May 2012 Weddings

Health care and the US (update)

Just to update you all on my FI who needed back surgery...

My insurance denied him because of the pre-existing injury. So no go there.

Medicaid would not allow him to be seen as an emergency at a specialists office and no one will take him in to see him anyway without medicaid or health insurance approval unless they can do the surgery then and there. So ive had 3 docs tell me not to waste the 300 bucks  out of pocket we will HAVE to spend to see their specialist because Medicaid wont pay for them to do surgery anyway. If they took medicaid, then i could at least take him to the specialist, get the approval for the surgery, and wait for the mediciaid to kick in (will cover last 3 months of medical). So they could bill us and medicaid would pay for the bill...and we could at least get that ball rolling.

Even the specialist who takes medicaid at the hospital will not make him an appt. until we get the yay or nay from medicaid. 

 My FI is bed ridden right now. I am basically taking care of him while still trying to work. So i have to leave him with everything he needs for the entire day and his mom and dad have to help him get to the bathroom when i am not there.

Plain and simple...this sucks.

I dont understand how we can do absolutely nothing right now but wait. Even taking him to the ER is a MAJOR risk if he gets denied Medicaid.

The only participating hospital we found was in Stony Brook...but like i said they wont see him until Medicaid accepts or rejects him. If he gets rejected, then i really do not know what the hell we are going to do.

I am losing my mind with everything going on right now. I am trying to go to work and focus before i get fired here...but its constant phone calls all day to medicaid, the doctors, specialists, hospital ets.., calls to check on him, etc. My stress level is through the roof.

Re: Health care and the US (update)

  • BTW... im working 2 jobs....and my salary is decent...but still in no way can i afford 100K surgery. Hes out of work due to this...yet he cant get comp and he is awaiting approval for disability but that could take months and we are thinking that he will most likely be denied anyway because they like to do that.

    Right now all he is getting is unemployment. Some people told me to just get married by the JOP but then my income would def. not qualify him for anything. I think most people thought he could go on my insurance which he cant.

    By him handling everything as his own entity i wonder if its better or worse????
  • oh man... sorry to hear that. I hope it gets better for you.
  • Wow, I hope Medicade approves you.  I am from Canada so I am not really farmiliar with insurance in the US. However every now and then people need to tavel across the boarder for sugeries and most host fundraisers to help with the cost. I don't know if that would be a possiblity for you guys or not. You would be suprised at the kindness of others when times are tough. I hope things get better for you soon! 

  • I work in the insurance industry, did your FI have coverage with a nother insurance co before he tried to go on your plan? if he had coverage and he can produce a letter of credible coverage to give to your ins co, sometimes that helps in these situations.  I'm sure you've already exhausted that avenue but thought I'd atleast ask. I found a site on line regarding CT ins for prexisting conditions and just thought I would pass it along.
    the company I work for does not exclude coverage due to prexisting conditions but we are in Mass and that wont help. The HCR will eventually make it illegal for ins co to deny coverage due to preexisting conditions but looks like it is a few years away.  I hope that he gets the help he needs, these things really piss me off to see people who need help not be able to get the help they need.  Best wishes!
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  • Thanks TopSecret12. He had coverage but they asked that also from my works HR and there was a huge lapse in his health care. By trade he in iron worker...and coverage is only received from the union when they reach a certain amount of hours. The problem is...that with most unions, work is scarce..and he hasnt had steady work since the economy took a turn for the worst. So he hasnt been able to maintain coverage. Cobra was exhausting his entire unemployment check and he had rent to pay and bills also. So he had to opt out of Cobra coverage. it sucks...but unemployment pays for nothing. We have been paying the entire wedding essentially on my salary. Ive probably paid for 85% of it on my own....which is why i work 90 hrs a week 6 days a week. occasionally he helps here and there but i dont expect him to because he really cant. plus it was more me who wanted a wedding.
    It sucks because i feel like we are stuck. Im exhausted, we cant make it on my salary....he cant work, not that he doesnt want to, he physically cant,..and even when he could, the union was so messed up and so unfair he worked 3-4 months the whole entire year. he was trying to get out of the union and get a different job, that he is hurt,...a job has to take a back burner until he gets the help he so badly needs.

    Today he didnt move from the bed. DIdnt even eat. Its driving me nuts. he is depressed and immobile. and at this point, everything has me so on edge i snap. we have been fighting because i just cant take the amount of stress im under right now. i feel like hes not asking the right questions to these people at medicaid and not pushing hard enough to get things moving.
    He even went back to try and get them to make a decision quicker...and still nothing. and i dont feel like he stressed how bad this is.

     if he is denied coverage...hes going straight to the ER and we will have no choice but to worry about the bill i guess afterwards. its going to really kill us and take a lifetime to pay off.  we are going to be really deep in debt and we dont even have a place to live right now. itd be easier if we were younger but im 31 ....would like to have a child one day...and i dont see how a house, baby, and life is possible with 100 grand in debt from a surgery. i have spent the last 2 yrs trying to get things in order from my own financial meltdown due to an ex running my credit through the roof. i finally got that debt paid off in full, the wedding paid off in full...and now this happens and i am back at square one all over again. after i tried so hard to pull myself out this past 2 yrs. :(
  • XxCrazy4U sending hugs and prayers for you and your FI
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  • It is true that there will be shock, depression and potentially anger that comes with any diagnosis of cancer but it is important to remember that certain cancers are not as dire in the grand scheme of things. However, when there is a life altering diagnosis made, it is always best to weigh the options and determine what course of treatment will provide you personally the best quality of life.

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