Job Denying Medicaid as insurance? ?

The question I’m answering reads: “Have any American citizens ever been personally denied healthcare in the USA?”

And my answer is: Yes. I have.

I have age-related macular degeneration; it’s incurable. As it progresses there is potential for it changing from the relatively benign (but still sight-stealing) “dry” version to the more unstable “wet” version. With wet AMD time is of the essence, so I’d been told if there were any sudden changes in my vision, if I had onset of anything interfering with my vision, I should contact an opthamologist immediately.

While visiting family in Indiana (some 800 miles from my home) I suddenly developed a serious vision problem in one eye, and thought I might have a detaching or tearing retina, or even the sudden development of wet AMD. Not having an optometrist locally, I began calling in the area. Each time I explained the problem - knowing I needed to see an opthamologist - I was told they would not see me, would not refer me, because I had no insurance.

Even though I assured them I would pay up front, cash or debit card, for the consultation.

I had already determined that I would pay for a diagnosis: whether or not I would pay for subsequent treatment would depend on what the diagnosis was, and how much the treatment estimated cost would be, and whether I had time to get home or not. It’s not like I’m independently wealthy. I just didn’t want to risk blindness.

The last optometrist I called grudgingly gave me the phone number of the only opthamology clinic in the area. His receptionist warned me that they might refuse to see me, both because I had no insurance and because I had no registration with any local optometrist.

I called the clinic, explained the situation and why I thought it had become urgent. No dice. They flat-out refused to see me, saying the only recourse they could suggest would be the emergency room. (Where again I would have no insurance, and where it would undoubtedly cost me much more than a relatively simple front-line diagnosis.)

Finally, flying under false colors (“I need new glasses”) I went to a chain discount store (do I need to name it?) with an optometry concession. Once inside with the optometrist, I explained the problem. She did a thorough examination of my eyes and told me my eye was undergoing “posterior vitreous detachment,” something I’d never heard of before.

Until that point, no one had seen me, no one knew what was wrong with me, and all of them were made aware I have macular degeneration. They understood what that meant: that if my condition was suddenly changing, or if I was undergoing a retinal tear / detachment, I might well quickly lose all vision in that eye, permanently, unless I was treated. Yet not one of them would grant me so much as a cursory examination.

Fortunately, the PVD didn’t need any kind of treatment, and since there was a rare chance it could become more sinister, she told me what to beware of. She also told me that I’d likely develop PVD in the other eye. The PVD never got worse, and eventually cleared up, but it was a very scary experience, all the way around.

I had no medical insurance, no coverage, and as I was less than a year shy of qualifying for Medicare, I was trying to hold out for it. That was risky, and probably foolish under the circumstances.

But my point is - all I needed was for a professional to look at my eyes and tell me “It’s a nuisance, but your vision will recover, and here’s what to watch out for—” or “Don’t wait. Go now. Without urgent treatment you may lose your sight altogether.” They could easily prove that I had the resources to pay for this initial diagnosis. The scariest part of all this is - no one would let me in the door.

I’m in the UK now, and last week my right eye began to show signs of PVD. Mostly the symptoms were similar to my previous experience but there was just enough difference that I wanted to have it checked. I called the local optometrist who said he’d refer me.

Now, while I think this sort of thing is urgent, it’s hard to say what the opthalmic department (or the NHS) might consider urgent. I expected the optometrist would call me back to let me know when an opthamologist could see me, or even that I might get a letter notifying me.

The office manager of the opthalmic department called me not 45 minutes after I spoke with the optometrist. She set me up for an exam the next day. The appointment was on time - no waiting, no delays.

One of the opthamologists gave me perhaps the most thorough examination I’ve ever had (I’ve been seeing optometrists and opthamologists since I was six years old). When she finished, she assured me it is indeed the same PVD now developing in the other eye, that there are no signs of anything worse happening, and that I can expect it to clear up as the other one did some months ago. And just as the chain-store optometrist had done, the opthamologist outlined which sudden changes might mean I’d need to come back.

Not one word of “You are a non-urgent case” or “This is / is not an emergency” or “What insurance do you have?”

So to answer your question - “Have any American citizens ever been personally denied healthcare in the USA?” - yes.

And now, in comparison, you have the same person with the same problem but in a country with a national health service.

I don’t think I would trust any medical insurance, any medical coverage, in the US unless I had the same type Congress (and the President) has. Until they have to do what “the rest of us” have to do, I think they should keep their paws off the ACA - and off Medicare, for that matter.

And unless the United States stops allowing medical insurers to determine what diagnostic tests they will allow and what treatments they will dispense, the average citizen in the US might as well give up on medical treatment, even if technically there is “coverage.” Why go to a doctor when it’s the insurance company that will decide your diagnosis and your treatment?

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Medicaid is not an insurance company. You have to choose one your employer is offering.

You insurance card wouldn't help her with her job, because your card would have your name and the name on the "proof" has to match the name of the employee who doesn't want work insurance.

I don't know what she wants your card; maybe for some sort of fraud.  But she can't use it to get out of having to take her job's insurance.

The bottom line here, whether it's legal or not, is that they are requiring her to opt in.  If she doesn't, she will not get the job or be allowed to stay there.  

If she wants to fight it, she'll have to obtain legal assistance.

If your friend is single, the income limit for medicaid as a signal individual in Maryland is $17784.

The minimum wage in Montgomery County, MD is $14 an hour.  If your friend is working full time, this places her income at $29,120 a year.

The employer is not accepting medicaid because they know your friend probably doesn't qualify for medicaid based on her income.

- If she is a household of 3 and does no overtime, she may still be eligible for medicare if she is making minimum wage.

In response to the comment:

The employer is NOT requiring the employee to "opt in"/participate in the employer based  health insurance.  The employer is making it a requirement to HAVE health insurance.  This is VERY VERY LEGAL. So the option for the employee is get her own insurance (which she can because she qualifies for a special enrollment period), opt in with the company, or don't work there. 

Besides likely not qualifying for Medicaid, medicaid is NOT health insurance.  It's government sponsored health CARE.  It's a welfare benefit.  It may be administrated by a health insurance company, but it is NOT health insurance.- Health insurance is a risk mitigation. 

Yes, probably legal.

Group insurance contracts require that a certain percentage of the employees are covered in the group plan or have coverage elsewhere if they opt out.   Medicaid probably doesn't count as it's income based.

Now that you have a job, are you sure you will still qualify for Medicare? 

ETA:   "I actually found out it’s illegal to make an employee opt in for insurance."   No you didn't find that out because in many circumstances it's simply not true.