Man, 87, Searches for Job to Pay for Wife's Medica... - Page 6

catwhisperer · ‎07-11-2010

Such a sad story. Everyone's situation is different, so I am not in a position to judge or make suggestions. Gov't. funding/low income help also varies by state. All I know for a fact is what I and DH are going through.

DH was in the hospital two years ago. I am his full time caregiver. We have a Medicare Advantage plan with a supposedly annual out of pocket max. That is a joke. We have paid way more than our "max". We cannot afford a "supplemental" plan. We are still receiving medical bills in the mail because our insurance carrier claims the charges were "not necessary", or "Not authorized". HUH???

Our county offers to pay full time caregivers a wage, but I do not qualify because they say our income is over their limit. I told the lady that our rent is over half our monthly income, but they do not take that into consideration. That is just not right.

After reading the replies on this thread, @Cakers3 seems to be only one of the very few who understand the struggles many of us are dealing with.

I promise to remind myself every day that I am strong, courageous, and resilient.

Snoopp · ‎02-02-2015

@catwhisperer wrote:
Such a sad story. Everyone's situation is different, so I am not in a position to judge or make suggestions. Gov't. funding/low income help also varies by state. All I know for a fact is what I and DH are going through.

DH was in the hospital two years ago. I am his full time caregiver. We have a Medicare Advantage plan with a supposedly annual out of pocket max. That is a joke. We have paid way more than our "max". We cannot afford a "supplemental" plan. We are still receiving medical bills in the mail because our insurance carrier claims the charges were "not necessary", or "Not authorized". HUH???

Our county offers to pay full time caregivers a wage, but I do not qualify because they say our income is over their limit. I told the lady that our rent is over half our monthly income, but they do not take that into consideration. That is just not right.

After reading the replies on this thread, @Cakers3 seems to be only one of the very few who understand the struggles many of us are dealing with.

Can you appeal any denials? See if you can get the doctor to write a letter of medical necessity on claims they denied. It's a lot of work and takes a long time but you may have a chance at reimbursement.

Carmie · ‎10-25-2010

@CrazyDaisy wrote:
@Carmie wrote:
@CrazyDaisy It amazes me that anyone would put this story on the internet to begin with.

The decent thing to do would be to take them to the senior help center to apply for aid it sounds like they desperately need. There is no need for them to have to be in this position and suffering at this stage in their life.

I wouldn't not appreciate my story being out there if I was needing help.
It was a story covered on the local news, they did not post it on the Internet.

Wrong, People posted this story on the internet back in August. This story is is not brand new.

catwhisperer · ‎07-11-2010

@Snoopp....thanks, but I did appeal and spent hours on the phone with the insurance co. What it boils down to is that they just don't want to pay.

We had to shell out over $1,300 for ambulance bills because the ins. co. did not feel the trips were necessary. I didn't even order the trips, the nursing home did. I guess they expected my DH to walk from the ER back and forth to the nursing home. Morons.

I promise to remind myself every day that I am strong, courageous, and resilient.

SilleeMee · ‎05-22-2016

If someone needs money these days then it's simple...'GoFundMe'....I'm not trying to be funny but that does seem to work for many people.

CrazyDaisy · ‎03-20-2010

@Carmie wrote:
@CrazyDaisy wrote:
@Carmie wrote:
@CrazyDaisy It amazes me that anyone would put this story on the internet to begin with.

The decent thing to do would be to take them to the senior help center to apply for aid it sounds like they desperately need. There is no need for them to have to be in this position and suffering at this stage in their life.

I wouldn't not appreciate my story being out there if I was needing help.
It was a story covered on the local news, they did not post it on the Internet.
Wrong, People posted this story on the internet back in August. This story is is not brand new.

EXACTLY it was a local news story, WEWS channel 5, ABC affiliate, August 28th. The person spoke to a local reporter, ironically the story was about the lack of truck drivers. This gentleman had nothing to do with it being posted on the Internet.

Someday, when scientists discover the center of the Universe....some people will be disappointed it is not them.

lovesrecess · ‎03-14-2010

He is to be admired for being willing to take on such a hard job in order to care for his wife. I wonder if they would qualify for Medicaid. I gladly pay taxes if those who are too old or disabled to care for themselves can get help through Medicaid....Medical issues sink your ship quickly. I pray this dear man and his wife do well in the future.

Cakers3 · ‎06-17-2015

@catwhisperer I'm so sorry. Medical bills are the pits but one bright spot is that they cannot garnish your SS.

We've had to appeal some decisions, even though we had in writing that the procedure/test was 100% covered prior to the event.

I wish you all the best. You are not alone.

"" Compassion is a verb."-Thich Nhat Hanh

Mominohio · ‎08-08-2010

@Alison Wonderland wrote:
@Mominohio wrote:
And I'll add that I think a lot of stories like this are brought forward by either the people or the media to raise not only awareness, but more importantly, the funds (through donations and go fund my type fundraising) for people in situations like this.

I think many times situations like this are exploited just for the ability to raise the money. Not that I'm against it, just that I think it is often a calculated plan, more than an elderly man really going to find a job driving truck.
Whose calculated plan? Do you think an 87-year-old man knows much about crowd-sourced fundraising?

My dad just turned 81 and he has no real awareness of those things and certainly wouldn't think to set one up. My mom is 78 and her internet usage is limited to a basic understanding of email and watching videos on YouTube. She has to call me whenever something doesn't work. She's certainly not going to be thinking about setting up a GoFundMe account.

@Alison Wonderland

Oh please. Yes it is quite possible the couple came up with the idea to take this to the media in order to set up funding for their cause.

Or their family could have, or someone from the media knew it would get attention and someone would do it.

Not every senior citizen is tech stupid.

He was a financial adviser. He knows money, even if he hasn't worked in the field for many years.

So my post was meant to say that yes indeed, he, his wife, other family member or the media knew this would start a fund, simply by bringing it to light.

And I never said it was a bad thing or wrong, just that it was intended from the start by some party.

Carmie · ‎10-25-2010

@catwhisperer wrote:
Such a sad story. Everyone's situation is different, so I am not in a position to judge or make suggestions. Gov't. funding/low income help also varies by state. All I know for a fact is what I and DH are going through.

DH was in the hospital two years ago. I am his full time caregiver. We have a Medicare Advantage plan with a supposedly annual out of pocket max. That is a joke. We have paid way more than our "max". We cannot afford a "supplemental" plan. We are still receiving medical bills in the mail because our insurance carrier claims the charges were "not necessary", or "Not authorized". HUH???

Our county offers to pay full time caregivers a wage, but I do not qualify because they say our income is over their limit. I told the lady that our rent is over half our monthly income, but they do not take that into consideration. That is just not right.

After reading the replies on this thread, @Cakers3 seems to be only one of the very few who understand the struggles many of us are dealing with.

@catwhisperer I think I understand what happened in your case. It sounds like your DH had a HMO Advantage Plan. With this type of Medicare you cannot purchase a Supplement and don't need one and it is against the law to have an Advantage Plan and a Supplement.

With an HMO you MUST coordinate your care with your primary care physician( PCP) That means you need permission and a referral to see any other doctor other than your PCP. That means all services MUST be authorized before you can receive them.

If you do not follow the rules of the HMO insurance plan, you will not receive any or very little payment for your medical bills, unless it is a life or death situation.

You have received denials because your DH did not follow the terms of his coverage. It is important to understand how your insurance works. In the future, always see your PCP before you attempt to receive medical care....unless it is an emergency...life or death situation. Then call the PCP immediately and explain what happened.

If a claim denies and you feel it was an emergency situation, write a letter of appeal to the insurance company and they will investigate the charges...and possible pay your claims.

You only have 60 days to appeal a claim after it has been denied or processed.