Insurance or no insurance?

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Myself

Senior member
Joined
Jul 16, 2020
Posts
76
I currently have no insurance and I'm having a very hard time finding a dr who will accept me and let me pay cash. At the same time I cannot get insurance right now that will cover a pre existing condition! It's just crazy ! Now I'm reading all these prices and problems y'all are having with insurance and I'm second guessing even getting any in November??
 

throwawaymcsneaky

Senior member
Joined
Feb 21, 2020
Posts
63
I'm really sorry that you're going through this. I think it's ridiculous that most people can't get insurance through the Affordable Care Act outside of the time window, unless you have a special qualification.

I don't know where you're located or what kind of doctor you're looking for, but a lot of doctors here have sliding scales or assistance programs for people who don't have insurance. I was on a sliding scale plan for my primary care doctor when I didn't have insurance and only paid $30. Perhaps try inquiring about those? Try looking for Federally Qualified Health Centers (FQHC), since they tend to cater to low income populations and have these kind of payment programs (that's where my primary care doc is located.)

All the best.
 

cupeater

Member
Joined
Mar 15, 2020
Posts
37
Navigating healthcare is always frustrating and I understand your pain. I decided to start my own small business several years back and was hit with insane monthly premiums because it was calculated based off my taxes, which were taken from my salary the previous year. Losing or quitting a job will help you qualify, but nothing helps you actually afford the insurance when you have suddenly have zero income.

Anyway, there are a lot of cash-only doctors available as of recent, especially because of the start of the ACA. The premiums are still set by insurance companies, so until that changes you will just have to deal with their prices. If you can afford a cash-only doctor with a pre-existing condition that is surprising you are concerned about insurance premiums, as the out-of-pocket visits can get much pricier much faster; It sounds like you would be one of the people that can benefit from the ACA marketplace, but I don't enough about your current situation.

You can try https://jointhewedge.com/ or Google cash-only doctors in your area. I've actually had the opposite problem where I accidentally found a cash-only doctor through Yelp and he wouldn't take my insurance.

Good luck to you
 

Myself

Senior member
Joined
Jul 16, 2020
Posts
76
Thanks for all the suggestions. I have tried most but not all. I went to the ER which only confirmed my suspicions that I will have to have several tests to pinpoint the problem and a specialist. He said it will be VERY costly thru it all. I know I'll have to get insurance I'm just trying to get by until I can actually get it. It's just that some of the quotes I've gotten and some I've read on here, it seems I'll get insurance but will still have to pretty much pay for everything. I'm doing a mental eyeroll lol.

Thanks again !
 

Gullible

Exalted member
Joined
May 15, 2011
Posts
2,558
Everything is MUCH more expensive if you don't have insurance. When you don't have it, the doc or hospital estimates their sky high bill and you pay or go away with no treatment. When you have insurance, first they take you in an treat you, then the sky high bill. Difference is that the insurance company has clout. They say forget that, here is what we are going to pay and the docs, hospital, etc take it and shut up. You then pay a portion of what it really should have cost

To give a real world example, I was in the hospital earlier this year. Had surgery which means other doctors involved too plus drugs, etc etc. They came up with a bill of over $300,000 and that did not include everything. Still to come was chemo and more treatment at high price. Well, the ins company looked at that huge bill and said you will get $35,000, doctors, hospital etc all said ok we will take it.

If it was one of us with no ins coverage, we would not even get the treatment until we had come up with a substantial portion of the sky high estimate and promised to make payments on the rest. You might have to pledge your house. Then you would be saddled with payments for a long time. No whittling it down to almost 10% of what they demanded, only the ins company can make them do that.

If you don't have a preexisting condition then get at a minimum a catastrophic health policy. Its one with a big deductible, maybe 10k and pays a percentage up to maybe a million or half million. Premiums are much cheaper and if something bad happens you are not out in the cold

Those policies won't cover routine stuff, you still pay out of pocket. So it will not help the OP in his case. But when you need it bad its there, most hospitals will let you in with a policy like that because they know that 80% or even 50% of the bill is still a big profit for them and you can make payments on the deductible. A pregnancy can trigger big bills, pneumonia, covid, and many things that sound kind of minor can cost a bundle

OP, look around like the others have said, there are programs that will help. They are working in washington on new plans but it will probably not be until after the election before we see any results.
 

Tron28

Honorable member
Joined
Jun 1, 2014
Posts
448
I don't understand the part you said about not being able to find health insurance that covers pre-existing conditions. My understanding is that the Affordable Care Act (assuming you live in the United States) requires that ALL health insurance providers cover pre-existing conditions.
 

throwawaymcsneaky

Senior member
Joined
Feb 21, 2020
Posts
63
I don't understand the part you said about not being able to find health insurance that covers pre-existing conditions. My understanding is that the Affordable Care Act (assuming you live in the United States) requires that ALL health insurance providers cover pre-existing conditions.

If you buy your plan through the Marketplace during the specified window (or at other times in the year, if you move somewhere new), then your plan has to cover pre-existing conditions. As I understand it though, if you miss this window, you can only apply for short term insurance, and these plans do not cover pre-existing conditions. As much as I support the ACA and think it has been a real positive for people like me who wouldn't have insurance otherwise, this is a real failing that needs to be addressed.
 

Tron28

Honorable member
Joined
Jun 1, 2014
Posts
448
I believe you need a "life changing event" to buy insurance or change your plan outside of the enrollment period. That's how it works through the marketplace or with employer plans. They don't want you to wait to buy insurance right before you think you need it.

I wish we just have universal single payer insurance. That would address this issue. But that's a whole different conversation.
 

throwawaymcsneaky

Senior member
Joined
Feb 21, 2020
Posts
63
Universal single payer insurance like the NHS in the UK or a mix between public/private insurance like in Germany (with most on the former), is the way to go. It's utterly absurd how much power insurance companies have in the US and that we have almost 30 million people uninsured.
 

Myself

Senior member
Joined
Jul 16, 2020
Posts
76
I don't understand the part you said about not being able to find health insurance that covers pre-existing conditions. My understanding is that the Affordable Care Act (assuming you live in the United States) requires that ALL health insurance providers cover pre-existing conditions.

If you buy your plan through the Marketplace during the specified window (or at other times in the year, if you move somewhere new), then your plan has to cover pre-existing conditions. As I understand it though, if you miss this window, you can only apply for short term insurance, and these plans do not cover pre-existing conditions. As much as I support the ACA and think it has been a real positive for people like me who wouldn't have insurance otherwise, this is a real failing that needs to be addressed.
Throwawaymcsneaky is right on. I honestly thought I was being punked when they quoted me $300 for insurance but it Would Not cover pre-existing conditions. I did months of research trying to find insurance and/or dr but came up empty handed. That research was how I stumbled onto this site...thank God. Now I'm still reading, researching, writing my way to senior area 😊
 

throwawaymcsneaky

Senior member
Joined
Feb 21, 2020
Posts
63
I don't understand the part you said about not being able to find health insurance that covers pre-existing conditions. My understanding is that the Affordable Care Act (assuming you live in the United States) requires that ALL health insurance providers cover pre-existing conditions.

If you buy your plan through the Marketplace during the specified window (or at other times in the year, if you move somewhere new), then your plan has to cover pre-existing conditions. As I understand it though, if you miss this window, you can only apply for short term insurance, and these plans do not cover pre-existing conditions. As much as I support the ACA and think it has been a real positive for people like me who wouldn't have insurance otherwise, this is a real failing that needs to be addressed.
Throwawaymcsneaky is right on. I honestly thought I was being punked when they quoted me $300 for insurance but it Would Not cover pre-existing conditions. I did months of research trying to find insurance and/or dr but came up empty handed. That research was how I stumbled onto this site...thank God. Now I'm still reading, researching, writing my way to senior area 😊

Yeah, it's totally crazy. Wishing you wellness - I hope you'll be alright until you can sign up for a plan on November 1st. Depending on what your income is, you might qualify for subsidies too for an ACA plan, which can reduce the cost quite a bit.
 

reroka40

New member
Joined
Sep 30, 2020
Posts
3
I currently have no insurance and I'm having a very hard time finding a dr who will accept me and let me pay cash. At the same time I cannot get insurance right now that will cover a pre existing condition! It's just crazy ! Now I'm reading all these prices and problems y'all are having with insurance and I'm second guessing even getting any in November??

Have you tried to apply for medicaid? if you go to your local depart of health and human services.
I do not know your income info or your location but this may be an option for ya.
 

Myself

Senior member
Joined
Jul 16, 2020
Posts
76
I work and am above the limit for assistance. I'd say I'm probably one of those "fall between the income gaps"...don't make enough to be rich but make too much to be poor lol. Thank you very much for the advice though.
 

Myself

Senior member
Joined
Jul 16, 2020
Posts
76
Everything is MUCH more expensive if you don't have insurance. When you don't have it, the doc or hospital estimates their sky high bill and you pay or go away with no treatment. When you have insurance, first they take you in an treat you, then the sky high bill. Difference is that the insurance company has clout. They say forget that, here is what we are going to pay and the docs, hospital, etc take it and shut up. You then pay a portion of what it really should have cost

To give a real world example, I was in the hospital earlier this year. Had surgery which means other doctors involved too plus drugs, etc etc. They came up with a bill of over $300,000 and that did not include everything. Still to come was chemo and more treatment at high price. Well, the ins company looked at that huge bill and said you will get $35,000, doctors, hospital etc all said ok we will take it.

If it was one of us with no ins coverage, we would not even get the treatment until we had come up with a substantial portion of the sky high estimate and promised to make payments on the rest. You might have to pledge your house. Then you would be saddled with payments for a long time. No whittling it down to almost 10% of what they demanded, only the ins company can make them do that.

If you don't have a preexisting condition then get at a minimum a catastrophic health policy. Its one with a big deductible, maybe 10k and pays a percentage up to maybe a million or half million. Premiums are much cheaper and if something bad happens you are not out in the cold

Those policies won't cover routine stuff, you still pay out of pocket. So it will not help the OP in his case. But when you need it bad its there, most hospitals will let you in with a policy like that because they know that 80% or even 50% of the bill is still a big profit for them and you can make payments on the deductible. A pregnancy can trigger big bills, pneumonia, covid, and many things that sound kind of minor can cost a bundle

OP, look around like the others have said, there are programs that will help. They are working in washington on new plans but it will probably not be until after the election before we see any results.
I don't know how I missed your post. You are soo right. I do have pre existing! I will have to give them my house lol unless something changes. It's just all so crazy and it really doesn't have to be!
 

cp2k

Senior member
Joined
Aug 28, 2020
Posts
91
I'm not certain what your health issues or location are but there are also telehealth companies in many states now that offer primary care for a set fee per month or year. Galileo is an example of those. They're in CA, CT, FL, NC, NJ, NY, PA, SC, TX, and WA and will become your primary care doctor for $9.99 a month or $99 a year. It obviously doesn't cover lab tests, medication, etc, but depending upon your situation it might be worth researching companies like them. It's all in what kind of care you need.
 

smott999

Lapsed Senior Member
Joined
Dec 21, 2011
Posts
108
What state are you in? The options do vary a lot based on where you are?
 
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