Tag Archives: Medicare

My Medicare Hates Me

I was very lucky when it came down to applying for Social Security Disability. I waited as long as I could before filing… I didn’t want to apply for it until I truly needed it to survive… and when it finally got to that point, I had to rely on family to help me through it. I believe I have written about it before, but if not, I will post my experience soon.

Then, what sucked WORSE than needing it in the first place was that after being approved, I had to wait a full year for Medicare. Can you say, “Are you serious”? I tripped out and frantically asked my case worker what I was suppose to do for a year with mental health issues and no other insurance… I NEEDED the medicare in a bad way.

Guess what she said??? Drum roll please…. “Go to the emergency room.” HUH?? If any of you have visited the emergency for mental health issues, you know that they do not prescribe psychotropics and they give out handouts about “sliding fee” psychs, but you learn quickly that as much as we like to think it is that easy, it is not. Every number I called was either out of service, or it was inaccurate information. It is worthless…

So, for a year I waited. I still needed to rely on others for help because my entire disability check was going to “out of pocket” medical expenses, including my prescriptions.

Once my Medicare kicked in, it was a God-send (even if for just a moment). Then, it got bad… really bad. My Doctors started dropping Medicare, no longer accepting assignment. AND, every Doctor that they tried referring me to, well, they also were dropping Medicare. I don’t live in a small town. I live in a very busy, highly active city… a 24 hour type of place… and I can’t find a doctor to treat me… not an MD, and of course, no Psychs. This is completely ridiculous.

I am stuck in this revolving door. Now that I have medical insurance, the Doctors out there are refusing to take Medicare any longer. Why?? Well, I don’t know if what I am going to say is completely true, but it is true in my situation…

Medicare SUCKS.

When a medical office tells me they no longer accept Medicare Assignment, I ask to speak to someone in the billing office… or someone in the “prior auth” department… so I can speak to them to figure out what my options are. What is the consensus?? In short, Medicare is failing me. 😦 This is totally unacceptable. I think of all the elderly patients who struggle to afford their medical care… often cutting their prescriptions doses to help with their costs… or not using their air conditioning in the summer, nor their heater in the winter, resulting in serious problems, and the worst of course, death. It is disgusting to think of all these people who struggle and can’t get the care they worked hard for, and they have to make serious cutbacks just to survive. This is tremendously heartbreaking.

I am told that many offices are dropping Medicare because Medicare is not paying. They are notorious for taking a very long time to reimburse the physicians, and when they do, of course it is at a fraction of the cost. They make it incredibly difficult for the Doctors to submit payment, often refusing because they somehow did not file the appropriate paper work, diagnosis codes, or somehow missed a step that Medicare requires of them. It isn’t because they are incompetent, it is because Medicare makes them jump through so many hoops, hoops on fire, and claims get rejected. Then more man-hours are spent correcting the mistakes and resubmitting for payment. Often not receiving payment for months and months, and sometimes, years.

I also learned that Medicare often will come back and claim that patients were “over-billed”, therefor causing Medicare to “over-pay”, and years after the fact, they come back and inform the Doctor that they over paid by 2$ and want the 2$ back, only now it is 200$ because of interest and penalties and if they don’t pay up in a short amount of time, Medicare threatens a lawsuit.

I have been completely disappointed and at a loss. I cannot get additional insurance through the marketplace, so I feel stuck. I had Medicare Original to start and I chose it because it is basically a PPO, and I could choose any doctor I wanted as long as they accepted assignment. Well, that didn’t go so well… so I just changed it (which can only be done one time a year during open enrollment). I went online and compared the Medicare Advantage Plans and chose a Humana PPO in hopes that I will have more options for physicians and specialty practices.

I am nervous and hoping it isn’t any worse than it is right now… and considering I have to pay quite a bit more for this plan, it better be an improvement.

I am staying positive about it, and I will keep you posted on how things go.

©bipolarmuse 2014

Ugggghhhh… come one Medicare! My Rant.

money

MONEY. I hate it and love it at the same time. Why is it that I will seem to be fine, then all of a sudden, I am broke for the next three months? Seriously. I know I don’t have much coming in, but I am very scrupulous with it because I know that a little must go far. That being said… this month I will be in the hole to my man about 500$. Yep. The mean green paper is taking a toll.

After Doc visits, prescriptions, plane tickets to get the kids back to TX on July 1st… I am flat broke… and will need my return flight paid for, and my prescription at the end of the month that is 170.00$ paid for as well. On top of the money I already owe him, yeah, I am looking at a 500$ bill. Not to mention that I have other bills to pay.  Grrrrrr.

**BUT, good news! My medicare begins on September 1st and my Doc visits and prescriptions will be covered. I cannot express how happy I am about this. Only two months to endure and then all will settle down and be great. I won’t be rich, but it sure will help with my  monthly expenses. It will pay for itself and then some…

I can’t believe that, being mentally ill, they wait 2 years before giving you medical coverage. This needs to be revamped. We have so many horrible crimes committed in the name of mental health issues but nobody wants to pay for Psychiatry or Psychological counseling. What is that about? We have gunmen going into schools, high school and college kids with mental disorders plotting bombings and other terrorist acts and I have had to wait 2 years for any type of medical assistance though I was deemed disabled with Bipolar 1 Disorder with Psychosis, Borderline Personality Disorder, and Anxiety Disorders. Know what I was told when I asked my case worker what to do for my mental health *care*?? Her response- Go to the ER.

Really?!

No… I am not comparing myself to those who commit these horrible crimes, and I do not believe they ALL have mental health disorders (because I do believe that some people are just bad people), but seriously?… I waited 2 years for medical assistance? That is like a person diagnosed with terminal cancer waiting 2 years for treatment. Especially when suicidal… ok, maybe not identical situations here… but you get my drift.

Sorry for this rant but I am seriously flustered at the system. I am grateful that something is in place for assistance, but it literally needs a program change and reboot.

!!I am grateful that medicare is on its way and I only have July and August left to pay for my own medical care and medications. Now I just have to hope I don’t get a CDR (continuing disability review) and be deemed no longer disabled. Wouldn’t that be a nightmare?? I don’t even want to put that thought into the Universe. Not that I plan to be on this all my life… I just want to make sure I do not make an impulsive decision to work before I know that I am stable enough to stay employed.

Thank God I have a wonderful man who helps me stay afloat…

Medicare Bound! Mental Health Covered!

approved

So after being approved for social security disability insurance for 19 months now (yet deemed disabled for 26 months), I am finally beginning to receive information/paperwork in the mail for Medicare! I have not been so excited for medical coverage as I am over this.

See, when you get approved for SSDI, unless you are already paying out of pocket for private health insurance, you are not offered any medical benefits when you are a single adult without any dependents to get your states assistance… so what I am saying is that since I was approved, I have had to pay out of pocket for EVERYTHING. All psych visits, therapy, and medical visits have come out of pocket, and on top of that, I have had to pay for all my prescriptions as well with the exception of Lamictal which I got through prescription assistance from the pharmaceutical company itself.

On Average, for the last 19 months, I have paid approximately $3500.00 out of pocket for medical care and prescriptions… and this is the bare minimum. I know it has been more than that but wanted to give you an approximate idea. So seeing the medicare information and medical card with an effective date of Sept. 1 made me do a happy dance!

Now comes the hard part… do I go with Medicare Original or Medicare Advantage? There are advantages to both so I will really need to weigh the pros and cons to figure this one out. The nice thing about Medicare Original is that I can be seen by any Doc who accepts Medicare rates… and I can get assistance with my low income to help offset the costs. From what I understand Part A (hospitalization) is automatic and I do not pay for this… Part B (medical) will be automatically garnished from the funds I receive, and I will have to add drug coverage to cover my prescriptions… and perhaps add a “medigap” policy to assist in paying for copayments, other out of pocket expenses, and things not other wise covered by Medicare Original. All the options have benefits and disadvantages so I will truly need to do my homework on this and make a sound decision. Medicare Advantage is more like your private HMO, PPO, plans and are all inclusive but you must read all the fine print to make sure you are not paying more for this coverage than you would with Medicare Original… and one perk of Advantage is that it includes some dental as well. So like I said, I really need to research this.

And praise baby J, mental health IS included. Wouldn’t it be ironic (and just like the government) to exclude it.

So therapy… here I come!!!

If any of you have any Medicare Original or Medicare advantage experience, please share it with me, either through comments, or on my “contact me” page. I would be very grateful for any insight into this difficult decision making process.

It may be a few months away… but things are looking up more and more. ♥