Losing insurance, need surgery

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Monty's Mom
Veteran Member


Date Joined Aug 2010
Total Posts : 664
   Posted 10/22/2011 1:30 PM (GMT -6)   
I got notice today that medical assistance drops me November 3. I don't understand how they claim that Tim made $, and that I have a $2000 a month income besides his. I haven't worked since 2009. We just got married. He doesn't make enough for me to be insured on his employer's insurance, doesn't even make enough to get insurance for himself through his employer. We wouldn't have the money to pay bills or eat if we get insurance through them.

This means no more meds after November 3. I have enough to last until November 20, but the withdrawal from the fentanyl patch is terrifying me. No more pain management appointments either because of the expense. No more anything. We can barely afford to live, how would I pay for appointments for med management and the meds?

We were in the ER yesterday and found that there is an ovary on the right side again, fully functioning and with blood supply. For those of you not familiar with me, I have had a right ovary removed twice now. This is my 3rd one. Its pulling everything out of whack and causing more pain. My surgeon wanted to take it out in August, but we tried Lupron instead to hold me through the wedding. It didn't work. How will I afford surgery? How will I manage my pain? without the meds I am unable to do anything.

Im in shock, scared, and unable to comprehend how this could happen. Jim, I really feel for you right now. This is making me take stock of everything we have and how to keep from living in pain until it gets straightened out.
The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them. That's the essence of inhumanity. George Bernard Shaw
Pelvic adhesive disease, IBS, SI pain, arthritis, kidney stones, depression, 10 pelvic surgeries for pain, ovarian cysts, adhesions, endometriosis, adenomyosis, and possible ovarian remnant syndrome. Unexpectedly growing ovary #3 on right side.

tmjpain
Veteran Member


Date Joined Oct 2008
Total Posts : 2024
   Posted 10/22/2011 3:19 PM (GMT -6)   
Oh my gosh Mindy, my heart breaks for you. This is awful and in this day and age it should not happen. I wish i could help you.
What is wrong with the American health system..... if you need an operation you should be able to have it and not worry about having to pay for it. Thank goodness it does not work like that in Ontario.
 
My thoughts and prayers are with you. It is not right that you have to suffer so badly.
 
Big hugs
Suzane

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 10/22/2011 5:41 PM (GMT -6)   
Mindy, I don't know what state you live in or even if I did, unless it is IL, I wouldn't know anything about their Medicaid programs since every state is different.

All I can suggest you do is round up all financial information information you can from the last 6 months to a year and make an appointment at your local assistance office and take it down there along with all other relevant documentation such as letter from the department, birth certificates for yourself, husband, kid(s), etc and have a long, long talk with them.

There could be many things going on here from them getting outdated data from the unemployment office or the IRS or even like what happened to me once some mean spirited idiot turned you in for fraud saying you had to be making "X" amount of money at the least which would put you over. Regardless though taking in proof of income, etc and showing that you meet requirements should get you back on track, though it may take some time.

In the meantime though if you do end up needing surgery you can probably get the cost written off through your area hospitals charity care program and if the doctor who does the surgery is employed by the hospital his fees would be written off too. So talk to the hospital before needing surgery and find out the requirements.

As far as your medications go, you might want to try talking to your PCP and/or your PM and telling them what is going on and see if they can make some kind of small change to your pain medicines and give you a script for 3 months worth and get that filled before you loose your insurance. (Also see if you can get a 3 month supply of any other medications you are on.)

Best of luck.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 10/22/2011 7:08 PM (GMT -6)   
Do what Jim has recommended. Take all supporting documents regarding your finances, pay stubs from your husband's employment, and a statement from his employer that he is not covered under his employment's insurance, nor are you and bring those with you. Get that appointment as soon as possible so that you can beat the November 3rd deadline.
There is no rhyme or reason to why things happen but hopefully you will be able to get it straightend out.
Sandi
Motorcycle accident 1992, Back problems from 92 to 2005. August 2005- early 2006- Chiropractor care
March 2006- consult with surgeon -PLIF/TLIF L4-5, spondylolysthesis, canal and foraminal stenosis, multiple herniations
Post Op Cauda Equina Syndrome
Revision August 2007- salvage op
March 2011- 2nd onset of Cauda Equina Syndrome
Needs surgery to prevent paralysis

Dagger
Veteran Member


Date Joined Apr 2008
Total Posts : 1522
   Posted 10/22/2011 7:27 PM (GMT -6)   
There is usually some way to appeal the decision but you have to make sure you follow the directions carefully and meet whatever deadline they have. Drop off the paperwork if you can and have them date stamp your copy so you can prove that you filed the paperwork.

Can you have the surgery before you lose the insurance? Talk to your doc on Monday so you can plan how to stop your meds.

I know 2 couples that got a divorce just so the one with the chronic illness could get medical assistance.

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 10/22/2011 7:45 PM (GMT -6)   
Sandi,

I am so glad you mentioned getting a letter or some kind of documentation from the hubby's employer about not being able to be put on the company insurance. I totally forgot about that.

When we went on Medicaid we had to provide something like that, though in our case it was showing that the insurance premiums, co-pays, deductibles, etc took too big a bite out of the paycheck, which is why we dropped the private insurance and went on Medicaid. There was no way we could live paying 43% of her gross pay each month for health insurance, and that didn't count all the monthly co-pays for office visits and medication after her employer's insurance hit them with a huge premium increase. Now though we don't even have the option of going on private insurance through the company since the company my wife works for was sold and the new owners don't offer health insurance.

Suzanne: I agree it is sad and there is much wrong in the US health care system, but to be honest the Canadian system has its own flaws. IMHO the single biggest problem in both systems is that they are governed by bean counters with advice from doctors who couldn't handle actually being doctors and treating people.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 10/22/2011 9:36 PM (GMT -6)   
Many well wishes in your struggles...please keep us posted and do fight like
the others said, you can appeal things, go in and talk to them...
Prayers
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

Heather Lynn
Regular Member


Date Joined May 2011
Total Posts : 283
   Posted 10/24/2011 3:08 PM (GMT -6)   
Mindy, this sounds like they have wrong information, so you definitely need to gather up documentation and start appealing the decision. I really hope you can get this resolved, you clearly need the medical support.

Have you applied for SSDI? One of the benefits of SSDI is it qualifies you for Medicare after 2 years, and usually for state medical assistance while you wait.
Fibromyalgia, low back pain/SI joint dysfunction, anxiety, obstructive sleep apnea, endometriosis, asthma

Monty's Mom
Veteran Member


Date Joined Aug 2010
Total Posts : 664
   Posted 10/24/2011 6:03 PM (GMT -6)   
Thank you all for your responses and advice. We are appealing the decision for the reason of not being able to afford the premiums, the copays, coinsurance and deductible and still survive, plus, no private insurance will take me. My husband asked for the insurance info with his employer knowing I am ill and getting surgery, and had the nerve to say that they may not allow him to insure me if I already had insurance including Medicaid. Also, if his insurance doesn't cover my medications or treatments, why pay for it at all?

I am getting free legal aid as well, which is a great big help. I will have an attorney with me for the appeal. They extended my coverage until the appeal decision, so the surgery on Friday will be covered as will recovery time.

Thank you all for the encouragement and advice! There is no better place than Healingwell for wonderful people willing to help.

Mindy

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/24/2011 6:20 PM (GMT -6)   
Mindy,

You have so much on your plate right now, it's mind boggling to say the least. Wish there were some quick or easy
answers, but I know it doesn't work that way.

You got my thoughts and prayers as you work through this maze of troubles, good luck in every way.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81, 6/11 5.8
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Monty's Mom
Veteran Member


Date Joined Aug 2010
Total Posts : 664
   Posted 10/25/2011 6:50 AM (GMT -6)   
David,

Thank you for your prayers. You have quite a lot on your plate as well. My prayers are with you.

Here is to feeling better, and the horrible mess that goes along with it!

Mindy
The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them. That's the essence of inhumanity. George Bernard Shaw
Pelvic adhesive disease, IBS, SI pain, arthritis, kidney stones, depression, 10 pelvic surgeries for pain, ovarian cysts, adhesions, endometriosis, adenomyosis, and possible ovarian remnant syndrome. Unexpectedly growing ovary #3 on right side.

swaye
New Member


Date Joined Oct 2011
Total Posts : 19
   Posted 10/25/2011 10:58 AM (GMT -6)   
Hi Mindy - I am new to the health boards and was going to post on another issues but just happened to notice yours. I had a lot of the same issues with being dropped from insurance and no one would insure me because of my pre-existing pain conditions. I know a lot of people don't know about the pre-existing health care plan that is now available with the change in the health care law. Some states that did not adopt it are under a federal plan and other states are on a state run plan. I live in Virginia so I am on a federal plan. I don't know if I am allowed to put links on this page but it is called the pre-existing condition insurance plan (PCIP). If you look that up online. I had to go 6 months without insurance before I became eligible and I don't know if you can wait that long to go without insurance but they don't reject you for any pre-existing conditions once it is available. During those 6 months I didn't have insurance, I talked to my primary care doctor and he gave me coupon cards for all my medications so I didn't have to pay more than $25. I also had to order a few drugs from Canada which I was not excited to do but had no choice. The premiums are are around $200 a month so it is very affordable compared to private insurance and it is a POP. You are not allowed to add any one to this plan so it would just be for yourself. Nobody seems to talk about it that much that this is available to people like you. It is for those that can't get private insurance or do not work but are not eligible for medicaid. I hope this offers some help.
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