Insurance problems

We have been getting our insurance through our state's family care plan. Basically it is a premium based medicaid. Well today we learned we no longer have it as of the end of the month. As upsetting as this is it is the why that really has my blood boiling. It would seem that someone made an anonymous phone call to the state and reported us for fraud saying we made too much money to qualify and that they knew we were not reporting income.

Supposedly the state tried to verify this and were not able to but apparently proof is not required, only suspicion and innuendo. So now we have to apply all over again and send in tons of documents again before we will have insurance. Last time it took just shy of 3 months. Nothing like being assumed guilty until proven innocent.

The state needs to change its policies and: 1. Stop accepting anonymous calls so they can go after and prosecute these people who make them out of spite for some reason, and the big 2: Do not deny benefits unless it can be proven that the allegations are true.

Jim

As you know the state is broke anyway, are you sure they are just not looking for any excuse they can muster to get out of paying???? I don't know anything about medicaid or the type of insurance your talking about, but I do know that allot of doctors and other medical institutions are having a difficult time because the state won't pay what it owes! That is why the Governor is releasing all those prisoners because they can't afford to keep them in prison any longer, they don't have the money!

I do wish you luck! Take Care!

White Beard

I too, get madder than a Hornet, at information like this. I have to agree with White Beard, and there is way too much funny stuff going on with the insurance companys, and SSD!

Sorry to hear of your dilema, it just plain sucks!!!

Will your doctor work with you to stock pile some necessary meds to get you through until this mess is cleared up?

All the crap I've been seeing on tv about all the wasted money being spent to get this new Health Care Bill passed it makes my blood boil. These people have no idea what real life is all about. I bet none of the people making these decisions will be going without necessary health care. I know we're not supposed to talk politics on here but I'd like to kick them all to the curb!!!

Nope, no appeal process. The only appeal process is if you are denied coverage for a certain medication or treatment. No appeal if you are dropped. Like White Beard said it could be, in part, the state looking for any reason to trim its participation in health care due to budget problems.

As far as stock piling meds that is not an option. My meds would run me just under $2000 a month out of pocket, and most of what I am on is not part of the sample stock doctors have available to them. That is more than our household income. My insulin alone is over $600 a month. Besides that, since I am not on any narcotics at the moment I have refills available to me on all of my current scripts, just no way to pay for any of them.

This weekend I am going to be trying to see if we qualify for those prescription programs where the manufactures pick up the tab and we are also going to be getting everything rounded up to send off to reapply to the state to get our insurance back. I know we qualify still, just irks me that we wont have any coverage until April.

Jim,

Would you be able to get samples of any of your meds from your doctor(s)? If they know the situation you are in & have samples, they'll likely give you enough to tie you over for a while.

Skeye

Oh Jim,
so very sorry your in this type of mess. wish I knew how to help you, finger crossed that this situation can be fixed fast for you, it never should've happened, you should've had the right to face the accused...
fingers crossed that this will get resolved for you soon...keep us posted as we do care...
(((((((((((((((((((((((((((((((Jim))))))))))))))))))))))))))))))))))))))))))
hugz

Jim, I am so sorry about all of this. But, something I wonder about and you can chew on this, with this being a state program whoever made that call knew your d/b and your SS#. This is how you are indentified in the system. not by strictly your name. There are too many people with the same names. Who in your mind which you do not need to divulge here would do something like this? It is obviously someone who knows you very well and has your info I just spoke of. I cannot believe a simple phone call caused all of this hoopla and grief.

Wow, I just cannot believe it, how awful. Its a sick world we live in no doubt. I am just sorry for you and your family. I cannot believe the system is so lax. So now do you have to reapply all over again and do all of the paperwork? If so and you get reinstated I would tell my wife not to breath a word about it to anyone at her job. Sleazy people. So wrong.

Hi Jim,

I guess I'm just too suspicious but how do you know that the state is telling you the truth? Gosh, can you imagine someone in government being dishonest? BTW, my hubby is a state employee so I feel I can get away saying that. BUT...he only keeps the computer programs running at dept of labor and industries.

Anyway, I'm with Pete on this one. Get yourself on the phone and start squawking to anyone and everyone who will listen. Jim, if this is happening to you just imagine how many others are being sacked like this. Fight, my Good Man, FIGHT!. Be calm and courteous but do not take NO for an answer. You can go actually do it online and you'll be surprised that you actually get responses. Online locate your local congressman, state that is. Doesn't matter which one because when you fill out their form online you can click one button and your message goes out to all of the people who represent you. Been there, done that!! Explain the problem, explain what will happen if you don't get your medications, explain you don't have $67/day or $2000/month over and above all of your other expenses just to keep you alive and with some sort of quality to your life. Your illness is not your fault and neither is it for the rest of us. It's time us regular folk stop taking whatever answers they feel like dishing out and start fighting.

In my family everyone knows about my "letter of the month" award!...lol When I have a problem with a product/service/or just being messed over I write. Now, I'm talking the real deal here...paper, envelope and stamp! But some times I resort to online. I've found it's easy to write a respectful letter of complaint and get results. It irks me that companies or government rely on the fact that 99.9% of the population will do nothing if they are cheated. Here's a tidbit from being a business owner...ever wonder how all of these fly-by-night TV sales can offer you a "double your money back" guarantee? No one every follows through! It's a safe bet.

OK, I've rambled on long enough. I do hope you at least contact your congressman. Even if you don't get what you want you at least have that person's ear and you know that you did whatever you could to fight for your family.

Best of luck and please keep in touch...ps, you know my email address if you ever want to chat,
Chutzie