my employers want to pay for my surgery — but I want a raise

by Alison Green on November 1, 2021

A reader writes:

I work in a large company (not in the U.S.) in a somewhat managerial position. I am in charge of three different crucial departments and work alongside the owner of the company and his lovely kids. It is a multi-million dollar family-owned company with approximately 35 employees.

I have been extremely lucky in terms of colleagues (well, most of them), job description, and ownership. However — and I do not want to sound cocky — I work my ass off. I am on call whenever needed (i.e., if an incident occurs or a claim arises), I am always prepared, and generally I try to bring results.

I want to believe that I have built an honest relationship, based on mutual respect, with the owner’s kids (as I report directly to them) and it does not hurt that we are all in our thirties (so we have a few things in common). In other words, I think they like me, not only as an employee but as a person as well. Also they are very nice people.

My problem is that I do not know how to handle nice, giving people. Our industry is very competitive, misogynistic, and sexist. I have fought tooth and nail to get where I am today. So this kindness always takes me by surprise.

To cut the story short, I was recently diagnosed with an illness and I need to get surgery, which unfortunately I need to pay for out of pocket. The cost is not exorbitant but it will put a strain to my and my husband’s savings. We have a private insurance at work (paid by the owner) but it will not cover me as it considers my illness a pre-existing condition and as such is excluded.

I advised the kids that I would need to take time off for the surgery. They asked me about the private insurance and whether the surgery is covered. I told them that I am looking into it with the insurance broker but I am not hopeful. One thing led to another and I found myself in a meeting with the family where they told me that they will cover all my expenses for the surgery. I tried to politely decline their offer, but they would not take no for an answer. The concession we have reached is that if the private insurance pays me back anything, then I will give that money to them.

I am so very thankful to them, but I do not know how to accept this. Thing is, in the past, another (also wonderful) employer paid half of my masters degree and, and as much as I am still thankful to my previous boss, that meant that I never asked for a raise (nor did she ever gave me one). This resulted in me ending up severely underpaid by the end of my tenure there, which was one of the main reasons I left. Now I fear the same thing happening. I cannot say no to them — they are capable of shoving the money to my hands or simply transferring it to my account and even if I do not use the sum, they will not take it back — but I also do not know how to move forward.

Prior to the surgery, I had intended to gather my courage and go ask for a raise (as again I believe I am under-paid in relation to the market and my job description), but now I don’t think I can.

I know these people and I am certain that them paying for the surgery is not a ploy in order for them not to give me a raise or have me work harder, but their way of showing me that they care, that they are there for me and value me. I know I should be thankful that I work for people such as them, but how do I move forward?

If we take for granted that the surgery will eventually be paid by them, do I go in at the end of the year and ask for that raise or not? If yes, then how do I handle the fact that they will have already given me money for the medical expenses? And if do not go in the end of the year, then when should I go?

As I am writing this, I feel that if other people hear me they will tell me that I am selfish and what more do I need? But a raise goes a long way as not only is it “forever” but I will give me the boost I need mentally and in my CV. Hell, I am working really hard for many years now and I feel that I need to see the number going up as I get older.

You’re not being selfish! It’s very reasonable to want to be paid what your work is worth.

In theory, you should be able to treat the surgery assistance as completely separate from the question of your salary.

In practice, though, of course you feel weird about that! They’ve just offered you something that they didn’t need to offer, and you feel like you’re responding to that with “give me more!”

That’s not what you’d be doing. But emotionally it feels that way to you, and it’s possible it could feel that way to them too.

One thing that’s worth looking at is how the surgery costs compare to any raise you’re likely to get. If they’d be covering more in surgery costs than you’d be likely to get from a raise, there’s an argument for accepting the surgery help and wait a year to broach a raise (depending on what the math is).

But if the math doesn’t make that an obvious choice, another option is to be up-front about what your concern is and propose taking the surgery costs off the table for that reason. For instance, you could say, “I really appreciate your offer to help with this. It’s very generous, and I’m so appreciative that I’m working at a company that would offer that. Part of my hesitation in accepting is that I’ve been gearing up to ask for a raise. My current salary is below market in our area for the work I do, and I’ve been preparing to ask you to bring it up something closer to $X. I feel awkward asking for that now that you’ve made this generous offer for my surgery, and so what I’d like to do, if you’re open to it, is decline your assistance with the surgery and instead talk about bringing my salary up to market.”

If they underpay as a business strategy and are reluctant to give raises, it’s possible that they won’t be receptive to this. They could feel like they were happy to cover your surgery as a charitable act, but that doesn’t mean that increasing your salary is on the table.

Or they might be happy to give you a raise once you explain why you’ve earned one. And they might see them as two separate things and be happy to do both.

But by asking to take the surgery help off the table, whether or not they agree to doing that, you’ll make it easier to ask for the raise you’ve earned without the surgery assistance muddling the picture.

Read an update to this letter here. 

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{ 133 comments }

{ 133 comments… read them below }

  2. Ally McBeal*

    I love Alison’s answer. It’s perfectly in line with a great piece of advice I got a few years ago (and have used several times), which is to “name the awkwardness.”

    Most people will understand whatever you’re grappling with, and having that honest conversation always works out better than one person silently struggling or stewing while the other person has no idea that there’s even an issue. Or, worse, the awkwardness gets wedged in the middle, and interferes with the relationship.

    1. MissMeghan*

      I totally agree, and I think from the owner/kid side they are definitely not getting this angle for why OP is trying to turn down the funds. It seems like everyone involved here is doing their best to do right by each other. Leaving something as important as your salary and your concerns about it unsaid in this situation could turn a good relationship into an awkward one, when that absolutely does not need to happen.

    2. Greg*

      I tell my team, “A vacuum will always be filled, it’s better if it’s filled with the actual information rather than my suppositions.” In this case, the management team doesn’t even know there is information to be filled in (as you eloquently pointed out).

    3. OP of this letter to Alison*

      I am trying to reply to all, as I want to thank you all for your time! I will take your advise at heart and will try to eloquently tell them what are my thoughts and advocate for myself.

  3. Wy-Leen*

    “I feel that if other people hear me they will tell me that I am selfish and what more do I need?”

    I’m so sorry you feel this way. I’m not sure who these “other people” are. If you mean the ones at the company who are offering to pay for the surgery, perhaps; I don’t know them. But most people in the working world would understand that you deserve to be paid a fair, competitive wage, notwithstanding your health condition. I hope you can separate these 2 problems, in your own mind and with the company.

    1. ecnaseener*

      Absolutely. It’s not selfish at all to want to be paid what you’re worth, on an ongoing basis, “even though” you’re also receiving a monetary gift. You wanted that raise before you knew about the surgery — the gift is taking the surgery costs off the table, so you’re back where you started: wanting a raise for perfectly good reasons.

    2. thisgirlhere*

      I’m wondering where this feeling that asking for a raise is selfish comes from. OP states this is a pattern with her. I know she’s in a difficult industry for women and wondering if it’s something she has absorbed. OP, by asking for and getting a raise, you’re also helping others by normalizing it at your company and paving the way for more women to do so. Think about it that way if it helps.

      1. Stevie*

        I’m kind of surprised that feeling that way seems unusual! I feel the same way as OP. Objectively, I know that asking for a raise is obviously not selfish, but it can certainly seem that way – especially if you’re in an environment where leadership is always griping about money woes or something.

        1. RebelwithMouseyHair*

          Yeah some employers will say anything to make you feel bad about asking for more money.

    3. Radical Edward*

      I used to work outside the US in a culture where this was absolutely the prevailing attitude and any attempts to push back or pursue alternatives were met with puzzlement at best and deep offense at worst. It was endlessly frustrating (and heartbreaking to hear coworkers have this sort of conversation with themselves while trying to navigate similar situations, not just around healthcare). Alison’s answer is fantastic, and I wish I had been able to frame things half as clearly in the past!

      OP, I hope that your employer is able to better understand your needs after this explanation. But if they stick their fingers in their ears and refuse to reconsider, please know that it’s still not because you’re being selfish or unreasonable.

      1. OP of this letter to Alison*

        Thank you! The thing is that, despite the fact that obviously I have my personal thoughts keeping me back, the consensus where I am from is that you should not change jobs often, or ask for a raise, or speak up. The youth is changing that but in most companies the top management is of an age and mentality that they see these things as something foreign and forbidden.

        1. Radical Edward*

          I am all too familiar with that as well! Oof. The wheel turns slowly, but here’s hoping you can get them to think about your situation a little differently. Good luck!

  4. Philly Redhead*

    I know this isn’t the point, but I thought the ACA banned refusing to pay for care on the basis of pre-existing conditions? Or was that only refusing to issue policies on the basis of pre-existing conditions?

    4. Presea*

      OP is not in the US, so the ACA doesn’t apply to them. There isn’t evidence to suggest what’s going on here with the insurance coverage is anything but legal, sadly.

    5. jms*

      This is literally the first and only time I’ve ever seen someone having an issue with health insurance and thought “if they were American this wouldn’t be an issue”

        1. OP of this letter to Alison*

          As a fellow commenter said, like NHS, I could have used our public healthcare system but I would have to wait for over 6 months to get the surgery (especially during Covid). So off we go to the private sector..

      1. OhNo*

        I missed that the first time through, too! I had to go back through when I saw “pre-existing condition” to try and figure out why it wouldn’t be covered.

        1. Tiffany Aching's imaginary friend*

          I saw the “outside the US” bit, but (I’m dating myself here) I’m used to the idea of pre-existing conditions being an issue and I didn’t remember that ACA addressed that issue.

      2. Avril Ludgateau*

        Don’t worry, I somehow skipped over the “not” in the parenthetical, too, and I had the same exact question.

        It’s (not) good to know that there are other countries in the world where these kind of actuarial games are allowed to be played with people’s lives.

  5. SentientAmoeba*

    Your previous boss was not really that wonderful if she never offered you a raise. I am guessing you worked for that boss for several years and a wonderful boss will advocate for their direct reports forth and advancement. I am assuming that your previous employer offered tuition assistance meaning that paying for your degree was not a personal favor, but a program available for employees to use.
    LW I wonder if you are one of the people who believes that if you work hard enough, that your employer will recognize it and reward you accordingly. What I hope you are realizing, is that you also have to advocate for yourself. And I hope you also realize that your pay isn’t a favor your employer is giving you. You are exchanging your time and expertise for money.
    If you’ve ever noticed people who seem to have lesser contributions seemingly getting ahead, it’s because they advocated for themselves.

    1. Uranus Wars*

      This was my thought – when I had my degree paid for by the company my boss advocated for a pretty decent raise on my next review. A lot of which had to do with the quality of work, the degree adding to qualifications for other employment, and the fact that I took on projects while working and in school full time.

      OP, I have to agree that while your boss may have been great in other ways we don’t know this isn’t one of them. And what you’ve seemingly taking from that experience is that if someone gives one thing you can’t ask for something else meaningful. It’s not one-for-one. You deserve to be paid and if they are offering to cover the cost of your care, consider that a bonus. Not part of your salary.

    2. OP of this letter to Alison*

      My previous boss did pay out of the goodness of her heart. It was just that she did not have any connection to the employees in general nor was she ever able to grasp the difficulties each one of us faced. She is surrounded by a select few who feed her the info they want.. that is why I never dared asking for a raise. I knew that these people would tell her no.

  6. Detective Amy Santiago*

    I’d be very surprised if a raise would be equivalent to or greater than the cost of surgery.

    Medical costs in the US are outrageous.

    How long have you been employed with this company? Are they paying you fair market rates right now? Have you received COL/merit increases thus far?

    2. New But Not New*

      That didn’t take long for the bashing to begin. While medical costs in the US may be “outrageous”, self-pay patients are charged far less than those with insurance. It’s a game, because those with insurance probably pay the same as those without it. My experience has been that larger providers in particular are agreeable to reducing bills upon appeal, and making affordable payment arrangements. It ain’t perfect but it’s what we’ve got.

        2. MCMonkeyBean*

          It kind of is when in this particular scenario they would actually have more coverage in the US, since companies are no longer allowed to exclude or charge more for pre-existing conditions…

      2. poor*

        I didn’t have insurance last year and even with self-pay discounts then one hospital visit for a possible concussion was 15k. And no, I didn’t stay overnight. Just tests, scans, and use of a bed.

        1. londonedit*

          Whereas over the last three weeks I’ve had a phone consultation with the GP, blood tests, an ECG, a face-to-face appointment and now have a specialist referral, plus I’ve been prescribed medication in the meantime, and out of all of that all I have to pay for and will ever have to pay for is the standard £9.35 NHS prescription charge (and even that annoys me, because if I lived in Scotland or Wales I wouldn’t even have to pay for my prescriptions). My sister pays £9.35 a go for long-term medication that costs the NHS over £20,000 a year.

      4. COHikerGirl*

        Providers don’t always reduce payment (I’ve come across some who didn’t). And even when they do, it’s never to the insured amount.

        I had to get bloodwork done and my insurance at the time didn’t cover it. While I was pleasantly surprised that I was able to get everything for $125, had I had any of my other insurances, it would have been zero. I didn’t really have the money to pay but I also couldn’t afford to not get the tests.

        I priced out MRI scans. Self-pay was $500 (with doctors orders…another cost). Some of my insurance plans have covered MRIs completely. Even when reduced by thousands, it doesn’t make it affordable. And a payment plan? When you need high cost treatment, those payment plans add up. Hospitals don’t let you pay small amounts (though you can just to be paying the debt…they just won’t set those up).

        The system in the US is awful. When you have people who declare bankruptcy to get out from medical debt, that is awful. And shouldn’t be defended.

        1. Elizabeth Proctor*

          “And even when they do, it’s never to the insured amount.”

          That’s not entirely accurate. The NYT ran an article recently about how some negotiated rates are lower than cash pay rates, which leaves people with HDHP plans out to dry. I will link the article in replies, but you can find it by searching “Hospitals and Insurers Didn’t Want You to See These Prices. Here’s Why” by Sarah Kliff.

        2. Mannequin*

          I am in the US and was uninsured with a serious chronic health issue for nearly two decades. I discharged tens of thousands of dollars in medical debt in a bankruptcy, and that was entirely for the large number of trips to the ER I required *because* I could not treat my chronic condition properly (I made minimum wage & couldn’t afford hundreds of dollars of proper meds a month.)

          And NO hospital ever reduced an ER bill to anything less than 1000s of $ just because I was poor & sick.

      5. Mid*

        It’s not bashing to state facts. People in the US die from preventable illnesses more than any other high income country. One of my high school classmates died last year because he couldn’t afford insulin and was rationing it. There are pros and cons to every system, however the con for the US is that people literally die without being able to access care, and medical debt is the leading cause of bankruptcy.

        2. Mannequin*

          I was born with several serious chronic health issues and once I aged off my parents insurance (at 23) I wasn’t able to get insurance coverage again until I moved in with my now-husband at 39. Nearly 20 years of pure effing hell living with a potentially deadly condition I could not afford to properly treat. I tried getting every kind of aid I could but I fell into a Catch-22 for their requirements- I wasn’t eligible because with proper medication/treatment, I can lead a totally normal/functional life, but I could only *afford* medication/treatment if I had insurance or some kind of public benefit! And because of not just my obvious conditions, but the invisible ones that I didn’t get diagnosed until middle age, all I could ever get or keep were low wage jobs that didn’t offer benefits.

          I’ve known people that died or ended up with serious medical conditions because they were afraid of screwing up their credit rating with an ambulance or hospital bill they can’t afford to pay. It’s horrific that people should even have to consider things like that when their lives & health are at stake.

          The guy that made insulin suddenly become unaffordable (we had a diabetic cat & it used to be hella cheap) needs to be put in prison for mass murder. If they can go after drug companies for the opium crisis (instead of, you know, fixing to social problems that cause people to become addicted in the first grade lace), then why can’t they go after this a-hole for making a drug people *require to be alive* so unaffordable that people DIE?

  7. anonymous73*

    Yes to everything Alison said. You state that you “think” they like you. I would trust your instincts, but know that their response in doing what Alison suggests may be more telling. Actions speak louder than words isn’t just a tired cliché.

  8. Ktv123*

    Hi! Person in the insurance industry here. If you are in the US and you don’t have a short term plan, they can’t exclude a surgery based on a pre existing condition (part of ACA). It’s worth contacting your insurance company and bringing it up the chain if needed.

  9. Properlike*

    Two words: compounding interest.

    You are not selfish to want to be paid your worth, and immediately. The math says so.

    1. Rose*

      This isn’t a great reason to ask for a raise. If they get the raise rather than the surgery they’ll be getting something spread over a years worth of checks instead of one lump sum. They already said getting the surgery would mean dipping into their savings. It would make more sense to think about compounding salary increases if you’re advocating for the raise over the surgery.

    2. Colette*

      You don’t get interest on a salary, or on a lump sump for surgery.

      (Yes, raises can be based on a percentage of a previous salary, but that’s not interest, and there’s no indication that’s how this company does raises.)

      1. AyNonyNony*

        I think Properlike is assuming a raise will also allow OP to save more of their take-home every month? In which case, especially for long-term things like retirement funds, compounding interest can make a real difference.

        1. Properlike*

          Yes. Both that, and the effects of accumulating raises.

          Speaking strictly to the guilt talk of “I’m a bad person to want raises and paid for my worth now.” Independent of circumstances.

        2. MCMonkeyBean*

          Yes, the idea behind the time value of money is that money now is worth more than money later because you can invest the now money and earn interest on it. If the money would not be earning interest then that doesn’t really factor in, but if their savings account is invested than that should be part of the cost/benefit analysis. As, on the other side, should they account for how a raise now may mean higher salaries in the future.

    3. anonymous73*

      I’m not sure what your compounding interest is referring to…

      If the company is only willing to do one or the other (pay for surgery or give a raise) then interest really has nothing to do with anything. Yes OP should be paid what she’s worth, but if the cost of surgery is comparable to a bump in salary, it makes sense to wait for the raise (or find another company that pays what they’re worth).

    5. SomebodyElse*

      I’m with you on this train of thought. Presuming an annual raise; an increase now will increase the base salary which in turn makes the raise dollar amount increase year over year.

      Example (hopefully the formatting doesn’t go wonky);
      Base Salary Raise Raise amount
      YR 1 $50,000.00 5% $2,500.00
      YR 2 $52,500.00 5% $2,625.00
      YR 3 $55,125.00 5% $2,756.25
      YR 4 $57,881.25 5% $2,894.06
      YR 5 $60,775.31 5% $3,038.77

  10. katkat*

    Honestly, if I was OP, I would be worried that if I explained the awkward, declined the offer and asked for a raise right after, the owners would be “offended” and decline the raise, because I “didnt need the money”. Maybe thats just my personal horror picture … but in this situation I would propably take the money now and after a while, harden my skin and make my case for the raise and hope for the best.

    there is a chanche that these are not reasonable people. In that case you will find out sooner or later. And in this spesific instance I would rather find out later, after the surgery and after getting any “loose” money I could collect.

    1. katkat*

      oops, i sound very harsh! not my intention. writing too quickly in a second language. good luck to you OP, however you choose to go forwad.

      1. LemonLime*

        I don’t think you sound too harsh at all. Alot of commenters are commenting based on what is ‘right’ as in the OP deserves to be given a raise and it should have nothing to do with the surgery or cost there of. However what’s right and how humans actually behave are two separate things and I think you’re right to point that out.
        I’d say if there’s any chance they’ll be angry you refused their help and then asked for a raise I’d go with take the surgery money, be gracious and thankful and then ask for a raise down the line.

      2. OhNo*

        I agree with LemonLime, I don’t think this is harsh at all. It’s just doing what is, in the end, best for you as a person regardless of the employer’s interests. If your employer is going to decline your request for a raise, they’re likely going to do that regardless of when the ask occurs. If we remove any emotion from the situation, the best thing for the OP to do here is to accept the money now, then ask for the raise later like they were planning to do. If the employer says no, at least they had the surgery paid for.

        Though emotions have value in the workplace and in building work relationships, there’s also value in situations like these to putting emotions aside and looking just at the financials, too. Both are part of the complex equation here, so both should be evaluated on their own as well as together to try and find the best outcome.

        1. katkat*

          Thank you LemonLime and OhNo for putting my thought into actual words. :D Thats exactly what I meant.

    2. Dona Florinda*

      Oh, I agree. Maybe OP’s bosses are not like this, but I’ve worked for and with people that totally would think that declining the money for the surgery but then asking for a raise is insulting and that OP is ungrateful and greedy.
      Obviously compensation shouldn’t be about need, but there are people who think so and may deny your raise because you don’t need the money, if you can afford the surgery.

    3. Jennifer*

      That’s why LW has to do both in the same conversation, as Allison suggested, so it’s all painted as one big picture that the owners can possibly understand.

    4. anonymous73*

      I get what you’re saying, but asking for a raise isn’t about need, it’s about being paid for the work they’re doing at a rate that’s comparable to market. And if companies is basing an employee’s compensation solely on need, then they’re glass bowls.

      1. OP of this letter to Alison*

        I just have to say that I re-read OhNo reply and that resonates so much in my mind. Many thanks to all!

  11. OP of this letter to Alison*

    Well, first of all many thanks to Alison for taking the time to reply to me! I appreciate it very much!
    Second of all, many thanks to all of you for having an interest and spending your time commenting to this post! I appreciate the words of encouragement and you give me the confidence to think things through with a clearer head.
    Indeed many times I feel that by working hard and proving my worth, others will take notice but you are indeed correct that I need to advocate for myself better. I honestly believe that my employers only want to help me, so I guess “naming the awkwardness” is something that I need to do. I need to stew on this a bit and see how best to approach the subject with them, as I genuinely enjoy working here and I really don’t want to create any misunderstandings. Alison’s advice about looking at how the surgery costs compare to any raise I would be likely to get and waiting until the surgery amount is covered in order to discuss the raise is the one I am more inclined to follow. But as I said I need to think about it! So please keep the comments coming! I appreciate any advice given and I am open to all of your point of views!

    1. LilyP*

      No real advice, but I hope your surgery goes smoothly and your recovery is quick! And I hope you can internalize that it’s not selfish or greedy to want to be paid competitively for all your hard work, even if you also have a generally friendly relationship with the people who employee you. Think of it this way, you’re probably bringing a lot of value to this company right? And if you never get a raise, you’ll eventually need to look for a job elsewhere to keep your pay competitive (like you did before), so really it’s in their interests to know what it would take to retain you and all the awesome work you’re doing for them.

    2. Detective Amy Santiago*

      Something else that occurred to me that you should consider – the tax implications if they cover the cost of surgery vs any increase in tax withholding for your raise. Without knowing your location, it’s hard to know if that will potentially cause an issue. If they give you a check to cover the costs, you might have to declare it as income. I’m not sure if the same would hold true if they directly pay the bills, but I am far from a tax expert in any country.

      1. sacados*

        Ooh, this is a really good point as to taxes! Definitely find out how that would work and factor it into your calculations. (For example, would they pay for the surgery directly? Would they just give you the amount of the surgery cost and call it a “bonus”? Good question)
        I can imagine that might have an impact as to which one feels more “worth it.”

        Also, it sounds like OP has a bit of PTSD from their last job(s), as frequently discussed on this site. Like someone recovering from a toxic micromanager, who still feels the need to check with their boss before every email. Assuming OP’s current workplace is functional and reasonable (which it sounds like it may be!) then it will take time to unlearn the negative behaviors/thoughts from those toxic experiences — but you can do it!!

      2. JSPA*

        Came here to say this. It may be a lot cheaper for the company to pay the cost of the surgery direct to the provider, than to pay you what it would cost to cover both the surgery and taxes on the extra income. (Yes, you may be able to write off some of the medical costs, but that can also be a bit of a minefield.) Certainly if they were to pay as a personal gift, money that goes directly to the medical provider isn’t taxed on your end (it’s a gift, not income) and furthermore, gift tax limits that would otherwise apply (eventually, to their estates) are not in play. So it’s worth asking WHY they prefer to do it that way, before you decide on the tradeoff. You may decide to handle some awkwardness or feelings of indebtedness if the other option is being stuffed into a higher tax bracket, and not having the money to cover your taxes.

    3. HigherEdAdminista*

      Wishing you luck with your surgery! I also was brought up to believe that if you are doing well, people will notice your good work and reward you for it, but sadly I have not found that to be true. Some people might notice your good work, but mostly people are focused on themselves and their own needs.

    4. New But Not New*

      OP never apologize for wanting more money unless you are working for the fun of it all. Money is the whole point.

    5. SentientAmoeba*

      Best of luck to you OP. I wish you a successful surgery, a speedy recovery and a pay raise.

  12. Finland*

    Just a thought: if they’re willing to offer you a lump sum payment, it follows that you could ask for an advance on a raise in order to pay for your surgery. That way you’re not forfeiting increased future pay in exchange for a lump sum.

  13. Chairman of the Bored*

    There is nothing wrong with being selfish at work, “selfish” should not be a bad word in the context of career and compensation.

    The fundamental motivation to work at all is inherently selfish – I go to work to get money I will then use to improve my life and further my interests.

    I like what I do, but if my employer stopped paying me I would stop showing up. This is selfish, and that’s OK.

    1. anonymous73*

      I would go further to say that there’s nothing wrong with being selfish in LIFE. Selfish is only bad when it harms others. I have friends who run themselves ragged because they never want to tell anyone no and take time for themselves. You can’t pour from an empty cup and sometimes it’s good to be selfish so that you can be your best when others truly need you.

    2. Jean*

      This is a really good point. Your work isn’t a favor to your employer. It’s an exchange of your time and labor for compensation, and it should be fair and as beneficial to you as possible, since your employer is ostensibly profiting from it.

  14. BA*

    Not sure which country you’re in, so this may not be a large concern, but depending on how the company pays for the surgery, it might lead to some negative tax implications as it could be seen as income by the government. You might want to check into that, as it could help your conversation when you “name the awkwardness.” They sound incredibly generous wanting to help an employee like this. And you should definitely be paid what you deserve to be paid. Both can be true.
    Wishing you a successful surgery and speedy recovery, no matter how this works out.

    1. Bagpuss*

      Good point – it may also make a difference whether they pay out of the company funds or as a personal gift /loan from the business owner as an individual.

    2. New But Not New*

      If OP is in one of those medical care for all countries, why are they even having to pay for the procedure at all?

      1. londonedit*

        They only say they’re not in the US, not that the country they live in has universal healthcare. Plenty of non-US countries don’t.

        Even if they were in the UK, there are situations where if you can afford to, it’s far quicker to ‘go private’ and pay for a procedure yourself rather than waiting for surgery on the NHS.

        1. After 33 years ...*

          Same as in Canada – not everything is covered completely or partially, and coverage differs by province. I had to pay a substantial proportion of my child’s laser eye surgery – the remainder covered by insurance – as it was not a scheduled and therefore govt- funded procedure.

          1. londonedit*

            The NHS will pay for anything that isn’t deemed ‘cosmetic’, and you don’t have to wait for emergency or urgent treatment. But for example last year my mum was told there would be a 12-month wait for cataract surgery (thanks to the backlog of cases caused by the Covid shutdowns) and rather than spend a year with increasingly failing eyesight she chose to pay privately for the procedure (which I think was around £1000 per eye).

        2. Lester*

          You mean the NHS isn’t the perfect, amazing, faultless health care system that so many commenters around here make it out to be!?!?!!

          1. The Prettiest Curse*

            As someone who has lived in both the US and the UK, I can testify the NHS is a long way from being faultless, and in general there are good and bad aspects to both systems. But I would never, ever want to live under the US healthcare system again, because dealing with insurance is such a huge time suck.

            1. DJ Abbott*

              Yes it is! I’ve spent several days on it this year that could have been put to better use by, say, looking for a job! And yesterday I got another email from my agent about my next healthcare plan. If they want to make all of us unable to get jobs and have lives, just make us deal with insurance some more!

          2. UKDancer*

            The NHS is definitely not perfect. Routine treatments take time, waiting lists for things like hip replacements and cataracts can be long. Like Londonedit’s mother my aunt decided to pay for a cataract replacement. I see a private physio because the waiting list is too long.

            On the other hand my father got an organ transplant when he needed one, all his ongoing aftercare and the treatment for 2 subsequent infections and we have not had to pay anything for what he’s received. There are no words for how amazing the NHS has been in treating him and the ongoing care he receives now is second to none.

            The NHS does an amazing job of providing baseline services to the UK and it’s free on the point of delivery to UK citizens (and some others). It doesn’t matter who you are or what you do, you can expect the same level of care and not worry about the cost. It’s not perfect, but what system is?

          3. RebelwithMouseyHair*

            The NHS is the best system ever invented for healthcare, staffed by the most wonderful, cheerful, caring and professional people ever employed, but it has been chronically underfunded since the Thatcher years.

      2. Captain dddd-cccc-ddWdd (ENTP)*

        That was what occurred to me too (as a UK-er) — I found myself wondering “what do other people do in the same situation?” What would OP do if she didn’t have these options?

        If they don’t have savings to pay for a surgery, or don’t have an employer paying for a private insurance policy (that would cover ‘other’ procedures/illnesses)… what do people typically do? I thought it was probably a case of “moving up the waiting list faster” and/or getting a better quality of treatment than the universal healthcare.

        1. Metadata minion*

          I can’t speak for wherever the LW is, but in the US people without (adequate) insurance generally either just go without healthcare or they go into massive debt to pay for it. :-/

          1. OhNo*

            Unfortunate but true! My own experience (in the US, prior to the ACA when pre-existing conditions were still a problem) was that when “go without” isn’t an option, the answer is “beg for donations and sell everything you and every member of your family owns to try and pay for it”.

          2. Le Sigh*

            Yup. And even if you have insurance, depending on how it’s structure or its limitations, you might still find yourself paying more out of pocket than you can afford. Especially if you’re unlucky to say, go to an in-network ER only to later find out the doctor who saw you is somehow out of network and now you owe $13,000.

            1. MCMonkeyBean*

              I had a surgery once where I specifically chose a doctor in the network, I called in advance and walked through someone in billing with what all the expenses should be, and still got a surprise bill because they brought in an anesthesiologist who was out of network. Wtf. So, so aggravating!

        2. green beans*

          Honestly, people wait or go without. Even outside of the US system, people fall through the cracks or fail to receive appropriate treatment in a timely manner.
          I’ve been outright horrified by some of the treatments cases I’ve heard or read out with regards to cancer care (almost always either advanced and/or rare cancers, or time to implement new curative or life-extending treatments for more common cancers) in well-regarded single-payer systems.

          No system can eliminate the reality that healthcare is a limited resource. Most systems only differ in how they limit it.

      3. Le Sigh*

        Are you doing PR for the U.S. healthcare system? Yes, the endless “US healthcare sucks” bashing gets old because we know and it’s a tired conversation. But you’ve gone into several threads now either calling people out for bashing US healthcare (they were not) or making comments like this…which had nothing to do with the original comment. This reads like you’re trying to bait someone.

      4. Radical Edward*

        In some countries, the healthcare coverage is universal but there might be a copay of a certain percentage (think 10-30%) of the cost for all procedures/exams/prescriptions. While doctor visits and medication are affordable or free (depending on other public assistance availability), surgery can end up costing a hefty amount. Still nothing like the hellscape we enjoy here in the US, but enough for people to take out short term loans.

  15. Middle Name Danger*

    I think a lot here depends on how the owners see their offer. It might seem charitable to them but it also might seem like part of your benefit package to them. Like, oh our insurance has a gap that we are covering by making this offer.

    1. Captain dddd-cccc-ddWdd (ENTP)*

      Or that the procedure gets the OP back on their feet faster / reduces the need for ongoing sick time / etc and thus benefits the employer directly…

    2. Ginger Baker*

      This is my take also. There’s every possibility the employer did not intend to offer medical coverage that didn’t actually COVER MEDICAL EXPENSES and they see this as their opportunity to remedy this oversight.

      1. OP of this letter to Alison*

        I have thought about this too. And there might be some truth to this. Which would make things much easier for me (at least emotionally and would ease my anxiety about it).

    3. fhqwhgads*

      Yeah the way the letter was worded – which I realize is not necessarily a verbatim account of the conversation – made it sound like they were offering because they didn’t realize the plan they provided wouldn’t cover it, and when they found that out they wanted to put it right, kinda thing.

  16. irene adler*

    ” I feel that if other people hear me they will tell me that I am selfish and what more do I need?”

    I’m assuming “other people” means your co-workers-right?

    Assuming that is the case, if other people do hear you, they will be in line right behind you, asking for a raise as well. And more power to ’em! And they will have you to thank for opening that avenue.

  17. CaviaPorcellus*

    OP, you’re muddying the lines between “good person” and “good employer”.
    Good people hear you’re in a bind (you’re going for a Master’s degree and don’t want to go into debt to do it or you need an expensive surgery that your insurance won’t cover, for example) and step in to say “Oh, I can help you with that!”
    Good employers, though? Maybe they offer these things as perks, but they also reward good performance with raises, or extra PTO, or a stronger insurance package.

    You’ve been lucky to work for some good people. Now it’s time to see if you work for some good employers, too.

    1. Reba*

      I know this is kindly meant but I think it’s nitpicking. It’s common to refer to adult offspring as someone’s kids. And in this situation, the fact that the managers are the owner’s family members is very salient! Even if the OP referred to them as “management,” it wouldn’t change the way this company seems to operate as a family. OP isn’t going shift that culture on her own.

    2. anonymous73*

      I assumed that OP only referred to them as “kids” to distinguish them from the owners, i.e. the “parents”. There are no indications in the letter of boundaries being crossed.

    4. OP of this letter to Alison*

      By no means do I mention them as kids due to lack of respect or lack of boundaries (we are after all in the same age). It was just an easy way to express the dynamics whilst I was writing to Alison. Please don’t take more out of this than it actually is, i.e. a factual characterization of how the company management is structured that came to my mind and just wrote it in an email.

    5. fhqwhgads*

      I took that phrasing as a way to identify the relationship between the bosses and the owners without having to bring gender into it (ie “sons” and/or “daughters”).

  19. Sparkles McFadden*

    Take the emotion out of it (somewhat) but doing the math. Cost of surgery vs. income increase with a raise. Include tax liabilities etc. once you know what would be best for you financially, speak openly to your employers about all of it. There is nothing wrong with doing this, just as there’s nothing wrong with asking to be compensated for your contributions.

    Many people think of work as very one-sided, as in “the boss hired me” not “The boss made an offer I decided to accept.” “The boss gave me a raise” not “I earned a raise though the following contributions.” Many people wait for the boss to notice how hard they work and reward them, and that’s just not how that works.

    A work relationship is a series of ongoing discussions and negotiations. Employees need to keep track of their contributions and meet with management to say “Here’s what I’ve done for the company and it’s why I think I my salary should be this amount.” Management responds and each side decides what they can live with. Do what’s best for you!

    I hope everything works out surgery-wise and business-wise.

  20. Ben Marcus Consulting*

    I wouldn’t hesitate to ask for both. Paying for medical care is extremely generous and isn’t necessarily a commitment to continuous payment at that level, and handled correctly can be a tax-free benefit for you.

    I feel that the fact that they offered such a generous benefit means that they may very well be in favor of a raise, too.

  21. Ginger Baker*

    It would literally never occur to me that a job providing one benefit [tuition reimbursement, covering medical costs] would therefore preclude me from asking for (and receiving!) a raise. These two things are NOT connected in any way at all, any more than the company suddenly offering dental coverage when they hadn’t previously should keep me from a salary increase. You are thinking of this as all being one “bucket” but I would encourage you strongly to recognize that salaries are always their own bucket and you can ALWAYS advocate for additional salary when you are underpaid/have taken on increasing duties/cost of living has increased or any other reasonable reason (that is a “any one of these reasons” NOT a “must check every box” list btw).

    Always ask for your salary increase ESPECIALLY as a woman. Please don’t ever wait to be “awarded” as we aren’t in school and sadly companies and managers aren’t great at doing this on their own. (Also, I highly recommend reading the Go Get Your Dog post as an example of where an amazing work benefit can be something you accept as a lovely gesture [and that does not mean you don’t get raises! It’s a gift, not a substitute for salary!!].)

    1. CM*

      This is exactly what I was thinking! At OP’s previous job, the way the letter is phrased, it sounds like OP didn’t ASK for a raise because they felt bad about receiving tuition reimbursement. And here OP is worried about being perceived as selfish for wanting to be paid market rates.

      I 100% agree with Ginger Baker. If your employers want to pay for your surgery as a lovely, kind gesture, that’s wonderful. It is completely separate from the discussion of whether you deserve a raise. From everything you say here about your new employers, it doesn’t sound like it’s a toxic “we’re like family and you owe us unpaid labor” kind of workplace. It sounds like they genuinely appreciate and value you. So I would encourage you to reframe how you’re thinking about this. Instead of imagining yourself asking for a raise and the reaction being, “You’re so selfish, how could you ask?” — imagine that you ask for a raise based on market value, and their reaction is, “Of course we want to retain you, and it’s important that you’re not underpaid. We would hate to have you leave because you could make more somewhere else. Thank you for bringing this to our attention.” (This is a best case scenario, but it may be closer to the truth than the first one!)

  22. J.B.*

    OP – I don’t know what cultural issues are at play here, but I think you have a history of having a hard time advocating for yourself in salary, and maybe working extra extra hard to be recognized? Your concerns make the surgery offer feel a little like emotional blackmail. I think I’d do some analysis about what your requested raise would be in the long run. I think I’d talk to them about raise and paying for surgery together, as in “that’s such a nice offer, here’s what I think is the best overall compensation for me, if you don’t mind I’d prefer the raise”. But if that’s unlikely to be successful you could decide at what point you feel you’ve “paid back” the surgery and look to move on then.

    1. RebelwithMouseyHair*

      “emotional blackmail” yes that’s it. It’s a special kind of bonus, OP is being treated to something others are not entitled to, it may well be because they thought it would be covered normally, but the fact is that other employees could well have a similar problem but haven’t mentioned it because they’re just resigned to powering through. It’s exactly the kind of thing that can happen at “family” businesses with paternalistic boss.

      And all that stuff about OP hoping the kids like her… is not appropriate for the workplace and reeks of favour-seeking, daddy’s girl behaviour.

  23. MsInMS*

    I wouldn’t want have that permanent feeling like I “owe” them something. Whether or not I should, I probably would. Maybe they can donate items to hold a fundraiser. A family member of mine had cancer and his company donated items that brought in a lot of money. Or they could contribute a certain dollar amount. Offering to pay for the surgery in total just seems a bit too personal.

    1. Sola Lingua Bona Lingua Mortua Est*

      I wouldn’t want have that permanent feeling like I “owe” them something. Whether or not I should, I probably would.

      I agree 100%. I’m also concerned about favoritism (will others consider OP the favorite and be resentful?). But the biggest stick in my crawl is that this feels tantamount to acknowledging the benefits are lousy by trying to compensate for it instead of just fixing the health benefits. These aren’t other grunts in the trenches; ownership can actually buy and contract for better benefits for everyone in the company, not just one employee that they seem to like.

  24. awesome3*

    If it was me, I’d be thinking, well, if I get that raise, how much of it will I be using on the surgery? And it will probably be less than the lump sum, so I’d be inclined to go for the lump sum, and then decide when I’d be comfortable asking for a raise from there.

    But as it’s you and not me, I really think Alison’s advice is your best option. Especially if you do plan on declining the lump sum, I think letting them know why would be helpful.

    Really you don’t want to be in a position where you feel indebted to your employer in a way that feels like you can’t stand up for yourself.

    Best of luck with all of it!

  25. OP of this letter to Alison*

    Again I would like to thank you all for your well wishes! I think that this “Really you don’t want to be in a position where you feel indebted to your employer in a way that feels like you can’t stand up for yourself.” is my main issue and source of anxiety. But your comments so far have helped me start thinking things from a different point of view!

  26. Koala dreams*

    Firstly, I’d advise you to consult a local employment lawyer. There might be tax issues. Is payment for surgery different compared to a paying for better insurance or paying a bonus or a higher salary? Would there be any claw back if you quit or change jobs after the surgery? Or other conditions?

    If you’re an union member, you might want to consult the union too.

    Secondly, I’d recommend you to do a budget with different scenarios. The risk of negotiations going wrong, and losing out by not negotiating, will depend on your financial situation. Of course I’m hoping that you’ll get the surgery paid for and also a nice raise, but when you go into negotiations it’s always good to know what’s the best, what’s good enough and what’s unacceptable.

    Good luck!

    1. OP of this letter to Alison*

      Thank you! Things are quite different here interns of taxation. And we certainly do not have unions in the private sector. So I am not worried for these. But the point for the budget is good one!

  27. MyGoingConcern*

    I think Allison is spot-on as usual.

    One thing I’d add that might help on the emotional/self-recrimination front: If your employer-provided insurance is denying a medically necessary procedure on the grounds that it’s a pre-existing condition, that means it’s a plan that is not ACA-compliant. You work for a small company that has deliberately chosen to save money on benefits by going with this sort of plan, which is no longer market standard for employer-provided insurance. If you worked for another company there’s a very good chance your insurance would be covering this surgery. So in a way what your employer is doing now is simply addressing a shortfall in the competitiveness of their benefits package. Good for them – they’re not obligated to do it and it’s still wise to respond with gratitude. But it’s worth keeping this aspect in perspective if you’re struggling with feeling like you’re being greedy (which you are NOT btw).

    1. MyGoingConcern*

      I somehow missed the Not in your first sentence, sorry. Obviously ACA doesn’t apply. But I’d consider looking at private health insurance plans typical in your country & industry and see what’s standard. This may still be a case where a small company has a benefits package that isn’t quite competitive with larger employers and is making up for that here.

      1. OP of this letter to Alison*

        Trust me I have seen all options available in the market. Unfortunately most companies would treat my issue a pre-existing condition even though medically speaking this is not the case. So my hands are tied on that front.

  28. Drifter*

    Would you feel better advocating for a company wide annual review of salaries? If you are dithering about asking for a raise having a process in place where it is part of the normal way of doing business makes it a lot easier and normalised. In the current climate of ‘the great resignation’ it’s also good business sense to get ahead of these issues. It’s good business sense to be reviewing these sorts of things regularly anyway, but right now even more important.

  29. ElleKay*

    I also wonder, based on where this is, if they can claim giving you the surgery funds as a legitimate charitable donation/write off! In that case, a one-time donation (with tax benefits for them) might be in their favor- particularly since these are likely personal funds, not business- while a long-term raise is a different thing alltogether.

  31. Good luck*

    I understand where you are coming from.

    I’d start reframing my thinking about the surgery cost the owners are offering to be no different from the insurance the company is providing to cater to medical needs of employees. Since that insurance didn’t meet your needs, the company owners are stepping up.

    Also, I’d have that conversation with the owners sooner than later and get this conversation done and over with, as it seem to be creating a lot of anxiety. Don’t hesitate to ask for the salary you are worth… Some of us have been groomed by our upbringing to do the work and rewards will come…. but good things come to those who ask! Go for it, we are all rooting for you. and keep us posted. Good luck with the surgery and the raise!

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