Poll

How should I increase my cash flow if another large medical bill comes?

top up mortgage: spend $300-600 in fees + 3.89% interest
sell etfs (can access discounted capital gains tax and partially offset with a $1200 capital loss)
ask family members for loan

Author Topic: Carers and disabled spouses - preparing for medical bills (australia)  (Read 3734 times)

Annie_R

  • 5 O'Clock Shadow
  • *
  • Posts: 12
Hi

My spouse is recently disabled and likely to require continuous treatment; there is no cure. regular medication etc. and 2 surgeries are projected to cost around 27k this financial year even w/ insurance. i also have some minor health conditions and health bills for myself are 3-4k per year (Australia and all $ in AUD).

we are on the waiting list to get assessed for ndis (disability insurance for ppl with mild disability where you can still work) but don't expect a lot of support from them given other ppl's experiences. my spouse can only work 3 days a week rn and that may also decrease. i only work 4 days a week also. we are both in our early 30s now. her earning power is likely to decrease while mine has been stagnant for 8 yrs. i had a side gig going on for a bit a few yrs ago but don't have the energy for it now, plus it paid far less than my day job hrly anyway so if i wanted to increase my income the easiest thing to do would be to work 5 days/week which is a last resort for me.

i have around 150k in etfs. mortgage is 108k at < 4% interest and no other debt. this yr because of the surgeries i've stopped contributing extra to the mortgage, DRIP investment, etc. and opened a 6.8k balance transfer at 0% for 14 months just to improve cash flow and ensure i don't have to sell any more etfs.

i know this is not a bad situation by any means and probably better than most families w/ disability but i do feel discouraged about having a negative savings rate this year (previous years were very modest, 15-10% only, --that's my personal income not including hers, total household savings rate would be even lower.). i have also developed depression. my mother is dying rn.

honestly i know there are things i could improve, spend less on food groceries fuel blah blah but tbh i'm emotionally drained and can't do any of that rn. basically surviving and not taking on debt is my priority atm and that's probably achievable.

so i guess stuff that helped me with these sudden medical bills:
- i didnt know that it took so long to get a balance transfer sorted out (2-3 weeks). i would've started the process sooner if i'd known.
- i open/close a lot of credit cards for the sign on bonus points and that has made me rejected for new balance transfers by several lenders. i currently have access to about 50k in credit cards (i don't use that much and pay off in full tho) which looks bad to lenders. next time around i'm planning to close most of the cards as soon as i don't need them any more.
- i forgot to turn off my DRIPs and so lost access to a few hundred in cash before i realised i should turn those off for a bit.
- we should've started applying for ndis earlier, i didnt realise it took like 6 months just to get a rejection note (!!!). apparently writing to your local mla might help getting it pushed through faster.

on the plus, my work and local carers association does free/cheap psychological counselling; as does cancer council Australia (although I haven't used some of those services).

idk, hope this helps someone out there, just knowing about other carers helped me and joining a local group has been helpful also.

if I were talking about someone else in this situation I feel like I would be more compassionate towards them than towards myself. I kind of feel that the focus on frugality, independence, developing skills and FI in blogs can be disheartening some times when you can barely stay on top of the laundry but like all of us have different starting points/hazards and that FI is not the end-all to life and stuff can happen suddenly but that the practices and lessons from FI do make them easier to bear.

tldr; be gentle with yourself and others. you are doing the best you can and it's ok.

question time: so we will be ok for this year but spouse might need another more complex surgery at some unknown point in the future and if it occurs within 12 months I will have no cash on hand to pay for it (will also have to travel to a different city + pay for accommodation as have been told there are no specialists within 1hr distance. some of the travel/accommodation costs may be offset under a government health transport scheme but would still result in hundreds out of pocket). should I:

  • draw down from my mortgage at 3.89% interest + 300-$600 topping up fee (current loan is 108k, around 22 yrs remaining, house was valued 3 yrs ago at 350k
  • sell some assets, they have been held for over 1 yr so the capital gains tax at the marginal rate would be 0.5*.345 = 17.25%. I also have around $1200 in capital losses rolling over that can offset any gains.
  • take an interest free loan from family member but I have already asked and I don't think this is a viable option unless I press for it and possibly damage relationships.

I could also increase my working hours if absolutely necessary but only at significant detriment to mental/physical health. I would also try to get another balance transfer at 0% in the first instance to help with the immediate hit.

« Last Edit: November 02, 2017, 05:39:57 PM by Annie_R »

urbanista

  • Stubble
  • **
  • Posts: 227
  • Location: Australia
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #1 on: October 31, 2017, 12:19:08 AM »
I am sorry you are in this situation. Would you mind to share what exactly medical costs are for? Are you going public or private? Do you utilise Medicare safety net? 27K yearly medical costs seem very high for Australia.


MayDay

  • Magnum Stache
  • ******
  • Posts: 4983
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #2 on: October 31, 2017, 11:12:12 AM »
I was wondering that as well. 27k is high in the US, but possible under a family deductible. One thing that has helped us is my husband's company moving to individual deductible/OOPMax. I don't know anything about Australian health system do hopefully others can comment.

Without knowing how much time you spend caring vs. working it's hard to say if you should work more. I know you say it is a last resort but to me it seems like the easiest first step to work full time (I assume your four day schedule is part time).


Annie_R

  • 5 O'Clock Shadow
  • *
  • Posts: 12
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #3 on: October 31, 2017, 02:25:16 PM »
Hi and thank you for your comments. This response may seem negative but I'm just trying to lay out the circumstances.


So I have rsi from work (why I went parttime to begin with) and I find 5 days per week physically painful but I do sometimes do it during the busy period just to stay on top of things. Before spouse got sicker I had actually intended to drop my hours further to around 70% full time equivalent however to pursue other interests.

Costs are :
Out of pocket gap for gp and gynaecologist (she also sees a bulk billed gp for a $100 membership per year for normal stuff like infections etc, the private GP is for pain management). We are no where near the medicare safety net which from memory is over 2k. I see a bulk billed gp for my stuff.

Medication --we probably won't hit the safety net for this either. She's on about 200-400$ of pills per month. (prescription). Private health insurance pays a little towards the non pbs scripts (non pbs don't count towards the medicare safety net either, and are about $80 per 28 days before rebate, I'm probably going to add to that with my own scripts sadly)

Surgery this year is 5.5k out of pocket (oop) for the 1st one (booked 2 days after we asked for one, I don't know how long it would have taken public system given its a 2 year wait for the pain management clinic here and they don't even treat you) and 14k oop for the 2nd one.

The next major surgery I anticipate will be an 8 hr procedure so potentially quite expensive even after rebates and requiring 2 surgeons. After that major surgery she will probably need top up surgery every 6 months as the tissue grows  back.

I have increased her level of private cover twice this year but from writing this out I think I need to increase it again?Currently premiums are around 110$ per fortnight . I'll have to look into it again to see if some other package is more cost effective.

Other costs are psychologists (hers ongoing around $200 per month,r; I use my works free service and carers group counsellor which has almost no oop .

Also while it was legal here we bought about 2.5k worth of cbd oil. I gave it to my mother for her cancer but it's listed in my spreadsheet as a medical expense. She wasn't willing at the time to risk something not legal.
« Last Edit: November 02, 2017, 05:42:26 PM by Annie_R »

Annie_R

  • 5 O'Clock Shadow
  • *
  • Posts: 12
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #4 on: November 01, 2017, 12:20:29 AM »
Went to carer's group today and they had some good suggestions. We're going to sit down every week or fortnight and review the budget. Right now I do everything financial and that's clearly not working.

I also spoke with my insurer, they reminded me that I had been previously under insured and have not yet finished waiting periods so that's partly driving up hospital costs (although even if I had been covered it would have saved around 6.5k over both of them  not the full amount. Still a lot but we just couldn't wait).

marty998

  • Walrus Stache
  • *******
  • Posts: 7372
  • Location: Sydney, Oz
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #5 on: November 01, 2017, 01:54:53 AM »
I'm sorry to hear you and your partner are going through this. It sounds like some terribly invasive surgery your partner has to endure.

Has she got TPD insurance? She may be able to make a claim if she is no longer able to work.


urbanista

  • Stubble
  • **
  • Posts: 227
  • Location: Australia
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #6 on: November 01, 2017, 03:00:01 AM »
Ok, now I see that the bulk of expense is in private surgery gaps.

Two things: increase her private cover (but then she needs to serve waiting period), and ask doctors to reduce their fees. Some doctors are willing to do it if you explain your situation.

In terms of psychologist fees, I presume you claim 12 visits a year on Medicare?

Fresh Bread

  • Magnum Stache
  • ******
  • Posts: 3612
  • Location: Australia
  • Insert dough/bread/crust joke
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #7 on: November 01, 2017, 05:34:04 AM »
On my insurance it makes a massive difference if a doctor is in network vs off network. If I go back to have a similar surgery I will do what I can to get a Bupa surgeon as last time a 3hr op left me $5k out of pocket (with a discount) and I reckon I can probably get the same thing for much much less. As a smaller scale example, my local dentist is in the BUPA network and charges me $26 for a checkup, xrays and clean - at another one nearby it costs $200+. Obviously it makes it harder if there is only one specialist that will do the surgery for your SO.

MayDay

  • Magnum Stache
  • ******
  • Posts: 4983
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #8 on: November 01, 2017, 06:29:29 AM »
Is a hysterectomy an option? Top up surgery every 6 months seems insane and plus then she wouldn't be in pain.

Annie_R

  • 5 O'Clock Shadow
  • *
  • Posts: 12
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #9 on: November 01, 2017, 05:16:03 PM »
Thanks everyone for all your comments.

Is a hysterectomy an option? Top up surgery every 6 months seems insane and plus then she wouldn't be in pain.

MayDay, a hysterectomy used to be recommended but is no longer standard practice as it does not actually remove pain in most cases and in younger women the induced menopause causes more problems. Excision surgery is the current standard but in this case there is a high risk of complications which may result in a much worse outcome. there is a loooot of misinformation about endo out there, even government websites (health vic) do not have their facts straight.

Has she got TPD insurance? She may be able to make a claim if she is no longer able to work.

she does have IP and TPD insurance but it's maybe a good idea to up the coverage as currently it is extremely low since when i last reviewed it our circumstances were different.. thanks marty!

Two things: increase her private cover (but then she needs to serve waiting period), and ask doctors to reduce their fees. Some doctors are willing to do it if you explain your situation.

In terms of psychologist fees, I presume you claim 12 visits a year on Medicare?

urbanista, i just rang my insurer yesterday and it seems our cover is appropriate now but the reason why the oop's were so high this yr was due to previous underinsurance which will be corrected for. I personally did claim the (10) visits/yr on Medicare for me but even that is too expensive really (around $70 oop minimum) so i'm planning to use work (free for 6 sessions) then the local carer's group ($10-$15 per session).

On my insurance it makes a massive difference if a doctor is in network vs off network. If I go back to have a similar surgery I will do what I can to get a Bupa surgeon as last time a 3hr op left me $5k out of pocket (with a discount) and I reckon I can probably get the same thing for much much less. As a smaller scale example, my local dentist is in the BUPA network and charges me $26 for a checkup, xrays and clean - at another one nearby it costs $200+. Obviously it makes it harder if there is only one specialist that will do the surgery for your SO.

Fresh Bread, that's true and honestly if we moved to somewhere like sydney it's possible it would be cheaper and better quality service for the price. we are in the ACT and lots of endo sufferers here travel to see a particular gynie in sydney because he used to do public practice.
« Last Edit: November 02, 2017, 05:38:39 PM by Annie_R »

Fresh Bread

  • Magnum Stache
  • ******
  • Posts: 3612
  • Location: Australia
  • Insert dough/bread/crust joke
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #10 on: November 01, 2017, 05:28:33 PM »
Oh and as someone mentioned upthread, do make sure you are registered for the family safety net. It saves a fortune.

I had Stage 4 endo removed a few years ago. Not sure exactly what it's like now but it hasn't come back symptom wise as bad and tbh the pain was managable with OTC pain relief even before. It can affect people so differently depending on how and where it attaches. Your SO sounds like she's got it so bad, my sympathies :( A hysterectomy doesn't bring on menopause if they leave the ovaries, but if they are affected too with cysts then I guess they would be removed. I'm surprised a specialist would not be able to remove endo once and for all if the ovaries went too. I guess you have to weigh up repeated anaesthetic and recovery against early menopause risks. I'm very looking forward to menopause.

tn42y

  • 5 O'Clock Shadow
  • *
  • Posts: 12
  • Age: 49
  • Location: South Australia
  • I'm new here
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #11 on: November 01, 2017, 06:08:28 PM »

I don't think I can offer any advice or comment but having read your posts I offer my thoughts, prayers, and best wishes.

Annie_R

  • 5 O'Clock Shadow
  • *
  • Posts: 12
Re: Carers and disabled spouses - preparing for medical bills (australia)
« Reply #12 on: November 01, 2017, 07:30:18 PM »

I don't think I can offer any advice or comment but having read your posts I offer my thoughts, prayers, and best wishes.

thank you I appreciate it :)

Oh and as someone mentioned upthread, do make sure you are registered for the family safety net. It saves a fortune.

I had Stage 4 endo removed a few years ago. Not sure exactly what it's like now but it hasn't come back symptom wise as bad and tbh the pain was managable with OTC pain relief even before. It can affect people so differently depending on how and where it attaches. Your SO sounds like she's got it so bad, my sympathies :( A hysterectomy doesn't bring on menopause if they leave the ovaries, but if they are affected too with cysts then I guess they would be removed. I'm surprised a specialist would not be able to remove endo once and for all if the ovaries went too. I guess you have to weigh up repeated anaesthetic and recovery against early menopause risks. I'm very looking forward to menopause.

thanks for letting me know your story and I'm so happy that it improved for you! do you mind pming me with your surgeon's name?

yep we're on family safety net :) although I don't understand how anyone benefits from it as it's November now and we are no where near the threshold!! it's crazy.

eta:
had finance discussion w/ SO and very happy with outcome, going to finally implement a jar system (similar to envelope method although not as strict) and do a weekly review. planning to call the tpd insurer next week to learn about what they count as pre-existing.
« Last Edit: November 02, 2017, 05:37:31 PM by Annie_R »