Thursday, April 9, 2009

Insurance No's...Medicaid Woes

Ok..this may not be my best writing people. I've been thinking about this one for over a month. I still cannot come up with a creative, respectful, or playful way to put this information into words. I can, however, promise it WILL be informative. If you are struggling and are considering going to a state provided insurance ..PLEASE read on.

Hi everyone. Debbie here. If you are coming to this site looking for some answers because you or loved one just got news about Head, Neck, or Oral Cancer. This site may help. My brother started this blog a year ago as a means to communicate information to family. His informative detail and blunt honesty has been encouraging to those all across the world....the key was how he linked it all together. Most of the writings are his own. I only recently took it his earlier request.

Last summer, It was my brother's intention to return to work after his first round of treatments. He wasn't quite ready to return when his FMLA ran out. ( most cases whenever FMLA runs out; the position you held at your job is terminated) To protect his coverage of any "preExisting" problems; it was decided the best option was to pay the cobra payment for his insurance. (Which covered him and two of his children). Yes...I cringe too at the sound of the word "cobra" . Everyone in America cringes. HOWEVER....please read on as you will begin to learn all about the almighty system that ....truly...needs some work.

Shortly after this decision. John discovered his cancer treatments had not worked. There was a 10% or less chance that this treatment would not respond at all. Thinking of that right now offers me comfort to you my friend. His cancer...his experience.. is hopefully the sacrifice he made to help encourage YOU to know your chances are now better. The "cancer" itself was not what took his life..but did make complications that for him were lifetaking.

As I was saying..the insurance...Now comes the time to take the next step. The dreaded State Insurance, aka, medicaid. It's there to help those in John's situation. On disability, unable to work, raising kid(s) at home still, CONSTANT hospital, doctor, radiology bills,....state insurance would be a blessing and soo much cheaper than cobra right?? W R O N G

After much paper pushing (apparently), this is what was discovered. Any money that is made over 600-700 dollars a month is what your monthly out of pocket "spend down" is EVERY MONTH!! Meaning: this is what has to be paid before any bills are paid or any expenses covered by the insurance. Soo here are two examples:

1. person's sole income from disability is 800.oo /month. If the state's minimal allowance is 700/month. The person's out of pocket monthly expenses before anything else is covered is 100/month. Not bad. Considering the person would also qualify for other benefits such as food assistance and other programs to offset money expenses. So...700 a month plus food is paid by the state program. Rent is often based on income in some of the brand new apartment homes..that's a benefit here. Sometimes heat and other bills as well.

2. person's sole income from disability is 1250/month. State min allowance being the same at 700. The person's out of pocket is now 550/month. Leaving the person $700.00 to pay for a Here is the kick in the teeth; This person's income is 50 dollars over the minimal allowed for food assistance..and makes just barely too much money for income based homes. The out of pocket expense is not accounted for in any of the considerations. BUT..for chemo..radiation..etc to be continued..must be paid. Here's another...if someone is being fed thru a feeding system as John was via peg tube. The food assistance would not have even helped him if he was alone and made the amount as in the first example. (BUT..they would have insisted for him to take the program..and ..use it on "who ever" even if he didn't have children)

W H A T??

Yes..that is what we've learned. The system may work for some.....few actually in greater needs. But there are many in severe need of the funding and I just don't see how it's working.

I've worked in the medical field all my life. I've seen it's pro's and con's. Lately, more con's as insurance tends to dictate what is needed for the patient and not the man or woman that holds the degree in medicine...let alone specializing in a specific area.

Yes..sometimes guidance is needed. much is too much. At what cost are they going to take this?

There were wait times..and delays in care specifically due to insurance needs for coverage. How is this a working system??

I don't have the answers. In fact this only raises so many more questions. But I felt compelled to inform those considering state insurance. It works at times..but in some cases the deductible was over that of what the cobra premium would have been. NOT to mention the state insurance would not cover his children due to ages. The one child 'should' have been covered under the state guidelines of emancipation..(still being decided...STILL). HIP is a program that offers insurance to those 19 yrs or older that do not have coverage. It is quite affordable. (VERY REASONABLE.)

I may not have answers..but I have learned alot. If you have any questions, I will try to help make things a bit more clearer than the mud that is appears to be.
Again..I do apologize..not one of my better posts. I've tried not to vent..but that sometimes is needed to get the point across. Even John did that from time to time.

Until next time:
............putting one foot in front of the other....finding tomorrow.

Much care to all