Medical insurance question

You know how sometimes you knock a coffee mug or porcelain vase over, and it breaks in a couple of pieces, and you glue it back together, but it's never quite the same? Or when you rip a hole in your clothes that isn't at the actual seam-- you can darn it or patch it, but it's not like new?

The human body's kind of like that. You can reconnect bones, and muscles, and two sides of a laceration, but it's never going to be quite the same. A lot of cosmetic fixes may not be covered, like skin grafts over a surgical site to minimize scarring, might not be covered, but I highly doubt that what you're asking about-- deformities leaving a limp after the accident-- has anything to do with insurance. That seems like something down at the structural level that was just so damaged that you can't reconstruct it all the way.

I am no insurance expert by any means, but 10 years ago, policies could have lifetime maximums that were actually pretty low when you're talking about something catastrophic. But it may also be that his injuries were such that it couldn't be corrected completely.

The ACA did away with lifetime coverage limits. Before that, lots of plans had limits like $1 million over your life. In 2013, when I was diagnosed with cancer, my insurance company spent over $500k on my treatment (two surgeries, 20 rounds of chemo, one ER visit and an overnight in the hospital, plus 50-some outpatient appointments with MDs and a PT). Doesn't take much for things to add up at all. Definitely one of the good things to come out of the ACA.

As for the guy with the limp (RN here with 15 years of experience specializing in orthopedic and trauma patients), there are lots of reasons why he may still have a limp. He may have had enough damage in a leg that the bone loss made one leg end up shorter than the other; he may need a hip or knee replacement but doesn't have the $$ to pay the out of pocket costs; he may just have chronic pain from post-traumatic arthritis that you can't really get rid of.

The $$ factor comes into play a bunch. My insurance has a max out of pocket of $2500 a year. You'd think that would mean that I only paid $2500 for my care in 2013, for example, but that isn't true. Medications don't count towards the OOP amount. Copays for my overnight in the hospital (I think it was $200 a day) don't count. Tons of other things. I ended up paying more like $5k out of pocket that year (plus $11k for fertility preservation, which wasn't covered at all). So gofundme accounts help with the copays, or for things that the insurance refuses to cover--I needed a bath seat to sit down and take a shower, because the chemo hit me really really hard for a few doses and I just couldn't stand up in the shower that long. Not covered. Lots of things like that come up and aren't covered at all or aren't covered fully.

Also, you think about things like time off of work--once you blow through all your sick and vacation time, you are not getting paid anymore. I would have absolutely lost my house if there hadn't been a program at work for people to donate their vacation time. I worked 40% for the 20 weeks I did chemo, and took off another month between my two surgeries. Had over 500 hours donated to me. Gofundme would be a lifesaver for someone without this option.

There are some things my insurance will cover 100% but there are other things it is an 80/20 coverage meaning the insurance will cover up to 80% but the other %20 is mine and that can be a huge burden!  A friend was recently in an accident and was life flighted to a hospital that could handle his level of trauma. He has a $25,000 bill after insurance has paid its share.

While your company may have great coverage now it may not have  had great coverage 10 years ago.  His accident may be the reason the company realized they needed to provide good insurance. And it may be whatever his accident was caused injuries that couldn't be completely healed.  My dad broke his leg (a bone shattered to be more precise) they had to glue bits of bone together in some places and he had a lot of pins holding things together while it healed. There was some damage that simply didn't heal back. He has experienced the lose of muscle in that leg (when he wears walking shorts you can see the leg muscles are very different)  I can tell when he is tired because his limp becomes more pronounced.
Save

In most states, car insurance has a specific limit for what they will pay for injuries.  It is called PIP (personal injury protection).  The standard amount that people choose on their plans is $10k.  Once that $10k is spent, that is it.  That will get you an ER visit, some XRays and blood draws and maybe one night in the hospital.  Doesn't last long at all. After that, you are on your own, regardless of who was at fault in the accident.  Only way you're getting more money is to sue the person who WAS at fault and hope they actually have money.  Even that will take years, so don't count on there being any money.  There are a few states (I know Michigan is one of them) where car insurance is a lot more expensive, because the PIP is unlimited when you are at fault and injure someone else. 

As for the asking for help with expenses, lots of daily expenses arise that are not covered by insurance. My max out of pocket is $3k and DOES include drug copays. DH hits the max in January every year.

But, I use my PTO faster than I earn it, so I am taking time off w/o pay. It costs $6 to park at the clinic. I have meal expenses when he is in the hospital. We spent a year traveling to Chicago every 3rd week for a clinical trial. The travel costs were all out of pocket. We spent $15k on just that.

DH was forced to retire early due to his cancer, so our income took a big hit. He does collect SS disability, but it's nowhere near what he earned.

We are so very lucky that I have a good job, so we haven't gone into debt or lost our home. I know other cancer patients that are not so fortunate.