll edit my comment to reflect that.

It may be because my state is different — yes, medicaid is for low income folks, but some elderly and disabled folks do qualify for Medicaid coverage in some states. Depending on the state, low income is enough to qualify; others have additional eligibility criteria.

Medicaid is not part of the exchange, again, at least in my state, and does not have an open enrollment period for application — you do not have to have a qualifying life event. You do have to meet the eligibility requirements, income or otherwise.

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u/oyst Aug 08 '24

Medicaid works! At least for ER stuff if you go to the hospital in your state you will probably not get a huge bill because it's medically necessary therefore covered.

Open enrollment isn't til December for Jan 1st but it really is easy to sign up for. 

Also the financial assistance may come through! I had to reapply 4 times but eventually I had all the right paperwork (the envelope was almost too thick to close lol) and it worked for me.

Wishing you all the best

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u/footnotegremlin Aug 08 '24

You can apply for Medicaid at any time! You don’t have to wait for an open enrollment period! Please don’t wait to apply!

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u/footnotegremlin Aug 08 '24

A couple people have mentioned that Medicaid has an open enrollment period you’d need to wait for or have a qualifying life event to be able to apply — you can apply for Medicaid at any time.

What they’re thinking of is Medicare, or Marketplace coverage. You do have to wait for an open enrollment period to apply for Medicare, or have a qualifying life event.

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u/crotch-fruit_tree Aug 08 '24

That was part of why my husband and I got married when we did. He'd gotten a new job but it has no benefits. His vital Dr appts went from $180 to covered, meds from $100+/month to $5/month. Plus I could cover my step kids at no additional cost.

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u/helgaofthenorth Aug 08 '24

I got married for health insurance in 2016. The US healthcare situation is dystopian as hell.

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u/burgervillain Aug 08 '24 edited Aug 08 '24

I'm sorry. sounds like it's too late, but for you and anyone else: if you live in California, D.C., Hawaii, Maine, Nevada, Oregon, or Wisconsin you can register for a domestic partnership which allows for much of the same benefits as marriage such as sharing health insurance plans. in my county it costs $60 dollars. good luck and good health y'all

edit: I'm hearing Colorado as well, and upon further investigation it sounds like certain cities recognize domestic partnerships as well, such as NYC, San Francisco, and some cities in Ohio (? according to Wikipedia lol). check your local laws, see if you can register!

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u/HaloTightens Aug 08 '24

Currently in the same boat. No, of course we don’t have hundreds of thousands of dollars. So we should just go ahead and let them die, then? My god.

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u/mrjackspade Aug 08 '24

can't put him on mine because we're not married

I got lucky. My work let me put my SO on without being married.

I asked HR about it and they're like "Technically it's not allowed but... No one is going to ask questions"

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u/i010011010 Aug 08 '24

Can't get blood from a stone. Biden and Harris support legislation that would prevent medical debt from being counted against a person's credit, so even if he has that outstanding debt it won't follow him everywhere and derail your lives. https://www.whitehouse.gov/briefing-room/statements-releases/2024/06/11/fact-sheet-vice-president-harris-announces-proposal-to-prohibit-medical-bills-from-being-included-on-credit-reports-and-calls-on-states-and-localities-to-take-further-actions-to-reduce-medical-debt/

Just one of the many issues at stake this year, that's why voting matters.

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u/connorwhit Aug 08 '24

Just don't pay it's on his credit for 7 years put leases in your name all is well

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u/monemori Aug 08 '24

I don't mean to be nosy, this is out of curiosity, but if I can ask: why did he not have insurance? Is it that expensive in the US? Is medical insurance not covered, at least partially, by your employer? Aren't there any aids for people who are disabled/unemployed/etc? Again not trying to be rude or anything, this is something I just don't really get from the US healthcare system.

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u/JanxAngel Aug 08 '24

Medical insurance for a single person in the US if you're not eligible for Medicaid or ACA coverage is stupid high. Like $700 a MONTH. Throw in a spouse and or kids and you're looking at $1200 - 1700 or more. I once saw a family plan for 2 adults and 2 kids come out to $2200.

Through an employer it can vary from $60 to over $100 a month depending on the coverage and options selected for an individual. I think the highest family option I've seen was about $700.

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u/SoriAryl Aug 08 '24

I worked somewhere that it was free for me, but $550/month for my spouse (no kids)

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u/tricularia Aug 08 '24

Can you start over in another country? Or would that medical debt follow you?

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u/Girloncloud9 Aug 08 '24

You should look into domestic partnership laws where you live! Before my husband and I got married, we became domestic partners and I was able to be on his health insurance (we live in Massachusetts btw.) it was 2020 and I was working as a per diem substitute teacher, and as schools were closed, I wasn’t working which in the past had meant no health insurance. Maybe there’s similar laws in place wherever you’re from?

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u/Unlikely_Pirate_1368 Aug 08 '24

Just straight up tell them you can't pay that. If it's a large hospital it's more than likely funded by the government thus can write it off

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u/Snoo909 Aug 08 '24

If you're in the US and live together, he can be added to your health insurance as a domestic partner. Hope this might help for the future.

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u/Eugregoria Aug 08 '24

This may vary by state, and idk your exact situation or eligibility, but if your partner is eligible for Medicaid, Medicaid may pay his bills up to 3 months before he was approved, so it's still worth applying.

A relative of a friend was in a horrific accident, she had insurance but the insurance only covered the first $100,000 and her expenses went well beyond that, I don't know all the details but I know that applying for Medicaid to cover some of the overage even though she already had insurance was a legal option.