Goodness....I am starting to get some medical bills for the transplant evaluation...EEEK! I work for a hospital...so my insurance is actually great. HOW DO PEOPLE AFFORD TRANSPLANT? I have primary and secondary insurance....I am wondering when and if I can get medicare. I am only 37, but I know I can qualify for medicare eventually like when the transplant happens.....but I don't think it will be worth my time. I know that part B medicare isn't worth me to get it because my insurance with the hospital will pay for transplant meds at almost 100% as long as I am still working with them.
What kind of medicare can I get? There are so many plans. I get monthly bloodtests that run over $960.00 a month...again at least I have good insurance...I think my portion will be less than 10%.
I am talking in circles....I guess I feel overwhelmed. I thought I had this figured out....apparently I don't!
Vicky
www.sjogrensandme.blogspot.com
Hi Victoria
I don't know what to say. I'm just so glad I don't have to contend with the whole insurance thing. I don't know how you do it and I can't imagine at all being in the shoes of someone with no insurance in the US who requires medical treatment.
I hope you can work it out.
Take care - Scottie :)
Hi Vicky,
If you are overwhelmed right now... put the stuff away for a little while... and breathe.. ;D
I had commercial insurance thru work and medicare. They usually go after the commercial insurance
first, then medicare, but I think there is a different set of 'rules' for kidney patients.. ???
Do you have a friend in the billing office at your hospital ? in Coding perhaps ?
I'd send for the Medicare 2009 book too...
Good luck Vicky !!
Scottie,
That's why Brits live longer then Americans and so many people have lost their jobs with the economy in the tank, that means more folks without health insurance.
I feel very lucky that my wife works for the government and we have good insurance at an affordable price, I'm going to need that insurance:o
Vicky, I know what you mean by confused over the medicare. My hubby has been on disability for years and now the medicare and part D--he is 70 years old now. He had 2 back surgeries in about 3 weeks and then massive infection in his spine. Ended up in hospital for 3 months on IV antibiotics every 6 hours. He had taken out the BCBS Senior Gold supplement
as it was called a few years ago--don't know if it still has the same name.
His 3 month surgeries and infection was close to $200,000 and his insurance and medicare paid all but about $1000. Be aware that when you go on disability you have to be disabled 2 years before rolling over to medicare. Also, I don't know if things are different when a person is young. Also, be aware that you do have to pay for medicare. It is now about $96 a month and they take it out before you get your check. Then the supplement costs extra plus the part D is a monthly charge. None of it comes cheap, but it is needed.
I have a lot of bills due to my state of health or lack thereof. :D I get the IVIG infusions every month and that runs my insurance $5,000 plus I see so darn many docs and also have a nebulizer plus "The Vest" which is an airway clearance device plus my meds. I don't pay any doctor bills, etc but do have drug charges. Like all the part D you have a choice of plans and then when you reach the donut hole you pay 100% until you reach a certain amount and then you pay a lot less out of pocket. I pay 30% until I reach donut hole or 4$ etc on the generics for a months worth of drugs. Have to be on the ball to keep this all in order.
Don't worry about it until you are back on your feet as I doubt a decision has to be made too soon. Do you plan to work and have the same insurance??? Good luck to you. Irish ;D
Irish, my plans are to keep my job and work as long as I am well enough. I question at times if I am able to still keep a 40 hour per week job and maintain a household with a 2 & 4 year old running around. Thank goodness my hubs pitches in. I hope your hubs is doing better now.
I know because of my age medicare is a bit different. I know end stage renal disease is covered when you are on dialysis....I know that when you get the transplant (I think the day after or day of surgery it will go into affect) I know it will only cover me for 3 years from the date of transplant and then I am on my own unless I reject the kidney and put straight on dialysis. Right now I am not on dialysis. I am doing the renal diet to maintain whatever life I have left of my kidneys, which according to the doctors was less than 2 years.
I give myself weekly injections of procrit to build my hemacrit and hemoglobin up. My kidneys have caused me to get a type of anemia that I don't produce enough red blood cells. Plus I take a bunch of sodium bicarb to help me get rid of the toxins in my blood. Also...all the meds for Sjogrens.
I really don't know if it would be to my benefit to get medicare. I know as far as the transplant meds after the surgery...it isn't worth it. My insurance for the meds "as long as I am working" will be less than $100.00 a month compared if I was on medicare it would cost me over $400.00 a month plus the monthly charge of $96.00 I THINK???
I have last years booklet on medicare....I guess I will need to talk to someone from the medicare office and see what they think. You are right...I don't need to worry about it. I plan on getting this transplant regardless how much it costs...I plan to be around for a long time with my family and friends! ;D
Take Care!
Vicky
Seabreeze,
;D I do have a friends in billing, but it is for Homecare and Durable Medical Equipment. I am embarressed to say that I also have a part of this at my job. I have to call and verify insurances, give diagnosis codes, HCPC's, and the like. I do this for pediatric nebulizers, aerochambers, Bilby blankets, etc.
I know that because of a diagnosis being off or code not right insurance will deny it in a heartbeat. If you go with a diagnosis code of 493.92 with blue cross blue shield a nebulizer won't get covered....if you go with 519.19, they will cover one. AND IT IS BASICALLY THE SAME. RAD "reactive airway diease".
Craziness.....I can't stand to deal with insurances.....especially my own! :-\
Take Care!
Vicky
The Medicare D prescription coverage can be wonderful if you are on a few 'maintanence' meds. I'm grateful for it.
But the initial benefit is a little over $2400 and used up in less than 3 months... then it is up to me to pay $2500+ cash to cover the 'gap', once I pay out that amt, you go to the catastrophic level and prescriptions are $4-12...
I depend on a lot of samples and pay cash for some, others like thyroid, diuretic, warfarin and plaquinel are 'free' but my psych meds are outrageous... New FDA guidelines have made samples hard to get too. I don't qualify for 'assistance' anywhere and I'm too young for supplemental insurance... :( and around and around we go... all I can say is research, research, research....
Seabreeze,
Have you thought about going North or South of the boarder for less expensive drugs? I remember last year my dad hit the donut hole in Medicare D, November's pharmacy bill was over $1800.00 dollars :o
Hi Vicky!
I can TOTALLY understand what you are talking about when it comes to insurance! Don't get me wrong...I am so thankful that I have insurance...in fact I don't know what I would do without it.....but it has become my part time job to keep all of my bills, meds, EOB's, etc straight. I make so many phone calls to my providers and my insurance company when there is an error or something isn't covered correctly. Like a said....its become my part time job!
I just recently switched to an HSA (Health Service Account) PPO plan at work...I hope I made the right decision in doing this!
Hang in there.....as you said you are having the transplant done no matter what.....then you can take it one bill at a time when you are able and keep your fingers crossed that it all works out a-ok! (it will eventually.... ;)).
Epson, I appreciate the thought.. and yes, In 2007 I was able to get 'generic' Provigil (Modafinil) from Canada as generic is not avail in US (of course) and saved considerable amount of money, unfortunately the 'rules' changed in 2008 and they will not fill prescriptions for Provigil anymore (habit forming ?).. I take two other psych meds that are expensive each $400/500 a month, they are a little cheaper up there... the 3 meds run 1200 a month easy... figures, they keep my bi-polar in check so I can't stop them... I've been there, done that... I hate that donut hole !
Quote from: Scottietottie on January 15, 2009, 04:45:49 PM
Hi Victoria
I don't know what to say. I'm just so glad I don't have to contend with the whole insurance thing. I don't know how you do it and I can't imagine at all being in the shoes of someone with no insurance in the US who requires medical treatment.
Scottie,
This is actually a misconception that medical care for uninsured folks is not available in the US, uninsured people can receive health care through their county or state either fully covered or at a great discount depending on their finances. True we don't have national health insurance and I hope we never do, here each state handles the health care individually, and it is similar to what you receive in socialized health care. Our county health care systems and the hospital are available to anyone at any time, and people come from all over for the special burn unit.
Missy
Hi Missy B
Well it's good to know that health care is available to everyone but I've read an awful lot on various forums about people wondering if they are 'covered' or not for various medications or procedures or having to choose between medications and things.
I would find brainfog alone would make sorting out a good 'deal' difficult.
Take care - Scottie :)
I keep getting a bill for 9 grand from the Cleveland Clinic, it appears that they had my insurance information wrong. No matter how many times I call or how many people I talk to, they all assure me that every thing is straighten out and I get another bill. ???
QuoteI keep getting a bill for 9 grand from the Cleveland Clinic, it appears that they had my insurance information wrong. No matter how many times I call or how many people I talk to, they all assure me that every thing is straighten out and I get another bill.
Just get out your checkbook and keep them satisfied. All they want is 9,000. ;D ;D
This is actually a misconception that medical care for uninsured folks is not available in the US, uninsured people can receive health care through their county or state either fully covered or at a great discount depending on their finances. True we don't have national health insurance and I hope we never do, here each state handles the health care individually, and it is similar to what you receive in socialized health care. Our county health care systems and the hospital are available to anyone at any time, and people come from all over for the special burn unit.
Missy
[/quote]
Hi Missy B
Now I'm totally confused. If everyone can receive health care through their county or state then why do people have insurance?
Do you mean that it is possible to get the same standard of health care, medication, tests, surgery etc whether you have insurance or not? That's not what people on this forum seem to say; they seem worried about the cost of meds, and Victoria is getting bills for her transplant evaluation. Could she get her kidney transplant through her county health care system at no cost?
You say that you hope you never have national health insurance - do you mean you hope you never have a national system of socialised medical care which is free at point of delivery? In the UK the NHS isn't perfect - as all UKers here on SjS World will tell you - but we all pay into it through our taxes and then when we need something we (generally!) get it. Life with SjS is stressful enough but worrying about paying for meds, dealing with insurance companies, or even facing a kidney transplant while worrying about paying the medical bills just seems too much. How could a socialised medical system be worse?!
You'll probably say I'm naive - and you'd be right because I'm one of those odd people who believes in sharing, caring and looking after other folks - but it seems to me that we should all help take care of people in need. What could be kinder than to share our wealth through taxes, so that we can fund a medical system that gives people all the help they need regardless of their wealth, status, job or age. Why would anybody refuse to do that?
And Epson - I'm sure you're delighted to be spending part of this weekend thinking about bills for the Cleveland Clinic. Thinking of you today and hoping all goes well tomorrow. Do let us know how you are.
Chana x
A debate on "medical insurance/medical costs?comparison) always ends up with bad feelings on this board or any other. It's like debating religion or politics (which insurance may be). Lets just not light that fire. There are many wide and valid opinions on this.
Lucy
I apologize for this causing "bad" feelings. That was not my intention. I was just venting and worrying over medical bills. If you are a working middle class individual....IT IS HARD to pay for crap extending beyond the normal maintenance of a certain disease.
Here is a link of how I feel. This fellow blogger nailed it on the head for me. I am not saying it is the right way, but it sure looks good to me.
http://www.lupusandhumor.blogspot.com/2008/10/lupus-and-money.html
Take Care!
Vicky
Hi Vicky :)
No need to apologise for anything. If anyone was at fault - it's me because it was me who commented on our different systems. I wasn't actually advocating one over the other - just commenting they are different. So if anyone needs to apologise it's me.
I apprecuiate Lucy's post. She is so right. Let the sleeping dogs lie!! :)
Take care - Scottie :)
I just got SSI and Medi-Cal (California's Medicare right?) I am very embarrassed about it. I've worked since I was 16. I don't know the ins and outs of being on Gov assistance. Also I don't know who to go and see! There is an aption to get Bluecross, Kaiser or City Health Plan... which are managed care. Staying Regular Medical means I can see who I want if I go managed care I have to stick with those networks. But having an Primary Sjogren's (i hope that is true), on top of other Chronic Pain, I just wonder how I can manage the system and if I can find the correct coding... I'm assuming I'll need to be an advocate to get the correct care... just like anywhere else... will the gov take care of me properly? Since Sjogren's is newly recognized?
Paperdoll,
Yes, you are going to have to advocate on your behalf. I don't think the goverment is going to try and make things worse for you. I know at the hospital I work at Medicare is just about approved at any medical office or service. It seems to be a good thing. I know the ones that have medicare and a supplemental insurance don't seem to have to worry about bills. We write off the balance if one is left after both insurances have been used. When it is something that medicare doesn't pay for we get help from the community through different funds to help pay for the cost of a medical necessary item.
I don't know if I answered your questions....sorry!
Vicky
Half of all the bankruptcies in the U.S are due to medical costs and illness, sounds like a great system to me, not! Fifty six percent of this group were college educated home owners and three quarters had insurance prior to their filling for bankruptcies.
This subject should cause bad feelings, I know I feel bad that people have to go broke, because they got sick.
seabreeze, I know those psych drugs and others also can really be spendy. I really think the drug companies are mopping the floor with us. I was wondering if you have ever used the lithium for the bipolar as it is so much cheaper.
Victoria, I know that you will probably have a much easier time getting onto medicare and enjoy the 3 years and then become uninsurable when you try to get back into the private health insurance. I think I would talk to all the people I could before your surgery to get this figured out. If you have Medicare it becomes your primary insurance and whatever isn't covered rolls over to your supplement. Like I said, we have had very good luck with out BCBS. I know that if we had some other supplement I would be in trouble with my IVIG as my supplement pays most of it. Medicare pays only about 20%---which is fine. My IVIG comes to about 70,000$ a year now so I can't complain at all cause I don't have to pay any of it.
Epson, Maybe it is about time to call and ask to speak to the head of the billing department. If you get any collection notices I would call again and tell them the Better Business Bureau and the Attorney General are going to get a call. Good luck. Hope you are feeling good. Irish ;D