Family member w/bad diagnosis yet financially disinterested

[24601NoMore]

Hey, everyone..looking for some friendly advice..

My sis (6 years younger than me) has always struggled financially (lives mostly paycheck to paycheck, little in savings, always has more bills than she can pay, etc) but often takes a very lackadaisical view when it comes to caring about what things cost. She also pretty much buys what she wants to buy, even though she doesn't make much - probably just a bit above $20/hr. This has all been a major annoyance to me for many years as I'm concerned about her future, but to make things worse..

She just got a cancer diagnosis on Sunday.

Knowing her the way I do, I suspected she probably has no idea whatsoever what she's covered for, not covered for, how to work within the rules of her healthcare plan, etc. And it turns that not only was I right, but I can't seem to get through to ANYONE including our Mom as to how important it's going to be to start caring about these things, lest she find herself at the wrong end of an unexpected medical bill that could be tens or hundreds of thousands of dollars - which she would never be able to pay.

(A quick recent example - she needed to get an MRI. Did no research at all on cost to find a reasonably priced option. Basically went to the hospital her Dr recommended, which of course is likely to be THE most expensive place she could have gone. Probably will be $1,500+ she doesn't have. Yet, I had told her and Mom previously that I knew a place she could get it done for $300 that I had used previously. Sigh...)

I offered to figure out everything and help guide her through the part of the process (the financial, what the plan allows, etc) side of things that I know she doesn't like to worry about or do. Even took it upon myself to call her healthcare plan to get a copy of her docs - which I knew she had never read. Started trying to talk to family members about why it will be important to work within what the plan allows. Even told our Mom - "I know sister and that she won't want to deal with all this - I can handle it" and was basically told that "isn't her" and that she may just do whatever she wants, whether it's within plan or not.

I'm super concerned that she's going to do something that's going to result in a massive surprise medical bill - a bill she will never be able to pay. I told our Mom of my concern and asked who it was that would be bailing her out if that happened. I know that's selfish, but we worked our tails off to ER and are living on a pretty limited income with savings that are not infinite. It would frost me no end if she just continues the "I don't want to have to think about these types of things" approach and incurs some massive cost that either DW & me or Mom needs to write a huge check for to get her out of trouble - because there's no way she'd be able to pay a big surprise medical bill.

Anyone else ever run into a situation like this? I'm having a heck of a lot of anxiety as to what might happen, as I don't think I can get through to anyone without people getting really tweaked off (even moreso than they already are) at me..plus, and I totally get this - sister is more worried about survival and what she is going to have to go through than she is even a tiny bit about the financial aspects of all this.

 

[Lewis Clark]

... It would frost me no end if she just continues the "I don't want to have to think about these types of things" approach and incurs some massive cost that either DW & me or Mom needs to write a huge check for to get her out of trouble - because there's no way she'd be able to pay a big surprise medical bill.

Though it would be very generous of you, you have no obligation to write a check to bail your sister out of trouble. Especially since you have tried to head off problems and have been pushed away.

 

[Sunset]

OP - She may well run up a huge medical bill, but here is the most important financial thing to remember: You & Your Mom are NOT responsible for the bill.

From a cold analysis I see this as the outcome:
Your sister lives, has a huge bill, can't pay, medical billing accepts far less or forgives it or sells the debt to debt collectors who also can't collect for 7 yrs.
Your sister dies: debt dies with her.

The giant screw up in all of this will be if your Mom tries to help out, pays thousands and sister still owes a lot that can't be paid. Or worse Mom co-signs to pay the debt and is on the hook for it all.

 

[Fermion]

If I made $20/hr and had no savings, I don't think I would bother shopping around for the best deal on an MRI either.

I would hold off on any rescue aid until well after she has filed bankruptcy, which sounds like the eventual path here. She should prioritize getting better above all else and you should prioritize your own financial health.

 

[24601NoMore]

I'm actually hoping DW, who's far more tactful than I am, can get through to people in a less direct manner than I tend to take .

There's a morale in this story to those who have considered not having traditional indemnity-based health insurance and an Emergency Fund..I can't stress this enough - HAVE BOTH.

Sis is expected to need 6-8 weeks off work. Another (lesser) problem is..how's someone who lives mostly paycheck to paycheck going to pay for anything during that time?

I was raised to be a good Christian person and help those in need..so if I can't even help my little sis during her time of most need, what kind of jerk would I be? So for that reason I suspect I'd ultimately give in and help her with at least her day to day bills..but it still does tweak me off majorly that I've been the "saver" in the family and at the end of the day would be the only one in a position to help..all while she's, well, NOT been a saver. She also wanted to work in a job (that doesn't pay much) where she's "happy". That's lovely, and I would have liked to do that also, but I didn't. I was in a career for many decades where I was majorly UNHAPPY. But it paid pretty well, to the point I could ER @ 55 (DW at 59). And that's unfortunately real life. It's not easy.

I've tried to coach her over the years on the importance of saving, having an emergency fund, etc..but as an example, I can't get her to take her beer bottles back to the store to get the deposit back. "Too much trouble/I don't want to", etc. I have far more in the bank than she does and still use coupons when I go to the grocery store. And I definitely take my returnables. So two kids raised in the same household who are TOTALLY and completely different when it comes to managing money. Go figure.

 

[swakyaby]

I know you love your sister and want to protect her from financial ruin. She sounds like a train crash happening in slow motion and has little motivation to follow your advice. I think you’re doing what you can by offering her advice and guidance. But it would be a mistake to consider paying any of her debts when she doesn’t demonstrate the desire to change her bad financial habits.

 

[ivinsfan]

So your sister has basically never cared much about money, she sadly has cancer, so I'm pretty sure she's not suddenly going to start caring about money now.

Some might disagree but we live in a pretty great country with lots safety nets and backups in situations like this. Medical providers are experts and figuring this stuff out.

It's been two days and it's a tad early to be having these kinds of talks. Frankly I think you overstepped in calling and getting a copy of her health care plan without her telling you to do that. They told you to butt out so butt out. Just give support for the cancer and prognosis. There is no way that you are responsible for her medical bills either legally or morally. I realize this is your way of wanting to help and coping with what's going on but focus your energy somewhere else right now. Going to appts or just being supportive.

 

[24601NoMore]

If I made $20/hr and had no savings, I don't think I would bother shopping around for the best deal on an MRI either.

I don't follow. If you don't make much and don't have much in savings, shopping for a decent price on a MRI or other test/procedure is one of the smartest things you can do.

Would you rather get a bill in that scenario for $1,500 (or more), or $300? Unless of course you plan to declare BK and not pay either.

Short of having to file BK, I know what I'd prefer..

 

[24601NoMore]

It's been two days and it's a tad early to be having these kinds of talks. Frankly I think you overstepped in calling and getting a copy of her health care plan without her telling you to do that.

Understood. Her focus at this point is obviously getting over the shock of the diagnosis and trying to emotionally cope.

That said, appointments are already happening. She's had 2 in the past 2 days. One with a 4 Doctor "cancer board" just this AM. And surgeries, tests and other things are already being scheduled.

Going into this without know what is covered and what isn't is a catastrophe waiting to happen.

Not sure that I'd agree getting the plan docs was overstepping. I knew for certain she had no clue, and someone unfortunately has to..and I'm darn glad that I did, because I learned that she has a "Tiered" plan for in-network coverage. Yeah, the plan actually has two separate tiers/classes of in-network doctors, and get this - TWO in-network deductibles to meet. When have you ever seen that? Out of network is not even covered. It's ALL on you if you go out of network, soooo....and Tier 2 is not a lot better scenario.

 

[ivinsfan]

I'm actually hoping DW, who's far more tactful than I am, can get through to people in a less direct manner than I tend to take .

There's a morale in this story to those who have considered not having traditional indemnity-based health insurance and an Emergency Fund..I can't stress this enough - HAVE BOTH.

Sis is expected to need 6-8 weeks off work. Another (lesser) problem is..how's someone who lives mostly paycheck to paycheck going to pay for anything during that time?

I was raised to be a good Christian person and help those in need..so if I can't even help my little sis during her time of most need, what kind of jerk would I be? So for that reason I suspect I'd ultimately give in and help her with at least her day to day bills..but it still does tweak me off majorly that I've been the "saver" in the family and at the end of the day would be the only one in a position to help..all while she's, well, NOT been a saver. She also wanted to work in a job (that doesn't pay much) where she's "happy". That's lovely, and I would have liked to do that also, but I didn't. I was in a career for many decades where I was majorly UNHAPPY. But it paid pretty well, to the point I could ER @ 55 (DW at 59). And that's unfortunately real life. It's not easy.

I've tried to coach her over the years on the importance of saving, having an emergency fund, etc..but as an example, I can't get her to take her beer bottles back to the store to get the deposit back. "Too much trouble/I don't want to", etc. I have far more in the bank than she does and still use coupons when I go to the grocery store. And I definitely take my returnables. So two kids raised in the same household who are TOTALLY and completely different when it comes to managing money. Go figure.

OK so this about more then the cancer? Stop and take another deep breath. Your sis has no responsibility for the fact you worked for decades in a job that made you unhappy. You have no responsibility for the fact she choose to work in her happy place and has no money.

I suggest you stop borrowing trouble and support your sister through her treatment without talking about money. If you want to help with her bills, do. If you don't, don't do it. But try to give with a kind heart and not resentment or obligation. If the worst happens you'll feel more at peace.

 

[Fermion]

I don't follow. If you don't make much and don't have much in savings, shopping for a decent price on a MRI or other test/procedure is one of the smartest things you can do.

Would you rather get a bill in that scenario for $1,500 (or more), or $300? Unless of course you plan to declare BK and not pay either.

Short of having to file BK, I know what I'd prefer..

I mean I don't have all of your sister's info but from what you describe she probably lives close to paycheck to paycheck. She is going to be absent work and will probably end up putting day to day expenses (gas/food/hotel) on credit cards if she has any. Do you really think that a bill of $300 or $1500 or $15,000 is ever going to get paid? Any amount over the next year or until she can't get more credit is going to get discharged in bankruptcy anyway, so why would I bother shopping around for the cheapest?

Also, based on the above, I would not pay any medical bills that come due. She should save whatever money she can scrape together to fund day to day expenses that can't be put on credit. This is just playing in the rules of the system we live in today.

If you want to talk fair, think about the fact that the mini storage facility in our area got over half a million in PPP loans that was forgiven. CEOs get millions in golden parachutes after running a company into the ground.

 

[ivinsfan]

Understood. Her focus at this point is obviously getting over the shock of the diagnosis and trying to emotionally cope.

That said, appointments are already happening. She's had 2 in the past 2 days. One with a 4 Doctor "cancer board" just this AM. And surgeries, tests and other things are already being scheduled.

Going into this without know what is covered and what isn't is a catastrophe waiting to happen.

Not sure that I'd agree getting the plan docs was overstepping. I knew for certain she had no clue, and someone unfortunately has to..and I'm darn glad that I did, because I learned that she has a "Tiered" plan for in-network coverage. Yeah, the plan actually has two separate tiers/classes of in-network doctors, and get this - TWO in-network deductibles to meet. When have you ever seen that? Out of network is not even covered. It's ALL on you if you go out of network, soooo....and Tier 2 is not a lot better scenario.

That sounds so stressful but in reality what can you do, she needs treatment and if you push for something covered in network that isn't considered "the best" the ramifications to your family could be awful. By that I mean the relationships between you Mom and sis, obviously you want the best treatment for her. All you can do is protect yourself by not signing any responsible to pay papers.

Gosh this sounds like a tough cancer and a horrid situation for everyone. I'm sorry.

 

[Fermion]

That sounds so stressful but in reality what can you do, she needs treatment and if you push for something covered in network that isn't considered "the best" the ramifications to your family could be awful. By that I mean the relationships between you Mom and sis, obviously you want the best treatment for her. All you can do is protect yourself by not signing any responsible to pay papers.

Gosh this sounds like a tough cancer and a horrid situation for everyone. I'm sorry.

I think the above needs to be bolded.

 

[mystang52]

OK so this about more then the cancer? Stop and take another deep breath. Your sis has no responsibility for the fact you worked for decades in a job that made you unhappy. You have no responsibility for the fact she choose to work in her happy place and has no money.

I suggest you stop borrowing trouble and support your sister through her treatment without talking about money. If you want to help with her bills, do. If you don't, don't do it. But try to give with a kind heart and not resentment or obligation. If the worst happens you'll feel more at peace.

+1

OP: No matter what the topic, it is extremely rare that someone heeds unsolicited advice. So it should be no surprise that your sister ignored your prior suggestions, or current ones. Offer to give her support and any advice that she requests, but other than that "lay low" unless she seeks you out. If you're so inclined, you can offer to pay for her groceries or rent during the 6-8 weeks she'll be out of work.

 

[Aerides]

sister is more worried about survival and what she is going to have to go through than she is even a tiny bit about the financial aspects of all this.

As would I be. I would take Living Broke, vs. dying without debt. Who cares if I can find a cheaper MRI if I can go to the one - now - that my doctor recommends.

And if my sibling was harping to my parents about the financial impacts of my choices to stay alive, I'd probably be very upset. I'd want them to be supportive and kind and hold my hand, let me cry all over them, but...not ask me how I'm going to pay for the bills.

 

[24601NoMore]

As would I be. I would take Living Broke, vs. dying without debt. Who cares if I can find a cheaper MRI if I can go to the one - now - that my doctor recommends.

And if my sibling was harping to my parents about the financial impacts of my choices to stay alive, I'd probably be very upset. I'd want them to be supportive and kind and hold my hand, let me cry all over them, but...not ask me how I'm going to pay for the bills.

I should have clarified that I have not said ONE WORD to Sister about the finances.

I did, however, try to get through to Mom privately, and ran into an absolute brick wall on that. Was basically told sis is going to do what she's going to do, and that's "just her". Mom also suggested "let's worry about all this AFTER her surgery", which is obviously not the way it works. You can't buy a service (surgery) and THEN start to ask about the cost of it after said service has been completed and you're on the hook for whatever it cost. That's potential financial suicide.

And to the point about not shopping services - I recently thought *I* might have cancer..had a strange lump in a place that usually indicates cancer. Even though I have a LOT more saved up than sis, I still got on the (same healthcare company) website and did some price shopping for the ultrasound that was ordered. So I "get" the stress of the situation. But that aside, none of us have unlimited money. And to not spend what you do have wisely is imprudent, regardless of the situation.

Because they caught this in "Stage 1", her cancer apparently has a 96+% survival rate, which is fantastic. So it's highly likely that unless something spreads that she'll make it through this. I just hope that she isn't financially destroyed in the process, and that's what I'm trying to prevent the best I can, as it's very likely she's going to survive this physically.

 

[daylatedollarshort]

24601NoMore, I share your pain as we have had close friends / family members like that. It is "none of your business" until they face homelessness and then you have to make the hard choice of whether to help them at that point or not. We had one or two we were concerned would end up homeless, and we have a house with extra bedrooms since the kids moved out. I wanted to help them before we had to make the decision of letting them be homeless or live with us, which I really didn't want to have to do. The well meaning financial advice part, pre-destitution, fell on deaf ears.

What I did was research all the local community and government programs for senior and low income people as my fallback, plus how to live a normal life on as little money as possible. So far it has not come to supporting anyone more than buying groceries, but if the time comes, I have a tentative plan in place should someone need more help. We might have to pay some bills but they wouldn't have to move in with us and not be homeless.

As to the medical debt, once she become indigent she can go on Medicaid. Otherwise let the debt pile up as others have suggested. The hospitals usually have aid for low income people or she can declare bankruptcy.

 

[athena53]

Please try to distance yourself from your sister's financial issues and focus on giving her the emotional and other forms of support she'll need. I've been there/done that with caring more about someone else's financial issues than they do and it just causes you unnecessary stress and grief. When I first met the guy I'd eventually marry, he was between houses after a divorce and had let all of his mail pile up at the post office- for weeks- while he stayed with friends. I was worried FOR him- all those unpaid bills. One day he was going to pick them up so I could sort through them and he didn't, and I was so upset I CRIED. Like, WTH was I thinking? (The marriage did not end well even though we had separate accounts and I eventually let him deal with his own blunders.)

A book I've never read but which gets high recommendations is "Boundaries". It covers relationship issues with needy people.

 

[The Cosmic Avenger]

A lot of good advice here so far, so I'll just add my two...points:

1) You're expecting her to be concerned about the consequences of her spending, but it sounds like you have been protecting her from them or suffering them for her, so she has learned that she doesn't really have any consequences.

2) If you are going to help anyway, make payments directly to the utilities, landlord, or medical providers rather than giving her money, or she probably will not use the money for what you intended (to stave off immediate and grave hardships).

 

[disneysteve]

I mean I don't have all of your sister's info but from what you describe she probably lives close to paycheck to paycheck. She is going to be absent work and will probably end up putting day to day expenses (gas/food/hotel) on credit cards if she has any. Do you really think that a bill of $300 or $1500 or $15,000 is ever going to get paid? Any amount over the next year or until she can't get more credit is going to get discharged in bankruptcy anyway, so why would I bother shopping around for the cheapest?

I agree completely. That was my first thought when I read this thread too. It sounds like she was already living on the edge before her diagnosis. There's no way she can afford the bills that are about to come her way even if she wastes her time and energy shopping around for the cheapest place to get an MRI. When you're broke, there's really no difference between a $300 bill and a $3,000 bill. She's going to be bankrupt either way. And she may not even need to file because if she has no assets to protect, there's not much point. The creditors can sue all they want but if there's nothing for them to get, it won't matter.

 

[Sojourner]

I'm super concerned that she's going to do something that's going to result in a massive surprise medical bill - a bill she will never be able to pay. I told our Mom of my concern and asked who it was that would be bailing her out if that happened. I know that's selfish, but we worked our tails off to ER and are living on a pretty limited income with savings that are not infinite.

You never mentioned what kind of medical insurance plan she has, but I would assume it would have to meet the ACA rules for maximum out-of-pocket expenses. I have never seen an ACA-compliant plan that has a maximum out-of-pocket much greater than about $8,000 for a single person. So wouldn't that be the most she (or you, or your mom) would be on the hook for?

Having said that, I fully agree with others that you have no responsibility— morally, spiritually, or otherwise—to cover the medical bills for your sister, given her attitude and behavior.

 

[24601NoMore]

You never mentioned what kind of medical insurance plan she has, but I would assume it would have to meet the ACA rules for maximum out-of-pocket expenses. I have never seen an ACA-compliant plan that has a maximum out-of-pocket much greater than about $8,000 for a single person. So wouldn't that be the most she (or you, or your mom) would be on the hook for?

Having said that, I fully agree with others that you have no responsibility— morally, spiritually, or otherwise—to cover the medical bills for your sister, given her attitude and behavior.

She has a reasonably decent plan (far as I can tell), even though she works for a small company in a fairly low paying job. It's a bit quirky, though, in that it covers NOTHING outside of the HMO, and within (ie: in-network) the HMO, there are TWO different "Tiers" to be aware of - each with it's own deductible and OOP max. And of course the Tier 2 deductible and OOP max is way higher than Tier 1. A provider (doctor, hospital, etc) could be in Tier 1 or Tier 2. It's up to the person seeking treatment (ha..sure) to know ahead of time. And unless I or DW do it, she's not going to even think about what Tier a provider is in..and at this point, I'm pretty confident she doesn't even KNOW there are Two Tiers.

Max OOP **IF** she jumps through all the plan's many often unreasonable and illogical hoops (which is one of the things I'm concerned about..if you don't KNOW of the hoops, how can you jump through them properly?) is $7,050. So not horrible, and DW & I could absorb that if we had to. But it's the inadvertent "whoops! I didn't know that wasn't covered OR that I had to do X, Y and Z before-hand" that concerns me..for example - we had another family member (wife's side) battle cancer a few years back. He worked for Chrysler, so had "gold plated" insurance that covered all sorts of crazy things including experimental treatments. He got on a couple of those. One required a monthly shot that was - get this - 95 THOUSAND DOLLARS...PER SHOT. That's over a million dollars a year. Now, I don't think she would fall into something that egregiously obvious..but I do worry about the "Tier 1" vs "Tier 2" IN network difference, or her even staying in (vs out of) network for everything..or, making sure she doesn't do things the plan totally doesn't cover to begin with. That's where I think the risk is..

DW & I get our insurance through the same company, and while we have an "A"CA vs company sponsored plan, have come to learn they LOVE their hoops. I at times think they employ hundreds of people to just sit around day long thinking of new and creative ones. For example - I had a shoulder injury from the 1st COVID shot. Wanted to get an MRI that my Orthopedic Dr recommended. BWAAHHAHAHAHA. Um, no. No, you can't (get an MRI) - DENIED!. UNLESS you do 6 weeks of PT (yes, 6 full weeks) FIRST. Who would ever think that's a requirement? Crazy. I eventually just paid for the MRI out of my own pocket, and that's where I went price shopping and found a $300 Cash price for a shoulder MRI, vs $1,100 - nearly $2K that area hospitals wanted for the exact same thing..

 

[ivinsfan]

OP here's the question you need to ask yourself, at least a dozen posts here have said you have no legal or moral obligation to pay her medical bills.


Add that to the fact your sis is completely unconcerned about the the size of any possible bill.


The question you need to answer for yourself.. is why do you keep saying you and your spouse could probably cover these bills "if you have to". Just step off that train.



Is there some reason you can't?

 

[Texas Proud]

OP - She may well run up a huge medical bill, but here is the most important financial thing to remember: You & Your Mom are NOT responsible for the bill.

From a cold analysis I see this as the outcome:
Your sister lives, has a huge bill, can't pay, medical billing accepts far less or forgives it or sells the debt to debt collectors who also can't collect for 7 yrs.
Your sister dies: debt dies with her.

The giant screw up in all of this will be if your Mom tries to help out, pays thousands and sister still owes a lot that can't be paid. Or worse Mom co-signs to pay the debt and is on the hook for it all.

+1 on this.... you can give recommendations to your siblings and parents but there is no ability to make them take it...


IMO you offered to help and was rejected... end of story... you can still support her and hope for a good outcome but I would let her continue to do what she wants.... she IS a grown woman...

 

[Bamaman]

I've been paying for a 34 year old daughter's top line BCBS healthcare insurance for years--including dental insurance.

We cannot get her to go to the doctor. Now she's missing a front tooth and had a molar break off, and she breaks dental appointments. Then she complains about tooth aches--which always come on Fridays when no dentists work.

The trouble with many people is that they just don't take care of themselves. I continue to worry about her health 10-15 years from now--when ladies start having more serious problems.

This BCBS plan is no longer available, and its price is $411 a month. Cancel it and she never gets decent healthcare insurance like this again.

Our daughter will never be without food. But I've paid enough, and we refuse to pay any bills she runs up.