View Full Version : medicaid info -please help

12-08-2003, 06:14 PM
We are about at the end of our rope. Our state legislated insurance (IN) has changed the way they pay out. Now instead of our providers being held to a contracted amount, they are free to bill us what our insurance won't pay - which right now is 10% over medicare. The first two months of this system lands us owing $3,600 (this would be on top of what we've already put out this year for $2,500 deductible and $2,500 coinsurance payments). We have about $10,000 more being processed through our insurance, and we are expecting them to pay only about 25% of that. Needless to say I am somewhat in a panic. We've always had medical bills, and managed somehow, with God's help, to pay them off. However, we are getting in over our head, and it's obviously going to get worse fast.My husband (the one with CF) is the main bread winner. Although his health has really declined (FEV's staying at 30% - he's been referred for a lung transplant) he is determined to keep supporting us, living life as actively as he can, although it is getting difficult. He is so exhausted.We need some suggestions - I really know nothing about medicaid. I assume it is the same from state to state, since it is a federal program - right?Here are some questions - can you help or direct me to someone who can?What can he earn and be on medicaid?What can the spouse earn?Can we continue to own our home?Do they ever pay old bills?Do they deny meds? Like Pulmazyme, TOBI, etc.? I swear I read a newspaper story earlier this year about a mom who had a seriously ill child whose meds were paid by medicaid and she was worried about them continuing to pay for his meds this year because of some funding shortage. Comments?Do they deny medical treatment?Do they limit services?Do doctors/hospitals hassle you or refuse you?How long does it take to qualify?Where do we go? What do we have to do -- fill out a form?If you're on it, are you thankful or regretful?Please feel free to share any information you think would help us, even if I didn't think to ask it.Thank you so much for taking the time to help. I always enjoy reading everyone's messages. You guys are great.Merry Christmas and God's blessings to you all. - j

12-08-2003, 07:10 PM
One more thing - was reading on an Indiana medicaid site = what's 'spend down?' I don't think we could ever qualify for medicaid after reading about it (not that it's crystal clear). What will be our options? Bankruptcy? This stinks. -j

12-09-2003, 04:13 AM
Ok I can not answer all your questions but I can try. I have a paper here and I sure wished I had a scanner and I would scan you what it says about Medicaid and insurance coverage. If you want I can mail it to you, if you feel comfortable in giving me your address e-mailed to me of course. Thats up to you. but there is to much to type out and send. On this paper it has a lot of question you asked plus some, with long answers. I think I also have a Social Security pamlet laying around. But you can go to any social security office and pick up there free pamplets on just about everything that their offices do. Also talk to your social worker at a cf clinic they usually have all the newest info and have many programs to help you get meds as well.I can answer some of your questions right now though.To be able to get governement help it varies state to state on how much your income is. Since you are married they count all income together. It is usually harder to get help when they count spouses income because alot of times that brings you over their income limit. but don't let that scare you. you can fight and get around it.they never pay old bills. medicaid only covers in the time you have medicaid. but it helps out alot.i haven't had them deny my meds yet. but if they deny you can appeal it usualy.you can keep your home. in texas they only count if you have over one or two vehicles as a source of income or soemthing like that because you can sell it for money. but not your home because you have to have shelter and at least one vehicle for transportation.its not that dr.s hassle its whether or not the place they work at accepts medicaid or medicare. you can call a number that tells you what dr.s accept them and most of the time cf dr.s accept medicaid or medicarethe time it takes to qualify can vary state to state. but usualy a few months. you know the government is slow.I am very gratefull for medicaid. without it we would be in a 10 feet whole of debt. my husband's insurance only pays 80% of everything plus it had like a $1000 deductible. not much but when only one med would be your deductible and a pharmacy wants it all at once thats alot of money. but jsut like any insurace they can be a pain in the arse to deall with. like they may threaten to take you off for a month because you had a highre pay check for a certain month or something.also if you work and have insurance you can get your husband on your insurance if its any good. if you have had coverage through medicaid, medicare, or a state health insurance program the time you were covered under such a plan can also be used as creditable coverage if you become eleigible for a private health insurance plan.Also Beth Sufian is a lawyer out of texas who has CF herself and who strives to help in these types of situations. I know someone with her e-mail address and I will try to get it for you as soon as I can. Don't lose hope. There is always a way around things and of course with God's help you can make it through [email protected]

12-09-2003, 08:48 PM
OK here is Beth Sufian e-mail [email protected] She is the lawyer who can help answer your questions.If i can find more info or contacts that can help you I will post it. I hope this helps you out.Amanda