i just read a thread from katie belle and she said her insurance doesnt pay for any ra meds.
deanna's cant get hers to pay for a electric wheel chair.
how a bout we make this thread about insurance and drugs that they wont pay for or anything we need to get through life.
lets be specific, and name insurance companys and plans as well. (nothing personal)
then maybe i could flood the newspapers and tv stations with the information and see what we can do about this.
yes?
i think its a great idea Herold! Its time that that people know how many of us are out there that are inadaquilty being helped
Sure.
I can't get help because I am on the AZ state medical assistance program called AHCCCS. I had to go on that because I could not afford COBRA because there is only General Assistance (which I have been fighting for since September because they gave me the wrong form for my doctor to sign) that's only 4 a month once I get it while waiting for Social Security which will be repaid out of my SS so why is it so small? To get on this program, I had to get below 00 in total assets including cash. Literally, I had to be starving. I was saved by the United Food Bank which has a fee for donated food.
The specific medical plan I have is Mercy Care. My daughter has been on a couple of the others and they are worse.
The rules are:
The insurance will not pay for a electric wheelchair unless the doctor writes a script saying that I have upper body problems. In order to countradict his refusual to do this, I have to get a second opinion from another specialist. And, I can make another trip in to see him to appeal for it once more. I have asked my Rheumatologist and Orthopaeic surgeon to help me with this. I have no idea if they will.
Also, I cannot get a chair, period, if I need to use it to get out in the community. I must need it just to get through my house. So, I am restricted to the mobility of my house.
And, no one will help me with getting a chair lift. So, I can roll around my house, cannot leave my house because I can't get ramps. Can't use it out in public because heaven forbid that would be too much mobility. I cannot lift this chair in and out of my house or in and out of my car. But that makes no difference. They gave me a chair, so shut up already.
Plus, I was told the only way I could get more help is if I gave up my right to drive. If I had a chair, I wouldn't have to stand in lines that hurt too much to stand in. I would not have to sit in chairs that hurt my spine so bad. I wouldn't be afraid of falling. The tremors might not start in public which is so embarassing even though I try not to notice it. I can barely make it through my doctor's appointments. But that is not a valid reason to have an electric powered chair or a chair lift. No, I have to wait until I am graced with Social Security in some far distant future and can pay for it out of the luxurious amount of money they are going to give me that will keep me in a state of poverty for the rest of my life.
To get ramps from my insurance, I have to need full time nursing care. What, is this so the nurse doesn't have to strain themselves pushing my chair? How are the two even related?
I am getting ramps in a couple of weeks or so through the Mesa Senior Citizen center. They are getting me a shower seat, possibly bathroom bars and will do a safety inspection. But I don't qualify for many of their programs because I am only 49. I am disabled, not a Senior. They are trying to get me a case worker from Jewish Family Services.
This in counter to the fact that I cannot get an Occupational Therapist because I am over the age of 21. If I got Occupational Therapy, I might be able to take care of myself better, learn to do things in spite of my disability and maybe, maybe start to function well enough to get off disability again. But heh, they'd rather keep me like this and feed me pain killers the rest of my life.
I cannot get the blood pressure medicine that I've been on for three years now because they want my doctor to go through the process of trying cheaper ones first. And, they are perfectly content for me to have no medicine in the meantime. It has taken over two months to get to this point.
I have requested a Case Manager from my insurance four times now. Yesterday, they had no record of my requests and because I couldn't name names, they are treating it as my never making a request. Then, I was told the only people who can get Case Manager's are the terminally ill. This is an out and out lie. Supposedly a new application has been put in. But I won't be notified unless one is assigned. I will not get a call stating I am refused. No, I cannot speak to that department until I am declined which will be in about 5 business days. This is after asking for the Supervisor and then the Supervisor's boss.
I did get help from EMPACT, one of the local crisis numbers. They brought me food, let me cry and gave me phone numbers to call. However, no one still has ever offered me any relief from the depression. I'm crying all the time now because of the sheer frustration and constant humilation.
I did get help from the Mesa Community Action Network. They paid one utility bill and bought me a new water heater when mine decided to flood out. I am very grateful to them. But I can only get one time help, once a year from them.
I have written letters to both the Senator and Governor of my state. I have heard nothing. I sent an email to the local news station. Nada.
I'm not experiencing the magic of Christmas here.
I have aplastic anemia and my shoulder problems because my former Rheumatologist, Dr. Ralph Bennett, listed in Phoenix Magazine as the best Rheumatologist in Phoenix, overlooked both problems. Because of the anemia, my optic nerve may be damaged. Yet, he is a good Rheumatologist. He has, for the most part, given me excellent care. He wasn't paying attention though this last year and it could have killed me.
And, his doctor's group, though most very nice to deal with, takes weeks to do the disabiltiy paperwork. And, I have to pay for each disabilty form they sign except for Social Security who legally prevents them from doing so. My new Primary has posted all over their office that it's a charge up front for any paperwork that they do. Does that leave you with warm fuzzies?
LabCorps is the one that did the bloodwork for my Rheumatologist. I got the work done over a month ago and they did not have it his hands for my appointment. This is when he said that I could drop dead in two weeks if he didn't get me off the MTX. The bloodwork was almost identical to the last that my previous Rheumatologist had done back in June/July.
I had to wait through over two months with no medical care. I have waited over six months to get with the surgeon for surgery I was told needed to be done immediately.
I have been having MS symptoms from the beginning. There has been no follow through. I am still not being treated for it except for a medicine to help the tremors.
I couldn't get Remicade previously because my insurance, Strategic Resouce, had a 00 copay. I couldn't get it through the Patient Assistance program because I got a slight raise. That was the one medication that I felt helped me. Now, I can no longer take any biologics because my immune system is too damaged.
My LTD disabiltiy company, Genworth, is trying to go through every loop hole that they can find not to give me LTD. Obvisously, they cannot deny me on medical basis. So, they have started the strategy of asking for random pieces of documentation. This gives them another 4-6 weeks to make a determination.
I have not been silent. I have spent since the beginning of August, an average of 4 hours a day on the phone trying to resolve these problems. I have filled out dozens of applications. I have begged for help.
I have to use food stamps and still must go to the food bank. I was going to try them for a Thanksgiving turkey. But guess what, I couldn't stand in the line. Besides, there were so many families that so obviously needed them. All those kids needed those turkeys.
I applied for Arizona Long Term Care (ALTCs). I wanted help with with mopping my floors and cleaning my bathroom and help with the durable medical goods. I was told by another organization that the only way one can get help is if you have had multiple falls and multiple hospitalizations. Is that crazy or what? I have to risk a broken hip so I can get a minimum of care? What I was told is that because I am lucid (know my own name and address), can go to the bathroom by myself and not a senior, I don't qualify. This is after having to once again expose all my financial and personal information. Oh, but I can apply again with I have knee surgery. Surely, I'll qualify then. But I have to give them a new bank statement while I am in the hospital. Or, I can reapply and fake my condition because when they came out before I was having a relative good day, as in I could move. This was before the wheelchair.
This is so insane. Please tell me when this nightmare is over with.
Oh, and get this, because one can fill out their own SS paperwork, they are considered able to hold a desk job. So the fact that I can write this and advocate for myself (certainly no one else is going to do it) probably means in the eyes of SS, I can hold down a job.
Yes, I am upset. I'm tired. I just want to be a human being again.
keep them coming. we'll build a list, the more the better.
thanks deanna for all the details.
i don't even know what my medical will/won't pay for yet.
guess i'll find out, soon.
I'm too tired to write tonight but I do have something to add. I want to get this to the top. I'll write tomorrow.
Kathy
I was on my insurance company for many years through my husband's work (Medica). When he retired and then af ter he died, I stayed with Medica for several years through cobra. Last Feb 2006 I HAD to go on Medicare because I've been on SSDI for 2 years. I've never had Medicaid. When I went on Medicare I HAD to buy a medicare supplement different from what I had with Medica, but I stayed with Medica, changing plans and group numbers. My doctors and my hospital were from the Mayo health systems - one of their satellites in southern MN.
In March 06 Medica and Mayo health centers parted ways, each blaming the other. The problem - Mayo would not accept what Medicare offers per procedure and Medica would not pay more than Medicare offers. Medica says Mayo wants their regular customers, but not their Medicare clients as Medicare sets the price.
I was supposed to have gotten a letter from Medica telling me I had to change doctors and hospitals, but I never got it because I had changed groups numbers in Feb. They admit that. When I realized that they were not paying anyone it was like August, and they said it was because my doctors were using the old cobra number. It was Oct. when I realized what the real deal was and they were not paying since my group number changed in Feb.!!
Changing hospitals is impossible. Any other small hospital around here would immediately send me to the Mayo hospital because I have a difficult bleeding problem. If I changed doctors, any other doctor around here would want to use the Mayo hospital.
I had a fit - called everyone, finally called my nephew who is a VP at Medica, and they finally agreed to pay through Dec. 06, but then I would have to change doctors and hospitals or insurance plans. I signed with a different company yesterday who had to take me because I turn 65 next Monday (yes, Christmas Day!) and I have open enrollment.
What I've discovered is the prejudice against Medicare clients and it is not likely to get better. I think Medica deceived me when they sold me the medicare supplementi in Feb. Surely, they knew before February that they were parting ways with Mayo since they supposedly sent me a letter in March. They certainly knew I was using Mayo docs because they were paying for them previously!
Hope this helps the cause! Kathy
The big problem is had was that I enrolled inn the Medica supplement plan in eb. Didn't get the letter in March. Then I used my doctors and hospital services from Feb. through Oct. before I realized they weren't paying and ran up a lot of bills. Theyu are finally paying now.That is awful Kathy. But a lot of doctors here will not take Medicaid patients. When I was forced on to Medicaid, I had to change not only doctors but medications because they are not on their formularies. Doctors absolutely hate them. Also, since they don't get paid as much for Medicaid patients, they will not spend the time necessary. They rush you through as fast as possible like you were in a really good express line. That's just not something you can afford to have happen with this illness.