Uninsured patients

  1. 0 There has been a rather heated discussion on health inusurance and drug coverage on a disney forum I subscribe to and it got me thinking (I am from the UK so not really familiar with US health care), what happens if a patient is unisured but requires care, not thinking on "emergency" care such as major trauma but more arround cancer or long term health needs.
    I am not trying to start a discussion on the NHS VS US health care but am genuinely interested in the situation in the US for uninsured patient.

    Thanks

    Colin
  2. Visit  15isto2 profile page

    About 15isto2

    15isto2 has '19' year(s) of experience and specializes in 'Resuscitation, CCU, HDU, ICU, ER'. Joined Jul '10; Posts: 19; Likes: 9.

    44 Comments so far...

  3. Visit  heron profile page
    5
    They may be able to qualify for medicaid, if not, and if they don't qualify for any free care, then they are billed and have to either pay up (on a payment plan, if the provider allows) or declare bankruptcy or do without.
  4. Visit  Mexarican profile page
    5
    You options are extremely limited. Mostly you will die, especially with cancer. If your extremely lucky and find someone or someplace that will treat you then you may have a fighting chance. But, then there's the question of the super expensive meds/chemo/radiation. The reality is for every one person who does find a way to get treatment..there's about 100 who can't find care or treatment for these conditions and eventually die. It's not uncommon for specialist to request incredible amounts of money up front before treating anyone who is uninsured...it happens every day in the "land of the free"...That is the reality in this country...
    Mex
    "Don't Tase Me Bro!"
    DogWmn, StNeotser, Not_A_Hat_Person, and 2 others like this.
  5. Visit  GM2RN profile page
    11
    Quote from Mexarican
    You options are extremely limited. Mostly you will die, especially with cancer. If your extremely lucky and find someone or someplace that will treat you then you may have a fighting chance. But, then there's the question of the super expensive meds/chemo/radiation. The reality is for every one person who does find a way to get treatment..there's about 100 who can't find care or treatment for these conditions and eventually die. It's not uncommon for specialist to request incredible amounts of money up front before treating anyone who is uninsured...it happens every day in the "land of the free"...That is the reality in this country...
    Mex
    "Don't Tase Me Bro!"

    ...yet someone wanting to get vaginal creme because they claim they can't afford it at the drugstore, or someone wanting a pregnancy test, or another person who just wants to refill their prescription, can go to the emergency room and rack up a $1K or more bill that they will never pay (and call and ambulance to take them because they don't have a ride) because they won't do without a fast food meal or pack of cigarettes to pay for what they need themselves, so the taxpayers have to foot the bill for them...
    sparklie.lady, Hoozdo, Fribblet, and 8 others like this.
  6. Visit  Hospice Nurse LPN profile page
    0
    The charity hospital system takes Medicaid/Medicare/insured/intigent pts. The one in my area has an awesome oncology unit, which is staffed with oncology docs from a local clinic, donating one day/week there. The clinic is staffed by several docs, so there is uninterupted service. The pts receive the same care and treatment that is offered at the for profit hospitals. This same hospital is the leader in HIV/AIDS care. I've been told that you have have HIV/AIDS, charity is THE place to go because the care in outstanding. Just my
  7. Visit  chloecatrn profile page
    0
    Quote from Mexarican
    You options are extremely limited. Mostly you will die, especially with cancer. If your extremely lucky and find someone or someplace that will treat you then you may have a fighting chance. But, then there's the question of the super expensive meds/chemo/radiation. The reality is for every one person who does find a way to get treatment..there's about 100 who can't find care or treatment for these conditions and eventually die. It's not uncommon for specialist to request incredible amounts of money up front before treating anyone who is uninsured...it happens every day in the "land of the free"...That is the reality in this country...
    Mex
    "Don't Tase Me Bro!"
    Anyone who is diagnosed with a chronic health condition is eligible to apply for Medicaid. Medicaid then should pick up the costs of treatment.
  8. Visit  elkpark profile page
    15
    Many states have cut 'waaaaay back on Medicaid as their economies and budgets have gotten into deeper and deeper trouble over the last decade or so. I know that, in my state, it's no longer enough "just" to be poor and sick to qualify for Medicaid -- unless you are a child, pregnant, or have one of five or six specific chronic illnesses, you're just !@#$ out of luck.

    There are public "charity" hospitals in some areas, primarily urban areas. Much of the US just doesn't have anything like that available. In my (rural) area, I see lots of donation jars in local businesses and fund raising events being put on by interested groups, churches, etc., to raise $$$ for people who need expensive surgery or ongoing treatment for cancer, etc.

    It's pitiful and disgraceful, IMO, that this is what people are reduced to in a supposedly "civilized" country.
    sparklie.lady, SharonH, RN, nursel56, and 12 others like this.
  9. Visit  AnxiousRNtobe profile page
    18
    I'm a social worker in Michigan. Medicaid has nothing to do with illnesses people may (or may not) have. Medicaid is for people with very low income and assets. In Michigan, that means an income of under $13,000 or so a year (I think) for a single person and less then $2000 in assets. Whether someone is sick with cancer, diabetes or anything else is irrelevant. I have been able to get applications "expedited" when a person is terminally ill and then the application itself is considered in about a month instead of the 2-3 months as usual. But that doesn't mean the person gets approved if they have a higher income then that.

    My area doesn't have charity hospitals. Here, if a hospital system makes a diagnosis of cancer, they are ethically responsible for treating the person (otherwise it's patient abandonment). Sometimes patients don't want to stay with that system but that's all that can be done. For diabetes, hypertension, hepatitis, etc., there's free clinics in some areas where people wait for hours to see a provider.

    Patients who are diagnosed with end stage renal disease or ALS get Medicare automatically without the two year waiting period for other diagnoses, including cancer. The Medicare then picks up costs of dialysis or whatever treatment. Interestingly, patients only get Medicare for two years after kidney transplant so paying for their antirejection meds after that can be difficult.

    Pharmaceutical companies have "patient assistance programs" for brand name drugs that patients can get for free if their income meets each companies criterion and there's someone at the office willing to do the paperwork for each medication.

    And of course we all know that having that insurance card doesn't mean that treatment will be affordable. The Medicare Part D plans vary in how much they'll cover in that donut hole. A month of Lovenox is thousands of dollars, Nexxevar also thousands. Even a copay of 20% can force a decision about stopping treatment for financial reasons. And medical bills are the leading cause of bankrupcy in this country. Oxygen can be hundreds of dollars a month for someone on anything over 4L, radiation course is often tens of thousands of dollars, TPN is a few hundred a day.

    Americans can get health insurance from their employers for whatever the employer charges employees, from the government (Medicare and Medicaid as explained above), piecemeal (from free clinics, patient assistance programs, etc), the Veterans Affairs system (if eligible and with some waiting lists but provide excellent care once accessed), from individually purchased policies (which are very expensive and usually cover only catastrophic expenses and not the chronic care needs, usually not outpatient medications).

    It's an amazing system we've developed here where we have the right to vote, right to high school education but healthcare is reserved for the very very poor or those who have access to employer based policies. But you asked the question out of curiosity, not in wanting to know opinions about the disgracefulness it represents.
    sparklie.lady, smartin13, SharonH, RN, and 15 others like this.
  10. Visit  DogWmn profile page
    4
    I will be 60 years old next month and have been unemployed for over 2 years now and have no health insurance, can't afford it, I have some chronic but manageable health issues that require Rx's that I can also no longer afford, I'm not elegible for Medicare/Medicaid, so I do without my Rx's and I don't feel all that well most days.

    So to answer your question, if I get sick and go to the ER they will treat me for the emergent condition and send me a bill (that I can't pay), anything else is not covered and I go without. Our health insurance is tied to our jobs, so no job - no health insurance. We are offered what's called COBRA if you are laid off from a job but it's un-afordable for most people.

    Even before I lost my job, my premiums, co-pays and Rx's had skyrocketed to the point that I really couldn't afford to go to the doc unless I was sick or needed Rx refills.
    MAISY, RN-ER, TakeOne, tewdles, and 1 other like this.
  11. Visit  Anne36 profile page
    7
    "Even before I lost my job, my premiums, co-pays and Rx's had skyrocketed to the point that I really couldn't afford to go to the doc unless I was sick or needed Rx refills. "

    I can understand that. We have a healthy family with no ongoing medical issues and are paying $800/mo to keep that piece of plastic in our wallets. How can I afford to go to the DR now?? No freaking way should a healthy family be paying this on top of co-pays, deductibles, and % of the bill its outrageous! The flip side is doing without ins and then having a major illness or injury occur. Either way, healthcare keeps us in the poorhouse.
  12. Visit  Katie82 profile page
    0
    [quote=15isto2;4529088]what happens if a patient is unisured but requires care, not thinking on "emergency" care such as major trauma but more arround cancer or long term health needs.


    One of the myths that allowed the powers in Washington cram Health Care Reform down our throats is that there are people dying from acute issues like cancer. I work with Medicaid patients. I have many patients who became enrolled in Medical Assistance because of issues like cancer. Those who truely cannot afford health insurance most likely qualify for Medicaid. Even those whose income is too high to qualify under normal circumstances would probably be eligible because of the high costs they are incurring. These folks are usually enrolled, receive treatment, then are disenrolled. Problem is that most people who have not been living in "the system" don't know how to navigate it, and aren't aware that they are entitled to assistance, and as a consequence suffer from poor health until someone comes along who can point them in the right direction. Most of the "pointing" is currently done by hospital social workers. Among my duties is to act as a liason between Medicaid and the medical community, and although I do receive an occasional referral from a doc asking for assistance in helping a patient enroll in Medicaid, most providers today simply do not understand how the system works.
  13. Visit  AnxiousRNtobe profile page
    11
    I wish it was a myth that people die in the US for lack of health insurance. I see a patients at least a few times a week whose disease is diagnosed so late that they can't be treated, or they decide not to take Tarceva/Nexxevar/TPN/stereotactic radiosurgery/whatever because they can't afford the 20%/50%/whatever copay. Diagnoses are made too late for some people because they get "care" in the emergency room and procedures like EGD or bronchoscopies aren't done in the ER. Diagnoses are made too late because the patient is too afraid of the outpatient doctors' copay to make an appointment. Once made, all those copays for medications, appointments, hospitalizations, tests, etc are outlined and even the insured have to consider them. For an uninsured patient to be given a choice between putting down $50,000 upfront or seeking care elsewhere... .well, maybe that's one of the places where people die for lack of health insurance. If it was as easy as getting people into Medicaid or whatever other system was out there (that isn't so broke that they stop accepting applications), I'd sure like to know where to send my patients. And so would the dozens of social workers at my hospital and dozens of hospitals in my area.
    GaMBA, canoehead, Williss2, and 8 others like this.
  14. Visit  dthfytr profile page
    14
    I can answer your question from current personal experience! Been out of work since January due to a perfect storm of back problems. My sick time ran out in late March. To see a Dr it's $30 up front, and if I don't have it they offer to reschedule my appointment. Prescriptions also required from 20 to 45 dollars copay if the insurance company agreed with the doctor that I needed that medication. All I wanted was someone to fix me so I could get back to the ER nursing.

    15 (fifteen)! doctors later, most with multiple appointments at $30/per, I'm near bankruptcy. I've been paying for all these Dr's visits, meds, and my health insurance via COBRA ($$$) with credit cards. Borrowed money from my daughter to pay rent, eat PBJ sandwich's, no income since 1st week of April, I owe over $30,000, and Social Security has just begun giving me disability payments, 1 so far.

    I used up all my retirement savings, my wonderful coworkers have helped out, I'm now living with my daughter for free. I still hope to find a way to earn a living, but cannot do a job requiring standing, walking or lifting. The rehab doc says get a phone from home job.

    The net result is that after selling all my personal belongings, maxing out my credit cards, and the wonderful generosity of coworkers and my daughter I survived to get income from SS disability. Without all this help my life expectancy would have been only months.

    My answer to your question is that without money the healthcare system will shun you. Sorry for the verbose answer but it's been a long difficult year, and all I want is someone to fix my back so I can work. Numerous medical encounters have made it quite clear that without money, it's not their problem if I die.
    JeanettePNP, GaMBA, canoehead, and 11 others like this.

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