what to do about insurance issues?

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Monty's Mom
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Date Joined Aug 2010
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   Posted 11/1/2011 10:52 AM (GMT -6)   
For anyone who doesn't remember, I am losing my Medicaid because I got married and his income is too high. We are appealing on the grounds that his employer's insurance is too expensive for us to afford, and doesn't cover the number of appointments I need per year. I filed the appeal, which means that I have the insurance until the appeal decision is made.

What do I do after that if they deny me? I am filling out SSD disability papers now, because it appears there are little to no options left for me, I need an income. What do we do about insurance? Does anyone know of a private insurance that takes people with pre existing conditions that covers pain management? Most of the companies I have called either don't cover my area or won't take me with my medical conditions.

I guess I am just lost and in limbo. I am terribly depressed, have no motivation to even eat, and no hope for the future. I didn't want to be disabled at 31, to have to file for it because I am a burden to my family. What types of insurance are others here on? My husband's insurance company has the option to deny me coverage because of my conditions, which would leave me with no hope for meds, nothing. Its really not an option because I refuse to make my family go without paying bills and food so that I can have my meds.
I am scared of what my pain and life will be like without medications. Not so much of withdrawal, but of what I will be able to do if I don't have anything to treat the pain. Has anyone ever gone through something like this before?

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Date Joined Jul 2009
Total Posts : 2042
   Posted 11/1/2011 11:55 AM (GMT -6)   
You might try /www.pcip.gov/

Getting breaks on the cost of non narcotic medications is not too hard, but I have never seen any help with narcotic pain meds.

The only thing I can really suggest is that you talk with your doctors about this and see if you can get switched over to something that you can afford that will at least take the edge off.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

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Date Joined Sep 2006
Total Posts : 2861
   Posted 11/1/2011 12:30 PM (GMT -6)   
narcotics are relatively inexpensive. My hydros are 8-10 dollars a month. As Jim says, try that link or pparx.org for prescription assistance.

I am on SSDI, so get medicare and my daughter also (hers is better than mine-good). That took 2 1/2 years. Some take 6 months. I don't know what meds you are on or your conditions so hard to say.
I'm sorry this is happening to you at 31. I lived most of my life working hard and finally gave it up at 52. The older you are, the easier it is to get because they know no one wants to hire a broken down nag_LOL.

Anyway, you have my sympathies. We suffered while I was waiting and you might be entitled to assistance if husband is only income , and see if the kids are eligible for state insurance.

Good luck and let us know, would you?

"We never realize how strong we are, until being strong is the only thing left"
Major Depressive Disorder, ptsd, fibromyalgia, chronic pain, l3/4, L4/5 gone, bursitis arthritis sciatica

welbutrin HBP meds abilify seroquel hydrocodone flexeril klonopin magnesium

Monty's Mom
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Date Joined Aug 2010
Total Posts : 664
   Posted 11/1/2011 2:17 PM (GMT -6)   
Jim, thank you for the link. I called my PM doc, and he and I are making a plan to handle withdrawals from fentanyl patch if the insurance gets canceled despite appeal.

Maggie, it is Medicaid that is canceling because of my husband's income. It is just over the limit of the income guidelines. Throw in that his employer's insurance allows 6 visits per family per year and don't cover any of my pain management appointments or psych stuff. They cover 2 of my 6 meds at $30 a prescription, even if the rx is cheaper than $30. I have a $40 office copay, then a $2000 deductible for hospital/surgical. It doesn't cover labs, x-rays or diagnostic studies. All of which I have to have regularly.

I feel as though no one wants to help, or knows what to do for me. Add in that my long-term disability claim has been reopened after an appeal I filed months ago, and it looks as though I may get even a partial approval, and now I have some money to cover meds for the required 6 month wait until the PCIP insurance can be applied for. The dept of welfare here that administers the Medicaid, PCIP, and Medicaid for Disabled workers is encouraging me to get any kind of work, even cooking or baby sitting for a neighbor, and then reapply for Medicaid for disabled workers.

This doesn't make any sense. We make too much for Medicaid, but if I make $10 a week cooking for a neighbor or babysitting, as long as we don't make $XXXX a month, I can get Medicaid? But I can't get it when we make under that $XXXX a month now? confused

Am I the only one who has had this trouble? Who else doesn't get the system? I checked on private insurance, and the cheapest plan for me is $895 a month, and it won't cover my injections or 2 of my meds.

I GIVE UP! mad

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Date Joined Sep 2006
Total Posts : 2861
   Posted 11/1/2011 3:41 PM (GMT -6)   
the medical "system" is so screwed up!!!!It doesn't work anymore.

At least it sounds like your case was reopened and there might be relief there...sometime. Like I said old hydro or oxycodone cost nothing...wean off fentanyl patch, I wore them for 2 years...you know very expensive....besides pain meds, what else do you take? I'm kinda good at pharma-let me know.

I don't know how they even call that plan insurance, who has 2000k to shell out before it kicks in??? I am so sorry this is going on in this great country with billions to bail out banks but won't help a poor woman get her meds. I better not get started.

Please let me know what yr meds are and I'll check on cheap alternatives, if that would be helpful.

"We never realize how strong we are, until being strong is the only thing left"
Major Depressive Disorder, ptsd, fibromyalgia, chronic pain, l3/4, L4/5 gone, bursitis arthritis sciatica

welbutrin HBP meds abilify seroquel hydrocodone flexeril klonopin magnesium

Veteran Member

Date Joined Mar 2011
Total Posts : 816
   Posted 11/1/2011 4:41 PM (GMT -6)   
Hi, so sorry you are going thru so much, this is supposed to be a great time, you just got married, altough in hindsight, maybe it would have been better just to live together, then the issue of medicaid would not be an issue. Now though it is, I can tell you that methadone is very inexpensive, I got 100 10 mg pills for under 50 dollars.  I didnt even have to pay that as I have medicare but it is no expensive.
I also think you should find a good local SSI, SSDI, lawyer who only does that one thing, get your SSI for you.  I was turned down twice before I got a lawyer after that, he looked over my tons of records, and took my case, once he took my case, I knew I would win, they only get paid if they win.  So I would look into that right away.  From the time I found him until I received my award letter for SSI, it took maybe 6 months.  So move on it right away if thats what you decide to do.
Good Luck and take care,
degenerative disc disease, fibromyalgia, osteoarthritis, neuropathy, lumbar laminectomy july 1998 no help, rechargeable neurostimulator unit low right back w/lead wires to left side and right leg unit not working just sitting there.i am 57 years young in may will turn 58. i have 2 grown daughters, 25 and 29. i have 2 grandchildren, 9 year old grandaughter and 5 yr. old grandson

Heather Lynn
Regular Member

Date Joined May 2011
Total Posts : 283
   Posted 11/2/2011 5:32 PM (GMT -6)   
Mindy, I sent you an email. I am really sorry you are going through this.
Fibromyalgia, low back pain/SI joint dysfunction, anxiety, obstructive sleep apnea, endometriosis, asthma

Regular Member

Date Joined Nov 2011
Total Posts : 31
   Posted 11/25/2011 10:51 PM (GMT 0)   
Did you contact the manufactuers of the medications, sometimes they can work things out and send your medication for either free or a reduced rate to your doctors office for them to dispense to you. It is worth looking into.
Good luck
DX: spinal fracture L5/S1, fusion 1/96, Spondylolethsis, DDD, nerve damage to both legs and bladder, 4/2007 anterior & posterior fusion L1-S1, 4 Bladder surgeries. Multipe injections, depression, PTSD

Meds: MS Contin 60mg bid, oxycodone 30mg tid, clonazapam 1mg bid, Pristiq 50mg.

Regular Member

Date Joined Dec 2010
Total Posts : 213
   Posted 11/26/2011 9:10 AM (GMT -6)   
Years ago I had a girlfriend on the fentanyl patch and this was before Medicare Part D. They do have a patient advocacy program and sent her the patches for free bases on a phone call to determine financial necessity. So definitely check into that.

There are also other meds that are less expensive and are available in generic form that would hopefully work for you that are cheaper than what you are on now. Other medications may have a compassionate patient program also - call the actual company the manufacturers the brand names of the drugs you are on and see if they have any such programs for people without insurance,.

Hope this helps!
DX pyoderma gangrenosum, Acute Myelogenous Leukemia, Bone Marrow Transplant, Chronic Pain syndrome, Chronic Kidney Disease Stage 3, Major Depressive Disorder, Radiculopathy, Bilateral Hip Pain, Insomnia,Left Groin Hernia, Bulging Disk in Lumbar Spine, Tear in Lumbar Spine, Tendonitis and Bursitis in both hips, hypoxia due to sleep apnea and new problems with my lungs. Have had 2 abnormal CT scans.

Forum Moderator

Date Joined Feb 2003
Total Posts : 16804
   Posted 11/26/2011 11:05 AM (GMT -6)   
Mindy pretty much all private insurance companies have the pre-existing clause. This is something many of us has had to deal with forever. The clauses differ on each policy. Did you say in another post your boys Medicaid was also canceled?

My sisters granddaughter was a single mom with one child. Both had Medicaid benefits, plus she was living in a very nice apt paid for my the state. When she applied for all of these different programs they made it clear to her that if she got married or moved a boyfriend in she would lose all the benefits except for Medicaid for the little girl. She did just that and lost it all except for Medicaid for the little girl. They really have strict guidelines in place. The guy that moved in was not her father so her Medicaid was not stopped. Did you say they stopped it on your sons?

There are different programs listed in CP101 that helps with the costs of medications, perhaps one of those can help you with your pain medications. How long is the appeal going to take with Medicaid? Let us know.
Moderator Chronic Pain Forum

Veteran Member

Date Joined Oct 2010
Total Posts : 932
   Posted 11/26/2011 12:33 PM (GMT -6)   
During the "Obama Care" roll-out, there are various options for individuals with pre-existing conditions. Many states have established insurance pools already, tied to pre-existing conditions and/or income. I know someone who gets (good!) state insurance for only $200 per month because of his income. There's also a federal program: https://www.pcip.gov/

I don't know much about these, but hope this may work out in lieu of Medicaid.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray
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