Need help finding insurance in NY for uninsured Hep C patient

itsmejuli · Feb 5, 2011

Did you try the local health department? Where I live the county health department does low cost medical for those who don't qualify for Medicaid.

BabyLady, BSN, RN · Feb 5, 2011

I seriously doubt if his MD has personally surveyed every physician in the area.

On top of that..a physician CANNOT pick and choose which services they are going to provide based on reimbursement.

If they accept Medicaid, they have treat anyone that comes to them with a Medicaid card.

You can get Medicaid for isolated treatment if you do not qualify for general Medicaid benefits...this is a very little known fact about Medicaid.

You apply for it through the the department of social services.

No way would I take ONE Physician's word for it.

Ruthiegal · Feb 6, 2011

Would your friend qualify for SSI? He should apply, and try to get that, then he most likely would qualify automatically for Medicaid coverage.

merlee · Feb 6, 2011

It's unlikely that many of us could really tell you what qualifies. He should contact the local health dept, or social services dept.

And getting SSI (social security disability) had nothing to do with medicaid. One is based on your ability to work, the other is a financial issue. After 2 years of SSI, many people then get medicare.

Home Health Columnist / Guide · Feb 6, 2011

your friends fathers nursing home care is being paid for by medicaid, therefore affected by [color=#0000cc]medicaid estate recovery

my previous post covers this in depth.

https://allnurses.com/social-health-care/medicare-insurance-eligibility-282781.html#post2667736

states are prohibited from making estate recovery when

in the case of the former home of the recipient, when an adult child has lived in the home for at least 2 years immediately before the deceased medicaid recipient was institutionalized, has lived there continuously since that time, and can establish to the satisfaction of the state that he or she provided care that may have delayed the recipient's admission to the nursing home or other medical institution.

son is legally able to inherit home but lien should be waved in this case if he can prove caregiver over 2 yrs---often statement from parents doctor, visiting nurse documentation etc will suffice.

ny program: medicaid

information about medicaid, including what it is and who qualifies for it.

[color=#0e774a]www.health.state.ny.us/health_care/medicaid/

[color=#0e774a]

[color=#0e774a]please tell him to appeal this decision:

what are my rights?
the medicaid application, access ny health care, tells you what your rights are when you apply for medicaid. see the pages titled "terms, rights and responsibilities." people who receive medicaid have privacy rights. medicaid keeps your health information private and shares it only when we need to.
if you wish to apply for medicaid, contact the local department of social services.you may also contact an enrollment facilitator. they can help you apply for medicaid and family health plus.
generally, local districts must determine if you are eligible and send a letter notifying you if your application has been accepted or denied within 45 days of the date of your application. if you are pregnant or applying on behalf of children, the local district has 30 days from the date of your application to determine if you are eligible for medicaid. if you are applying and have a disability which must be evaluated, it can take up to 90 days to determine if you are eligible.
if you are not satisfied with a decision made by the local social services district, you may request a conference with the agency. you may also appeal to the new york state office of temporary and disability assistance and request a fair hearing.
how do i request a state fair hearing?
you can ask for a fair hearing by:
1) telephone: you may call the state wide toll free number: 800-342-3334; or
2) fax number: (518) 473-6735; or
3) on-line: complete and send the online request form at: http://www.otda.state.ny.us/oah/forms.asp;

it's a mistaken belief by nurses and public that physicians can care for all patients.

physicians have to apply to insurance companies to become "eligible providers" in order to receive payment and be able to provide care and treatment to members of the insurance plan. many do not apply to medicaid so unable to provide care those recipients.

patients with hep c are best cared for by infection disease specialist --with liver involvement gastroenterologist gets involved. it would be in your friends best interest to seek initial consult at the recommended clinic who should know which providers available in his area while the insurance situation gets resolved.

hoping for a quick resolution so your friend can get needed treatment.

BabyLady, BSN, RN · Feb 6, 2011

It's a mistaken belief by nurses and public that physicians can care for all patients.
Physicians have to apply to insurance companies to become "eligible providers" in order to receive payment and be able to provide care and treatment to members of the insurance plan. Many do not apply to Medicaid so unable to provide care those recipients.

Exactly!

I didn't want anyone to confuse my post with what Karen just posted. She is absolutely correct.

But a physician cannot say, "Oh, well, you have been diagnosed with ____________________, and even though I accept Medicaid, it wouldn't be worth my while due to low reimbursement...so I am going to have to send you elsewhere."

If they take Medicaid, then they take Medicaid.

NurseLisa64 · Feb 8, 2011

Hi all,

I gave him the information you all provided. Guess we will go from there. You know men- they need to be prodded to do anything!

I will post any new information for others if I get some to share.

Thanks again! :yeah:

NurseLisa64 · Sep 28, 2011

Just updating- I found a plan for pre exisiting conditions after much legwork!

It's the NY Bridge plan. There are 2. My friend has been through hell with the drug companies and the Bridge Plan its self. It isn't well coordinated-I beleive it's fairly new. If anyone does look into this plan-PLEASE- you have to argue with them-don't give up! They told my friend he would have to pay a $6,000 co-pay! The drug company covered it-he is taking Pegasys injections which are new so the drug company wants to promote their products and pays for it.He is on a 6 month maintenance of 3 pills in the am,2 in the afternoon and 3 at night. They are huge pills! The injection is once a week-that is what makes him sick for a few days after. You do need to attend a class before you try this new injection.

He had to wait for a few months because of all the confusion. Hope this works for him...

SuesquatchRN, BSN, RN · Sep 28, 2011

It sounds as if he's in a clinical trial. Good luck to him, but he's already lucky to have such a good friend.

NurseLisa64 · Sep 29, 2011

Thank you.. that's why I'm a nurse- love to help others :)