Friend with no insurance just broke his collarbone

Submitted by Cdclimber t3_yicmrc in personalfinance

As the description states, I had a buddy recently break his collarbone in a mountain biking accident. He works for a tree company, and although he makes $1-1.2k/week, does not have insurance. I took him to the hospital after the accident. They took an X-ray, gave him a pain medication script, and told him to he would likely need surgery as the bone is significantly displaced. They counseled that he visit an orthopedic to get a second opinion and possibly schedule surgery. Due to the physical nature of his job, he will be out of work until it heals completely. He has about 6K saved up and minimal living expenses (~$500/month in rent/utilities). What is his best course of action? He lives in SC, so it will be very hard to get on Medicaid. Should he try to get an insurance plan activated, or should he shop around for Orthos who will allow him to set up an "out-of-pocket" payment plan? I really want to help him get through this and would appreciate any advice you all may have. Let me know of any other applicable pages I could share this post too. Thank you so much!

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mrschro t1_iuhxmip wrote

As second opinion could be useful, but may be an additional expense and delay treatment. If income is based on physical hours worked, the best bet may be to have the surgery as soon as possible. The buddy can ask for a payment plan or uninsured discount before the procedure and after try to negotiate the cost down further. The risk of going uninsured has already showed the downside and this will be a very expensive lesson. Do not let them put all their cash into the surgery or there will be further needs for cash to fund living expenses while out of work. Plan for the off time and life expenses, get the surgery, pay for it later and rebuild emergency money by living at a lower standard of living.

That salary is far too high to neglect health insurance. In the US, one needs health insurance or risk this type of financial catastrophe.

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wilsonhammer t1_iuipl4z wrote

> That salary is far too high to neglect health insurance. In the US, one needs health insurance or risk this type of financial catastrophe.

yep

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Suffolk1970 t1_iui11xe wrote

In some countries it's cash up front for surgery or medical treatment (China, India, Brazil, Africa), so be thankful he's in the USA. (During the 1930s in the USA maternity care was not a sure thing, and I heard stories of babies being held hostage for payment.)

Schedule appointment asap, it will only get worse without care. When they ask for insurance information, say none and make sure to ask if there is an out-of-pocket discount. There often is.

Paying cash is preferable to the hospital because insurance companies nickle and dime every bill and so providers have to overbill just to get paid their expected amounts. This leads to a normal "cash" discount, which even some "self-insured" companies take advantage of - so don't be shy. (Essentially without 3rd party insurance coverage, you are self-insured.)

Ask for an estimate of work from the doctor/surgeon and remember paying for the initial procedures is just the beginning, there will be follow up to make sure the bone is healing properly, antibiotics, etc. Avoid further injury if at all possible.

Typically hospitals here offer a payment plan, although being out of work even that seems a challenge. In your/his case, maybe paying $1000 up front, and then negotiate a payment plan for the rest. Hopefully he heals well, and gets some kind of income or family help in the meanwhile.

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kepler1 t1_iuiztio wrote

Geeez, not to pile on bad news, but... working for a tree company and mountain biking... without health insurance!

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Knipfty t1_iui56mg wrote

Tell your friend to get ready to write some checks. There are rules in place to prevent people doing what you are asking. That is to get insurance only when you need it. This drives up costs for everyone else while saving your friend money.

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shadow_chance t1_iuik1z7 wrote

He's pretty screwed TBH. Sorry, just don't want to sugar coat it.

Medicaid is unlikely as you said.

No insurance plan is going to allow enrollment right now except a new employer plan. Marketplace open enrollment starts in November for coverage to take effect Jan 2023.

He needs to talk to the financial aid people at the hospital ASAP. It can be tricky to get surgery even scheduled without prepaying or insurance.

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ElysiumSprouts t1_iuhxlpc wrote

Many hospital systems have financial aid. Get him sorted out medically ASAP and then he'll have to figure out how to pay the bills. That's when he'd apply for financial aid. I'd also recommend getting health insurance asap. I'm not sure if new insurance would help with recovery from this injury, but worth looking into.

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shadow_chance t1_iuikj2c wrote

The earliest he can get insurance coverage is Jan 1st. Unless something wasn't mentioned, he has no QLE for enrollment now.

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___lalala___ t1_iui9drr wrote

If he's otherwise healthy, going to an orthopedic surgeon that can do the surgery at an ambulatory surgery center will be cheaper than surgery at a hospital.

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dcdave3605 t1_iui9paa wrote

Realistically, he can stay put in south Carolina and work with the hospital and pay a ton of money for the surgery,etc.

Or, he can move to a state and live with someone for a few months while he recovers. That state should be one that does allow adults with no dependents to apply for Medicaid. If he has a period of time where he will earn no or very low income and/or has proof that income has ended (termination letter from employer for example) he can apply for Medicaid based on that income. He could apply and during that pending period (waiting for approval) go to the hospital and get treatment and surgery arranged. He would need to do a change of address and provide proof to show he is a resident, but most states don't have more than a day wait for establishing for Medicaid purposes.

Once approved and the bills are paid by Medicaid (could take a few months), he can end Medicaid and move back to south Carolina.

I live in Maryland and had friends do this.

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AllTheyEatIsLettuce t1_iujbmmy wrote

>recently break his collarbone

>does not have insurance

Can we fix that before the next body part breaks? Shopping mall opens at 12:01am his time.

>shop around for Orthos who will allow him to set up an "out-of-pocket" payment plan

Do be aware that health care vendors are not regulated as credit-granting entities. They can, will, and routinely do offload receivables to 3rd party debt servicers/debt buyers despite timely payments from indebted health care customers made in accordance with the vendor's own payment arrangement agreement. You can include the facility where any prior medical care was delivered, as well.

tl;dr: a>$0 balance owed can wind up in collections at any time.

Also be aware that no orthopedic surgeon is going to proceed with treating an elective surgery consumer without a 3rd party payer in the mix. Cash up front and in full should yield an in-person consult exclusive of any diagnostics involving any form of imaging.

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Agrippa04 t1_iui1h7d wrote

First and foremost, make sure he doesn't forego proper care. Make sure he heals correctly the first time instead of life long messed up collar bone and other possible issues related to this. It doesn't sound like it's life threatening (or he would have received further treatment in ER) but if it's actually displaced enough to require surgery, he could have significant issues down the road. If it comes to it, you can discharge medical debt in 7yrs through bankruptcy. Much harder to fix a shoulder, arm, nerve damage, etc.

Second, don't assume he can't qualify for Medicaid. I don't think private insurer will cover pre existing conditions, but double check. Many hospitals (especially non-profits) have payment plans or financial need assistance.

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Fabulous-Ad6844 t1_iuiam6e wrote

Will unemployment kick in if he’s fired for not coming to work?

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ThrowawayTink2 t1_iujegdp wrote

No because you have to be able to and available for work to collect unemployment.

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clyjr t1_iuitii4 wrote

He should look into medicaid. I don't know how they do it, but I'm in SC and I know of quite a few younger people (20-30) that are either on Medicaid, or got on medicaid temporarily. Sorry, I don't know how they get it so easily, but it's possible. Several of these that I've heard about had good jobs and got pregnant., quit the job and got on Medicaid to cover the pregnancy, then go back to work after having the kid...

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8FaarQFx t1_iui526j wrote

He needs to go to a county hospital (in my area it's called [County Name] General Hospital). They will help him and provide more financial options than a regular hospital. I had a buddy in a hit & run on a motorcycle. In addition to other injuries, his shoulder was destroyed. Ambulance took him to the closest hospital that did nothing but kept him alive becausehe didn't have insurance. The next morning, his father signed that he will cover the bills and took him to the county hospital which kept him in for a week and then did the surgery. Financial piece was handled between assistance, writeoffs and payment plan.

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___lalala___ t1_iui8uh2 wrote

Going to another hospital ER will be far more expensive than going to an orthopedic surgeon.

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