Medicaid/Payments/Cancer Coverage Question

TracyLynn72

I'm trying to figure this out and thought maybe some of you could help me. I was diagnosed this past February with MEC and had applied for Medicaid in January since we already knew there was a tumor there and the doctors "had a strong feeling" it was cancer.  I fought and applied and provided paperwork from January to June and finally got my card in July.  They did go back and cover me from February on.  Question is...they have already dropped me.  I had coverage from February to the end of September.  Now, I am VERY grateful they helped with all of the big expenses...surgeries, radiation, etc.. but I had coverage for 8 months total.  Two friends of mine have just been diagnosed with breast cancer and I was helping them figure out the Medicaid paperwork.  They both were approved within 2 weeks and were given a guaranteed year of coverage.  Why is that?  I called Medicaid and they said that breast cancer had a one year coverage but "other cancers" did not.  I'm confused.  Cancer is cancer.  I still have follow ups, scans, appointments, etc.. to take care of. Since I did the rads and they deem me "clear margins" then Medicaid has dropped all coverage.  They also told me I'd have an $18K deductible once they finished paying what they would pay.

 

Why is H&N cancer treated so differently?  Already we have so many teeth issues to deal with (that aren't covered AT ALL).  I'm about $3k out of pocket on my teeth already and more to go. Don't get me wrong..I am very thankful for all of the blessings and help we've gotten, I'm just frustrated with the responses I keep getting.  

phrannie51

My guess would be that

because it's money given by the government, ....there is probably a different length of time for coverage given for all cancers, abritrarily doled out by non-medical personnel.  The answer to "why" when dealing with the government is usually "because", with no real answer to the question.  

Have you given the new Obamacare stuff a try, yet?  It won't get you covered until the 1st of January, but at least we're only a couple months away from that now, and it might offer a way to get covered for the down the road check ups and stuff.

p

meaganb

I don't have  any insight,

I don't have  any insight, but it certainly seems a but unfair. We were very blessed because the insurance we had through my husvand-s job is amazing. We have a deductible of a little over 3K and then we pay 10% up to a max of 5K I think. That will be increasing this year because of Obamacare but we are still very lucky. We also have the ability to put money in a HSA which means deductibles don't come out of our monthly budget.  I wonder if Medicaid will cover breast reconstruction for your friends if they need it? I think that is a very important step for a lit of women to feel better about themselves after breast cancer. But my point is that having your teeth healthy & functioning is also very important & could actually present even more health problems.  We also have very good dental coverage (although I think that may change in the new year too) but I have often wondered why dental coverage is typically so expensive & not covered under major medical insurance since most dentists would agree that oral health is linked to overal health.

Tracey, I really don't know why H&N cancers are treated differently, but I have heard so many times there is a huge disparity in how more "spot-lighted" cancers are treated. Maybe there is more awareness & therefore more pressure on the insurance companies to cover more?

I hope you're able to find some help to cover any costs that come up related to treatment!

katenorwood

hello TracyLynn !

This subject pops up more than I can bare !  You sound like you were put on a spend down because of household income ?  But I don't understand their reasoning for the 8 month rule ?  Makes no sense.  You always have the opportunity to appeal their descision. 

Also contact your providers.  Alot of times if you explain your situation and show your household bills and income they will help with past bills.  (meaning their billing dept.)  On the dental issues...wow unless you have great dental insurance, most of this was out of pocket for me.

I too am saddened that H/N dx's are kind of floating amist a sea of other more public (in your face) dx's.  Maybe we as a whole need to make a bit of noise to get people's attention for knowledge and funding also.  Hugs sent !  Katie 

denistd

katenorwood said:

hello TracyLynn !

This subject pops up more than I can bare !  You sound like you were put on a spend down because of household income ?  But I don't understand their reasoning for the 8 month rule ?  Makes no sense.  You always have the opportunity to appeal their descision. 

Also contact your providers.  Alot of times if you explain your situation and show your household bills and income they will help with past bills.  (meaning their billing dept.)  On the dental issues...wow unless you have great dental insurance, most of this was out of pocket for me.

I too am saddened that H/N dx's are kind of floating amist a sea of other more public (in your face) dx's.  Maybe we as a whole need to make a bit of noise to get people's attention for knowledge and funding also.  Hugs sent !  Katie 

bills

HI Tracy, unfortunately a lot of us were put in the position of having to spend our life savings on treatment and bills. Phrannie mentioned Obamacare, you should as soon as they can get their act together apply for this and the subsidies. It will not be the panacea that Obama said it would be, you will have a large deductible and dental will still be uncovered. As Katie said, appeal to your providers, a lot are very sympathetic and will help. Reapply for medicaid and any local help there is, in  York here we have something called the Healthy York Network, it is a consorteum of local doctors and clinics/hospitals that dole out cutrate and free sevices, also try the ACS. Denis

PJ47

Tracy Lynn, What State are you in?

I am a suddenly retired LCSW due to the SCC, but have a couple of suggestions.  First, I would write or speak in person to your local Congressman and see if he/she can put some pressure on DSS or at least look into why there is such a disparity.  I do think that Breast Cancer has much more clout and awareness as does HIV/Aids and that is how things get changed.  Actually, the Aids epidemic and the radical protests caused many changes such as drugs not yet approved by the FDA were given to patients, Medicare allowed an expedited process for Social Security Disability determinations and retrovirus drugs were discovered fairly quickly.  A lot of this was due to the incredible pressure by advocates, patients and the media.  Breast Cancer patients were often denied life saving drugs not yet approved by the FDA after the Aids epidemic, until they banded together and protested and got the media behind them.  So, where does that leave us?  We need to be heard and be active as a group.  

One other footnote;  Medicare began to cover dialysis due to a Congressman  having a family member with renal failure!  There surely must be someone in Congress with a family member with head and neck cancer.  That person would be sympathetic and perhaps be your hero.

Each state has Mediciad Federal guidelines, but since a lot of the money comes from the state budget, then each state may have different ways of managing the Medicaid funds.  Remember Oregon would not cover some illnesses.  I  am quite sure there is an appeals process if they have denied you Medicaid so do not give up and so appeal it.  It does sound like you have a spend down, and the idea of going to the providers although tedious is a good one.  My dentist has given me free flouride treatments and 1/2 price cleanings since learning about my cancer.  A lot of good physicians and people want to help, but you may have to go to them directly and not their "gate keepers".

Best of luck to you, PJ

TracyLynn72

No real answers

First, I'm in NC.  I've tried to talk to my case worker but she doesn't really seem to know very much.

 

I was told "Well, you don't have the one year coverage because you didn't/don't have breast cancer.  THAT one is much more serious and could be fatal"   Ummm...really?  There are non-dangerous, non-fatal types of cancer?  H&N cancer is safe?

 

Very aggravating. 

katenorwood

TracyLynn72 said:

No real answers

First, I'm in NC.  I've tried to talk to my case worker but she doesn't really seem to know very much.

 

I was told "Well, you don't have the one year coverage because you didn't/don't have breast cancer.  THAT one is much more serious and could be fatal"   Ummm...really?  There are non-dangerous, non-fatal types of cancer?  H&N cancer is safe?

 

Very aggravating. 

Don't give up !

Alot of times coverage can be based on what your onc's are writing up in their reports.  Have they given you clearance that you are no longer in tx's and have given you a clean bill of health ?  Which is unlikely.  Ask what they're basing this on !  YES what's up with one dx is more deadly than another....get real.  I would ask to speak to your workers supervisor.  This in no way is disrespecting your worker.  But may help you understand their position on coverage.  Continue to ask any and all questions until you are satisfied with the responses.  Hugs sent Katie 

jackflash22

PJ47 said:

Tracy Lynn, What State are you in?

I am a suddenly retired LCSW due to the SCC, but have a couple of suggestions.  First, I would write or speak in person to your local Congressman and see if he/she can put some pressure on DSS or at least look into why there is such a disparity.  I do think that Breast Cancer has much more clout and awareness as does HIV/Aids and that is how things get changed.  Actually, the Aids epidemic and the radical protests caused many changes such as drugs not yet approved by the FDA were given to patients, Medicare allowed an expedited process for Social Security Disability determinations and retrovirus drugs were discovered fairly quickly.  A lot of this was due to the incredible pressure by advocates, patients and the media.  Breast Cancer patients were often denied life saving drugs not yet approved by the FDA after the Aids epidemic, until they banded together and protested and got the media behind them.  So, where does that leave us?  We need to be heard and be active as a group.  

One other footnote;  Medicare began to cover dialysis due to a Congressman  having a family member with renal failure!  There surely must be someone in Congress with a family member with head and neck cancer.  That person would be sympathetic and perhaps be your hero.

Each state has Mediciad Federal guidelines, but since a lot of the money comes from the state budget, then each state may have different ways of managing the Medicaid funds.  Remember Oregon would not cover some illnesses.  I  am quite sure there is an appeals process if they have denied you Medicaid so do not give up and so appeal it.  It does sound like you have a spend down, and the idea of going to the providers although tedious is a good one.  My dentist has given me free flouride treatments and 1/2 price cleanings since learning about my cancer.  A lot of good physicians and people want to help, but you may have to go to them directly and not their "gate keepers".

Best of luck to you, PJ

Micheal Douglas

Had tongue and node cancer two years ago, he was doing a programme on uk tv promoting the disease, his took 9 months to diagnose, maybe he,d be a good ambassador to contact.

jackflash22

PJ47 said:

Tracy Lynn, What State are you in?

I am a suddenly retired LCSW due to the SCC, but have a couple of suggestions.  First, I would write or speak in person to your local Congressman and see if he/she can put some pressure on DSS or at least look into why there is such a disparity.  I do think that Breast Cancer has much more clout and awareness as does HIV/Aids and that is how things get changed.  Actually, the Aids epidemic and the radical protests caused many changes such as drugs not yet approved by the FDA were given to patients, Medicare allowed an expedited process for Social Security Disability determinations and retrovirus drugs were discovered fairly quickly.  A lot of this was due to the incredible pressure by advocates, patients and the media.  Breast Cancer patients were often denied life saving drugs not yet approved by the FDA after the Aids epidemic, until they banded together and protested and got the media behind them.  So, where does that leave us?  We need to be heard and be active as a group.  

One other footnote;  Medicare began to cover dialysis due to a Congressman  having a family member with renal failure!  There surely must be someone in Congress with a family member with head and neck cancer.  That person would be sympathetic and perhaps be your hero.

Each state has Mediciad Federal guidelines, but since a lot of the money comes from the state budget, then each state may have different ways of managing the Medicaid funds.  Remember Oregon would not cover some illnesses.  I  am quite sure there is an appeals process if they have denied you Medicaid so do not give up and so appeal it.  It does sound like you have a spend down, and the idea of going to the providers although tedious is a good one.  My dentist has given me free flouride treatments and 1/2 price cleanings since learning about my cancer.  A lot of good physicians and people want to help, but you may have to go to them directly and not their "gate keepers".

Best of luck to you, PJ

Micheal Douglas

Had tongue and node cancer two years ago, he was doing a programme on uk tv promoting the disease, his took 9 months to diagnose, maybe he,d be a good ambassador to contact.

PJ47

Tracy Lynn, Take Heart

The case worker you have is uninformed (aka clueless) so make it your mission to show her some stats and go to meet with her supervisor.  I am also in North Kackey Lackey.  This state also does not recognize Autism as an illness either and therefore insurance companies such as Aetna have not had to pay for testing and treatment for children in NC.  This is why things have to change on a National level so that uniformity and fairness prevails.  Hope I live to see that.  Keep your chin up,  PJ

TracyLynn72

PJ47 said:

Tracy Lynn, Take Heart

The case worker you have is uninformed (aka clueless) so make it your mission to show her some stats and go to meet with her supervisor.  I am also in North Kackey Lackey.  This state also does not recognize Autism as an illness either and therefore insurance companies such as Aetna have not had to pay for testing and treatment for children in NC.  This is why things have to change on a National level so that uniformity and fairness prevails.  Hope I live to see that.  Keep your chin up,  PJ

Thank you all!

NC has some serious problems when it comes to things like this!  I'm on my 4th caseworker simply because 2 of the first ones didn't know "what to do with me"  because they really didn't understand "what kind of cancer I had".  Well..cancer is cancer.  It's ALL serious.  It's ALL lifechanging.  It's ALL expensive.  I'm keeping on them.  Calling every other day.  I had to get tough on them to even get coverage, and now I guess I have to be a loud mouth to get it back  Good thing I've healed up enough to talk enough to be the squeaky wheel! haha