Merry Christmas to me.....NOT

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Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 12/23/2009 3:37 PM (GMT -7)   
We have been getting our insurance through our state's family care plan. Basically it is a premium based medicaid. Well today we learned we no longer have it as of the end of the month. As upsetting as this is it is the why that really has my blood boiling. It would seem that someone made an anonymous phone call to the state and reported us for fraud saying we made too much money to qualify and that they knew we were not reporting income.

Supposedly the state tried to verify this and were not able to but apparently proof is not required, only suspicion and innuendo. So now we have to apply all over again and send in tons of documents again before we will have insurance. Last time it took just shy of 3 months. Nothing like being assumed guilty until proven innocent.

The state needs to change its policies and: 1. Stop accepting anonymous calls so they can go after and prosecute these people who make them out of spite for some reason, and the big 2: Do not deny benefits unless it can be proven that the allegations are true.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 12/23/2009 5:45 PM (GMT -7)   
Oh Jim.....Why can't people mind their own beezwax?  I mean, why call in on someone without having a reason to do it?   I hope that you can try and enjoy the Holidays...I know that's hard, but you can worry about it later...
 
We are all here with and for you and your family...
 
Me.

I have been a spectator for so long..Now it's time to participate.......
 
Post Lamenectomy Syndrome, Spinal Stenosis, DDD....
1999 Hemi Lamenectomy/2005 Spinal Fusion(L4-S1)
Methadone 120 mg. a day/  30 mg. Oxycodone as needed(up to 4 x a day)
High Blood Pressure: Lisinopril HCTZ 10 mg. daily
Type 2 Diabetes: (March 16, 2009)
Metformin HCL ER 1000 mg. at night..Glipizide 10mg. 2X in the morning
Lantus 35 units at bedtime with Solostar Pen                                                                   

 


White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3611
   Posted 12/23/2009 5:57 PM (GMT -7)   
Jim

As you know the state is broke anyway, are you sure they are just not looking for any excuse they can muster to get out of paying???? I don't know anything about medicaid or the type of insurance your talking about, but I do know that allot of doctors and other medical institutions are having a difficult time because the state won't pay what it owes! That is why the Governor is releasing all those prisoners because they can't afford to keep them in prison any longer, they don't have the money!

I do wish you luck! Take Care!

White Beard

Lindaloo
Veteran Member


Date Joined Sep 2006
Total Posts : 1713
   Posted 12/23/2009 6:52 PM (GMT -7)   
Not fair, not fair, not fair. I get so steamed when I hear things like this. It takes a very small person to do this- to get involved and falsely accuse one's neighbor. It is a sin and I'm sorry that happened to you. God bless you. And I hope you are able to find all your paperwork quickly and without too much of a problem.

Lindaloo
Co-Moderator Chronic Pain and Fibromyalgia Forums
 
Believe in yourself.  Be kind to fellow humans and animals.  Take time to smell the flowers and the coffee.
And by all means, when you are down, ask me for help.  I will be there.
 
Linda


Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 12/23/2009 9:36 PM (GMT -7)   
I too, get madder than a Hornet, at information like this. I have to agree with White Beard, and there is way too much funny stuff going on with the insurance companys, and SSD!

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1228
   Posted 12/23/2009 10:16 PM (GMT -7)   
Jim.
I'm truly sorry to read about this. It is a darn shame that someone had to be so small as to decide to make that phone call, because it effects not only you, but your family. Who knew that you had that type of coverage? If you can narrow down that list, then you might be able to figure out who made that anonymous phone call. My husband and I had to deal with an anonymous report made once, and it was the most frustrating, aggravating situation. Guilty until proven innocent is not how this country is supposed to operate but I find it is exactly that way more often than not.
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.
Avascular necrosis of left wrist- maybe hips too


bsjaguar
Veteran Member


Date Joined Jun 2009
Total Posts : 974
   Posted 12/24/2009 1:55 AM (GMT -7)   
Sorry to hear of your dilema, it just plain sucks!!!

Will your doctor work with you to stock pile some necessary meds to get you through until this mess is cleared up?

All the crap I've been seeing on tv about all the wasted money being spent to get this new Health Care Bill passed it makes my blood boil. These people have no idea what real life is all about. I bet none of the people making these decisions will be going without necessary health care. I know we're not supposed to talk politics on here but I'd like to kick them all to the curb!!!
---Jag---
 
DDD, osteoarthritis, fusion surgeries C-5/7 & L-4/5 both in 2006, torn meniscus left knee 2000 & 2002, buldging disc L-2/3


arneeb
Veteran Member


Date Joined Nov 2009
Total Posts : 2350
   Posted 12/24/2009 2:42 AM (GMT -7)   
There has to be an appeals process and u usually have 30 days... demand an appeal...

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 12/24/2009 4:20 AM (GMT -7)   
Nope, no appeal process. The only appeal process is if you are denied coverage for a certain medication or treatment. No appeal if you are dropped. Like White Beard said it could be, in part, the state looking for any reason to trim its participation in health care due to budget problems.

As far as stock piling meds that is not an option. My meds would run me just under $2000 a month out of pocket, and most of what I am on is not part of the sample stock doctors have available to them. That is more than our household income. My insulin alone is over $600 a month. Besides that, since I am not on any narcotics at the moment I have refills available to me on all of my current scripts, just no way to pay for any of them.

This weekend I am going to be trying to see if we qualify for those prescription programs where the manufactures pick up the tab and we are also going to be getting everything rounded up to send off to reapply to the state to get our insurance back. I know we qualify still, just irks me that we wont have any coverage until April.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 12/24/2009 6:10 AM (GMT -7)   
Jim, Why not try calling your Congressman, TV news or anyone else you can think of and tell them about this injustice done to you! Maybe someone higher up can help??? I don't know but maybe it's worth a try?? I like the others get so pissed at government and the way they waste out taxes!! But I won't go there now.
Good Luck Jim and try to have a happy holliday anyway!
Your Buddy,
Pete

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 12/24/2009 8:35 AM (GMT -7)   
Jim,

Would you be able to get samples of any of your meds from your doctor(s)? If they know the situation you are in & have samples, they'll likely give you enough to tie you over for a while.

Skeye

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 12/24/2009 9:58 AM (GMT -7)   
Dear Jim,

I am ever so sorry to hear this happened to you, and just before the holiday season at that. I was once dropped from our local state health iinsurance, years ago when I was a teenager. It was a loong 3 month hassle after that. I know this dilemma will not be easily fixed and I am so sorry you have to deal with it. Please know you are in our hearts here in New Mexico. I hope that you can find time to relax a little.

*huggs*
dani

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 12/24/2009 9:05 PM (GMT -7)   
Oh Jim,
so very sorry your in this type of mess. wish I knew how to help you, finger crossed that this situation can be fixed fast for you, it never should've happened, you should've had the right to face the accused...
fingers crossed that this will get resolved for you soon...keep us posted as we do care...
(((((((((((((((((((((((((((((((Jim))))))))))))))))))))))))))))))))))))))))))
hugz
**********************************************
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc (Lower Lumbar S1-L3 and Cervical C5,C6, C8 and T1), Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's, Ocular Migraines, mild carpel tunnel, ect.... "Would be nice if we could use the edit button in real life"...

********>^..^<********>^..^<********>^..^<********


Dagger
Veteran Member


Date Joined Apr 2008
Total Posts : 1522
   Posted 12/25/2009 3:35 PM (GMT -7)   
I am sorry this is happening to you. Dealing with these state agencies is sooo frustrating. My teenage son is on our state's medical insurance and we have a problem every year at renewal. They "lose" everything we fax or hand in and wait until the last minute to have us resend it. Then he's canceled for a month or two until they get around to doing the paperwork.

This year, he lost coverage during November & December. I tried to verify by phone call, fax, and letter that they received everything but you can't get a person. I've had them hand stamp receipts that I've turned stuff in but that doesn't matter - they don't care if you can prove that you turned it in, if they lose it, you have to do it again. They can do whatever they want and you get to suffer for it.

Good luck, maybe you'll get lucky and they'll resolve it quickly.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13470
   Posted 12/26/2009 5:45 PM (GMT -7)   
Jim, I am so sorry about all of this. But, something I wonder about and you can chew on this, with this being a state program whoever made that call knew your d/b and your SS#. This is how you are indentified in the system. not by strictly your name. There are too many people with the same names. Who in your mind which you do not need to divulge here would do something like this? It is obviously someone who knows you very well and has your info I just spoke of. I cannot believe a simple phone call caused all of this hoopla and grief.
 

crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & psoriasis and psoratic arthritis. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 17 different daily medications. Intrathecal pain pump implanted June 05.


Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 12/26/2009 6:09 PM (GMT -7)   
Actually they wouldn't need that much info. Name and address would suffice.

But beyond that whoever did it would have known my name, my wife's our kid's name, which is more than enough for the state to know who is being reported.


Odds are it was someone who my wife works with. There are several up there who are card carrying members of the trouble makers club, but sadly there is not any way to prove anything unless they start shooting their mouth(s) off. There are not too many people who I know that also knows that I had state insurance. Actually there is only one and I know he wouldn't do anything like this even if he knew we really made 10 million a year, but he also knows that we are honest people and wouldn't commit fraud in the first place.

I figure there is one of two possibilities. It was someone who works with my wife who either isn't happy unless they are causing problems or it was someone who works there who tried to get state insurance, either the Family Care like we have or who tried for actual medicaid and was turned down for making too much money and was pissed and in the process said something like "Well so and so has it and she makes a lot more than I do".
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13470
   Posted 12/27/2009 11:28 AM (GMT -7)   
Wow, I just cannot believe it, how awful. Its a sick world we live in no doubt. I am just sorry for you and your family. I cannot believe the system is so lax. So now do you have to reapply all over again and do all of the paperwork? If so and you get reinstated I would tell my wife not to breath a word about it to anyone at her job. Sleazy people. So wrong.
 

crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & psoriasis and psoratic arthritis. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 17 different daily medications. Intrathecal pain pump implanted June 05.


Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 12/27/2009 8:13 PM (GMT -7)   
Yep, we have to reapply all over again. If we get the application and all documents in before Jan 1, 2010 we can be reinstated April 1, 2010.

I have also already discussed this with my wife. I told she needs to leave our home lives at home and not to discuss our insurances or finances with anyone regardless of how much she thinks she can trust that person.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


Chutz
Veteran Member


Date Joined Jan 2005
Total Posts : 9090
   Posted 12/28/2009 12:22 AM (GMT -7)   
Hi Jim,

I guess I'm just too suspicious but how do you know that the state is telling you the truth? Gosh, can you imagine someone in government being dishonest? shocked rolleyes BTW, my hubby is a state employee so I feel I can get away saying that. BUT...he only keeps the computer programs running at dept of labor and industries.

Anyway, I'm with Pete on this one. Get yourself on the phone and start squawking to anyone and everyone who will listen. Jim, if this is happening to you just imagine how many others are being sacked like this. Fight, my Good Man, FIGHT!. Be calm and courteous but do not take NO for an answer. You can go actually do it online and you'll be surprised that you actually get responses. Online locate your local congressman, state that is. Doesn't matter which one because when you fill out their form online you can click one button and your message goes out to all of the people who represent you. Been there, done that!! Explain the problem, explain what will happen if you don't get your medications, explain you don't have $67/day or $2000/month over and above all of your other expenses just to keep you alive and with some sort of quality to your life. Your illness is not your fault and neither is it for the rest of us. It's time us regular folk stop taking whatever answers they feel like dishing out and start fighting.

In my family everyone knows about my "letter of the month" award!...lol When I have a problem with a product/service/or just being messed over I write. Now, I'm talking the real deal here...paper, envelope and stamp! smhair But some times I resort to online. I've found it's easy to write a respectful letter of complaint and get results. It irks me that companies or government rely on the fact that 99.9% of the population will do nothing if they are cheated. Here's a tidbit from being a business owner...ever wonder how all of these fly-by-night TV sales can offer you a "double your money back" guarantee? No one every follows through! It's a safe bet.

OK, I've rambled on long enough. I do hope you at least contact your congressman. Even if you don't get what you want you at least have that person's ear and you know that you did whatever you could to fight for your family.

Best of luck and please keep in touch...ps, you know my email address if you ever want to chat,
Chutzie
The three grand essentials of happiness are: something to do, someone to love, and something to hope for. — Alexander Chalmers

(\o/)Co-Moderator Fibromyalgia & Chronic Pain Forums
(/|\)
Fibromyalgia, PTSD, UC, Diabetic on insulin, collapsed disk, arthritis scattered around and a few other delights.

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