Mama Needs Insurance Plz View & Advise

[MamaNeedsHelp]

Hello,


My name is Donny. I am writing this on behalf of my mother.

she is going to be 64 years old this november.



i am writing this post here because i need help!!!! my mother has gone through a whole list of illness's and procedures....

subdural hematoma
kindey failure - twice
high blook presure
colestrol
seizure's
hypertrophic cardiomyopathy (HOCM)
strokes etc....

here's my problem.she WAS on straight PPO California Medi-Cal

THEN they took her off of that and put her on HMO Medi-Cal.

it's not that bad because atleast they pay for all of her kidney transplant meds. the problem is that Cedar-Sinai does not accept the HMO part of Medi-Cal which is LA CARE OR HEALTH NET. the doctors that are affilliated with the Cedar-SINAI group doesn't accept the insureance either. the doctors and medical facilities that the HMO agree to pay for is no where near sub par quailty.

she has been going to Cedar-Sinai hospital for over 15 years. the quality to me and care that they give her there is really great. every time my mother had a problem or they didn't think she was gonna make it..they found a way to keep her alive.

dr. william chow is a neurologist at cedars sinai and he is seriously the only one who has had any luck in controling my mothers seizures.

the question i have here today and what i need help with is this....

i need to get my mother medical insurance that will allow her to go to Cedar-Sinai hospital.

we are not financially stable but for my mother i will go broke just to make sure she get the car that she deserves.

she has been a great mother to me and my younger brother. nothing but positive advise and loving care even through her thoughest times.

im sorry for the long post but i really don't know much about insurance companys and pre existing conditions and acceptance.

please some one help me get my mother the coverage she needs.

i would be forever greatful.

Donny

 

[xrac]

I think you are stuck with what you have until she reaches age 65 and Medicare kicks in.

 

[Yagents]

CA has it's own special rules, and I'm not familiar with any of the plans you are speaking about. But SOMETIMES, when changes like this are made, and your mom is under CURRENT care with these providers, they may allow her to continue her care if it would be detrimental to her health if she had to change.

 

[Josh]

Is your mother by any chance on Medicare? If not, she's likely stuck until she is.

Although this is not likely what you want to hear, many people in your situation don't have access to any type of healthcare from insurance carriers. She has access to doctors now and the great state of California is footing the bill for most (if not all) of it.

At 65 she'll qualify for a GI MA plan (if she isn't already) and she'll be able to pick one that participates with the providers you want (most likely). Even if medi-cal doesn't cover it, your family would only need to come up with some copays and deductibles vs the whole thing, so that may be your next best solution. If she's already on Medicare, she has that option now. To verify Medicare eligibility she can likely call up 1-800-Medicare and give them her SSN and ask if she is on it. If she has a read white and blue Medicare card with Part A and Part B then that would mean she is on Medicare as well. If she is, you should go to Medicare Supplement California | California Medicare and get some help from that fine gentlemen.
- - - - - - - - - - - - - - - - - -

CA has it's own special rules, and I'm not familiar with any of the plans you are speaking about. But SOMETIMES, when changes like this are made, and your mom is under CURRENT care with these providers, they may allow her to continue her care if it would be detrimental to her health if she had to change.

Sounds like a tough sell to me. If it was talking about a different drug or treatment, maybe, but it sounds like we're just talking about "your doctor isn't as good as my doctor".

 

[Dave020]

Even if she were a year older or is pre-65 disabled on Medicare she'd likely be Medi-Medi dual eligible and from what I understand the state of CA is going to migrate an large number of people in SoCal off of A & B medi-medi and onto Health Net HMO MAPD to reduce cost.

@Greensky (Rick) has some experience with Medi-Cal and Healthy Families as well as the HMO migration, perhaps he may have some thoughts here.

So if she's medi-medi she's likely stuck where she is, if she's not medi-medi then it's a Medi-Cal decision on what they offer. If there is no PPO option, she is stuck with the HMO.

Her only other option would be an employer plan since she's not going to be underwritten with that health history and both PCIP and MRMIP are off the table for those eligible for Medicaid.

And if she's 133% FPL or below, she won't have able to get an Obamacare plan due to FPL.

 

[GreenSky]

Just for the record, about 4 hours ago I sent a PM to the poster. Haven't heard back.

Rick

 

[xrac]

You need to consult with your insurance policy provider, may be he can help you write the correct application.

What a brilliant reply!

 

[Cory]

Donny,
Sympathize with your problems and that's what we do for our mothers. A new individual policy with her medical history is very likely unattainable. Supplemental plans may cost more than you will receive. Unless she can be enrolled on a group policy of some sort then xrac is right... you may be stuck with you have until aging into Medicare. What you have is better than nothing at all...wish you both the best.

 

[Orlando1]

Were your mother's previous kidney failures due to End Stage Renal Disease - ESRD? With ESRD you can qualify for Medicare without having to be age 65.

Just trying to offer some help. Good luck!