Please Pray. Medicaid suddenly decides not to cover women with stage 4 breast cancer

[Muushka]

This is how insurance companies in the U.S work.

This is why I don't live there anymore.

FYI this is Medicaid, not an insurance company. I could get political here, but won't.

 

[Muushka]

My insurance would only cover part of my chemo but I was fortunate compared to other women who were going to the same cancer center as I was. I only had to pay $4220 OOP for each of my chemo treatments and we were financially able to do it. I talked with one woman who was paying for all of hers OOP and I met with another woman who was unable to do chemo because of no coverage.

In my situation (with advanced stage breast cancer), I was told that the chemo would only improve my "odds" by +/- 6%. Perhaps insurance companies feel that isn't good enough odds? Because of our situation, my husband and I also debated whether the 6% was going to be worth what we were going to have to spend.

Under any circumstance, it's very sad.

 

[tiggger1]

Ok I found out from her caringbridge site that she was told that it was due to the fact that she now receives Social Security Disability, which is a completely different option than SSI, Social Security Income. She has been found to be disabled and therefore cannot work, which Medicaid was aware of. She was told she was still eligible for Medicaid after SSD kicked in but for whatever reason they dropped her out of the blue and offered no recourse or guidance.

 

[shrubber]

death panels

 

[agnes!]

I just e-mailed both of the US Senators from Texas about this, it's something anyone can do. Just Google "Texas senators" and on the first page of results you'll see the website URLs for both Senator Kay Bailey Hutchison and Senator John Cornyn. If you'd rather, there are also phone numbers listed on both websites for the Senators' various offices.

agnes!

 

[tiggger1]

I just e-mailed both of the US Senators from Texas about this, it's something anyone can do. Just Google "Texas senators" and on the first page of results you'll see the website URLs for both Senator Kay Bailey Hutchison and Senator John Cornyn. If you'd rather, there are also phone numbers listed on both websites for the Senators' various offices.

agnes!

Thanks! I am on it!

 

[diznygirl]

I just e-mailed both of the US Senators from Texas about this, it's something anyone can do. Just Google "Texas senators" and on the first page of results you'll see the website URLs for both Senator Kay Bailey Hutchison and Senator John Cornyn. If you'd rather, there are also phone numbers listed on both websites for the Senators' various offices.

agnes!

FYI - If you aren't a registered voter for their state, they will give you the polite brush-off. Well, maybe not so polite. I've emailed senators around the country for other issues, and it seems to be standard operating procedure - you aren't one of my constituents, thanks anyway.

 

[robinb]

It might not work so let her die? Frightening!

If she is terminal, then yes. People go into hospice care every day with terminal illnesses. Of course, if her cancer can still be treated then she should be provided treatment. We are not her doctors. We don't know.

It does seem like there was a SNAFU between Medicare and Medicaid. I hope that it gets worked out very soon!

 

[clarabelle]

Well I guess it is a moot point -because it is a stupid, senseless error- it has nothing to do with her condition.



You misunderstand me.
I feel for her -because I do -I don't want her to suffer needlessly through treatments that will be painful and not work.
Sometimes the biggest gift, most loving thing you can do for someone is to let them go.

 

[OceanAnnie]

Thx you for bringing this to our attention, as it is every woman's nightmare and anyone of us could find ourselves in same situation.

Such a very sad story . My heart and prayers go out to your friend, Connie, and her sweet children, for quick resolutitions as she fights for her life.

My dear Mom is a 16 yr breast cancer survivor, so I am very familiar with the frightful journey.



The above article link had these additional facts off Facebook:

Connie was on Medicaid and was encouraged by her social worker to apply for Social Security Disability. As soon as she was approved for that (and what we were not advised of ahead of time) she qualified for Medicare and therefore Medicaid dropped her as soon as they could. The issue here is that Medicare has a mandatory 2 YEAR waiting period before benefits are paid. THIS is the situation Connie and many, many other critically ill or disabled people are now stuck in. The state will not tell you about this situation in advanced so that they can get you off of their books. Medicaid is supposed to pick up the slack during the 2 year Medicare wait but giving someone like Connie the run around encourages people to give up. We are just now finding all of this out and so took the story public to raise awareness. The 2 year Medicare wait should be fixed. The Medicaid scam to not cover qualified people needs to be fixed. But it all costs money and I don't know how to fix it. Right now I just know that my sister Connie qualifies for Medicaid and therefore someone needs to step up and push it through. And I want all those out there getting the same exact run around to know their rights as well. Connie worked for years and paid into the system so she wouldn't be in this situation.

Thanks for sharing this information. So disheartening. Maddening. It looks like if she had not applied for SS disability as she was advised, she may have gotten her treatment.

I'll say a prayer for your friend, OP. I hope she can break through the red tape and get the treatment she needs.

 

[trip]

Does anyone know if this 2 year waiting period in a situation like this (changing from SSI to SSD) is something new? If it isn't, the social worker should have explained what the results would be. Hopefully, they will find some sort of exception.

 

[kpm76]

What are her doctors saying? Would they administer treatment if she had coverage for Chemo? These are questions we might not know the answer to but they are important questions to ask. The doctors may have determined that her cancer is so advanced that Chemo will not help. There is a risk/benefit analysis conducted when deciding who gets treatments. Chemo does cause harm to the body and if someone is already in a completely diminished state, the benefit of Chemo will not outweigh the risk. Doctors are held to strict ethical standards and if they feel it would not be ethical to put a patient throgh the rigors of Chemo because there would not be any benefit, then that might be the reason Medicaid is not paying. One of the articles I read said she was in the hospital a month ago and the family thought she was going to die. In addition, she had a lot of fluid removed which further indicates that she may not be strong enough for Chemo. This may not be the case at all with this situation but it is something to consider since we don't have all the facts. In any case, it is very sad for both the woman and her family. Sending prayers and good wishes for all them

 

[tiggger1]

What are her doctors saying? Would they administer treatment if she had coverage for Chemo? These are questions we might not know the answer to but they are important questions to ask. The doctors may have determined that her cancer is so advanced that Chemo will not help. There is a risk/benefit analysis conducted when deciding who gets treatments. Chemo does cause harm to the body and if someone is already in a completely diminished state, the benefit of Chemo will not outweigh the risk. Doctors are held to strict ethical standards and if they feel it would not be ethical to put a patient throgh the rigors of Chemo because there would not be any benefit, then that might be the reason Medicaid is not paying. One of the articles I read said she was in the hospital a month ago and the family thought she was going to die. In addition, she had a lot of fluid removed which further indicates that she may not be strong enough for Chemo. This may not be the case at all with this situation but it is something to consider since we don't have all the facts. In any case, it is very sad for both the woman and her family. Sending prayers and good wishes for all them

the doctors are the ones that are the ones that are telling her not to miss the chemo but the hospital wont do it without cash in hand.

 

[agnes!]

I just e-mailed both of the US Senators from Texas about this, it's something anyone can do. Just Google "Texas senators" and on the first page of results you'll see the website URLs for both Senator Kay Bailey Hutchison and Senator John Cornyn. If you'd rather, there are also phone numbers listed on both websites for the Senators' various offices.

agnes!

FYI - If you aren't a registered voter for their state, they will give you the polite brush-off. Well, maybe not so polite. I've emailed senators around the country for other issues, and it seems to be standard operating procedure - you aren't one of my constituents, thanks anyway.

In situations where an elected representative is contacted by someone not from their district/state, you would usually be right.
*BUT*
seeing as how the news-story is about one of *their* constituents and is being reported by a Houston TV station and is published on that TV station's website, I think the Senators from Texas would be interested ...

I think I'll give their offices in DC a call right now, if only to be a burr under their legislative saddle.

agnes!

 

[kpm76]

the doctors are the ones that are the ones that are telling her not to miss the chemo but the hospital wont do it without cash in hand.

Gosh, that is horrible. Something like this should never happen in this country. I will keep this woman in my prayers....keep us posted

 

[Magic Mom]

Well I guess it is a moot point -because it is a stupid, senseless error- it has nothing to do with her condition.



You misunderstand me.
I feel for her -because I do -I don't want her to suffer needlessly through treatments that will be painful and not work.
Sometimes the biggest gift, most loving thing you can do for someone is to let them go.

If it is a gift, shouldn't it be her choice to take it and not forced upon her?

 

[C.Ann]

Prayers going out to this poor young woman and her family..

As for her prognosis - statistics are just that - statistics.. To write her off or to say, "Well she's going to die anyhow" is ludicrous.. There's always that "one" person who beats the odds - or that "one" person who is given 6 months to live and with proper treatment, manages to live another 8 to 10 goodyears.. How can anyone say, "Well - she's terminal - so why go to the expense?" That's both mind boggling and infuriating to me..

When someone is battling cancer (or any other terminal illness), to take away whatever hope they may have is equivalent to putting a gun to their head and pulling the trigger..

 

[arminnie]

I truly feel for this woman's family as I personally nursed my mother for almost 3 years when her breast cancer returned as stage IV. It was a long, horrible experience even with all bills paid and having absolutely no financial limitations.

But I DESPISE the tone of these articles. Yes, the snafu between Medicaid and Medicare should be rectified IMMEDIATELY - but the television interview makes it sound like her life could be saved if she got the chemo.

A family friend is the past president (or chairman whatever the title is) of the American Cancer Society. This is his opinion: This woman is terminally ill. Her life MAY be able to be prolonged - but unfortunely it cannot be saved.

And as a previous poster stated at some point in the process chemo does more harm than good. My mother actually did not eventually die from the cancer but from the side effects of the chemo (lungs and heart function destroyed).

The Medicare/Medicaid issue is absurd and should be addressed for what it is. The issue here is an administrative one. I haven't seen where anyone said "You are going to die. You don't deserve treatment." It seems to be a ridiculous "it's not my job" kind of approach from two government agencies with her falling through the cracks.

I wish this had been approached from a "this woman deserves what time she can get with her children" rather from a "we could save her life if we tried" approach.

 

[solotraveler]

Does anyone know if this 2 year waiting period in a situation like this (changing from SSI to SSD) is something new? If it isn't, the social worker should have explained what the results would be. Hopefully, they will find some sort of exception.

Nothing new. If you qualify for SSD and are under 65, your clock starts on your Medicare waiting period, which is two years.

Part of this issue in this case could be that when she was approved for SSD, she now makes more than the income threshold for Medicaid in her state. More most adults, this threshold is very VERY low.... and she will have to go through the appeals process to attempt to get on a spend down plan or approval for coverage.

One option for your friend may be to contact the manufacturer of her drug and see if any assistance is offered. Programs and guidelines can vary, but it might be worth a shot....

 

[barkley]

her best bet is to get an elder law attorney (even though she's not an 'elder') who specializes, in that state, in medicaid and medicare law. they know all the in's and outs of that particular state's programs.

yes, she would have the 2 year waiting period under social security, but for some terminal illnesses social security waives the 2 years and give medicare coverage immediatly on the begining date of aid so that would be one thing a lawyer could look at. in some states there are special programs designed especialy for people whose income, based on ss approval has created financial disqualification for medicaid-that could be looked to as well. the 3rd thing to look to is weather she could appeal the discontinuance from medicaid flat out on another basis.

but-in the long run does anyone know if the treatment is even covered under either program (i've got medicare-it does'nt cover everything, i administered medicaid in one of that states that exceeded the federal requirements for coverage-it did'nt cover everything).

i understand the concept of contacting politicians about this, but realisticly it's not like they can do anything immediatly IF that state's medicaid program is not set up to cover the 2 year wait. they would have to work towards making changes in their medicaid laws (more often than not when a politician is contacted on these types of issues it's handled by one of their staff who will call on behalf of the politician, then the politician's office is faxed the state and federal law justifying whatever rule/regulation the action/inaction is based on).