Insurance hassles

[LindaT5761]

I had a job with no health insurance. For primary care I go to a community health center, paying out of pocket on a sliding scale. My primary care doc referred me to Beth Israel neurology who provide a discount based on income. So I paid for a brain & lumbar MRI, EEG with VEP, plus 2 office visits using that discount.

Then I got frustrated with their neurological care due to too much time going by between appointments and not being able to reach anybody between them. So I went to the NYU MS Comprehensive Care Center.

I also bought the pre-existing condition health insurance, the NY Bridge Plan by GHI Emblem. It has paid for my appts at NYU.

At the beginning of April I had to admit that doing my job was wearing me out. Basically I was too tired to eat. So I left the job & applied for food stamps & Medicaid.

I'm still trying to find out whether I'll be able to use the
GHI to pay for the Tysabri infusion my neuro has referred me for, and I have to go to the Medicaid office to find out why I was never notified of a decision one way or the other.

Has anyone else had difficulties with health insurance?

[bulldogman]

If you have health insurance you have had some type of hassle with it. It is the nature of the beast. You need to understand your policy and work within your coverage.You would be surprised most people do not understand there insurance coverage. If can afford health insurance get the best coverage you can. If you left your job more than 30 days ago the GHI insurance will not cover your infusion. Most health insurance stays in effect for one month after you leave. You need to find out if you have been approved for Medicaid it should cover it. Good luck.

[heliotrope]

Am I reading this correctly - you've paid for your own health insurance, right? From the quick look I took at the site, you should be able to use it.
This is, unfortunately, really typical. Insurance will ignore you until you can't fight it, and social service offices are often overwhelmed.
You NEED to do something. You can't just let it sit, as tempting as I know that can be. Call your neuro's office, explain you can't get your meds approved. Explain that you need them to mediate. Call the insurance office. Get a copy of their policy on MS meds (I know with this kind of insurance it can be hard). Also, look in your area. See if there's a disability services offices/healthcare advocate in the local government. These are a great resource.
Good luck!

[LindaT5761]

GHI insurance

I did not have any insurance through my job. I paid for this myself.

[Lendi]

Call the tysabri folks. They should be able to help you out if your insurance doesn't. Plus, if I remember right, they checked on my insurance for me. They're nice and helpful people.

[LindaT5761]

follow up on ghi insurance hassles

Thanks to all who replied.

Far from letting it sit, I've been driving myself crazy calling these people daily. Heliotrope, after reading your post I left a message for my neuro, telling him that the infusion services supervisor promised someone would call me Mon & no one did, doctors are not supposed to have to worry about this sort of thing, but said "someone's not doing their job."

Also, he saw me there on 5/31, when the staff was behaving as though they were going to do the infusion. That seems like a sign that it would be covered. The only reason they didn't was because I couldn't say I never had TB because I've gotten some positive reactions on tine tests. He wanted me to have a chest x-ray to be on the safe side, & by the time that was finished, it was too late.

So now I have paid for another month of the insurance & have made another appointment for mon 6/13. I am going to proceed as though it's going to be covered. Worst case scenario, I'lll have it on another day.

(I hope)

[LindaT5761]

a new chapter

The end of that story was I had the Tysabri infusion on Monday, & the GHI insurance was fine. Now my next appt is for July 11.

The next chapter is finding out what the heck happened with my Medicaid application. I applied on April 7, & have never gotten a reply yes or no. I have to get to the bottom of this, as I cannot keep paying for this GHI insurance. I'm going to the Medicaid ofc on Thurs, determined to get to the bottom of it.

[Spydre]

One thing to keep in mind, in every state, unless you applying for FAMILY Medicaid, medicaid due to possible disability will take usually a minimum of 90 days to hear back from, because they have to go through your medical records. You can speed the process up some times by giving them your records, although it doesn't always speed it up, it just ensures that they'll see ALL the medical records, rather than relying on them to get medical records, which they may not get all of them, so their decision would be based on incomplete information.

[LindaT5761]

Spydre...

It may not have been clear when I applied, & maybe that's the reason for the delay. Or confusion. Or whatever.

Disability is the reason I'm not working, but when I was working I didn't have health insurance through my job, and neither does my husband. If we are eligible, and i think we are, he needs the coverage too. My daugher is ok, as she has Child Health Plus.

[mjan]

Yes I an identify with insurance frustrations. So sorry for all you are going through.

If you have a child, why aren't you added on to her T19?
And..if you are approved, it usually start coverage the 1st of the next month (once approved). BUT if they see you already have insurance it will go in as secondary which means the ins you paid for pays first and the balance is paid for by T19. But it sure sounds like you are low income enough to qualify for full T19. THATS if you were not working at time you applied. If your income changed in the meantime, you need to go to the T19 office in your area and update them. THEY can see in their computer where you stand in the process.

Whew.. its a nightmare..but worth it to have T19 pay for your medical care.

Hugs, Jan

[LindaT5761]

?

What is T19?

[LindaT5761]

I found out

Title 19, Wisconsin Medicaid.

[LindaT5761]

my trip to Medicaid office

bottom line: I was told the application was denied on 6/1 because the $400 a week my husband grosses (family of 3) was too much. I have never gotten a notification of this.

I should probably say a bunch of stuff about requesting a fair hearing and how it's hard to do that when you've never gotten a notification, which I know is against the law. But I'm tired. With these govt agencies the phone doesn't help you, you have to go there. But how can we do that when we have trouble getting around? Going there is a major ordeal. And we have to get used to a whole new way of doing things, since our old ways don't work anymore.

[heliotrope]

I hate to say it, but this is typical. If you have a copy of your denial, keep it though. You can use it to apply for aid from any hospitals you use.

[LindaT5761]

i don't have copy

I never received the notification they are required to send.