I can 100% answer that question. My wife and Sensei’s wife were both at MD Anderson Cancer Center Houston. MD Anderson won’t serve you until they get insurance pre-authorization. We have seen people get turned away in the line in clinic because they had some insurance problem. They don’t do the incur the bill / haggle over it later thing.
They do have a program for cash customers where I would imagine the cash customers pay some kind of preferred rate, maybe the same as insurance companies or Medicare after all of the network discounts and all, but 50% off of $2,000,000 is still $1,000,000.
They don’t take ACA plans either. I think these elite, top-shelf places where you get the best chance at living do this… MD Anderson, Cedars Sinai, Memorial Sloan Kettering, etc.
The consensus of people we know with her particular disease is that MDA / MSK etc are head-shoulders above the rest in a field where a tight linkage between the clinic and R&D is required for the best outcome. There has been lots of research showing who you see first if you have Multiple Myeloma dictates how you do.
Her oncologist has decades of clinical and research experience in MM. A regular doctor might see a few MM cases in a career. How can the decisions and outcomes possibly be the same? We read in the press about “coming breakthroughs in MM treatment” then we realize, oh, her doctor has already been doing exactly that all along. MDA gets lots of referrals from doctors who are out of their league and know they are outgunned by the disease. But waiting 6 months, a year with this disease growing unchecked can be a death sentence. It’s better to start with the best team.
But sure… you can get treated for blood cancers at the County hospital “for free” under the indigent care programs. Until you get refractory relapsed disease and have to go to MDA anyway, or decide to accept the end-stage disease without a fight.
I guess make sure you choose not to get highly complex diseases or injuries, they’re you’re OK without insurance?
I’m not sure my insurance would pay for me to go to MD Anderson. If not, then I’m back to the uninsured problem if that’s what I need.
The other choices here in town are Houston Methodist, Memorial Hermann, and HCA (“the killing hospital”). I have no idea what their policies are. Maybe the same, maybe different from MDA. Who knows.
Your scenario is exactly why I started this thread in the first place. Why is there so few, if any, catastrophic options? I know there are diseases that are a nightmare to treat and cost a fortune. I would love to purchase a policy that just covered that kind of thing and let me fend for myself with the year-in-year out medical, dental, and vision expenses. But there wasn’t any catastrophic policies like that in my area. My option is to pay tens of thousands annually on insurance premiums, high deductibles, medicare taxes, co-pays and prescriptions every year of my working life. They get to pick what they will cover and who you will see. Also don’t get sick near the end of the year otherwise your deductible and max out of pocket will re-set and you’ll have to keep paying the following year. And if you don’t get a plan, someday you might get a rare and horribly expensive disease that will ruin you financially (sometimes it still does, even with health coverage). It’s just such a stupid and corrupt system in my opinion.
You recognize the problem and have examined the options, but I do not think that you are making the appropriate decision. As Rjratnip commented “you certainly don’t want to go without any coverage as a major issue could be hundreds of thousands of dollars out of pocket and make the $12,750 look like peanuts.” Similar to other risk management issues (disability insurance, term life insurance), the solution is getting coverage for possible catastrophic events.
I am not sure that this is a good idea but perhaps you can hire a Patient Advocate for an hour or two to get more knowledgeable about the limitations of negotiating hospital bills.
Take a look at Blue Cross “Access Plans”. These are not ACA (Affordable Care Act) plans, rather are private plans through Blue Cross. There’s a plan that provides catastrophic coverage.
Suggestion: Google Blue Cross (your state), then see if there’s a private plan that is consistent with a catastrophic plan. Another thought, reach out to an insurance broker in your area. They can access catastrophic plans available in your area. Best to you!