Page 2 of 3 FirstFirst 123 LastLast
Results 11 to 20 of 29

Thread: Is Texas a good state to live in with CF, are Insurance and CF Hospitals/Centers good

  1. #11
    Junior Member
    Join Date
    Feb 2010
    Posts
    14
    The CF centers appear to be good BUT Texas is among one of the highest uninsured rates in the country. If you plan to move here make sure that your job has insurance. Texas is one of the states that refused to expand their Medicaid program, and their rules regarding who can get coverage as such that when I checked for our then 18 yr old son he didn't qualify for Medicaid even though he was an unemployed full time student. They told me to qualify he had to be declared disabled. Luckily he's covered under my insurance until he's 26. He's working 20-30 hours a week now but his job doesn't appear to offer insurance. If you have asthma you also might want to check out how air qualify effects you - Dallas and Houston's (as well as other cities in the state) air quality is pretty bad during the summer.

  2. #12
    Senior Member
    Join Date
    Sep 2011
    Posts
    684
    I have lived here my whole life and we have BCBS 20/80. They have covered all of Abby's care no problem. We go to Texas Children's and love it. We get co-pay assistance and hardly pay anything for Abby's meds and it's not because we are poor...CF just has great co pay assistance programs. I've never been anywhere else .... but Texas is a great place to live. If you have any other questions or need more advice feel free to email me: [email protected]

    I do agree with the air quality in Houston and Dallas.....not great at all. And Houston seems to have a lot of MRSA as well according to TX Children's. I think it is because it is so close to the coast and is constantly rained on so lots of dampness to grow bacteria. Of course that's just my assumption. We live in the Bryan College Station area and have no problems.
    --Jenny
    Mom to Clayton 12 no CF
    and Abby 9 diagnosed at age 2, mutations are DF508 & 2585delT
    multiple sinus surgeries and currently on Kalydeco since June 2012

  3. #13
    Junior Member
    Join Date
    Feb 2010
    Posts
    14
    Quote Originally Posted by JENNYC View Post
    "CF just has great co pay assistance programs"
    Jenny,

    Can you provide more info on the co-assistance programs? We do get co-pay help with Kalydeco from the pharmaceutical company, but that's the only help we have get outside of my (private) insurance. The state agencies I contacted, and the CF social worker told me my son didn't qualify for any other assistance so am crossing my fingers that I got the wrong info.

    Roe

  4. #14
    Senior Member
    Join Date
    Sep 2011
    Posts
    684
    Absolutely!!!
    There is the Cystic Fibrosis Patient Assistance Foundation. Web address is www.cfpaf.org and the phone # is 1-888-315-4154
    There is Genentech Access Solutions http://www.genentech-access.com/ 1-800-240-1224
    There is Patient Access Network Foundation www.patientaccessnetwork.org 1-866-316-7263
    There is Solvay Pharmaceuticals creon.com 1-800-256-8918
    And then there is a Recreation Grant that will pay 500 for any physical activity to help your CFer Cystic Fibrosis Lifestyle Foundation http://www.cflf.org/apply-grant

    With these assistance programs I pay nothing for Creon and Hyper-sal. And I pay 30.00 for Pulmozyme. I think one of these will help with Tobi and cayston but Abby is not on those so I'm not sure.

    I hope this helps!! And all of these are easy to apply for. I've never had any problems.
    --Jenny
    Mom to Clayton 12 no CF
    and Abby 9 diagnosed at age 2, mutations are DF508 & 2585delT
    multiple sinus surgeries and currently on Kalydeco since June 2012

  5. #15
    Senior Member
    Join Date
    Nov 2008
    Posts
    100
    Quote Originally Posted by roeann View Post
    Jenny,

    Can you provide more info on the co-assistance programs? We do get co-pay help with Kalydeco from the pharmaceutical company, but that's the only help we have get outside of my (private) insurance. The state agencies I contacted, and the CF social worker told me my son didn't qualify for any other assistance so am crossing my fingers that I got the wrong info.

    Roe
    More copay assistance programs to add:

    TOBI: www.tobitime.com/info/co-pay-card-tobi.jsp
    Zenpep: www.Zenpep.com
    Cayston: www.cayston.com

    My husband and I live in Texas (he is the CFer) We have a High deductible, high out-of-pocket plan that pays 80/20. We have a deductible of $2,500 and an additional out of pocket max of $5,000. With this type of plan, we pay 100% until our $2,500 deductible is met. After that, the insurance company pays 80% and we pay 20% until the $5,000 out of pocket is met. So.......we are responsible for $7,500 total cost per year (of course, this doesn't include the cost of the premiums) There are lots of advantages to a high deductible/OOP plan:

    1.) It qualifies for an HSA (we contribute monthly so we have savings for OOP expenses)
    2.) The insurance company pays 100% after the deductible and OOP max are met.

    For us, we NEVER have to pay more than $500-$1000 out of pocket per year because we STRATEGIZE the order that we refill prescriptions. For example, my husband takes Kalydeco, so we order that Rx FIRST at the beginning of the new insurance year so that we can utilize the HUGE copay help that Vertex provides. Basically, by just ordering that drug first, Vertex will pay not only our deductible for us, but basically all of our OOP Max, too.

    I realize that many of you aren't taking Kalydeco. Before my husband started the drug in 2012, we still had a strategy when refilling all prescriptions. We analyzed every single copay/assistance program and figured out which ones payed/helped us the most. We then ordered THOSE drugs first, so that our personal out of pocket expenses were less.

    There is a lot of money to save out there if we just put research and strategy to the test! For us, ordering Kalydeco at the beginning of the year saves us thousands of dollars. Before Kalydeco, we weren't able to save as much, but it was still in the thousands!!

    Hope some of this helps. Good luck!! We've never lived in another state, but we love living in Texas!

  6. #16
    Super Moderator
    Join Date
    Mar 2012
    Posts
    2,034
    Hey CareBear,

    So does the insurance policy treat it as if you had paid the out of pocket for the amounts covered by the pharma companies? Does the pharma company send you a check? The pharmacy? If so, that's awesome and what a great job on your guys parts to be able to figure it out that way! If not, how does it work?

  7. #17
    Super Moderator
    Join Date
    Apr 2007
    Posts
    1,133
    Quote Originally Posted by CFcarebear View Post
    More copay assistance programs to add:

    TOBI: www.tobitime.com/info/co-pay-card-tobi.jsp
    Zenpep: www.Zenpep.com
    Cayston: www.cayston.com

    My husband and I live in Texas (he is the CFer) We have a High deductible, high out-of-pocket plan that pays 80/20. We have a deductible of $2,500 and an additional out of pocket max of $5,000. With this type of plan, we pay 100% until our $2,500 deductible is met. After that, the insurance company pays 80% and we pay 20% until the $5,000 out of pocket is met. So.......we are responsible for $7,500 total cost per year (of course, this doesn't include the cost of the premiums) There are lots of advantages to a high deductible/OOP plan:

    1.) It qualifies for an HSA (we contribute monthly so we have savings for OOP expenses)
    2.) The insurance company pays 100% after the deductible and OOP max are met.

    For us, we NEVER have to pay more than $500-$1000 out of pocket per year because we STRATEGIZE the order that we refill prescriptions. For example, my husband takes Kalydeco, so we order that Rx FIRST at the beginning of the new insurance year so that we can utilize the HUGE copay help that Vertex provides. Basically, by just ordering that drug first, Vertex will pay not only our deductible for us, but basically all of our OOP Max, too.

    I realize that many of you aren't taking Kalydeco. Before my husband started the drug in 2012, we still had a strategy when refilling all prescriptions. We analyzed every single copay/assistance program and figured out which ones payed/helped us the most. We then ordered THOSE drugs first, so that our personal out of pocket expenses were less.

    There is a lot of money to save out there if we just put research and strategy to the test! For us, ordering Kalydeco at the beginning of the year saves us thousands of dollars. Before Kalydeco, we weren't able to save as much, but it was still in the thousands!!

    Hope some of this helps. Good luck!! We've never lived in another state, but we love living in Texas!

    BINGO!! I thought I was the only one that did that. I did that for a couple years while we had our high deductible health plan, and it worked amazingly!
    At first I thought the HDHP was going to be terrible, but it turned out to be awesome. My husband just started a new job in March, and there was no HDHP option, so back to the PPO we went. It's been a rude awakening with all the copays. We'd already met our OOP max on our HDHP by March, so everything was free. Makes me sick to think we could have skated the rest of the year for free.

    Anyway, I'm not on Kalydeco, but it worked for me to call in my Cayston and Pulmozyme the beginning of January, and that met our deductible and put a big dent in our OOP max. The Cayston Access Program and CFPAF picked up the copays so we didn't pay any of our deductible. By March we had always met our OOP max, and paid very little out of our own pocket, so it was awesome.

    Aboveallislove, yes the insurance treats is as if you had paid it out of your own pocket. The insurance just pays their portion and then whatever they didn't pay they apply to your deductible/out-of-pocket max. After your insurance pays, the pharmacy bills the copay assistance program directly, and the assistance program pays the pharmacy.

    The assistancy programs definitely are amazing, I can't say enough about how they've helped me.

    Autumn 33 w/cf

  8. #18
    Dank
    Guest
    I'm reviving this post. When I was a kid, I lived in San Antonio for the summer and it was brutal. I'm contemplating moving down there again though because my brother lives down there and I'm falling on hard times and he might be able to get me an IT job down there. Do you guys know if the climate has any researched negative effects on CFrs? I was told in the past the humidity is really brutal for people with CF, I just have never seen any real data on it. Although this is one of my last options and I may have to do it anyways, it would be nice to know if I'm sacrificing my health in addition to all the other things I'm leaving behind, lol.. I'll ping the local cf nurses for an opinion as well - but figured I'd ask to see if anyone knew of this..

  9. #19
    Super Moderator
    Join Date
    Apr 2007
    Posts
    1,133
    Quote Originally Posted by Dank View Post
    I'm reviving this post. When I was a kid, I lived in San Antonio for the summer and it was brutal. I'm contemplating moving down there again though because my brother lives down there and I'm falling on hard times and he might be able to get me an IT job down there. Do you guys know if the climate has any researched negative effects on CFrs? I was told in the past the humidity is really brutal for people with CF, I just have never seen any real data on it. Although this is one of my last options and I may have to do it anyways, it would be nice to know if I'm sacrificing my health in addition to all the other things I'm leaving behind, lol.. I'll ping the local cf nurses for an opinion as well - but figured I'd ask to see if anyone knew of this..
    Hey Dank!

    I have been in SA for about a year and a half. Moved here from Nebraska. Last year was the first winter I made it through without needing IVs for as long as I can remember. I wondered if it was a coincidence or a result of the much less harsh fall/winter. Alas, I can't say the same this year as I'm almost 3 weeks into IVs with no improvement. Booo....

    As far as the heat/humidity, yes it is brutal. But for us, it's much like winter in Nebraska where we just stay inside for about 3-4 months. My husband has a theory that the humidity is better for me because it keeps my lungs moist. Not so sure about that theory.

    Anyway, I chose to go to the CF clinic in Austin after multiple reports that the clinic in SA is in shambles. When I moved here they had no director, we're looking for a nurse etc. My doctor in Austin did say that when SA center gets back on its feet they will start encouraging their SA patients to go back. Let me know if you want the contact info for my cf nurse.

    One AWESOME thing about the Austin clinic is that they have a grant program for cf patients that covers ALL of your clinic visits, xrays, lab, sputum cultures. So for example, if my share of my bill from an appointment is $535, they just bill that to the grant program and I don't pay a dime. This doesn't apply to hospitalizations, home IVs, etc, but you won't hear me complaining. Its amazing they have it at all and I wish other centers could follow suit to help CFs with huge financial burden of CF!

    Ironically my husband is in IT and we moved down here for a job. He is a Senior Systems Analyst.

    I've gotta run, but let me know if you have any follow up questions please. And good luck!! I hope you are feeling better too!!

    Autumn

  10. #20
    The Dot
    Guest
    While the humidity can be oppressive in parts of Texas, the dryer climate in West Texas is deadly for CF patients, so where you live in Texas definitely makes a difference. Austin tends to be rather humid and if you have respiratory allergies, they can get worse there because of all the Mountain Cedar.

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •