Hi all. It's been awhile since I last posted. I was going to post tomorrow about Carol's 1st week of treatment which went pretty well, but after checking the snail mail today everything seems as if its going back to square one and her treatment is a mute point.

Just to recap, Carol had received a full city contract for her care and we were getting use to the
routine...pharmacy, doctors, lab work, radiation, chemo treatments, red tape, dotting i's, crossing t's, etc., you know, everything a patient has to go through. She received letters today from Medicaid (approved, dating back to 1/10/10) and a letter from the facility she's being treated at saying her full city contract has expired because she was awarded SSI and Medicaid. She hasn't received an award letter from SSA saying she is approved for SSI. Neither one of us were aware that an application for Medicaid was made when applying for SSI. Carol's disability through SSA is still under review.

Couldn't these people pick a worse time to inform her? Another 3 day weekend and SSA, Medicaid aren't open on Monday. President's Day. I wish for the old days...Washington's Birthday, Lincoln's Birthday Now she has to go through the whole routine again... Will they still do radiation treatments in the meantime (of getting requalified - Whatever Medicaid won't pay for Shands will and whatever she gets from SSI won't be enough to pay household bills, etc AND the medical bills. It's not like she won the lottery!!) or if not how great will the lapse in treatment affect her? If Monday wasn't a holiday I would be able to get everything taken care of that day (wishful thinking on my part?) so she could resume treatments Tuesday. But because of the Monday holiday, it'll take all of Tuesday..then maybe treatment resume Wednesday? She has chemo on Fridays.

Another weekend of worry and Carol is really upset. It's not like she has a cold or the flu or a broken leg..this is her LIFE they're messing with!!!! Now she doesn't know what's going to happen, who's going to treat her, and if they're just going to let her die. Sorry all, but that's how she feels right now. I'm really pissed off and there's not a damn thing I can do about this mess until Monday (with hospital) and Tuesday with government. Cancer patients shouldn't have to deal with this crap...they need to stay focused with fighting this disease. I feel so bad for her. I'm at a loss. Carol had been doing pretty good this past week, her mental attitude had changed. She had finally gotten her head wrapped around this, then this happens.

Linda

elcee,
i hate to see postings like this...and agree that we have enough to deal with without having to deal with that too.

first of all, i dont think the lapse in treatment will effect her to much. especially a couple of days. andy is currently on a 4 week break due to complications, although from what ive learned, this is pretty lengthy.

i ran into something also with the ins co deciding to drop the facility that andy is getting his rads at. meaning that instead of them paying 100% for "in network", now they want to only pay 50% for "out of network". i am fighting with the ins co. at this point since he was in the middle of treatment. our facility continued treatment without making us pay...thank God, since it was $600/wk.

i understand yalls frustration. try to keep carol on track and let her know that a few days wont hurt her. then when u talk to SSA/medicaid, give them all u have..dont let up...make them understand what is going on.

i feel for yall. hope it all works out for the best. keep us posted.

Linda,

First, breath and be easy don't let this process stress you out or Carol for that matter. Your medical facility is still going to do treatments etc, please do not concern yourself there. It is standard procedure for SSA to qualify an applicant for Medicaid the same time they are qualifying them for benefits. I went through this process...I know and can relate to the situation.

The facility treating Carol understands this process as well and if they've agreed to treat Carol and bill the city's medicaid program (which pays the same rates) they'll continue treating Carol and bill State Medicaid which will backdate billing to when the city discontinues to pay. Everyone involved in this process has danced to this song before...except Carol and you.

I can detail how this whole process goes, I lived it and can tell you that all of my dr's, pharmacy etc..knew the game and were well versed on how to play it to get paid.

I've never been denied treatment, meds anything. I knew that before I had any procedure done or any prescription filled that there was an approval process but 95% of the time it was just billed out. The other 5% I had to wait a little bit if the script was outside what Medicaid would normally pay for (an authorization would be needed from Medicaid, which always was approved) or I would have to get pre-approval for surgery outside my state, both from Medicaid and the hospital doing the surgery (if they accepted Medicaid or not) again, never had a denial there, just had to wait for approval.

I hope this has eased your mind a bit and that when you read this you will have a better day tomorrow and at least enjoy one day of the weekend.

Keep those spirits up!

Eric

Teresa

I'm hoping with this facility they will continue her treatments as scheduled as she has already started and her cancer IS advanced. She's been to every appointment, even shown up for appointments she was told to go to but were never scheduled! Don't ask. I like to call these "phantom" appointments. Carol plans on showing up for her treatment Monday am and we'll talk to the RO's nurse. The RO won't be there this Monday. I'll have to ask the MO also if there will be any complications due to the break in treatment.

What galls me is that everyone involved with Carol's care has all our phone numbers, hers, mine and the house, email addresses, but no one called to let us know her "insurance" was being dropped. They have to use snail mail! The facility has obviously kept a close eye on her case. Chicken S@&*!

It makes me wonder if she'll have to be rescheduled for her rad and chemo or once they figure out who's going to pay what, she'll continue as if there wasn't a break in her insurance. From what I have been able to decipher so far is that Medicaid will pay for everything including chemo but no mention of radiation. Because of her financial status, getting reinstated with Shands shouldn't be a problem, Carol's still considered a hardship case, but will have a different level of coverage through them. God, at least that's what I hope. Even though she has been awarded SSI it sure doesn't compare to what she was earning when she was working. So many questions and no one available to answer them because of the weekend. Depressing.

I have been reading your posts and my heart goes out to Andy and you. I loved what you did with the remote. Classic

Linda

Linda, you're on! great now read my post above and breath easier.

andy will probably need therapy for the remote thing after his treatment is done

Eric

Geez when I responded to Teresa's post I know I didn't see your post. Oh I see. You had finished your post a minute before I did. I sure wouldn't ignore you. I thought I may have started hallucinating.

What you are saying makes a lot of sense. I passed on the info to Carol and she's breathing a little easier. One way or another the facility will get their money. We're going in the am for her morning rad as scheduled. I'm sure they'll continue to treat her while we go through the motions of getting the medical insurance ironed out. Thanks Eric, you did ease my mind.

Linda

Glad to hear you are getting financial assistance. So sorry you have to jump through all these hoops to get it. The financial side and insurance of cancer treatments sure makes me mad. Dealing with that adds an unneccesary layer of stress to the situation. I wonder what we can do to help.

I agree with you misskate. Unnecessary stress to an already stressful situation. Talk about needing help from "mother's little helper"! Geez, and they wonder why the world is such a mess! We could use some of that bailout money that's being used for bonuses....