What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied

waterOfLife

New Member
2
My friend lives in Kansas.

She has a pancreatic tumor and needs to get it biopsied. Apparently that could cost up to $20,000?

She is currently immobilized by pain. She is a registered nurse but had her license suspended. Even though she is still officially employed by her job she can not use her employer's insurance because of the suspension.

She literally has no money. She tried to apply for KanCare, the Medicaid of her state, but they denied her because of her cars, which, according to blue book values, come up to be assets worth more than $800, despite each car being 10 years old and probably hard to sell for such prices.

ObamaCare was considered and I could help her pay her premiums but the open enrollment starts on the Nov. 15th and she needs help NOW. I am uncertain if she could apply for the special enrollment period since she technically wasn't fired from her job and even if she was it has been more than 60 days.

She has no credit built up but is quite capable of paying off dept once she is able to return to her job as a RN.

I've considered cosigning with her on a loan. We've also considered Medicare. Her hospital won't accept any special payment plan deal with her doctor...Her doctor considered the option of taking her to the emergency room but apparently her condition isn't bad enough to do that yet.

Please, any advice or suggestions will be much appreciated. Should she contest/dispute the rejection of KanCare?
 
Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

If she has lost her employer plan and it's within 60 days she has a special enrollment on or off the exchange.
 
Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

If you have health insurance, you could Marry her and she'd be covered instantly, or purchase a 11/1/2014 effective date plan, if you marry her this month.
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Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

There is a Special Enrollment period available through healthcare.gov if her income has changed so she is now eligible for premium subsidies.

They would look at the entire year's income to determine this.

My recommendation is for her to call the Marketplace and use that income change as a Qualifying Life Event-if it works she will be covered on November 1st (if she calls this month).
 
Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

In your original post, you said it has been more than 60 days. How you count to 60 days is very important. So, when you call the marketplace, be sure to tell them the date she lost her insurance (which was probably later than the date she lost her job). Between all of the events she has experienced she may end up getting a Special Enrollment Privilege (SEP). But you need to hurry, because the next effective date is 11/1/2014, and you must have it done on or before 10/31/2014.
 
Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

Oh, didn't see "more than 60 days" but take one of the other suggestion's, all are correct.
 
Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

Her best option is to call the marketplace ASAP and tell the rep she has several things that might qualify for an SEP and she would like the rep to review the situation with her-that will give her the best possibility to get a plan on November 1st. She should definitely mention the loss of income along with the loss of group coverage.
 
Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

These were all fantastic and informative replies!!

AllenChicago she laughed a lot at the marriage idea! (actually hurts her a little laughing, so stop that, just kidding :D), but I'm still considering that option (not sure if my insurance would transport to her though).

She called the Marketplace but they said that she'd have to call again to speak to someone specifically experienced with special enrollment.

Also, they said that she would need to wait at least 30 days before her insurance could cover surgeries if she did get insurance. I don't know if someone can confirm this is how things should be?
 
Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

Even though she is still officially employed by her job she can not use her employer's insurance because of the suspension.

She is either "employed" with group coverage, or, "not employed" without group coverage. Which is it?
 
Re: What Health Insur. Options Available to Friend who is Currently Immobilized by Pain from Unbiopsied Tumor in Pancrea

These were all fantastic and informative replies!!

AllenChicago she laughed a lot at the marriage idea! (actually hurts her a little laughing, so stop that, just kidding :D), but I'm still considering that option (not sure if my insurance would transport to her though).

She called the Marketplace but they said that she'd have to call again to speak to someone specifically experienced with special enrollment.

Also, they said that she would need to wait at least 30 days before her insurance could cover surgeries if she did get insurance. I don't know if someone can confirm this is how things should be?

No waiting periods for coverage under ACA, period.

I am assuming this is very important to you and your friend and time is running out rapidly for a November 1st effective date so even if the Marketplace rep wasn't helpful go create an account on healthcare.gov and work through the application. Here is the link to the screener: https://www.healthcare.gov/screener/

There is every reason for your to take some time on your own and see if you can get this done-if you complete the application and it does not allow a SEP then call the Marketplace again and ask why-they should be able to escalate it at that moment if you say this is urgent, don't let anyone put you off by saying to call back.
 
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