Family member w/bad diagnosis yet financially disinterested

[24601NoMore]

+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...

Technically, I offered to Mom since I did not want to mention any of this to little sis 2 days after getting such a horrible diagnosis. It was Mom who basically told me "worry about it AFTER her surgery" which IMHO is absolutely stupid, horrible and potentially financially devastating advice.

That said, I know sister. And I know she LIKELY (not 100% for sure - maybe this will be different) won't really want to "deal" with any of it. That's why I offered (albeit, to Mom) to offload all of this and manage it all for sis.

With all the "hoops" this company we both have has in their plans, it's going to be a potential minefield to navigate. Just look at my own experience with a simple MRI - DENIED! (even though it was fully "covered" in the plan) unless I jumped through their ridiculous hoops of doing 6 weeks of PT first..

Bottom line - unless you're VERY fortunate to have some super gold plated plan, it's incumbent on every single person that has healthcare coverage today to know what your plan requires of you as a member. And if you don't, you're very likely to get absolutely slaughtered in terms of denials, refusals, delays and other nonsense that just makes the entire experience of dealing with healthcare in 2022 a real nightmare. My pre-ER job involved writing a lot of very lengthy, very complex contracts and working with a lot of lawyers. I have a ton of experience writing and reading contracts. And even I find reading through the insurance company declarations of coverage darn near indecipherable - not to mention incomplete. (For instance - that requirement for 6 weeks of PT before MRI approval? Not even listed in the docs. IIRC, they got around that fact by some more open-ended vague language about "potential other pre-approval requirements which the Plan may require in their sole discretion at any time") or some other open ended catch-phrase..

 

[ivinsfan]

Technically, I offered to Mom since I did not want to mention any of this to little sis 2 days after getting such a horrible diagnosis. It was Mom who basically told me "worry about it AFTER her surgery" which IMHO is absolutely stupid, horrible and potentially financially devastating advice.

That said, I know sister. And I know she LIKELY (not 100% for sure - maybe this will be different) won't really want to "deal" with any of it. That's why I offered (albeit, to Mom) to offload all of this and manage it all for sis.

With all the "hoops" this company we both have has in their plans, it's going to be a potential minefield to navigate. Just look at my own experience with a simple MRI - DENIED! (even though it was fully "covered" in the plan) unless I jumped through their ridiculous hoops of doing 6 weeks of PT first..

Bottom line - unless you're VERY fortunate to have some super gold plated plan, it's incumbent on every single person that has healthcare coverage today to know what your plan requires of you as a member. And if you don't, you're very likely to get absolutely slaughtered in terms of denials, refusals, delays and other nonsense that just makes the entire experience of dealing with healthcare in 2022 a real nightmare. My pre-ER job involved writing a lot of very lengthy, very complex contracts and working with a lot of lawyers. I have a ton of experience writing and reading contracts. And even I find reading through the insurance company declarations of coverage darn near indecipherable - not to mention incomplete. (For instance - that requirement for 6 weeks of PT before MRI approval? Not even listed in the docs. IIRC, they got around that fact by some more open-ended vague language about "potential other pre-approval requirements which the Plan may require in their sole discretion at any time") or some other open ended catch-phrase..

No here disagrees with you just posted but none of are your sister or your Mother... when it's all said and done this is not your issue and no amount of input from you to sister or mom is going to help anybody.

 

[travelover]

OP is very generous but it is still the old horse to water problem. My condolences, every family seems to have at least one.

 

[24601NoMore]

No here disagrees with you just posted but none of are your sister or your Mother... when it's all said and done this is not your issue and no amount of input from you to sister or mom is going to help anybody.

Well, I guess we're just going to have to agree to disagree on that.

I can't sit idly by and watch her go into many months of medical appointments, surgeries, etc and have no idea how to engage properly in it. And since I know her and what she's good at (and not good at, which includes things like this), it's "older brother responsibility time" to do everything and anything I can do to help - REGARDLESS of whether that gets people p'ssed off at me or not).

And I suspect at the end of the day, virtually all of you would in reality do the exact same thing in my shoes.

 

[ivinsfan]

Well, I guess we're just going to have to agree to disagree on that.

I can't sit idly by and watch her go into many months of medical appointments, surgeries, etc and have no idea how to engage properly in it. And since I know her and what she's good at (and not good at, which includes things like this), it's "older brother responsibility time" to do everything and anything I can do to help - REGARDLESS of whether that gets people p'ssed off at me or not).

And I suspect at the end of the day, virtually all of you would in reality do the exact same thing in my shoes.

This would be a 100% true if they had asked you for your input...but in the families I know (including mine) saying I'm doing this for your own good seldom has a good outcome...


Regardless I'm hoping your sis has the best possible outcome and that when this all over, you guys have a good relationship.


This news is all very fresh and as time goes by things can change...maybe a month from now sis will be asking for your help. I've had close family die from cancer and I know the feeling of being upset because there is nothing we can do to make it better and that your wanting to help comes from your heart.

 

[Sojourner]

Bottom line - unless you're VERY fortunate to have some super gold plated plan, it's incumbent on every single person that has healthcare coverage today to know what your plan requires of you as a member. And if you don't, you're very likely to get absolutely slaughtered in terms of denials, refusals, delays and other nonsense that just makes the entire experience of dealing with healthcare in 2022 a real nightmare. My pre-ER job involved writing a lot of very lengthy, very complex contracts and working with a lot of lawyers. I have a ton of experience writing and reading contracts. And even I find reading through the insurance company declarations of coverage darn near indecipherable - not to mention incomplete. (For instance - that requirement for 6 weeks of PT before MRI approval? Not even listed in the docs. IIRC, they got around that fact by some more open-ended vague language about "potential other pre-approval requirements which the Plan may require in their sole discretion at any time") or some other open ended catch-phrase..

As much as I hate medical insurance companies and their for-profit business model, I don't fully agree with this. I have never once had a "super gold plated plan" since I ER'd about seven years ago. Only bronze plans and (for one year) a silver plan. In all those years, I haven't found it to be the case that I had to meticulously read and understand all the requirements, technicalities, and declarations in order to receive the coverage benefits of my various plans. The only thing I've done routinely is look up each provider that I was scheduled to receive care from ahead of time to ensure they were in-network. Mostly they were, but sometimes they weren't, and even then some portion of the costs were covered. Just my two cents, but I think you might be engaging in "catastrophic thinking" and worrying yourself unnecessarily about something you have little control over.

 

[Sunset]

OP - Just remember should you pay for medical bills that you have no control over the cost and should your sister use out of network ones, there is practically no limit to the uncovered costs.
You could easily end up spending a tens of thousands of dollars, and she will still have to declare bankruptcy - meaning you wasted your money...

How large are her Credit Card debts right now ?
She may already be facing bankruptcy and you just don't know it yet.

Help her emotionally, drive to/from appts./ and with food/household bills, for the months she will be off work. And do it cheerfully without resentment or don't do it at all.

 

[RetMD21]

If she goes out of network providers are required to give her cost estimates and get her to sign paperwork. Will that get her attention? Tough situation.

 

[ExFlyBoy5]

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?

This bears repeating.

OP...as much as you would like to help (and I think you are going above and beyond) you should begin to accept that you CANNOT be her savior.

Bankruptcy law is around for a reason and this type of situation is EXACTLY what it is supposed to be used for.

 

[RetiredHappy]

Medical practices are not stupid. If they are out of network, they would have told her that she had to pay for the full amount before they provide services. She is an adult and what she does is really none of your business. She is the one with the cancer and has to navigate the process, and it includes finding the best doctors to treat her. If she asks you for help with the process, then extend your help.

I don't cut coupons and I don't return beer bottles to the store, not that I drink beer. We each decide on how we live our lives.

Just provide her with emotional support and not fret over her financial situation. Families are not responsible for debt incurred by another adult member.

 

[easysurfer]

Is the sis finances medicaid eligible?

I'd go as far as checking that route. But like others said, OP is not responsible for her bills.

 

[Calico]

Well, I guess we're just going to have to agree to disagree on that.

I can't sit idly by and watch her go into many months of medical appointments, surgeries, etc and have no idea how to engage properly in it. And since I know her and what she's good at (and not good at, which includes things like this), it's "older brother responsibility time" to do everything and anything I can do to help - REGARDLESS of whether that gets people p'ssed off at me or not).

And I suspect at the end of the day, virtually all of you would in reality do the exact same thing in my shoes.

I have an older sister who is completely irresponsible with money, and has never done a thing to take care of herself or pay her bills. She also wanted to "be happy" in her work. She has a university education and absolutely no impairments or disabilities that would have prevented her from working to support herself.

To the best of my knowledge she currently lives (in another state) in government supported housing, and receives all sorts of tax-payer benefits re: food, medical care, etc. I really don't know, because I long ago realized that the old adage is true - "you can lead a horse to water, but you cannot make them drink."

I would never in a million years do the same thing in your shoes, and I doubt that very many people would. Your sister is an adult, and as such it is not your responsibility to pay her bills or try to control the choices she makes now.

I will hasten to add, from my vantage point as a cancer survivor, the only thing she needs to focus on right now is getting better. Frankly, worrying about whether or not a surgery is covered at this point is beside the point. Is it going to save her life? Is she supposed to decline to have it if it can save her life, but isn't covered?

Back when I got my cancer diagnosis, it was all I could do to remember to BREATHE for the next many weeks/months. Your sister is terrified right now, believe me. You can either be her big brother and provide emotional support as she goes through this, or you can be the guy who is "always right," try to take control of the whole situation, and thereby alienate her and your mother at a time when they are already stressed beyond belief with fear and worry.

The last thing I will say is that I cannot wrap my head around the fact that her medical plan actually provided you with her plan information. That is so far over the line, and breaks so many boundaries, it must be unethical, if not downright illegal for them to do that.

 

[pb4uski]

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.

+1. And let her know that you are willing to help her through the hoops and that you will but if she chooses to do it her way and screws the pooch and goes bankrupt that you are not a bank and will provide no financial aid.

 

[24601NoMore]

As much as I hate medical insurance companies and their for-profit business model, I don't fully agree with this. I have never once had a "super gold plated plan" since I ER'd about seven years ago. Only bronze plans and (for one year) a silver plan. In all those years, I haven't found it to be the case that I had to meticulously read and understand all the requirements, technicalities, and declarations in order to receive the coverage benefits of my various plans. The only thing I've done routinely is look up each provider that I was scheduled to receive care from ahead of time to ensure they were in-network. Mostly they were, but sometimes they weren't, and even then some portion of the costs were covered. Just my two cents, but I think you might be engaging in "catastrophic thinking" and worrying yourself unnecessarily about something you have little control over.

Quite possibly the case..but I know from my own dealings with this particular insurer that they LOVE to find ways to deny things. Ways you'd never, ever, ever think of. Just look at my MRI. Denied, even though the plan docs say "80 (or whatever) percent co-insurance after deductible". Sounds straightforward. Who would have ever thought there's an invisible asterisk that leads to a later line in the doc saying "but only if you complete 6 weeks of PT first". CRAZY! (Well, actually, the doc didn't even say that..it had some vague "out" about "other pre-approval requirements that Insurer may at times determine to be necessary in Insurer's sole discretion")..

And then there's the surgery itself and the subsequent reconstruction. Maybe the insurance company wants and will pay for a lumpectomy vs masectomy. Maybe they'll cover X approach to reconstruction vs Y or Z approach. That's all the stuff that needs to be figured out and decided on by the full light of day..and if you don't stop to think about it, it's entirely possible you're incurring tens of thousands of uncovered cost. Surely ER of all places would realize this and be in agreement as to the importance of knowing and managing one's plan so that you don't come out the other side of this bankrupt.

The last thing I will say is that I cannot wrap my head around the fact that her medical plan actually provided you with her plan information. That is so far over the line, and breaks so many boundaries, it must be unethical, if not downright illegal for them to do that.

Not sure I agree. I called up and said "can I please have the Plan Docs for XYZ Plan". There's nothing in there that's PII (Personally Identifiable Info governed by HIPPA) or other info specific to her as a member. It's docs for a plan that any small company can buy. No personal info compromised whatsoever. It's basically equivalent in my opinion to pre-sales marketing info. In fact, for the "A"CA versions of the plan, they post them outright on Healthcare.gov for anyone to download.

 

[daylatedollarshort]

And I suspect at the end of the day, virtually all of you would in reality do the exact same thing in my shoes.

You've had almost two pages of posts now and most if not all posters are saying the opposite. We don't even get involved that much with our adult kids, unless they ask. You just have to let it go. The only way you might be involuntarily involved is if she can't pay rent or need groceries, and it sounds like that would only be a couple of months. You can come up with ideas on how to help with that, in case she asks, like food pantry addresses, SNAP or Medicaid eligibility, or roommate matching services, but otherwise she is an adult and allowed to make her own medical and financial decisions, even if they aren't the ones you would make.

A recent study found that "about 54% of Americans live paycheck to paycheck. And nearly 40% of high earners — those making more than $100,000 annually — said they live that way." https://www.businessinsider.com/high-earning-henry-millennials-six-figure-salaries-feel-broke-2021-6

 

[24601NoMore]

Quick update - DW was a Director at a Fortune 500 company who at times managed hundreds of people, and has a unique ability to gently cut through the most difficult, contentious situations that's among the best I've ever seen. She took sis to her 2nd (in 2 days) appt today and managed to work into the conversation that we can help her navigate all of this..and she surprisingly didn't totally shut down to it.

So, maybe we're making some progress..

 

[Badger]

It appears there are 2 issues: #1. Your sister has cancer, needs medical help, is scared, and needs emotional support and #2. She doesn't handle her finances to your satisfaction and you are upset that she doesn't listen to how you want her to live her life.
I don't see much in your posts that indicate that you are addressing the first issue independent of the second and your focus is mainly if not exclusively on the second issue.


FWIW I have an older brother who continually tried to tell everyone in the family how they should handle their money, live their lives, etc. ad infinitum. He constantly aggravated my parents, my sister, and me. This was even how he treated his grown and married children. My parents died more than 12+ years ago still upset with his meddling and my sister and I haven't spoken or seen him since and don't need to.
I hope your sister is able to survive the cancer and finds relief and that you find a solution to your problem.


Cheers!

 

[24601NoMore]

It appears there are 2 issues: #1. Your sister has cancer, needs medical help, is scared, and needs emotional support and #2. She doesn't handle her finances to your satisfaction and you are upset that she doesn't listen to how you want her to live her life.
I don't see much in your posts that indicate that you are addressing the first issue independent of the second and your focus is mainly if not exclusively on the second issue.

Cheers!

#1 - True, and my lovely wife is doing a lot to address that including taking her to all her appointments. Sister is a creative type, and not the best at gathering in and processing info. So, Fortune 500 Director lady wife is and is not only doing that, but being there "woman to woman" to support her.

#2 - I don't give a rat's patookie whether anyone listens to me or not. HOWEVER - I do have concern that she could be putting herself into a very difficult situation BECAUSE I CARE. I'm seriously not a "gee, I want to run things and no-one is listening to me" person, as I TRULY do not care about that. What I do care about is if someone I love deeply is going to potentially drive herself off a cliff and onto the rocks below..and if my own experience navigating difficult health care companies and finances can help her avoid that, then by God I'm going to continue to advocate for getting involved to the point I can do so.

 

[Bigdawg]

OP, I know what you are going through. Here is the link to my issues with my sister:

https://www.early-retirement.org/forums/f38/sister-end-of-life-110124.html

She passed in November at age 59. Up until just three weeks ago I paid off the last 2 years of property taxes on her house just before it was going to auction. I ended up saving about 30k for her kids. I echo what many here are saying. Help where you can. Don't push. Be ready to pick up pieces. Advise without TAKING OVER. You can't change her. Don't let yourself or your mother become responsible for any of the bills. My sister rang up almost 200k in bills over a 5 month period. We are not responsible for any of those bills. Good luck to you sir. I know how frustrating it is when you have information that will help the situation and people won't listen.

 

[ivinsfan]

Op the problem with post 43 is that you have history with DS where you have told her she doesn't handle money properly up to and including deposit s on beer bottles. So attitudes on both sides have been set. If she talks to your wife that's wonderful and a go between might be the best option.


I know you are pretty resistant to what the majority of posters are saying about this.

 

[Aerides]

#2 - I don't give a rat's patookie whether anyone listens to me or not. HOWEVER - I do have concern that she could be putting herself into a very difficult situation BECAUSE I CARE. I'm seriously not a "gee, I want to run things and no-one is listening to me" person, as I TRULY do not care about that. What I do care about is if someone I love deeply is going to potentially drive herself off a cliff and onto the rocks below..and if my own experience navigating difficult health care companies and finances can help her avoid that, then by God I'm going to continue to advocate for getting involved to the point I can do so.

Sometimes when faced with the mortality of those we love, it is easier to focus on the parts of the problem we can control. It's a great way distraction to think about numbers and dollars, vs. life and death. Perhaps that's what's happening here?

If not, your care - as it comes across in these posts - seems far more worried about her financial wellbeing (and your misplaced ownership of that), vs. her physical wellbeing. And perhaps that's just how it's coming across, and not reality, so it might be a good idea to step away from this thread while you are in the thick of the most difficult part of acceptance of the medical challenges your sister now faces.

 

[24601NoMore]

Sometimes when faced with the mortality of those we love, it is easier to focus on the parts of the problem we can control. It's a great way distraction to think about numbers and dollars, vs. life and death. Perhaps that's what's happening here?

If not, your care - as it comes across in these posts - seems far more worried about her financial wellbeing (and your misplaced ownership of that), vs. her physical wellbeing. And perhaps that's just how it's coming across, and not reality, so it might be a good idea to step away from this thread while you are in the thick of the most difficult part of acceptance of the medical challenges your sister now faces.

Her Dr. believes she has a 96+% chance of surviving this. So, while I'm concerned about the 4%, I'm more concerned that when she DOES get through this, that her life from that point forward could be inadvertently destroyed through bad choices over the next several months.

 

[daylatedollarshort]

Her Dr. believes she has a 96+% chance of surviving this. So, while I'm concerned about the 4%, I'm more concerned that when she DOES get through this, that her life from that point forward could be inadvertently destroyed through bad choices over the next several months.

Per my previous link, 40% of households making over $100K live paycheck to paycheck. It is pretty hard to change human nature. Many people are just short term thinkers, especially when it comes to finances.

 

[ivinsfan]

Her Dr. believes she has a 96+% chance of surviving this. So, while I'm concerned about the 4%, I'm more concerned that when she DOES get through this, that her life from that point forward could be inadvertently destroyed through bad choices over the next several months.

This response quoted A's post which was a great comment IMO.


Do you understand what she meant in the term "misplaced ownership"?


Your sister has not taken kindly to your efforts to educate her about the proper way to use and earn money. She now has cancer yet somehow you think she'll change her mind about you inserting yourself in her money stuff. That most likely won't happen and she won't forget you pressing her in the hardest time of her life.



I'm going to stop posting in this thread as I think it's run its course. God Bless you and your sister.

 

[FLD3C]

Dear OP,
I am an old retired doctor. There is no easy way to say this but your sisters illness is not the problem. Your sisters health coverage is not the problem. Her financial situation is not the problem.
The issue is clearly one of control and your desire for control. Until you accept that you can not control your family you will be unhappy