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So, You Can't Pay Your Health Insurance Because You're Sick. What Happens Next?

 
 
Reply Sat 9 Aug, 2014 04:42 pm
Here's a question. Let's say that someone has medical insurance not connected with a job. For definiteness, let's assume that it's an old person without close family. Every month, he pays his health insurance premium. Then he gets sick and goes to the hospital. He get's sick enough to be unable to move - maybe because he's unconscious. So, he doesn't pay his health insurance premium and his policy cancels. He has the money - he's just too sick to write out a check. Who pays the hospital bill after that? Do they move him out into the street? Do they move him to the county hospital for the poor? This doesn't pertain to anything happening to anyone I know. It's just something I am wondering about. Please don't give answers of the form - "he should have" done this or that. I am wondering what will happen to a person who is already in this situation.
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Type: Question • Score: 12 • Views: 3,470 • Replies: 60

 
jespah
 
  2  
Reply Sat 9 Aug, 2014 04:55 pm
@Brandon9000,
I'd like to think (and I could be really wrong here) that hospital stay would trigger an investigation into why premiums were not being paid. After all, the hospital is billing the carrier ...?

I'm sure this has happened many times. It is a highly plausible scenario. But consider that accident victims are brought in all the time, unconscious people (let's leave amnesia out of the equation), that sort of thing. Those people are admitted, under the emergency, and then the payment issues are figured out later.

I suspect someone who does not regain consciousness or mental capacity would have a guardian appointed for them.
cicerone imposter
 
  1  
Reply Sat 9 Aug, 2014 05:14 pm
@Brandon9000,
That's what they did before ACA. What difference are you trying to imply?
I'm sure in such situations, it's up to the administrators of the hospital to make that decision.
Before ACA, that patient would have been kicked out without question.

Quote:
Doctors Say Obamacare Rule Will Stick Them With Unpaid Bills
Print Share
TOPICS: DELIVERY OF CARE, INSURANCE, HEALTH REFORM

By Roni Caryn Rabin
MAR 19, 2014
Doctors groups fear their members won’t get paid because of an unusual 90-day grace period for government-subsidized health plans and are urging physicians to check patients' insurance status before every visit.

“This puts the physician and their patients in a very difficult situation,” said Dr. Ardis Dee Hoven, president of the American Medical Association (AMA), which advised physicians Wednesday about how to minimize their risk.

“If a patient is being treated for a serious illness, that requires ongoing care,” she said. “The physician is having to assume the financial risk for this. That’s the bottom line.”


If an enrollee in a subsidized plan falls behind on their premium payments, the Affordable Care Act requires insurers to cover their medical bills for 30 days.

But for the next 60 days, insurers may “pend,” or hold off paying the claims -- and ultimately, deny them if the patient doesn't catch up on his premiums. That means doctors don’t get paid for their services. If the insurer ends up canceling the policy after 90 days, doctors can bill patients directly but may face difficulty collecting.

"The doctors get left holding the bag on pending claims," said Robert Laszewski, a former insurance executive and consultant.

The way things work now, insurers generally cancel a policy if a subscriber falls behind more than 30 days. The insurer is usually on the hook for bills incurred before that cancellation.
Brandon9000
 
  1  
Reply Sat 9 Aug, 2014 07:59 pm
@cicerone imposter,
My motive in asking is curiosity about what happens to people without close family if they are sick or injured and unable to send the insurance company their premiums even though they have the money. What is missing is so simple - just someone to send in the checks in the mail. I am curious as to whether someone could suddenly be deprived of good medical care for such a frightening reason. Personally, I believe that good medical care should be guaranteed for everyone. If the hospital does continue to treat them and they eventually become well enough to mail in the checks, have they forfeited their insurance because it lapsed and the insurance company has an excuse to cancel.
cicerone imposter
 
  1  
Reply Sat 9 Aug, 2014 08:02 pm
@Brandon9000,
Did you read the article?
Brandon9000
 
  1  
Reply Sat 9 Aug, 2014 08:04 pm
@cicerone imposter,
cicerone imposter wrote:
Did you read the article?

Yes, and, while interesting, it completely fails to address the case of someone who is perfectly well able to pay but too sick to mail in the check. It's incredible that someone can't just mail the insurance check for them.
cicerone imposter
 
  1  
Reply Sat 9 Aug, 2014 08:08 pm
@Brandon9000,
If she/he's in the hospital, they will provide service for 30 days after any insurance runs out. If the patient is comatose, they aren't going to throw the patient out of the hospital. Your so-called 'interest' goes beyond the reality of "ability to pay."
Brandon9000
 
  1  
Reply Sat 9 Aug, 2014 08:11 pm
@cicerone imposter,
cicerone imposter wrote:
If she/he's in the hospital, they will provide service for 30 days after any insurance runs out. If the patient is comatose, they aren't going to throw the patient out of the hospital. Your so-called 'interest' goes beyond the reality of "ability to pay."

What do you mean "so-called interest?" I've been asking people this question since my mother died in 2004 and I was unmarried and alone. It strikes me as incredible that someone could lose his insurance because he got sick. Fortunately, I am now married and my wife could mail the check if I were sick or I could if she were, but we have no children and one of us will die last. Who will mail the check for the last one to die?
Butrflynet
 
  1  
Reply Sat 9 Aug, 2014 08:11 pm
@Brandon9000,
In the case of someone with Alzheimer's and other dementias, there can be a court appointed conservator to handle finances, etc. I do not know how that is initiated if there is no family to do so.
Brandon9000
 
  1  
Reply Sat 9 Aug, 2014 08:13 pm
@Butrflynet,
If it requires family to do it, then it is not a solution. The question pre-supposes that there is no relative who cares enough to do it. I believe that some people are in this situation.
djjd62
 
  2  
Reply Sat 9 Aug, 2014 08:19 pm
@Butrflynet,
here in Ontario there are agencies who step in as conservator, sometimes even if there is family, a friend of my mother was slowly losing her cognitive abilities, her family lived about 4 hours away and had little time for her, many folks had told them to get down and get the mother help, they eventually did get to her and have her admitted for evaluation, she was admitted to the hospital and deemed not fit to care for herself, her family had papers drawn up giving them power of attorney, but the mother was in no fit state to give consent, so the conservators took over
cicerone imposter
 
  1  
Reply Sat 9 Aug, 2014 08:20 pm
@Brandon9000,
You need to make clear on the front-end why you have specific issues with health insurance. With all insurance, premiums must be paid regardless of being ill. Usually, insurance is recovered after any premium is paid. Any single person living alone and sick will lose any type of insurance when the premium is not paid on time. No premium paid, no insurance. That's a fact of life. It doesn't matter how sick the person is. That is standard practice by all insurance companies. They usually give a 30-day grace period. After that, the insurance is canceled.
djjd62
 
  4  
Reply Sat 9 Aug, 2014 08:23 pm
yay for national healthcare, it ain't perfect, but it beats the alternative
Brandon9000
 
  1  
Reply Sat 9 Aug, 2014 08:23 pm
@cicerone imposter,
cicerone imposter wrote:
You need to make clear on the front-end why you have specific issues with health insurance. With all insurance, premiums must be paid regardless of being ill. Usually, insurance is recovered after any premium is paid. Any single person living alone and sick will lose any type of insurance when the premium is not paid on time. No premium paid, no insurance. That's a fact of life. It doesn't matter how sick the person is. That is standard practice by all insurance companies. They usually give a 30-day grace period. After that, the insurance is canceled.

Too bad no one can rouse himself to do the legal work to get the money deducted from the bank account. I believe that health care should be absolutely guaranteed to everyone.
Butrflynet
 
  1  
Reply Sat 9 Aug, 2014 08:25 pm
@Brandon9000,
https://www.caregiver.org/protective-proceedings-guardianships-and-conservatorships

There is more info at the link, but I think this is what you want.

Quote:
Q. How is a conservatorship established?
A relative, friend or a public official may petition the court for the appointment of a conservator of an individual. The petition must contain facts establishing why the individual cannot manage his financial affairs and/or make decisions concerning his personal care.
Once a petition is filed with the court, a court investigator is appointed to interview the proposed conservatee. The investigator reports back to the court with an opinion on whether or not the appointment of a conservator is justified.
The petition is set for hearing and the conservatee must appear in court unless medically unable to do so. The judge determines, based on the petition, the investigator’s report, and any evidence taken during the hearing, whether or not the conservatorship is required and what types of special powers may be granted to the conservator.

Q. What are the advantages of a conservatorship?
While the court supervision makes a conservatorship more costly and time consuming than other methods of management, it offers a higher degree of protection to the conservatee than other management mechanisms. The conservator must file an inventory which lists all the property of the conservatee and must file accountings with the court that reflect all transactions involving the conservatee’s assets.
A conservatorship allows for the management of an incapacitated person’s affairs when he or she does not have an alternative mechanism in place to do so.
Another advantage to a conservatorship proceeding is that it provides a structured method to assist an incapacitated individual who may be reluctant to accept such assistance.
Brandon9000
 
  1  
Reply Sat 9 Aug, 2014 08:25 pm
@djjd62,
djjd62 wrote:
here in Ontario there are agencies who step in as conservator, sometimes even if there is family, a friend of my mother was slowly losing her cognitive abilities, her family lived about 4 hours away and had little time for her, many folks had told them to get down and get the mother help, they eventually did get to her and have her admitted for evaluation, she was admitted to the hospital and deemed not fit to care for herself, her family had papers drawn up giving them power of attorney, but the mother was in no fit state to give consent, so the conservators took over

That still presupposes family who can ultimately be prevailed upon to do it. Someone with no siblings, no children, and only a few distant cousins who couldn't care less wouldn't have even that option.
Brandon9000
 
  1  
Reply Sat 9 Aug, 2014 08:27 pm
@Butrflynet,
Butrflynet wrote:

https://www.caregiver.org/protective-proceedings-guardianships-and-conservatorships

There is more info at the link, but I think this is what you want.

Quote:
Q. How is a conservatorship established?
A relative, friend or a public official may petition the court for the appointment of a conservator of an individual....


And if there is no relative to do it, are someone's acquaintances really likely to step up and do it? It seems unlikely unless they are really very close friends. I don't think this is what I am asking about.
Butrflynet
 
  1  
Reply Sat 9 Aug, 2014 08:31 pm
@Brandon9000,
I'll let you continue the treasure hunt from here. Good luck with the adventure.
Brandon9000
 
  1  
Reply Sat 9 Aug, 2014 08:34 pm
@Butrflynet,
Butrflynet wrote:
I'll let you continue the treasure hunt from here. Good luck with the adventure.

A rather disdainful tone to describe a serious question. Actually, this is exactly the state I was in before I got married and exactly the state whoever dies last between my wife and myself will probably be in.
0 Replies
 
ehBeth
 
  1  
Reply Sat 9 Aug, 2014 08:35 pm
@Brandon9000,
Brandon9000 wrote:
That still presupposes family who can ultimately be prevailed upon to do it. Someone with no siblings, no children, and only a few distant cousins who couldn't care less wouldn't have even that option.


here the hospital/facility social worker assigned to the case will arrange for the appropriate jurisdictional guardianship - there are litigation guardians, guardians for financial matters, as well as guardians for health care. There are sometimes all three on a team assigned to assist people. It's fairly well co-ordinated.

Oddly, it's sometimes easier to arrange if there is no family involved - as people assume the family is helping out so they don't look into it.

A friend of mine is the senior manager of a provincial agency that provides guardianship and arranges resources for people who are living on the street as a result of mental illness. Tough job with an awesome team.
 

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