The Dying Medicare Population

I've spent days in chaos via cell phone dealing with the state insurance program. My family is actually supposed to be automatically disqualified because my husband is a state employee (state trooper). Funny how they seem to think state employees must right away get good insurance; interest, since their self-funded insurance is not accountable to the state medical board or the dept of labor, so they can (and do) deny policies to anyone they damn well please. That includes me. They can also put notes on files saying to never pay claims of certain policyholders, to always deny them, and the boards can't do damn thing about it.

So I have Medicare and only Medicare which you already know. While in the hospital for 6 days a month ago the staff said to not worry about the state employee thing and required that I complete the application. I spent days on it, even one night spending a very painful 4 hours sitting up in a chair photocopying medical bills from the assigned two-month period. Yeah, there are that many and it doesn't matter what 2 month period they were to pick; it would all be the same.

I spoke to several people yesterday at the aid office who tried to figure out why my household showed 3 people instead of 4 (my daughter was missing), and 0.00 were allowed in medical expenses. "We can only count medical bills you MUST pay. Please speak with INSURANCE CARRIER to determine what you are responsible for."

Today I learned medical bills aren't counted at all.

Are not COUNTED?

What the FUCK?

(Sorry, if you know me personally you probably just had a heart attack by me typing that but there's no other suitable word I can pull out of my boiling soul right now.)

For Medicare patients, the state insurance assistance laws only allow them to count the premium that is taken out of our monthly Social Security Disability payment.

It didn't matter ultimately that they missed processing my daughter so we are down as a household of 3 (and much lowered the income guideline).

I became so angry I ended up crying like a baby, scared an employee half to death who transferred to me with no warning someone else.

Upon being asked what they COULD count if they can't include medical bills like 20% of 14 surgeries at typically $300,000 each (not including flights, hotels, transportation & food)?

They grew quiet by this point and apologized a few times, saying they wished there was something they could do.

There is an entire generation of people who had to go on SSDI in our 20's through no fault of our own, and we are turned down regularly by Medigap companies simply because of our age. I know full-well they deny us because obviously being approved in our 20's means there's something really wrong and if they were to provide us Medigap, they would have a great amount of expenses for the long-term.

And it's killing us and no one cares. How many besides me are also in need of surgery (in my case, plural) and they can't happen because of how the insurance industry in this country has gone from assuring us we would be taken care of to an attitude of "Fuck you, I'll deny you and approve some healthy person who will only have minimal cost to me so I can line my pockets some more!"

Think brain surgery is scary? Try the medical bills.

It's no secret we owe thousands in medical bills. My husband's insurance wouldn't cover me once Medicare started 12/06. Since they wanted to gladly accept our money despite getting busted for putting a microfilm in my file saying to never pay any of claims again (and to be sure to not tell me about it), the state department ordered them release me from our family's plan.

So, I've had solely Medicare since then. It's great because it's a national plan so I don't have to worry about the fact I receive care in 3 states. The bad part is that Medicare only pays 80%.

Right now I can't think of how many of my 14 surgeries were under Medicare, but I'm thinking it's around 5, including brain and spine work, and some odd work for a majorly squished artery.

Most of my neurosurgeries have run about $160,000 just to stay in the hospital (each time). The surgeries are another story, around $150,000 (each).

Now if you have more functional brain cells than I, do some quick mental math.

See the problem with paying 20% of costs? Every surgery, every admission, room and board, doctor visits, fluid drained off the hip, cortisone shots, MRI's, CT's, DEXA scans...this is the reality of not only my life but that of my family's as well.

We go without to pay off as much as possible. Are we making a dent? Not a chance. But we are doing the best we can. We pull off some great creative meals using whatever is on the shelf. Recently I discovered a Big Lots and their wonderfully cheap ($1 and $2) brand-name cereal such as Honey Bunches of Oats (about the only cereal I can handle).

I have been trying for months now to find a Medigap (aka Medicare supplement policy). What a frustrating journey! I sought assistance from the AZ Dept of Insurance, Medicare, and various other sources. There are plans GALORE for SSDI folks. In this state, there are 10 Medigap policies for people under 65 on SSDI. How many of those 10 have a program in my county? ONE.

Well technically, 2. Both are with the same company. I should theoretically be eligible for a no-deductible Medigap policy but it's $345 a month. YOWZAS!

Option 2 they offer the same coverage but it's $184. The deductible is $1900.

There really isn't a choice there. Things are tight enough as it is and there is no way we can have $345 withheld every month out of my SSDI payment.

I meet on Tuesday with an agent from this Medicare supplement company. I pray it will work out. There is no way I can have my CCF surgery redone without it. Now with this Tornwaldt business etc etc, I've just really got to get some help.

It stinks to have to go without even more around here, but beats adding to the astronomical bills already haunting us.