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buddhabelly
08-08-2006, 07:32 AM
I do have health insurance, but, after seeing all my medical bills piling up, I discovered my insurance doesn't cover most of it. Does anyone else have this problem? Thank goodness I don't have to see my doctor anytime soon. I used to see them every month. :shock: Lupus can be very expensive with all the bloodtests, urine tests, different doctors to see... :crazyeyes: Medicines to take... The doctors that I have now: a rheumie and a nephrologist were referred to by my primary MD(who's covered under my insurance-thank goodness). Should I change my dr's to ones who take my insurance? At least the office visits will be covered? Right? How about all the tests? Need some advice from you guys. Because I'm realizing that I can't afford this illness anymore. :cry:

browneyedgirl53
08-08-2006, 11:52 AM
Hi BuddhaBelly,

ABSOLUTELY.....is my answer to changing doctors that accept your insurance. I fully understand what you mean about medical bills; I have a rheumatologist, nephrologist, cardiologist, pulmonary, speech therapy, cognitive therapy....and physical therapy. I am on a weekly basis with all of them! So take heart, and understand this; please don't compromise your health to save a few dollars !! You are precious to so many....and the bills will be paid in time. After having been in the hospital 4 times this past year, I threw my hands up and I decided that it's not worth getting all stressed out over; so I do what I can and know that I'm doing the best I can every day.

STRESS is the single worst thing for lupus.....next to sun and everything else (smile); Do as much as you can do for yourself, and accept that paying these bills, meds, etc., is like having to pay the electric bill, or mortgage....it's a necessity!

So I'm glad you felt like you could vent, do you feel better now ? (smile)

Take Care
Browneyedgirl

p.s. I'm signing off for now - my CRP is at 7.5 today - feelin' pretty bad today - so I'm off for a nap!! Talk to you soon. Cheer up BuddhaBaby, you are loved !!

MARYCAIN
08-08-2006, 12:50 PM
If you have insurance, the company has to tell you why a specific service or bill isn't covered. With a lot of insurers, you can only use doctors within their specific network, so it pays to check beforehand. Many companies have websites which list participating providers. If you need to see a particular specialist who isn't in your network, try contacting your insurance company for permission to go out of network. I have done this several times because there are few specialists in my area.

If you have a very serious or chronic condition, many insurance companies have case managers they will assign to work directly with you to coordinate your medical care. This can be good because you can deal with one person, who may be willing to work the system on your behalf. If a bill was denied that you think should have been paid, appeal! Don't be afraid to ask your doctor's billing office for help - they have a vested interest in getting your insurance to pay up.

As for hospital bills, most hospitals have financial assistance programs you may qualify for , so be sure to ask. Most hospital social workers are very knowledgeable about what kind of help might be available. If you are having problems getting your meds, check out the Parternership for Prescription Assistance website - you may be able to get meds free or much cheaper. I know how stressful the medicals bills can be - my last hospitalization was almost four months long, with 2 weeks in ICU. i stopped worrying about the totals a long time ago, if I ever sat down and totalled up all my bills from the past six years, I'd probably have a heart attack. Do the best you can, and try to find as much help as possible.

pinkjmf
08-08-2006, 12:55 PM
I understand all to well. We had insurance up until last Dec. when my husband was no longer needed at his employer. Now we have nothing, it all costs so much. Thank goodness that my Rheumy gives me some samples. Rx's is what can get you, thank God for generic meds. and he gives me a 20% discount. Blood work is what costs so much, so if he does have to take blood I usually have to pay that out.
If insurance didn't cost so much for our family, it is about the same as our house payment for a family of five.
Good luck and I hope that you will find what is best for you.

MARYCAIN
08-08-2006, 01:34 PM
COPIED FROM THEIR WEBSITE - PPARx.org - or call 1-888-4PPA-NOW - YOU MIGHT BE ABLE TO GET AT LEAST SOME OF YOUR MEDS FREE. THIS IS A LEGIT ORGANIZATION AND DEFINITELY WORTH CHECKING IN TO.


The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them. Many will get them free or nearly free. Among the organizations collaborating on this program are the American Academy of Family Physicians, the American Autoimmune Related Diseases Association, the Lupus Foundation of America, the NAACP, the National Alliance for Hispanic Health and the National Medical Association. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

pinkjmf
08-08-2006, 01:46 PM
I looked this up once and I thought it was for people over 50. I'm 36, I have checked into the merck program but my doctor said there wasn't anything that was being offered free that I could take that was on their medicine list. I was hoping that plaquenil was on some program but when I looked it up it is a med.from France ???? and I didn"t see any discount meds. on that website.
Thanks for thinking of me .

MARYCAIN
08-08-2006, 02:29 PM
There my be some specific programs that have an age requirement, but I get several of my meds and started at age 38. So it's worth making the call to see if you're eligible.

buddhabelly
08-08-2006, 03:11 PM
Thanks for all the helpful replies. I'm trying not to stress myself out with all the medical bills. Thank goodness, my insurance covers my medication, at least. :) But everything else like the bloodtests, my kidney biopsy, urine tests, wasn't covered at all. Is there health insurace that covers these tests?? :( I have a dermatologist, rheumatologist, and a nephrologist. My derma is in my insurance plan, but the other two arent. I'm not sure how my insurance works, but, if I find specialist dr's listed in my network, will I only have to pay for my copay? Because right now, my rheumie isn't in my network, and his office is giving me a discount because of it, I pay for the office visit each time I go. Still costs a lot of $$.

Gosh, I apologize for all my questions. I need all the help I can get. Thanks again for the replies. I really appreciate it. :wink:

MARYCAIN
08-08-2006, 04:57 PM
If your insurance is through your job, the benefits manager at your employer should have a members' handbook or manual that lists all covered services. If you buy your insurance directly, call the company and ask for a list of covered services and any exclusions (things your insurance won't cover). Most insurance companies will cover laboratory tests like blood tests if they are ordered by a doctor who's in your network. If the doctor is out of network, many companies won't pay for tests ordered by that doctor. Your insurance company may also want you to use a specific lab for tests.

If you have to use a specialist who is out of network, get your network doc to order the tests and send copies to the other docs. That way the insurance should pay. If you use a specialist who is in network, you should only have to pay the co-pay amount. Be aware the specialist co-pay is usually higher. Also, many insurers have strict policies about seeing specialists. You may need a referral from your PCP, and there may be a limit on how often you can see a particular specialist. Just be sure you know your particular insurer's rules.

If the kind of specialist you need isn't available in your network, the insurer will generally let you go to the nearest available specialist regardless of network, but you do have to get permission from the insurance company in advance.

Remember you always have the right to appeal any decision by the insurance company about your coverage. Most insurance companies have a person called an ombudsman whose job is to resolve complaints. If a number of your claims have been denied and you don't know why, this is the person to contact. If you think you have been treated illegally or unfairly, contact your state insurance commission for help. All states have statutes and regulations about how insurance companies do business - and those laws are to protect you.

I guess the main thing is don't be afraid to ask questions and demand answers. If you have been hospitalized, or had a number of tests done, always ask for an itemized bill and review it to make sure you weren't charged for things you never got. On my last hospital bill, I was charged over $1,000 for I.V. gentamycin, which I know wasn't mine because I'm extremely allergic to it, and it's on
my medical records, so the hospital had to delete the charge. Stuff like that happens all the time, so you have to be careful to check your bills.

Hope this helped - sorry it was so long!

buddhabelly
08-09-2006, 04:55 PM
Thanks for the helpful info, MaryCain. :) First thing I will do is do research on finding new doctors who are in my network.

Beauchick
08-10-2006, 08:54 AM
I don't have insurance and running out of money. My husband and I both are self employed. I tried to get an individual policy before I was dx w/sle and was told that I was too fat to cover under a "normal" policy...I would have to go with $600.00 a month, a $5000.00 deductable, no vision or dental. Well at that time I was only going to my gyn every 3 months for my depo inj. and he was giving me a discount. By the way, at the time I was only 30 yrs old and that price did not include my husband. Well last year when I was dx w/ sle I tried again. They told me that they would not touch anything involving my lupus for 12 months and my premium would be $800.00 a month with a 30% increase every year around my birthday. Then I was told that there was a possibility that they would drop me at the time they were to start covering the sle. 2 other companies told me that lupus automatically excluded me from coverage. Since being dx, I've had a $3000.00 MRI, one set of blood test cost $1200.00, chest x-rays, hip x-rays, an ultra sound of my thyroid, etc. I see my Rhume every 6 weeks and get blood work done every six weeks. I'm on 6 different meds and start methotrexate as soon as I get rid of my bladder infection and bronchitis. By the way, the thyroid ultra sound showed problems so now I have to get a 2 day radiation test done to see if I have cancer. I have not worked in 3 months because of the "tooth ache" I have that runs down my back and my hip. It interfers with driving (I'm a real estate agent) and sitting and standing too long. Not to mention my increased problems with concentration and memory. I cost my husband a $1000.00 last week because I messed up a bid on one of his jobs....I have been bidding his jobs for the last 10 years and use to be able to do it with my eyes closed. I find amazing the things that you would consider second nature now requires the attention as if it was something you have never done before. I feel that I am starting to loose the confidence in my ablilities that have gotten me where I am today. Being able to represent someone in a real estate transaction requires you to sell yourself and you do that by exeuding confidence and ability. I also manage my husband flooring business and get new contracts for him...the same thing applies. He has had his business for 10 years now and we have never advertised. We are not even listed in the business section of the phonebook, but the phone rings. I am so scared of loosing my edge. I know I started this off with talk of insurance and money and I kinda veered off but it is all connected really. Even if the aches, pains, tiredness ever go away, where am I going to stand mentally. After all that is what is funding all of the aches and pains.

MARYCAIN
08-10-2006, 10:14 AM
CHECK OUT THE PARTNERSHIP FOR PRESCRIPTION ASSISTANCE WEBSITE FOR HELP WITH MEDS. ALSO, I COPIED SOME INFO FROM THE VIRGINIA SMALL BUSINESS ASSISTANCE WEBSITE BELOW

You or your family members may qualify, even if you work, for programs such as Medicaid and FAMIS in Virginia. Generally, you can get coverage if youíre pregnant, a parent with a child living at home, a person with a disability, or a person who spends most of your income on health care. Children can often get coverage, even if their parents donít quality. In Virginia, children can get coverage if their family income is less than the amounts shown below.

Size of Family
2
3
4

Income
$25,669
$32,180
$38,700

Income rules are complex

So itís best to apply rather than try to guess whether you are eligible. Contact Virginia Medicaid at 800.643.2273. For help in working with the system, call Legal Services Corporation of Virginia Inc. at 804.782.9438, or visit http://www.valegalaid.org or http://www.lsc.gov/fundprog.htm.

What's available if I have a serious medical condition or disability?

You might qualify for Medicare even if youíre under age 65, if you have a disability thatís expected to last at least one year or expected to cause your death. You have to apply for Social Security Disability Insurance and receive it for 24 months before you can enroll in Medicare. Until then, you will have to find other coverage, such as with COBRA or Medicaid.

Contact

Social Security Administration: 800.772.1213 (800.325.0778 TTY), or visit http://www.ssa.gov/disability.

Medicare: 800.MEDICARE (633.4227), or visit http://www.medicare.gov.

For legal representation and other advocacy services (under all federal and state laws, to all people with disabilities), contact the Virginia Office for Protection & Advocacy at 804.225.2042 or http://www.vopa.state.va.us.

If youíre blind or have a disability and your income is low or you spend most of your income on health care, you may qualify for Medicaid. People with a disability usually qualify because they receive Supplemental Security Income (SSI), or you may be able to get Medicaid while waiting to find out if youíre eligible for SSI. Even if you donít qualify for SSI, you may still be able to get health insurance through Medicaid. The rules are complex, and many people are turned down the first time they apply. You can appeal.

To find out if an insurer has received consumer complaints call the Virginia State Corporation Commission Bureau of Insurance at 877.310.6560.

For federal and state protections, visit http://www.healthinsuranceinfo.net. Thereís a separate site for each state.

For Virginia laws regarding coverage, call the Virginia State Corporation Commission Bureau of Insurance at 877.310.6560.

If I still can't find health insurance, what options do I have if I need medical care?

Virginia is fortunate to have a strong system of safety net providers who deliver basic health care services at no or low cost. Virginia's safety net providers include free clinics, community health centers, rural health clinics, and local health departments. Additionally, if you have a planned hospital stay, you may be able receive help with the bills at a nonprofit hospital. Also, some states require hospitals to provide free or discounted care to people who are eligible. Many hospitals have financial assistance programs; ask to speak with a financial counselor or patient advocate. You might be able to negotiate a lower bill or better payment plan.

For more information about safety net providers, contact:

Virginia Association of Free Clinics
http://www.vafreeclinics.org/

Virginia Primary Care Association
http://www.vpca.com

Virginia Department of Health
http://www.vdh.state.va.us/LHD/LocalHealthDistricts.asp






You may qualify for State Pharmacy Assistance Programs in Virginia that can help with drug costs and health care or other expenses. The services are mostly for people 65 and older, but some programs are available to younger individuals. Visit http://www.benefitscheckup.org.

Some pharmaceutical companies offer free or discount prescription drug programs to patients who have been prescribed their drugs. Visit http://www.needmymeds.com.

Beauchick
08-10-2006, 02:16 PM
Hi Marycain,

Thank you soooo much for all of the info. I knew about some of the programs but not all. I have spoken to a few people. I have an appointment with social security on the 24th. I think the biggest problem I have is that we look good on paper but that is not reality. My husband alone makes good money, atleast according to his 1099. lol. But business has been unpredictable for a while. We use to run seasonal due to new construction slowing down in the winter, so I could prepair. We also do "live in" residential and that normally picked up around tax season and major holidays....don't want the family seeing dirty carpet at christmas lol. But the economy has hit both of our professions. The carpet mills would increase thier price at the beginning of the year, if there was an increase at all. Last year we had an increase a month for the first 6 months. They blame it on the gas prices because most of the carpet manufactured comes from Georgia and all carpet is made of petroleum products. And on my end....everyone is waiting for that real estate bubble to burst. The other problem I have, no offense to anyone, we do not have children. It seems to be easier for people in the great commonwealth of va., assistance wise, with children to get help. Again, I am not trying to offend anyone. I guess my point is that self employed, middle class, small business owners fall in the cracks. We may look good on paper at the end of the year but the money is not a steady flow and sometimes not even on a weekly or even biweekly schedule. I have been told that if the disability does not come thru, after appeal and an attorney, that my next recourse would be to become legally seperated from my husband. I will be 33 on the 23rd of this month and on the 25th will celabrate my 16 yr wedding anniversary. Lets just say.....seperation is not an option. I will live out of my truck before I sign seperation papers. I'm sorry I'm venting. Again Marycain, thank you for your thought and time. I hope things are well with you and yours. I look forward to speaking with you again soon.


Sincerely,

Kathy

MARYCAIN
08-10-2006, 03:15 PM
I'm also self-employed so I understand the frustration when your income seems to depend on factors you can't control. It may not help you this year, but remember you can itemize and deduct your medical expenses on your taxes, so you do want to keep records on how much you spend. Also, if you can show that you are spending a substantial amount of your monthly income on medical expenses, you may qualify for some assistance regardless of your income. I think it helps to make out a spreadsheet that shows your estimated monthly income, the amount of fixed expenses such as house payment or utilities, and the amount you spend each month on recurring medical expenses like your doctor visits, labs and prescription medications. That way, when you apply for programs, you can show that you have a genuine need.

Neiram
08-24-2006, 08:13 AM
Hi all,

I just graduated from grad school and am looking for work. I extended my health insurance as far as I could through December of this year, but after that I don't know what to do. If I obtain employment how do I deal with the whole pre-existing condition issue? I think in Illinois they can deny coverage for about 12 months! And if I don't get a job by then or a job w/insurance, can anyone recommend a good individual insurance plan for someone with SLE? I've been very lucky. I was diagnosed as soon as my symptoms (joint pain) started back in May and have responded well to my meds. I'm 27 and otherwise healthy. I'm at a good weight for my age and height, don't smoke or drink. But I know there's a big stigma for lupus patient coverage with insurance companies. I would really appreciate any info or advice. Thank you all, and God bless.

Saysusie
08-24-2006, 10:04 AM
I hope that someone has answers for you. I was already a Government employee when I was diagnosed with Lupus, so my insurance etc continued with no problems!!

Saysusie