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An answer to a related question posted a four-panel comic:

Breaking Bad: Anywhere But America Edition

Doctor: Mister White... I’m afraid you have incurable lung cancer.

Walter White: But... How will I pay for my medical treatments? This will bankrupt my family!

Doctor: Nonsense! The government will pay your medical bills, taxpayer! What kind of barbaric society would allow medical care to hinge on a person’s wealth?

Walter White: Oh, phew. In that case I guess I’ll go back to teaching chemistry.

The End

This got me thinking: Walt was employed by the local public school system and had an insurance plan. Is it ever directly stated in the show that he was denied coverage? Looking at the Season 1 transcripts there's only two mentions of "insurance". Once in Episode 1:

Walter: This is so embarrassing. I am fine. Honestly. It's just some bug going around. First my wife had it, then my son, and now me. It's just like a chest cold. Could be some low blood sugar as well. I didn't have the greatest breakfast this morning, honestly. Hey, listen, can you do me a favor? Can you just drop me off at a corner somewhere?

EMT: No. Sorry.

Walter: It's just that I don't have the greatest insurance

And then once in Episode 5:

Skyler: The lady from the billing office said they usually bill the insurance company directly, but since our HMO is not paying for it, we can pay up front with a credit card.

Walter: Good.

Skyler: And then Elliott will send a check.

Walter: I will take care of it.

Was it that the insurance refused to pay for treatment outright? Or was this because Walt wanted to get treatment at a more expensive clinic that wasn't covered by his plan?

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  • My answer it longer, with more detail; but, you got it right. It's an expensive clinic that has enough clientele that they don't want to limit the treatment plans to only those a cut-rate insurance plan would approved. The benefits to such a clinic are multi-fold; they can direct treatment as they see fit, add items that might be optional elsewhere, and generally get to treat the patient without hearing "that's not going to be reimbursed."
    – Edwin Buck
    Commented Aug 15 at 23:18
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    transcribed to avoid copyright concerns Copying the text does not avoid such concerns. You can probably just copy the original comic
    – user182601
    Commented Aug 16 at 3:46
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    You didn't copy "short text snippets". You copied the entire text of a comic strip.
    – user182601
    Commented Aug 16 at 4:57

2 Answers 2

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The HMO will treat cancer, but not at the clinic that they are choosing, which is known to be one of the best cancer treatment facilities in New Mexico.

This kind of treatment, for Walt, is "out of network" treatment, and depending on the insurance plan, it would either be covered at a lower rate, covered with some fixed dollar cap, or possibly not at all.

Being in an insurer's network consists of having a prior business relationship between the facility and the insurance agency. This might include, using standard treatment plans for typical ailments, limiting or denying alternative expensive treatments or unapproved treatments, etc. It also includes working with the insurer's submission system and in many cases, integrating it into the facility's billing system.

In the story, this is one of the best treatment facilities in New Mexico, with one of the leading physicians for this kind of cancer. This would mean that they would have little incentive to be in a low-cost insurance plan, that would tell them exactly what kinds of treatments they could perform by stating that additional "extra" items would not be covered by insurance.

For such situations, the facility won't deny treatment to the patient, but the patient is fully responsible for all of the medical payments, and the patient then needs to take the bills to their insurer to attempt to get whatever is covered reimbursed.

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    Thanks! So sounds like Walt would've been in the exact same predicament in (say) the UK as the NHS would not have covered his treatment in a fancy private cancer clinic :-)
    – JonathanReez
    Commented Aug 16 at 0:52
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    @JonathanReez What makes you think the NHS would not have covered his complete treatment? That is how it mostly works.
    – matt_black
    Commented Aug 18 at 20:16
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    @JonathanReez The best cancer clinics in England are run by the NHs and the best cancer doctors work for the NHS. The idea that the system only funds "standard" treatment is largely a myth promulgated by right wing opponents of "socialised medicine".
    – matt_black
    Commented Aug 19 at 9:12
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    @galacticninja One thing to consider is that "best" often doesn't mean "best in everything", that's why MDs specialize. Another point it that England tends to have private healthcare mostly to shorten wait times, to obtain the funding (insurance) NHS would have provided. That said, getting to the best MDs is not a guarantee in NHS, even if they were in NHS, because NHS doesn't have a "pay to move the others out of the way" system.
    – Edwin Buck
    Commented Aug 19 at 16:05
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    @JonathanReez It is far from obvious in the show that the problem arises from family demand to see the best doctors. As the quote in the question shows, Walt is really worried about medical costs even before he is diagnosed with something serious. Insisting the US system is like the NHS is a very serious stretch of both the show and the real world facts.
    – matt_black
    Commented Aug 19 at 18:54
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Wanted to add some quotes from the show for full context. In 1x04 - Cancer Man there's the following conversation:

Marie: Okay. So first thing tomorrow, I talk to my radiologists, we find you the best oncology dream team.

...

Skyler: Yeah, anytime on Friday is absolutely fine. Thank you so much for working us in. Can I just put that on a credit card? Great. Perfect. Okay, so we will see you at 10:45 on Friday morning. Thank you so much. The best oncologist I mean, not even just in New Mexico, but one of the top ten in the entire nation. His name is Dr. Delcavoli. And we see him on Friday. I mean, Marie really came through for us. She had her boss call and this is good. From here on out, things are gonna...

Walter: What's that we're putting on a credit card?

Skyler: It's just a deposit kind of thing.

Walter: How much of a deposit?

Skyler: It's $5,000.

Walter: Five thousand? And what's that? Just to start? Just to tell me what I already know?

Skyler: Walt, he's not in our HMO, okay? So be it. We'll figure it out. Come on. Don't get hung up on money here. We can always borrow from Hank.

Walter: Absolutely not. No, I just, we're not gonna do that.

Walt's insurance would've been perfectly sufficient for a standard treatment at a local cancer clinic in Albuquerque. But Marie insisted that Walt goes to one of the most in-demand doctors in the entire country, which was outside the scope of coverage of his insurance plan.

So it seems like the comic got things wrong: the problem wasn't America's healthcare system, as Walt had a plan as a school teacher. The problem was that his family wanted "the best" doctor, which is a premium service that won't be covered in a single-payer insurance system either.

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