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how to explain health care to MI providers?

10 posts in this topic

Posted

Hi,

 

I'm running into some big problems and my anxieties are going so sky-high that I can't think straight anymore.

 

I just had a 30 min telephone conversation with a tdoc about why I still have to pay money even though I have medicare.

 

I CAN'T EXPLAIN WHY....it is the way it is. Ask a republican. I don't know what the fuck to say!!!!!!!

 

Tdoc asks "why do you have to pay when you are on disability?" me: "I don't know." tdoc: "that doesn't make any sense."

 

I did not create the medicare system. What do I tell these people?

 

And then don't even get me started on my child's supposed transition from healthy families program to medi-cal or medi-caid (i don't know which one and i don't know the difference). This is not my choice. It is Jerry Brown's the governor of CA made this decision - NOT ME!!!!!!!!

 

Arg!! I don't know how to explain this stuff and I really don't want to. I'm not being paid to educate health care professionals on the details of these various programs.

 

thanks for the vent,

db

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Posted

From what I know, if you make over a certain amount in disability, you have to pay the medicare premiums.  But if you meet the QMB status of it all (qualifying for medicare and medicaid), you dont have to pay anything.  It is based on some equation that determines your % poverty level. I really dont know any details, just this because it is what I have.

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Posted (edited)

Tell them to call Medicare or have their support staff call Medicare (1-800-Medicare [622-4227 iirc]) and ask for the Medicare provider line number.  Seriously.  It's a service directly for people who provide professional services to Medicare beneficiaries (e.g. doctors, therapists) and nobody ever uses it so there's no wait time.

 

It won't do any good for you to call the number because they ask for your Medicare provider #, if I recall correctly, and when you don't have one and your question isn't "how do I get a medicare provider number" they will probably shunt you off, but you can ask for it and explain that you want to give it to the doctor or therapist.  You may not get it, which is why I stated that the provider/support staff should optimally call.

Edited by saveyoursanity

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Posted

Did you apply for extra help through medicare.  My Dh was paying co pays for a while before I heard about it on here and told him to apply.  They won't sign you up automatically. 

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Posted

extra help as done through Medicare only helps with prescription costs.

 

Done through the state, like Medicaid, the QMB/SLMB (and one other acronym maybe I can never remember) programs do pay for some or all of the costs Medicare doesn't cover.

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Posted (edited)

.

Edited by TOT

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Posted (edited)

.

Edited by TOT

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Posted

Thank you all. :)

 

Yes, I have medicare and the "extra help" for part D. I do not qualify for anything else.

 

My child is/was enrolled in "healthy families." Per their website this program is being dissolved and all children are being moved into medi-cal slowly over a certain time period depending where one lives in CA.

 

As far as i know her father does not have health insurance but one would have to verify with him. not me.

 

I apologize to everyone on CB but I just can't write anymore about this. Stupid insurances and providers getting me in a tizzy.

 

I guess the real question is how do I not get "emotional" or angry at people for my inability to explain these mysteries?

 

db

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Posted (edited)

.

Edited by TOT

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Posted

In situations like this, my go-to is a one sentence summary.  "I know it's extremely confusing; it confuses me too, so I don't think I can explain any further or more clearly."  THEN I refer them.  "I've been told that if my providers have questions, they should use [this solution for your situation, such as the Medicare provider line, or calling the local MediCal office, etc]."

 

Repeat one sentence summary as necessary.  Give referral information no more than twice.  Don't answer any more questions.

 

It's upsetting and distressing to re-hash all of this, which is why I literally write out these summaries and repeat them verbatim when I'm talking to anyone who wants me to go through all of this shit to help their own understanding of the situation or problem.   :wall:

 

I hope this helps.  It sucks rocks.

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