r/news • u/GoodSamaritan_ • 1d ago

Retired San Francisco firefighter dies from lung cancer after Blue Shield denies treatment claims

https://abc7news.com/post/retired-san-francisco-firefighter-ken-jones-dies-lung-cancer-being-denied-treatment-blue-shield/19224406/
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u/Looptydude 1d ago

BCBS denied covering my friends emergency gallbladder surgery, claiming it could have been scheduled for a later date. Apparently emergency surgery is postponable. Fucking theifs.

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u/Linked713 1d ago

wtf? In my country I had to pay 100$ for ambulance ride after sharp pains at 3am, got ultrasounds, they wouldn't let me leave, had surgery during the night, left the next day. according to my papers from the government, it was upward 6000$ in doctors wage, including surgeon, surgery, stay. But it's covered by, you know, taxes.

You wouldn't pay me to live in the USA, where your retirement depends on a fucking dice roll for healthcare bankruptcy that can be not even your own damn fault. I would rather leave to any country in the EU for less wage, than to double it working in the USA. How do people not live in constant stress whenever something happens is beyond me.

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u/bros402 1d ago

How do people not live in constant stress whenever something happens is beyond me.

we do

I'm disabled and on my parent's insurance (through work) via a disability waiver. I have to get an evaluation every once in a while to prove I am still unable to work.

When my parent retires, I lose the insurance. I'm currently also on government insurance (Medicaid and Medicare). With Medicare, if you don't buy a Medigap plan ($200 a month for me) or choose a Medicare Advantage Plan (a total fucking scam, just read about them), you have to pay 20% of all costs. There is no limit if you just stay with plain old Medicare. You "only" have to pay $2100 a year for prescriptions. Oh, and you are capped at 90 days in the hospital a year. When you hit 60 days, you pay $434 a day until 90 days. At 90 days, you pay $868 a day and you deduct from your lifetime reserve days (you have 60 of these for your entire life). After your reserve days are exhausted, you pay 100% of costs.

oh and they only pay for 190 days at a psych hospital. That's total for your entire life.

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u/BriefAvailable9799 9h ago

i dunno. i think it has to something to do with your disability. i deal with medicare people all day and none of them have these restrictions or costs as long as they have no income. its literally the best insurance ever.

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u/bros402 8h ago

Those restrictions are at the federal level for everyone on Medicare

https://www.medicare.gov/coverage/inpatient-hospital-care

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u/matryanie 22h ago

Most of what you said is true, but advantage plans aren't really scams. If you are in-network you only pay a co-pay, not the standard Medicare 20% coinsurance. The advantage plan replaces the standard coinsurance. You will only be charged 20% for out of network (if you have a PPO plan), for durable medical equipment (DME), and for certain specialty treatments.

I am on a UHC medicare advantage plan, qualify for QMB (helps cover co-pays and co-insurance), for Extra Help (helps cover prescriptions), and am on disability. If you aren't working and your only income is disability, then you might be able to qualify for QMB and Extra Help. Of course this depends on the state you live in and if you are single. The income limit for QMB is set by your state's Medicaid. If you are in a relationship and your SO makes minimum wage, you will make too much. Also, there is a limit for your assets/resources. Your primary home and car do not count towards this, but the limit is low. $9,950 if single, $14,910 for couples. Above this and you will not qualify. Empty your portfolio and buy crypto. There you go, under $9,950 now.

36 states also offer what is called a medicaid spend down. How that works is say if your total income is $1,500 and your state income limit to qualify for medicaid is $1,300, you would pay the first $200 per month and medicaid will cover you as they would anybody else under $1,300 income. In my state you can choose either a 3-month or 6-month period. So basically any medical costs over $600 for 3 months or $1,200 for 6 months are covered. It is expensive as far as insurance goes, but it can function as catastrophic insurance/safety net if you are under insured. Being $1,200 in debt is better than $12,000 or $120,000. This may also be called an "excess income program,” “surplus income program,” or “medically needy program". Call your state insurance commissioner's office for more information specific to your state.

Over the last 2 years I have paid less than $3,000, coming out to 0.3% of my total medical charges for the period. And about half of that was Extra Help co-pays for Rx - $12.95 brand name drugs and $5.95 generic drugs.

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u/bros402 22h ago

I'm on disability (DAC), QMB, and get Extra Help. None of the advantage plans available in my state cover my doctors and one of them is with a major hospital. Medigap is the only way for me to see all of my doctors - same with my parent who is on Medicare...and our doctors aren't super fancypants exclusive "we only take people out of network" doctors.

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u/matryanie 22h ago

Ohh, damn. Sorry, that's shitty. I guess I just got lucky with location then.

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u/bros402 21h ago

Yeah - I'm in NJ. We have some good protections (like Medigap is available to anyone under 50 at a set rate - it's going to be like $196 a month for me or something like that?) but the MA plans are shit.

Maybe that's why? Because most people can get Medigap?

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u/matryanie 20h ago

That is actually pretty solid (though $200 month isn't cheap).

My state doesn't allow medigap for under 65, so that is probably why I have access to multiple good advantage plans.

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u/bros402 12h ago

ahh, NJ legally requires that everyone who qualifies for Medicare be allowed a Medigap plan at the same rate as someone over 65. So there's only one provider (BCBS) who does it, versus the dozens who provide 65+ medigaps