multiple myeloma, bone marrow transplants, hospital procedure, and an insurance question

[trovia]

Setting: Massachusetts, within the last five years.

I'm working on a fic about a doctor who befriends a cancer patient. Since I'm neither a doctor, nor do I have any experience with cancer (and I don't live in America), I'd really appreciate some help to get my facts straight. Cutting for length:

1.

Comments

[maeveth]

Medical reimbursement student and former insurance agent hat on.

With regards to her having no insurance -- why does she not have insurance? At eighteen, if her parents have health insurance and she isn't an emancipated minor, then she would be covered on her parents' plan (children can stay on their parents' plans until age 26). As mentioned by someone else, if it's post-January 1, 2014, then an insurance company would not be able to deny her on account of pre-existing conditions. There are also subsidies available through the ACA that can offset the cost of health insurance premiums provided her income falls within a certain bracket. Additionally, if she lives in a state where the Medicaid expansion was taken advantage of, she may well qualify for Medicaid (although that comes with its own huge issues). That said, not every state took the Medicaid expansion, and in quite a few states there's still a substantial amount of the population that can't afford health insurance (even with subsidized premiums) and can't qualify for Medicaid.

All that said, even with insurance cancer is a verrrrrrrrrrrrrrrrrry expensive disease to treat. She could have insurance and still be out of pocket for hundreds of thousands of dollars in deductibles, copayments, and non-covered services, especially if she's on a fairly inexpensive health insurance plan. I hope fiance's rich daddy is SERIOUSLY loaded.

[trovia]

Medical reimbursement student and former insurance agent hat on.

The internet is so awesome. :) (heh, your reply seriously strained my English abilities, but I think I made it through intact!)

She doesn't have insurance because she ran away from home a couple years ago. Lived on the street, met the right people, got off the street, got a contract as a musician and enough income to pay for rent and food. And a rich girlfriend. ;) So yeah, she's an emancipated minor by now.

All that said, even with insurance cancer is a verrrrrrrrrrrrrrrrrry expensive disease to treat. She could have insurance and still be out of pocket for hundreds of thousands of dollars in deductibles, copayments, and non-covered services, especially if she's on a fairly inexpensive health insurance plan. I hope fiance's rich daddy is SERIOUSLY loaded.

That is very good for me actually (not so good for real people with cancer obviously! :( ) because I need the dad to be spending a considerable amount of money on this for her. He's just a really great dad. And yes, seriously loaded. Money not an issue here.

Thank you very much for helping out. :))

[maeveth]

Any time. (Although I had no IDEA you weren't a native English speaker, so if you need clarification on something please tell me!)

You can have her have insurance and still have a lot of bills if she has cheap insurance (in the US, all insurance is most definitely not created equal). A lot of young people who signed up/are signing up for insurance via the ACA are signing up for what's called a catastrophic plan; it's basically only there to pay for preventative care and you're gambling that nothing seriously bad is going to happen to you. That way, while the costs of treatment will be blunted somewhat, fiancee's daddy is still shelling out a lot of money.

[trovia]

Thank you. :) Is "catastrophic plan" a term used by insurance people, or does everybody call it that? (or, when the patient herself talks about her insurance, would she say "I'm on a catastrophic plan"?)

I knew American health insurance is tricky, but... geez.

(Although I had no IDEA you weren't a native English speaker, so if you need clarification on something please tell me!)

Thank you. :) I'm usually fluent, but insurance language is a little outside of my usual expertise. American girlfriend helped me clarify, though.

[maeveth]

"Catastrophic plan" is an insurance term. If an eighteen-year-old patient was talking about her insurance and she had such a plan, I would be more inclined to believe she'd say "I've got insurance but it's cheap insurance" or something to that general effect.

American health insurance is an incredibly tricky field, just because there are SO many variations. And your English is excellent, I am duly impressed.

[tafkarfanfic]

I would add that, if you have an illness and are wrestling with insurance companies, you learn terms like "catastrophic plan" and "deductible" and so forth REALLY quickly.

[trovia]

Good point. It might make for a snarky quip. Thank you!

[trovia]

It better be, I plan on writing this one in English. ;) Again, thank you!