Health insurance woes...

[Dreamstalker]

In my state, everyone is supposed to have health insurance or we get penalized on our taxes (this should have made getting insurance easier). There's a state program (MassHealth) that's supposed to fill the gap for residents who can't afford private insurers. That was the plan, anyway.

I have the lowest tier of MH; it doesn't cover much but it's free and makes the state happy.

Mom has a job, but it doesn't include health insurance so she has been trying to get approved for MH. They do have a low-income plan which she should be able to get on.

Loooong story short, she's been fighting with them for over a year. She sends in all her info, they lose it (or come up with something else they need), repeat. If they do hang onto something for longer than a day they misread it (no, one day a week teaching adult ed is NOT A PENSION).

Yesterday, she finally hears from them. She has been denied for the lowest tier (which is only for applicants who are unemployed) because "income is above 300% of the poverty rate". Wait, what?

No. No, it is not. So mom calls our senator's office (not Scotty-boy, a woman). They point her to a state insurance clearinghouse that might be able to give more information.

So, turns out that MH does not use living expenses in determining how much they think a person's making.

Since mom has been uninsured for more than six months she is considered 'high risk' and the only insurance plan she is eligible for would be $600/month (some private plan that insures people with severe pre-existing conditions of which she has none).

We think they think she's trying to scam the system due to her age (zomg how can a person be almost 60 with no health insurance).

We're THIS close >< to going to the media (the local news "I-Team" loves stories about the system screwing up and in most cases the publicity results in the problem being fixed). Mom's going to see just how much more information she can wiggle out of the insurance folks.

[telecom_goddess]

If going to the media really gets results then I would quit screwing around and just do it.....y'all have spent enough time on this nightmare!

[Sapphire Silk]

When Massachusetts initiated its insurance mandate, it did not set up any kind of plan to contain costs within the health care system. So while residents are required to have health insurance, the state is not requiring providers to do ANYTHING to contain health care inflation, which has skyrocketed in spite of the fact most Mass residents now have insurance (that is totally inadequate to meet the needs of its purchasers).

As a result, even though residents have insurance, it does not meet the needs of its purchasers and so ER abuse continues, and cost shifting of health care continues because nothing is covered.

The Affordable Care Act (national health care reform) requires a similar mandate, but includes provisions to contain costs. These provisions are not yet fully implemented and won't be until 2014. At that time, CMS (the agency that runs Medicare) can set reimbursements based on the best medical evidence. Since the insurance companies do what Medicare does, this will reduce costs, insurance will cover more, and premiums will become more affordable as more healthy people enter the pool.

Dreamwalker's mom will have more choices in the new insurance exchanges. Hopefully, that will mean better choices. She'll just have to stick it out until 2014 when the exchanges become operational, or until she qualifies for Medicare.

In the meantime, contact the media. Mom is getting hosed by these people.

[Dreamstalker]

If you don't have insurance, you get penalized bigtime on taxes. Yet, they make it all but impossible to get said insurance (I still think the only reason I got approved so quickly is that I had the state disability agency file the paperwork on my behalf).

I can testify that their very-low-income system is for the most part inadequate (I've probably been very lucky in that I'm generally pretty healthy and don't waste the ER's time with stupid or unnecessary shit). I still don't have a primary care doc as the only ones that they'll pay for are a few towns over in the sketchy areas (mom doesn't want me venturing over there even in the daytime).

She wants to get as much information as she can before we go to the news, maybe catch them in a lie. I am starting to organize and type up all of her correspondence and notes with them though.

[42_42_42]

If you don't have insurance, you get penalized bigtime on taxes. Yet, they make it all but impossible to get said insurance.

The news will eat that up.

Also, seems to me like perfect grounds for filing a suit against the state.

[Dips]

Ugh. Flashbacks.

My daugher was on MassHealth. It took MONTHS even though she met the guidelines.

What's happening to your mom is just beyond ridiculous.

[Sandman]

One key thing about getting your MASSHEALTH application fast tracked.. have a good working relationship with your rep. to the general court

[lachesis]

Good luck to your mom, Dreamstalker. I have a friend who can't afford insurance and her boss does not supply it (the company she works for has less than the requisite employees needed to MAKE the employer offer it). Soooo, she goes without. She is a severe asthmatic and due to her compromised immune system, gets sick very often. I have had to offer her shots of my inhaler more than once because there were times she couldn't breathe and refused to go to the ER. I know, I know, I shouldn't share my meds, but it's better than just watching her have an asthma attack and no emergency inhaler to help it.