Workers' Compensation Discussion Forums

We are drowninin medical. This month it will cost us $300 more than our total income. Hubby has medicare plus a supplemental and I have my insurance through my employer that costs me $450 a month. Hubby's is only $90/ It's the copays. Most of our meds there isn't a generic for so right now it's costing us roughly $500 a month is prescription copays, not to mention Dr.s and the premium themselves. The plan we chose for Hubby is the only one his PCP and oncologist accepts. I don't understand this Gap thing with prescriptions and am so afraid we are really going to end up in trouble. I know you can't have two plans so that kills that idea. Hubby has to have an endoscopy done on Tuesday to see how extensive the radiation scars are. The Gasrto's office already warned him that it will cost him $$$$$ out of pocket. We don't know what to do. I am grateful that we have coverage but at times it feels as if we don't. Any ideas?

Capricorn

Cap

I don't know -- but have you looked at different prescription plans the are offered to those of medicare. My understanding is that your prescription plan can be different than the medicare plan. Something to check into -- not all plans have the gap formula from what I have heard -- but then again - we have insurance so we don't have these out of the pocket expenses other than the co-pays.

Also if your hubby has already met his $100/$600 for medical and hospitalization - then medicare should be paying 80% of the bill after they write down to the agreed amount. Just like with regular insurance you shouldn't have to pay over that amount. I know with my uncle they send him a statement after they pay a bill showing how much he owes on the bill and also his doctor doesn't charge him until they get paid by SS.

Cap, Is your hubby retirement age?. If not and on Medicare, he may be able to apply for Medicaid and drop his supplement and what Medicare doe's not cover Medicaid will, copays, scripts etc. > Worth a try. Even if retirement age and on Medicare may be able to apply for Medicaid if his SS benifits meet certain quidelines.

What most people forget is that Medicaid is a federal program administered by each state. You can usually check each states Medicaid program by going online. Here in Illinois it is Ilgov.com I will see what I can find for you.

sorry to hear this cap and thats why i dont do more for my self and i cant get insurance no one will have me,they wont even through out a big payment they just say no.wish you well.

Don't be afraid to negotiate prices with your health care provider. It can be done, although people are reluctant to do so, or are not aware you can do it.

I knew a man who, after surviving cancer, became a medical consultant, and worked to negotiate medical bills for clients. Because of his cancer he was required to get an MRI annually. His physician wanted to send him to a center that charged $1500 per scan. He found another one willing to do it for $700.

A few years back my sister had a work related injury, and she hassled with the insuror for 2 years before settling. It was a medical only settlement that, after attorneys fees, would pay most of the surgery she needed, but was not enough to pay physical therapy. I told her to ask the surgeon to cut his fee, using the fact that she was going to pay cash (bypassing insurance paperwork). He cut his fee by half ($6000), and she had enough to cover all of the therapy she needed.

Just a thought....

Angel that is a great thought, but the last time I worked in PA where cap lives medicaid would only provide coverage for medications in long term care if the client could show that he or she had less than $2,700.00 in assets. Assets included cars, insurance policies, home equity, or anything of value including jewery, home appliances and so forth. It all had to be declared to make a final decision about acceptance into the program. The last time I helped a family complete a application for coverage (as the administrator in a long term care facility) in PA was in 2002 so it may have changed somewhat. The last time I helped a familly wiht this process in NJ was in 2004 and NJ amount was $2,500.00 or less. The only exemption in both situations was if the client had a policy or had paid for their funeral expenses. They did not have to include this into the tally sheet.

Cap, this is so hard for so many people. Medical care is an outrage in my mind. We gave the banks enough to help people which they are not doing which would have solved medical issues for our entire population for a long time. Again, I have always said that I feel that medical care is a right, and I would agree that their is a responsibility that goes a long with it, but people have a right to feel healthy and feel safe in this country. I wish it were differnt but it is not. I don't know of any other sources unless you contact the pharmacy that Montell Williams advertising about.. I really don't know much about it. I like Admin's idea. I do know that as a healthcare organization we negotiated often with cost from distributors and pharmacies. The docs worked as contractors and did their own billing so I am not sure about negotiations with all of that... admin had some excellent points. I think I would give that a try. Always remember also, that doc's have what we call a "good boys club" which simply means they become friends with different docs and services and use them exclusively and vice a versa. Always know what the other options are that your insurances will pay for versus just where your doctor wants to send you. A lot of people do not know that they have the right to choose who what and where in health care. Another place where your hospital bills will soar out of control and it is unneccessary is that you can stipulate in writing when you sign into a hospital that no doc services can be given without your consent in writing. Also, if they bill you for such services that you have not approved, they must show in writing why it was necessary for your health, and most often doc's don't do this...so you have a loop hole there. Recently when I was in the hospital, I told the hospital that they must send me to the VA. They kept saying that they would just bill my medicare coverage. I don't have B, it is not neccessary due to my coverage with the VA. I wrote my request to be transferred to the VA on my sign in papers. This civilian hospital did not send me, and after discharge I got this BIG bill which was what was left over from what medicare A paid. I called them and explained that they were not authorized to bill Medicare A and that they were told and that I wrote it down that they were to bill the VAMC in Philadelphia. They didn't do it and kept harrassaring me. I finally went to the VA to find out how to handle this. The VA told me to bring the BIlls to them. I did, the long and the short of it was, that the hospital had to pay the what Medicare A had paid them, which was around $32,000.00 and they had to by law except what the VA would pay them which was $6,772.00. Also they were informed in writing that they could not bill the vet, me. THe reason the VA did not pay more was because they requested all the medical and financial records and found that I put in writing to be transferred. The VA would not pay after I was documented to be stable becasue they were suppose to by law to transport to the VA. They failed to do it, and I am free of all charges. THe amounts I gave you did not include all the labs, xrays, psychiatry, and other physician bills. I didn't have medicare b so that was all on me until the VA stepped in and rescured me. The long and the short of this story is that you have rights to document what they can and can't do. Also if they charge you for any thing such as tooth paste, etc, they must beable to prove this in writing and as I am sure Tuffy will tell you nurses are not really good in documenting these charges either so they can't get the money from you. Good luck in this. It is really a difficult situation. Love Red

Admin


That is good information to know.

Two years ago I went thru extensive testing for cancer of the spine.
After my health insurance paid their part I owed $7.500.00 (the testing I received was for the diagnosis only)

I can hardly wait for the bills to come in for the skin cancer surgery!

Several years ago my daughter needed leg braces and after the insurance paid their share I would owe $3,000.00. I told the owner of the business that I could not afford the braces and my daughter would have to go without leg braces.

After talking to the owner he realized he had gone to school with my older sister.
The next day the owner called me at home and told me he would accept the amount the insurance company paid and would write off the remaining amount.

Medicaid as I said before is a federal program, Google PA Medicaid and there are many sights that come up. It is administered by the state. They go by your income or dissability, and do not include your home, They will include a car if it is over so much. They also go by a single person or a couple..........

Try this site http://www.compass.state.pa.us

or this one http://www.cms.hhs.gov/home/medicaid.asp