A Caregiver, Insurance Termination and Tears

Yesterday I got a call from the wife and caregiver of my client who I went to the Mayo Clinic with in July for an undiagnosed neurological disorder.  With a diagnosis and treatment given, he has been receiving a radical treatment.  There seems to be some subtle yet positive changes.  The treatment is for a year and the doctor said it would be three months before any clear indication of progress.

His wife told me, as she sobbed, that the their state Blue Chip insurance was being terminated as of the the date on the letter 9/17/10.  Their ten year old son would be allowed to continue as per the law.  The reason given for termination was they now made $100.00 too much to qualify.  She told me of her notifying the department of the long term disability plan that kicked in.  She was now slightly above the 175% poverty level of $2500.00 a month.  They survive on his social security disability and the long term disability all totaling $2600.00/ month.  They do not qualify for food stamps because they make too much money.

My client is into the third week of treatment which includes high dose steroids which can not be just stopped. It would be life threatening.   The good news was my client is eligible for medicare disability in January, two years after onset but that is three months away .  What to do?

My first thought was let’s appeal.  However, if the appeal is denied, the consumer is then responsible to reimburse the state for any payments past the initial termination date.  Since appeals can drag on and treatment is expensive the cost could be astronomical.  I thought was there a good case for an appeal.  States tend to be very rigid with  laws regarding poverty level guidelines especially in this economic and political climate.  I knew it would be a risk to appeal.

My client’s wife had already spoken with the state representative and was not hopeful an appeal would go anywhere.  She also spoke with Blue Cross private division about private pay.  She got quotes and told me she could get a private family plan which would use up a larger portion of the insurance until Medicare kicked in.  Then she would cancel it.  As long as  the application was in 30 days, she was assured she could roll over into private pay without fear of pre existing conditions.

The decision was to seek private pay, tighten the belts more and maintain treatment for my client.  Family and church members are rallying in support which helps.

Am I outraged?  Yes!  The state sends a letter to a disable man living just at the poverty level and says sorry.  Not even a good luck.  My client was a hard working individual prior to his illness.  I am outraged at what families and caregivers have to face everyday when someone is ill.  I am so awed by the courage and determination of my client’s wife.  She cries, gets it out, feels hopeless and then moves on to solve the current problem.  This is what caregivers do.  I always tell her how amazed I am  at her strength.

I won’t feel relaxed on this issue until the insurance has started.  As an advocate, I won’t give up making sure my client gets his treatments as prescribed.