Tuesday, February 23, 2010

About Insurance Costs

Last night, at the pharmacy, I just about fell over. B's main med is over a thousand dollars a month. She's on three others which, thankfully, are generic. We pay 20% of the meds. That's over 200 a month in meds out of pocket.

I was thinking that we had several thousand in our FSA. (Flexible Spending Account). I found out we started the year with $1500. Only enough for our deductible.

Once that is met, we pay 30% and they pay 70%...that's tier two. Tier one coverage is 90/10.

There are no child psychiatrist on either tier. Hence the kerfluffle with the insurance company over whether they will pay for Bingham. Supposedly, they will pay at the 30/70 rate, but if they pay the pretend negotiated rate as opposed to the rate we paid up front, we will be screwed.

Oh wait! We are screwed already!

And they might say Bingham is covered, but does that mean that one small therapist there is covered, or everyone? I think they go by each one who works there, and not the place itself.

So, the intake visit was $280.00 . Med management visits might run around $160.00. Our part would be around fifty. Therapy? How much does that cost? She'll need that, too. 30% is ours to pay. Fifty dollars a week, perhaps, for our part of cog/behav. therapy? ...that's another two-hundred. It's going to be a HUGE chunk of change each month.

Lord, how are we going to eat? B needs this to stay alive!

17 comments:

Ο ΓΡΑΦΩΝ said...

This is too much to take.
I pray that God will strengten you. I had a friend who always said to keep the sparrow in mind.
We'll be praying our weak prayers. I've got your name on my altar-names list. There's really nothing more to say.

elizabeth said...

Keep your courage Alana!! It for sure is a lot but just think of God bringing you to this good hospital for B. I will pray for you for God's provision; I would think continued prayers to the Theotokos for healing and also to St. Nicholas for provision would be good. *hugs* Hang in there! Bonne courage!!

Alana said...

Oh so many prayers going up!

Anonymous said...

And still some people say we don't need health care reform.

Lord have mercy. Sometimes I wonder, what if all the mama bears with children who need medical care but can't afford it just, you know, went all Mama Bear on the system? Sigh. I can dream.

But prayers are more to the point at the moment than daydreams. You've got mine.

BelleArtMom said...

Oh, bless you, sister! It just doesn't seem right that good health care is only there for those with enough money. Definitely will continue to pray for you and your daughter.

margaret said...

I agree with Anonymous - and you also have my prayers. I've been praying for B. for a long time because I have just a tiny insight into psychosis and know how that felt but it never occurred to me that you would have to pay for a child's medication.

Alana said...

Oh yes, we pay and pay and pay and pay. How easy is it to move to the UK????? I would have, on principle, been a Tory, had I lived in 1776. Does that count for anything? ;-)

Rebecca said...

Continued prayers. I know how we struggle without all of those costs. I can't imagine having to add those things in. Hugs!

Victoria said...

Jumping up and dow--- Splat.

I have no real helpful words. But I wonder if somewhere in the Church there might be a lawyer who would be willing to help or advise. I attended a talk this morning about "elder law" and realized that a trained person can do a huge amount to help.

It was still wonderful to read about your excellent experience at Bingham yesterday.

Laura said...

You will certainly be in my prayers. Some hospitals do have programs that help you with bills in such cases. Is there a social worker on B.'s team who could help you sort that out?

Kristenmomof3 said...

That is why I had to stop going to my person I was supposed to go to and had to stop taking my meds. We couldn't afford it.

Philippa said...

Alana, call the company that makes the medication. Explain your situation and financial situation. They may have a grant system or financial program that your daughter qualifies for in order to get a discounted rate. This was the situ with my mother's cancer meds which were $3000/month and she only had to pay $30.

Tabitha said...

I agree with Philippa. My husband's monthly meds were killing us and sometimes we just didn't get them and many times God blessed us with samples. Then one day my dh found out about a program with the pharmaceutical company for people with low income, he had to fill out paperwork and have the doctor fill out paperwork, yada yada. But now we get his meds for free. I think its called Bridges to Access or something. I will ask him for you.

Prayers for the costs and much joy for the blessings of a) getting into Bingham and b) having read the article last year so that you would know just how special this place and this doctor really are. Love and Hugs.

P.S. your daughter always has been and continues to be such a beautiful person inside and out. Hang in there.

Michelle M. said...

Praying for you guys! I'm sorry this is so difficult. I hope things will improve.

Anonymous said...

Along with Phillipi, I urge you to contact the drug company. Persist until you talk to a human being. Look on the internet to find the drug manufacturer site or just put in the drug name to find out more information.

I am a pharmacist and heard a drug representative talk on a new drug coming out soon (not new, just a newly reformulated drug), but plenty expensive, no doubt in the new once a day dose.

Two things I took away from attending the talk; 1.) contact the drug company if cannot afford the drug. They have programs called Patient Assistance Programs to help with patients that cannot afford their meds. (I know this works because a friend of mine was able to secure a regular supply of the medication when she persisted in contacting the company after I attended the talk and told her how to keep going until she talked with someone that was helpful.)
2.) Payment of drugs is MEANT to be by either someone with insurance or via a free program. (Drug companies rip the payors off so badly that they simply have to do something for redemption!) I was told that if a person had to pay cash for the drug they couldn't afford it.

Either that or talk with the psychiatrist. If you wait until your daughter is older, there is a matter of 'confidentiality' and no one, absolutely no one, will talk to anyone who is not the patient unless the patient has a durable power of attorney, or some other legal arrangement. (I know this, too, because an adult family member refuses to let anyone in the family know anything, and we are sitting around helpless to help her in her state while she throws us all through the hoops.)

Tabitha said...

Husband says its not Bridges to Access (that was only worth about 10% off). He said that he went to the company's website and poked around until he found a link for free medication. Its the same thing that Anonymous was just describing as Patient Assistance. DH said the link took him to a list of eligible meds and then he got the paperwork started with his doc. Good luck with the search, here's hoping her meds are on the list!

Jo said...

The drug company programs are not going to help you. First, you have insurance and that alone disqualifies you for most of the programs. Second, she's a minor which means the drug companies know she has other options. Third, most of those programs have a lifetime cap on their programs, and its usually a year. If you use it now, she won't have if to cover gaps as an adult--assuming health insurance is the same then.

You need to apply for Mediicaid for her. Yes, I know your income is likely too high. But, you need the rejection for the appeal. After she is denied medicaid based upon family income, you go through whatever your state's waiver program is. Its usually called Katie Beckett, but that is falling out of style now. This program is an appeal that states your chlid has significant special needs and should be considered for medicaid based solely upon HER income, and not the family income.

Her diagnosis will get her the waiver. The funding is low with the recession, so it might take awhile depending on the state, but eventually it WILL come through.

Second, you navigate all the rules and regulations to get her on SSI. This is also based upon family income, but it opens up health insurance options, and it will establish her need after she's an adult should she not be functional.

Third, you hunt down and navigate whatever your state calls their Mental Health Waiver program. This is seperate to medicaid and covers the gap of ancillary services for her needs. Again, her diagnosis should qualify her for the program, but again its based upon funding and the length of the wait list.

Its a long and ardorous process. But, for children with mental health and other special needs, the programs DO exist and can be navigated.

If you are unsure how to navigate all of this, hunt down the contact for Parent to Parent there. There is always a chapter of Parent to Parent and they will be able to give you state specific information to navigate the myraid of beaucracy you face now.