+ 2 Need Information on Medical Insurance/Costs in the US regarding Surgery & time off work
Guys, there is a good friend of mine on here that I am extremely concerned about who needs some surgery asap on a lump that needs removing.
He has in the past discussed this on here, but back then he was in a different job and had Medical Insurance which was due to be covering the surgery - since then he has changed jobs and no longer has the Insurance. There are other factors affecting when he can now get it done as he has to be in work for a year again before he can get adequate time off work for both surgery and recovering - being about 4 months total. He can chime into this if he wishes or remain anonymous 
Now I simply cannot get my head around how the US can be so different to the UK - here we can get it done on the NHS as its funded by the Tax payer and because of the nature and urgency of the surgery there would be no problems at all with the employer regarding time off work - even if you had just joined the company.
I guess what I am asking here is there simply no way of getting this done other than taking time off and risking the employer sacking him during his first year, and would he have no choice but to pay this out of his own pocket? This just seems absolute madness to me that if he can't afford the surgery which will cost many thousands then he will be left to suffer the consequences of not getting operated on and possibly die?
I am worried about him and want to try and help in any way I can, but don't have $15k spare so any help or ideas is greatly appreciated. Surely there must be some kind of workers rights/Unions that allows someone to get Urgent surgery with no work repercussions.
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Our fucking healthcare and pharma industry is ungodly corrupt. Biggest flaw of the US for sure
I was supposed to get this surgery about 8months ago. I was on FMLA at my previous job which kept me protected but insurance was discontinued. During that time I was on call for surgery and was able to apply for a grant to cover all medical cost. When I finally got the call and a date for surgery it was 2 days after my grant ended. The said it was a one time deal and could not be extended. During this time I applied for medical but the process was long and before I could even finish that crap I was already back at work. still tried to go in for surgery and they called me and said unless I could pay it in its entirety before hand they would not perform the surgery. I ended up leaving that job for a better opportunity but I am only at the 7month mark. I do not qualify for FMLA.
I am also not putting money into SSI. Everything I put in is going to federal railroad worker retirement. Me pulling from that would be based off what I’ve put in not what I make. Someone I know went out for 4months for back surgery and was getting $90 a week! He already has 2 years with railroad retirement. I would lose everything if I did that.
I already know off the bat I’d need to pay 5k +- as copay. My biggest concern is the bills the rent the food to support my family. I am the only source of income and need to ensure I can cover 4months of not working.
I am in a much better financial position but I’m playing catch. The cost of moving and my rent doubling has wiped me out. Hence no TD pics lmao!
As of now I’ve trying to get out of this hole to get ahead to be able to support the family during that time off. I was given a coworkers number who had to take a long time off and when I talked to him he said there was some program that paid him however he didn’t get that money til after his 4-5months off. Again I would lose everything.
The way I see it is I need 15k atleast to hold me over for 4 months.
I won’t lie I’ve definitely put this on the back burner as it feels like I can’t do shit about it anyway. The goal is to have the money by the next 6 months. I have a 6cm mass that can flip on me and I also need to get a section of my colon removed before it dies on me. It’s definitely weak as I now have a canal going from my colon to my bladder. I piss blood, blood clots, and sometimes little pieces of shit. For the last 5months it’s been pretty good but it could lead to infection which it has twice in the last year.
Appreciate @press1 throwing this out there. I will go over the comments and take what I can from them.
Anyways! Blast tren and train hard motherfuckers! Thanks everyone for their input.
Ranger3252All he needs to do is have HR give him a FMLA packet and have it filled out by his treating physician. He turns it into HR and they have to give him time off, I think up to three months. It’s not paid time off, but they can’t refuse FMLA. As far as hospital fees, he needs to apply for financial assistance.
FMLA: If your employer is covered and you meet the eligibility requirements (including working for the company for at least a year), you can take up to 12 weeks of unpaid leave for your surgery. Your health benefits will be maintained during this time.
State and company policies: Some states have their own paid or unpaid leave laws. Your company might also have specific policies, such as a sick leave pool or the ability to donate accrued hours, which you can discuss with your HR department.
Short-term disability (STD): If you have STD insurance through your employer, it may provide a portion of your income during your recovery. This is often an option for illnesses and injuries unrelated to work.
Excellent reply Ranger. Your spot on with the FMLA. Get it signed by Physician who is doing the procedure.
THANKS FOR ALL OF YOUR HELP GUYS - IT IS VERY MUCH APPRECIATED
When he does go to the hospital he needs to ask about financial assistance, most hospitals won't tell you about it but chances are he will qualify for some kind of financial assistance from the hospital and something is better than nothing. It differs from state to state and by hospital as well but chances are the cutoff for 100% assistance is income above 3X the poverty level for the state, in my state 3x poverty level is 96k a year anything above that you still generally qualify for some kind of discount.
Well the first thing he should do is go talk to Human Resources (HR) at the new job and explain what is happening and see if they will be willing to give him medical leave. I am hoping he has full benefits at this new job like short term disability, long term disability that could help him out a little and health insurance. If he does not get benefits at the new job then he needs to get the bad insurance called Obamacare. He can purchase that off of marketplace but it's usually expensive and crapy insurance but better than nothing when it comes to big health procedures.
So how our insurance works:
1. deductible so say its $3000 that means you have to pay $3000 in a year on medical costs before any of your health insurance kicks in.
2. Max out of pocket. Once your deductible is met then this is the max amount of money you have to pay in a year before getting full coverage from the insurance so your insurance will pay say 70% after deductible then you pay 30% up to the max out of pocket which is like $5000 or more depending on your plan. A lot of times this includes the deductible but bad insurance is separate from deductible.
Thanks for the Help mate - So if I am reading this correctly it looks like its gonna be around $10k that he will pretty much have to bank on putting in? Regarding the Health Insurance Claim - once you have bought it is there a period initially where you cannot claim to prevent people just buying it once they have become ill?
Nope, you can buy insurance today and make a claim tomorrow. People get sick and buy insurance all The time. Until like 2010ish insurance companies could deny you for “pre existing conditions” but that was made illegal with Obama care.
So it all depends on what insurance plan he has but yeah it will probably be expensive. If he has benefits at his new job i hope he enrolled in insurance. Right now it is open enrollment for most jobs and the marketplace so if he does not have insurance he needs to enroll now and it will take effect in January. In the US you are protected from pre-existing conditions so if you have insurance they have to cover it. So if he gets insurance now during open enrollment then they will help with costs starting in January.
There's quite a few programs your buddy could look into, aside from insurance to help him with the cost of getting a needed surgery. Especially if it's cancer related.
If he has already been diagnosed and is/was working with a surgeon or Dr, they should be able to start tracking down charities and resources to help offset the costs. In addition to that, most hospitals are willing to write off large sums for life saving treatment and then pass the cost on to insured folks, Thereby exasperating our existing health cost problems.
People can complain all they want about our healthcare system in the United States, but there's PLENTY of poor people receiving no cost/low cost healthcare and procedures every day here.
Might have to put in some leg work tho.
It pays to be poor. It doesn’t always pay to be a hard worker. I’m above the FDL ( federal poverty line). The issue with that is it doesn’t take into consideration the cost of living. I’ve have grown to hate California. It’s easier to live off the system get section 8 food stamps and free healthcare than bust your ass.
As you said there has to be some kind of program that will assist. Got some leg work to do.
I'm a so cal transplant. Born and raised. Left when I was 26. Only traits I have left is my exceptional driving skills and my good taste in baseball teams.
California is a piece of shit.
Not sure what you do for a living, but you're definitely young enough to join a trade union and end up with tippy top notch insurance and be well into a high six figure career. There's lots of blue collar scum bags on eroids that could probably Help you get into something or point you in the right direction. You should definitely consider leaving California tho. There's much better places.
I just transitioned from Communications to “lineman”. Been trying to break into line work for 5years and finally got my break. The money is there for sure. I just won’t feel it til I get out of this hole I’ve been digging for the last 4-5months. Once I hit my 3months I’m able to work OT. That’s when the money will be rolling in.
Oh yah dude ur gonna be rich. Hang in there
We’ve been without contract for 4years. Currently going into mediation. Once that sucker gets signed I’ll get 10 raise but my 6month raises till I journey out. Then the job opportunity is endless. There’s good money in high voltage work. It’d also allow me to jump state
PLEASE try to explore all the avenues you can - I hate thinking of you living like this buddy. There has to be a better way round this than to have to wait at least another 6 months before you can get it removed and risk losing more of your colon - this is just madness having to live this way.
He did think it was cancer at first, but then it turned out not to be. It still requires a large surgery procedure to remove though unfortunately.
I think all the same things would still apply. "Quality of life" treatment is still a big thing. And benign growths can become malignant. It's hard to say not knowing exactly what/who/where. But I am almost certain there will be resources available to your friend. Is he an eroider? I think @Greg is a pretty handy guy. He could probably remove it for him
Lmao I’ll let him remove it but he isn’t aloud to cut me open I’d prefer his fist me to get it out
Sounds ouchie
He is a member on here buddy, he's just at work currently so not online but hopefully will be later on. I guess its just lunchtime over there.
Have him reach out to a state insurance broker. He probably qualifies for medicade (Obama care)
What time is it there? In that one country that we escaped from long long ago.
6.30pm lol Pitch Black too
If he hasn’t been with the company for 1 year he can’t get FMLA, and yes his employer could fire him. After a year he will be able to take FMLA and his employer is required by law to give him a job paying the same upon his return. Federally this is not paid time off. Just guarantees your job is there when you return. Some states may have laws to pay you during your leave, or atleast a % of your salary. This doesn’t mean he will get fired if he takes time off before 1 year. He needs to talk to his company about it. But he won’t have that protection.
You also have to think about this from the employers point of view. You have a job that needs to be done, what are you going to do when the person doing that job has to take off for a a long time? Ideally everyone else picks up a little extra but that’s not always possible. So you’d say just hire a temp. Which means spending a bunch of time and money training them and the temp will just be getting up to speed by the time the guy on leave is returning. Then you let the temp go when he gets back so it’s just a bunch of wasted money. Is it really their responsibility?
You guys have very different laws. I hate hiring people in the UK and EU. It’s so hard to fire them once you hire them on permanent because of all the legal protections. And for that reason it’s much harder for you guys to get full time permanent jobs vs temp assignments. If I remember correctly I can keep someone on a temp contract for up to 4 years and I don’t have to deal with any of the bullshit if I need to fire them like I would if they were a full time permanent employee. So for that reason I never hire anyone on a a permanent employee right off the bat. Always temp for a year to see if they’re going to work out.
So ya both of our systems have some flaws.
Regarding the cost. This can be negotiated after the fact to some extent. If he doesn’t have insurance they may want some portion up front. Try for as little as possible. Then after when the final bill comes you negotiate. Don’t ever refuse to pay and continuously engage with them. But my friend negioated a 250k bill for a 4 month NICU stay down to a 1 time $4000 cash payment. They did not have insurance. I don’t think they took anything up front. When someone comes in in labor they can’t be turned away. This is a little different than that.
Very Interesting
Thanks for this Info buddy, I guess this is where he is getting the idea that he cannot do anything for the first year without taking a big risk. He is not online till after work I am guessing - which is when he will see everyone's input today. I've run out of upvotes currently mate.
Tough situation. I would think the employer would work with this individual due to the rare circumstance and also have a few morals left in their worthless skin sacks
Are they prior service? Military
Not that I am aware of bud.
This is what I have said, surely any reasonable firm would allow for time off for something as serious as this. I think he just worried of losing a great new job he has secured by immediately asking for several months off.
"Aint to proud to beg " song popped up in my mind.
Of course, fear of the unknown at its finest. Bro will be just fine, request a seat with the manager and the bossman together. Have a little heart to heart with them, they WILL respect it. I bet they will even help him out financially possibly. You never know, so why the hell not find out. Could always start a go fund me type of thing as well
Your a good dude press.
I was thinking we should get Fuckin Milkshake Man in on the job and pick up where he left me off with the GoFundme mattress account again LMFAO @Milfpounder
I'm unreliable
So as far as the costs go - not much getting around it he's going to get railed in the ass. He can try to negotiate the costs down with the hospital and they will offer him some payment plan options, but typically they want a certain % up front at the least. He'll pretty much be out thousands best case scenario.
For employment - there is something called the Family and Medical Leave Act (FMLA). He will need to jump through some hoops getting everything approved ahead of time, but this will legally prevent his employer from terminating him due to his medical leave. However, he will not be paid during this time. It is unpaid leave and unless he works for a very "generous" company by US standards he'll have to live off of savings during that time thereby costing him thousands more on top of the surgery. There is honestly some degree of risk taking FMLA time off even though it is technically protected. A lot of employers will then look for any reason to fire him and claim it wasn't because of the medical issues it was because of this or that or downsizing or whatever. Especially if he lives in an at-will employment state, they can fire him at any time for any reason or no reason (barring some legal exceptions like race, religion, etc. but they will just claim it isn't one of those and do it anyways many times).
The state of medical care and employment protections in the US is abysmal. I went through this personally years ago as I had some really bad luck and ended up in a wheelchair for almost two years with several surgeries along the way. I'm still in debt from that experience and it's been years.
I did come across this FMLA scheme when I had a quick look mate, but really I don't have a clue how it will all play out in the real world. I was hoping that someone like you with past experience would jump in and say how you found it all - Thanks a lot matey
Depending on what state he is in, some states have PFMLA "paid family medical leave act" that you apply for and claim the weeks you are off and it pays like 75% of your normal wages other states have something similar but it is unpaid and is basically just job protection so your employer can't fire you for not coming to work after getting medical care or while you are taking care of an immediate family member
This is Really Helpful mate -Thankyou.
The healthcare here is a joke, especially the network I’m in. As far as your mate’s problem, if it’s necessary and not cosmetic, he’s going to have to bite the bullet and have it done. There’s ways to circumvent policy, go in to an ER, he cannot be denied treatment, and if he has to pay $100 a month forever, at least he’s alive. As far as losing employment over a medical procedure, there’s laws in place to protect him from that.
Cheers buddy - are those Legitimate options then? And the company CANNOT by Law get rid of him?
For sure. There’s a list of situations that protect people from termination from employment, they vary but are rock solid. Physical health conditions such as your friend, sexual preferences like with Rustyhooker, mental health conditions like with Shred777, it’s not a very long list, I’d like to say seven general categories with a few subcategories attached, but yes. It may take a little legwork and creativity, but he can certainly get treatment and keep his job. A kicker is if he didn’t mention this during hire or on his application, and it was existing at the time, it could be a complication. At the end of the day if he’s a good worker the company will do what they can to retain him. If he’s like Shred777 and trying to suck everyone’s cocks in the employee bathroom, he may have a problem.