by Gilek07 » Sun Jun 14, 2009 01:35 am
My father recently had a heart attack which his health provider put a stint in to help. It did the job but health care provider decided he is terminal and needed to be put on hospice. They said they no longer would provide sevice for his heart or internal organs...only if he had a broken arm or something. He was put on morphine and we were told he had a few days left. He had stopped eating and was fading. We then learned that the morphine was doing this to him. We took him off the morphine and he got better. A month later he was doing much better so we wanted to get a second opinion. We had a battle to get him off hospice (which we found was associted with the Insurance Comp) and were told that if we took him off he would be bakc on just medicare and we would have to pay the 20% for everything. We agreed and got him off. We took him to the hospital where we found he did not have only 15% of his heart working but had 25% and did not have 20% of his kidneys working but closer to 60%. He had treatment and is now doing much better. This would be a great ending to an almost tragic story but now the insurance comp says we have to pay for all because he can not be released from insurance until Nov 1st. What should we do?
Posted: Sun Jun 14, 2009 05:30 pm Post Subject:
I need a little bit more information, but can definitely get you the help you need. You said it was a Medicare Gap Health plan, but I need some specifics. There are Medicare Advantage (Part C) plans, and then there are Medicare Supplement plans as well. Who is the insurance company? When he goes to the doctor, does he show the original red, white, and blue Medicare card...or does he show just the insurance company card?
There are election periods throughout the year that Medicare beneficiaries are subjected to, but there are definitely exceptions to the rule. It would actually be Nov 15th through Dec 31st when he would be able to make an changes that he desiires, BUT there are also special election periods and processes that can be done AT ANY TIME!
The other information that I need has to do with his chronic illnesses. Does he have End Stage Renal Disease (is he on dialysis)? Does he have Diabetes? Does he have COPD? Does he have CHF? Any of these chronic illnesses would actually qualify him for a Medicare Special Needs Plan.
Does he receive any other benefits (such as Medicaid)? Also, is he participating in a state pharmaceutical assistance program or a low income drug subsidy for his medications? Does he have the full $96.40 for the Medicare Part B premium deducted from his social security check, or does he only pay part of it?
If you can get me this information, and feel free to PM it to me, then I will get all the information together for you and let you know what you need to do.
Posted: Mon Jun 15, 2009 12:07 pm Post Subject:
Hi Gilek07..
This would be a great ending to an almost tragic story but now the insurance comp says we have to pay for all because he can not be released from insurance until Nov 1st.
Could you explain a bit as to which of the above health problems have been mentioned in his policy papers? What does the exclusions show? Also, tell us about how long ago did he apply for it!
Steven
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