Getting Medicaid to pay for your surgery

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icepixycicle
Regular Member


Date Joined Jun 2006
Total Posts : 39
   Posted 1/27/2008 7:54 PM (GMT -6)   
My husband is considering getting the Brooke ileostomy, using the Medicaid "medically needy" program (there is no regular Medicaid for anyone other than pregnant women and children).   
 
Nathan thinks that the government won't pay for him to get this type of surgery since the regular kind with the bag is a lot cheaper, did any of you use any type of government insurance to pay for your surgery, and did it limit what kind of surgery you could get?  Also, did it limit you to use their "government doctors"?
 
We get WIC since we have two children under age 5, and for example, on WIC they give you milk and cheese and juice, but it specifically mentions you have to get the cheapest off brand available of every kind.  We don't want to use the cheapest, off brand doctor for a surgery this serious.....
 
 
and one other thing, Nathan thinks Medicaid won't pay for him to just opt to have surgery now, he's flaring but not severely, he's never attained remission since his diagnosis in april 2006, and he's tried every drug option other then remicade.  Do they make him try remicade before they will approve him for surgery?
Wife to Nathan (UCReallySucks)
Mother of two beautiful girls, Rachael (4) and Brooke (2)
Gave the stay at home parent job to my husband! 
Currently working as a legal secretary with all the stress and responsibilites minus the actual "title" and fair pay! That's what happens when you're promoted from within (no wonder companies like doing that so much!) :P


Shaz032
Forum Moderator


Date Joined Feb 2003
Total Posts : 1190
   Posted 1/27/2008 8:28 PM (GMT -6)   
Hi there

The Brooke Ileostomy is, in fact, the 'regular kind with the bag' - It's named after UK surgeon, Bryan Brooke who perfected the technique of making a stoma that actually worked properly. Perhaps, you're talking about the j pouch instead (an internal pouch where you don't have to wear a bag?)

I can't help you with your insurance questions since I don't live in the US, just wanted to clarify the above for you :)

PS. The Brooke Ileostomy may be cheaper to perform (I'm not sure) but the long term costs, ie the bags and stuff may outweigh the cost of actually having j pouch surgery which may be a point to bring up to the insurance companies.

Good luck.
I have had an ileostomy for 32 years now due to UC.
 
Moderator of the Ostomy Forum
_______________________________________________
 
I'm not a complete idiot - some parts of me are missing!


praying4healing
Veteran Member


Date Joined Dec 2007
Total Posts : 737
   Posted 1/27/2008 8:37 PM (GMT -6)   
icie,

i have family members on wic, and once when i got sick i got medicaid but it was only temporary(6mnths) and i had a nice lady that put me in the system as "medically needy" even though she said i technically didn't qualify. As far as the care goes, it's really a matter of if u can find a reputable doctor that accepts medicaid. Usually you have a better chance of finding them at University hospitals, from my experience anyway.
Also, I don't see them "making" him try remicade first, as that is very very expensive and is something that he would have to continue to get, as opposed to an ostomy that the gov't would probably consider for the most part a one part deal...being that most people are able to get off meds and dont have as many dr's visits and treatments. *Note this is just my opinion, no fact outside of my own experience*
25 y/o female- crohns disease since 14
Ileostomy pending-very worried
Tried asacol,pentasa,prednisone,remicade,6mp,azasan, no avail
Seatons placed
Worst year ever!

"For God has not given us the spirit of fear....."
Where does mine come from?!


icepixycicle
Regular Member


Date Joined Jun 2006
Total Posts : 39
   Posted 1/28/2008 9:34 PM (GMT -6)   
When we applied for food stamps and Medicaid, they said we make too much money to get Medicaid, but enough money to get the share of cost plan. We live in Florida, I don't know if this program is everywhere. We applied through the department of children and families, in our state we were able to apply for benefits online, then they send you a letter asking you for your proof of citizenship and state residency and income for the last 4 weeks. The process is sometimes very annoying getting all that stuff together (they make you prove *everything* again every few months) but we go through it anyway!

And shaz you are totally right of course, I had to smack my husband for swearing to me on all the terminology being right, and smack myself for just trusting him and not checking on it lol He said now that the one he wants is the Koch pouch (hope that's right), should be the one you put a valve in to empty.

BTW for all interested, I spoke at length to a person from Medicaid today, they said that we have to find a surgeon who takes Medicaid, and the hard part will be convincing that surgeon that Nathan has the medically needy program because there is not medicaid #, and you aren't in a computer anywhere, it's like you don't exist in their system at all if they try to look you up, so the surgeon basically has to take your word for it that you have medicaid share of cost and give you their surgery and THEN create the bill and send it to medicaid. The medicaid representative said it might be difficult to find a surgeon willing to take that risk. Also, once you find a surgeon who will trust you that much, certain surgeries need authorizations and the surgeon has to fill out a request for a special surgery and get it approved with the Medicaid main office before surgery. Sometimes the surgeon also has to do a "keypro" authorization so the hospital can get paid as well, which also has to be done before the surgery, or medicaid won't pay for it.

It sounds pretty complicated getting medicaid to pay for anything in this situation but we're going to try our darndest, I got the phone number of basically one surgeon who takes medicaid, which is pretty scary that we really don't get to pick a doctor based on credentials, but on whether they take medicaid. Nathan found online that patients having their colostomy surgery performed by Medicaid surgeons have a higher mortality rate.....how reassuring!
Wife to Nathan (UCReallySucks)
Mother of two beautiful girls, Rachael (4) and Brooke (2)
Gave the stay at home parent job to my husband! 
Currently working as a legal secretary with all the stress and responsibilites minus the actual "title" and fair pay! That's what happens when you're promoted from within (no wonder companies like doing that so much!) :P


summerstorm
Veteran Member


Date Joined Aug 2006
Total Posts : 6564
   Posted 1/28/2008 11:51 PM (GMT -6)   
i don't know how easy it would be to get medicaid to approve the Koch surgery, because it is only performed in a few places in the US, i don't know where you live, but i don't know how easy that would be for ya'll to deal with, and if you have a problem, you also have to go back to the dr that did the surgery, in most cases. Medicade is a strange thing, it's supposed to help people, but it's hard for people who need it to get it.
Random about the Wic, i used to work in grocery stores, for about 10 years, and WIC then didn't make you get the off brand. You could get, say juicy juice or Kraft cheese, or Cheerios, the thing with the cereals was that they couldn't be sugar cereals, like Froot Loops or something. I wonder if that is diff state by state?

Dancerpeg
Regular Member


Date Joined Dec 2007
Total Posts : 43
   Posted 1/29/2008 12:28 AM (GMT -6)   
icepixycicle
Back in 1993 when my husband was very sick with Crohn's Disease and I was pregnant with our last child. I was only making 6.00 a hour and went down and applied for medical coupons with DSHS and the in 1994 they did pay for his surgery. But I'm having to fill out paper work for charity this time at the University of Washington, we have insurance until the end of March. Because he's been out of work for 3 months and ran out of sick leave and vacation. His job is a great and they are asking co-workers to donate their sick leave for him that's why we will have insurance until the end of March. This will be his third surgery. I was thinking about just applying for Medical coupon again. But I'm not pregnant and can't get pregnant. I also took a looked at our basic health here with the state and they don't cover pre-existing for 9 months so that don't work for us. Well good luck and I think our states medicaid cover for the wrong reasons sometime. The only time you really can use them is if you are pregnant. We have a long road ahead of us to get my husband back on his feet and back to work. We also are waiting for is Long Term Disability to kick in but it doesn't pay as much a his regular pay. And I haven't work because he need 24 hour care. Do you know if there is help for having to take care of your spouse or family member?
Good Luck,
Dancerpeg

icepixycicle
Regular Member


Date Joined Jun 2006
Total Posts : 39
   Posted 1/29/2008 8:20 PM (GMT -6)   
So when youwere pregnant you were able to get insurance for your husband, as well? When I was pregnant it was just for me only. I've never heard of medical coupons, probably doesn't exist in florida since I haven't heard of it through dcf (probably the same as your dshs). That's nice of his co-workers to donate their sick time, too bad the company can't just donate it themselves. My husband was diagnosed and hospitalized at the worst possible time, he had just resigned from Walmart and had been accepted to Lowe's, so basically he didn't work for either place, although he had no gap in employment, he was still *at* walmart, but since he had already given his resignation they considered him quit, and refused to hire him due to "attendance problems" (he missed a week of work due to being hospitalized) and of course Lowe's had no obligation to him because he hadn't actually started yet, so we were left with absolutely no insurance to cover us (he didn't have walmart's insurance anyway because it was expensive and covered almost nothing at all) Too bad I can't just give him my health insurance, I could add him to mine, for $400 a month, and they wouldn't cover anything related to UC for a whole year of paying those premiums.
Wife to Nathan (UCReallySucks)
Mother of two beautiful girls, Rachael (4) and Brooke (2)
Gave the stay at home parent job to my husband! 
Currently working as a legal secretary with all the stress and responsibilites minus the actual "title" and fair pay! That's what happens when you're promoted from within (no wonder companies like doing that so much!) :P

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