Hello,
Alex's wife here. We never thought we'd be in this position as 20-somethings asking for help in a situation like this. Unfortunately, life happens and we've found ourselves here very suddenly.
In October, Alex and I were both celebrating new opportunities. Having just gotten married in June and returning from our honeymoon in July, we were very excited to both be starting new positions. Alex was recently asked to music direct West Mifflin's High School Musical and I started a new position in Warrendale. Shortly after, I received a text from him that he was going to an Urgent Care for chest pain. We thought maybe it was stress, anxiety, or possibly the beginnings of the flu.
While at UC, they did an Xray and sent him over to St. Clair Hospital. Knowing how healthcare is in the US, Alex waived the ambulance transport, not wanting to be hit with a bill that could potentially be denied as 'not medically necessary.' He signed a waiver and drove himself to St. Clair. At St. Clair, they ran some tests and quickly determined that he should be transferred to UPMC Shadyside for two reasons; 1) It was possible he had Lymphoma (Shadyside is the best for that) and 2) St. Clair was out of his network and they couldn't admit him or care for him there beyond an 'emergency room visit.'
Alex was then moved by ambulance to UPMC Shadyside where he spent a week undergoing various tests. Eventually it was narrowed down to B-Cell Non-Hodgkin's Lymphoma. Along with this news, we received treatment instructions. (6), week long hospital stays 3 weeks apart each that will take us (hopefully) until Mid-March (1 week in, 2 weeks out, 1 week in, 2 weeks out, etc). After that, assuming he doesn't need a 7th or 8th stay, he should be cured.
If you were following along, you'll remember I mentioned we got married and got new jobs recently. This would normally be good news. Unfortunately, having just started my job 8 days prior to this happening, my new insurance wouldn't kick in until December 1st. The insurance I had at my previous job covered me only, so I couldn't claim and back-date Cobra for him. When we got married in June, he had to start claiming my income on his ACA plan. This caused him to no longer be eligible for subsidies. His insurance premiums doubled (close to $300/month for just him), but his coverage got worse. He was now at $800 for an emergency room visit, $75 per specialist visit (and we have a lot of those), $7350 out of pocket max, and $3500 deductible. We hit that out of pocket max at the end of November. His ACA will expire at the end of December. He will then be on my insurance ($250 ER visit, $50 specialist visit, $5000 out of pocket (his portion only; $10,000 family), and $3000 deductible (his portion only; $6000 family). This looks like a better plan on the surface. Now account for the fact that my new companies insurance year runs April to April while every other companies in the world runs January to January.
What does that mean for us?
We definitely have two out of pocket maximums to pay ($7350 now and then $5000 in January) along with the $800 ER visit. If he goes for a 7th or 8th treatment (TBD), that will bring us into April, where we'll owe a 3rd out of pocket max within the same 6 month period.
So here I am, asking for help when I never thought I'd have to. We spoke to a social worker about SS Disability. It's a 6 month waiting process. That will bring us into May and he's supposed to go back to work in March. Being back at work by the time they even look at our claim, he will not be eligible. In the mean time, he cannot work due to a low immune system and the week long stays every 3 weeks (low immune system + teaching lots of kids was unfortunately not an option that could be risked). The weeks he's not in the hospital, we've been going in at least 2 or 3 times / week for a check up. He cannot work, he doesn't qualify for disability, his job offers no paid time off. We're only on my income (not even getting into the fact that a large portion of my income goes to student loans...that's another "Thanks America" story for another time) and we're worried about the months ahead.
$3500 is the first of many bills to come (due December 14th) with the rest of the out of pocket max due at the end of the year for a total of $7350. We also received the $800 St. Clair ER visit bill due by the end of the year that does not get counted towards his in network out of pocket max, since St. Clair is out of network. That's $8150 due before the new year. Just thinking about it, when we should be focusing on him getting better, is making this so much worse. In January, we'll get two more bills on my insurance; one for $3000, another for $2000 until that out of pocket is met. And then in April, we're potentially looking at another $3000 and $2000 bill again. That's over $18,000 in 6 months.
Any help you can give is very much appreciated.
Love,
Alicia
PS: I will update this page regularly as the bills come in. Thanks to all who have donated, shared our story, and sent us good vibes!
Edit:
Goal #1 for the $3500 deductible reached within 12 hours of launching the fund.
Goal #2 for the additional amount to total $7350 out of pocket max reached in the next 24 hours.
Goal #3, $5000 additional to cover the 2nd out of pocket max due in January, reached one week later.
We are leaving the goal as is for now, until we know if we'll be pushed into a new plan year or not in April. Please follow our 'updates' for more details.
Alex's wife here. We never thought we'd be in this position as 20-somethings asking for help in a situation like this. Unfortunately, life happens and we've found ourselves here very suddenly.
In October, Alex and I were both celebrating new opportunities. Having just gotten married in June and returning from our honeymoon in July, we were very excited to both be starting new positions. Alex was recently asked to music direct West Mifflin's High School Musical and I started a new position in Warrendale. Shortly after, I received a text from him that he was going to an Urgent Care for chest pain. We thought maybe it was stress, anxiety, or possibly the beginnings of the flu.
While at UC, they did an Xray and sent him over to St. Clair Hospital. Knowing how healthcare is in the US, Alex waived the ambulance transport, not wanting to be hit with a bill that could potentially be denied as 'not medically necessary.' He signed a waiver and drove himself to St. Clair. At St. Clair, they ran some tests and quickly determined that he should be transferred to UPMC Shadyside for two reasons; 1) It was possible he had Lymphoma (Shadyside is the best for that) and 2) St. Clair was out of his network and they couldn't admit him or care for him there beyond an 'emergency room visit.'
Alex was then moved by ambulance to UPMC Shadyside where he spent a week undergoing various tests. Eventually it was narrowed down to B-Cell Non-Hodgkin's Lymphoma. Along with this news, we received treatment instructions. (6), week long hospital stays 3 weeks apart each that will take us (hopefully) until Mid-March (1 week in, 2 weeks out, 1 week in, 2 weeks out, etc). After that, assuming he doesn't need a 7th or 8th stay, he should be cured.
If you were following along, you'll remember I mentioned we got married and got new jobs recently. This would normally be good news. Unfortunately, having just started my job 8 days prior to this happening, my new insurance wouldn't kick in until December 1st. The insurance I had at my previous job covered me only, so I couldn't claim and back-date Cobra for him. When we got married in June, he had to start claiming my income on his ACA plan. This caused him to no longer be eligible for subsidies. His insurance premiums doubled (close to $300/month for just him), but his coverage got worse. He was now at $800 for an emergency room visit, $75 per specialist visit (and we have a lot of those), $7350 out of pocket max, and $3500 deductible. We hit that out of pocket max at the end of November. His ACA will expire at the end of December. He will then be on my insurance ($250 ER visit, $50 specialist visit, $5000 out of pocket (his portion only; $10,000 family), and $3000 deductible (his portion only; $6000 family). This looks like a better plan on the surface. Now account for the fact that my new companies insurance year runs April to April while every other companies in the world runs January to January.
What does that mean for us?
We definitely have two out of pocket maximums to pay ($7350 now and then $5000 in January) along with the $800 ER visit. If he goes for a 7th or 8th treatment (TBD), that will bring us into April, where we'll owe a 3rd out of pocket max within the same 6 month period.
So here I am, asking for help when I never thought I'd have to. We spoke to a social worker about SS Disability. It's a 6 month waiting process. That will bring us into May and he's supposed to go back to work in March. Being back at work by the time they even look at our claim, he will not be eligible. In the mean time, he cannot work due to a low immune system and the week long stays every 3 weeks (low immune system + teaching lots of kids was unfortunately not an option that could be risked). The weeks he's not in the hospital, we've been going in at least 2 or 3 times / week for a check up. He cannot work, he doesn't qualify for disability, his job offers no paid time off. We're only on my income (not even getting into the fact that a large portion of my income goes to student loans...that's another "Thanks America" story for another time) and we're worried about the months ahead.
$3500 is the first of many bills to come (due December 14th) with the rest of the out of pocket max due at the end of the year for a total of $7350. We also received the $800 St. Clair ER visit bill due by the end of the year that does not get counted towards his in network out of pocket max, since St. Clair is out of network. That's $8150 due before the new year. Just thinking about it, when we should be focusing on him getting better, is making this so much worse. In January, we'll get two more bills on my insurance; one for $3000, another for $2000 until that out of pocket is met. And then in April, we're potentially looking at another $3000 and $2000 bill again. That's over $18,000 in 6 months.
Any help you can give is very much appreciated.
Love,
Alicia
PS: I will update this page regularly as the bills come in. Thanks to all who have donated, shared our story, and sent us good vibes!
Edit:
Goal #1 for the $3500 deductible reached within 12 hours of launching the fund.
Goal #2 for the additional amount to total $7350 out of pocket max reached in the next 24 hours.
Goal #3, $5000 additional to cover the 2nd out of pocket max due in January, reached one week later.
We are leaving the goal as is for now, until we know if we'll be pushed into a new plan year or not in April. Please follow our 'updates' for more details.
Organizer