The Sick Room

[Cooking Goddess]

I have been having pain in my left hip for the past month....She said I will probably need a hip replacement at some point. ...

taxy, don't cry. I have a long-time friend (41 years and counting) who has had arthritis issues all of her life because her dad was riddled with it...and she got his genes for this. She is my bionic friend, having had both hips and both knees replaced over the past, maybe, ten years. In fact, her recovery from her first hip replacement went so well that when she had the second one done last year, she refused home health care. After the first day home she decided that that was stupid (she lives alone), but still managed with friends coming with food and helping a bit. Still, I hope the shots help - but with Addie's vivid description the surgery might hurt less.

Well, finally I can see the light at the end of the tunnel...The nightmare is over!!!...

Glad to hear that you're adjusting to your new normal, Addie. Hang in there.


More Rick news: On Thursday, he had evaluations by PT and OT, and had his staples removed - 47! I told him he was no longer a metalhead, but he said he still is since the doctors replaced the bit of skull they had to remove with a titanium plate. At least the doctors left his sense of humor in place! He was also OK'ed to start playing tennis next week, as long as it's a gentle game of tennis. We'll see how that goes. He also stopped by the bowling alley on Thursday, just to visit. Would not surprise me if he's bowling in a few weeks. Finally, he and his wife will be meeting with Neuro-Oncology and Radiation-Oncology to plot the course of treatment. They will be making a mask of Rick's face so that he can be immobilized during his treatments. His wife said he's rather excited to think that he'll look like Hannibal Lector. Again, the brain has cancer but his humor is intact. God Bless him!

 

[Caslon]

Medi-Cal sponsored insurance companies will be the death of me, I swear. I have Medi-Cal, I swear. In that plan I had to see my Primary doctor to see a dermatologist about a lesion on my lip (2 weeks just to see primary). He sees the lesion, puts in a recommendation to the Medi-cal sponsored insurance company to see a dermatologist. That takes another 2 weeks for approval to get a consultation from the dermatologist. They snap a picture of the lesion for a biopsy and send it off to the insurance company for approval (Care1st). That takes another 2 weeks for them to approve the biopsy which then takes another two weeks to see the dermatologist to take the biopsy. They tell me it'll be another 2 weeks for the biopsy report. 2 weeks later I get the happy results that its pre-cancerous, and they'll freeze it off. However, that will take another two weeks for the insurance company to approve the freeze off. After approval of that, another 2 weeks before they can fit me in to freeze it off.

When I was able to afford private insurance, I was able to make an immediate appointment with a dermatologist. Within days I had a biopsy taken of a sore on my temple. The biopsy results took days, not weeks. They called me within 3 days of the results saying it was a dangerous squamous cell cancer and had me scheduled for MOH's surgery THE VERY NEXT DAY! Compare that to my current Medi-cal sponsored insurance company which took approximately 8+ weeks from the time I first saw my primary about that lesion on my lip, until I finally got the biopsy done and the results gotten back to me. If it had been squamous cell cancer, they probably would have had me wait for 2 more weeks to approve a possibly life saving MOH's surgery. Then again, probably another two weeks to actually fit me in to some Care1st doctor who would perform the MOH's surgery.

This all reminds me of the poor soul US veterans who died waiting for a VA hospital to treat them.

 

[Addie]

Each day I am making progress. I have a faux fir coat that is SO EVER WARM. Even though I have lost so much weight these past 18 or more months, I refuse to give it up. This coat is reversible and so heavy. This year I find I need to have someone help me put it on. Well, today my learning lesson was to learn how to put my coat on by myself. I laid it on the bed with arms outstretched and was able to put the coat on by myself.

Next stop is Winthrop. It is quite warm in there and I took the coat off. Well there is no bed to spread it out, so I struggled with it. Several folks offered me help, but I was determined to do it myself. Winter is just around the corner and this is something I need to learn. It took me a while to figure it out on how to put this coat on while sitting in a wheelchair. But I did it. Another lesson learned.

 

[Addie]

Caslon, hearing your lament, I am ever so grateful I have the medical care I receive. I get appointments within ten days at the longest. And I can make them myself without anyone's approval.

The senior program that is available to all senior citizens in this state is phenomenal. What Medicare doesn't cover, State Medicaid does, and what that doesn't cover the Senior Citizen program picks up the balance. Very few elders ever have to spend one cent of their own money. Only those who are living with their own retirement plans from their work, are making co-pays, and minimal ones at that. The senior citizen plan is so successful, that at least twice a week, there is someone from out of state here to gather information.

 

[Caslon]

Caslon, hearing your lament, I am ever so grateful I have the medical care I receive. I get appointments within ten days at the longest. And I can make them myself without anyone's approval.

I'm researching whether or not to dump California's Medi-Cal and go with Medicare. I might have to pay a co-pay (depending on the plan), but hopefully would receive more immediate care. With Medi-Cal, not only is there a ridiculously repeated long wait to get approvals from Medi-Cal for Care1st's doctors procedures, there's always the 14 day wait before my Care1st list of approved doctors can see me for each visit/procedure.

Waiting for the OK to do the biopsy (2 weeks) and then another 2 weeks to get back the results had me concerned. Had it been a squamous cell carcinoma untreated over that time, well...some squamous cell carcinomas have been known to turn into a melanoma if not dealt with within a timely manner. With Medi-Cal, there are only 4 choices of insurance companies to choose from, and they are all about the same as far as timely attention (even my primary doctor refers to Care1st as CareLast).

 

[Cooking Goddess]

Caslon, it sounds like you're stuck between a rock and a hard place with your medical issue. I hope things get resolved in your favor soon. Good luck.

...The senior program that is available to all senior citizens in this state is phenomenal...

No Addie, not ALL seniors. It's just available to people below a certain income level. You have to qualify financially to get that coverage. No state is crazy enough to give free medical coverage to ALL seniors - the state would go bankrupt. I would guess the majority pay their own way.

 

[Caslon]

Caslon, it sounds like you're stuck between a rock and a hard place with your medical issue. I hope things get resolved in your favor soon.

80% of most ailments will clear themselves up naturally. This benign growth on my lip is such.

It still blows my mind, the delays caused by insurance company paper work.

My Care1st medical insurance company state sponsored by Medi-Cal makes you go 2 weeks before approval of anything.
By that time, some ailments have already run their course. Therefore they say...wait two weeks or go to the Emergency room if its that serious. THEN we will decide whether that visit was warranted and whether or not to have it automatically paid for.

 

[Addie]

A little known fact I learned many years ago from the finance department in one of Boston's very large hospitals.

"If the medical facility receives even just $1.00 of Federal monies for research, they cannot refuse to treat you in the ER or later dun you for payment if your insurance refuses to cover the cost."

I was all set to refuse treatment from MGH for a very expensive treatment. I was in the finance office and the woman that I was talking to told me some interesting facts. That was just one of them.

She also stated at that time the majority of the populace did not have a PCP and used the ER for ailments that a PCP could have handled. I don't know how much of this still applies, but it sure saved my purse from wear and tear with boys prone to accidents.

 

[GotGarlic]

A little known fact I learned many years ago from the finance department in one of Boston's very large hospitals.

"If the medical facility receives even just $1.00 of Federal monies for research, they cannot refuse to treat you in the ER or later dun you for payment if your insurance refuses to cover the cost..."

She also stated at that time the majority of the populace did not have a PCP and used the ER for ailments that a PCP could have handled. I don't know how much of this still applies, but it sure saved my purse from wear and tear with boys prone to accidents.

That's a pretty well-known fact, except for the part about research and your insurance. If you have insurance and it doesn't cover your treatment, the hospital can indeed come after you for payment. This is how people end up going bankrupt from medical bills they can't pay.

If an emergency department receives reimbursement for services covered by Medicare or Medicaid, they have to evaluate everyone who comes in and treat those who have a valid emergency condition. This is why people without health insurance, or without the money to pay for co-pays and deductibles, wait until they're so sick they have to go to the ER.

There's much more to it, of course: https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

 

[Caslon]

That's a pretty well-known fact, except for the part about research and your insurance. If you have insurance and it doesn't cover your treatment, the hospital can indeed come after you

The latest is...some hospitals won't let you leave until you pay.

 

[GotGarlic]

The latest is...some hospitals won't let you leave until you pay.

Really? I'd like to see evidence of that. Sounds like kidnapping, which is a federal offense.

That's not the same as leaving against medical advice, of course.

 

[PrincessFiona60]

I have never had to pay anything to get out of the hospital or ER, even back before I had health insurance.

 

[Addie]

Really? I'd like to see evidence of that. Sounds like kidnapping, which is a federal offense.

That's not the same as leaving against medical advice, of course.

Something I have been known to employ. The only time I can see that the hospital can hold you is if you are a danger to yourself or the public.

 

[Addie]

Caslon, it sounds like you're stuck between a rock and a hard place with your medical issue. I hope things get resolved in your favor soon. Good luck.


No Addie, not ALL seniors. It's just available to people below a certain income level. You have to qualify financially to get that coverage. No state is crazy enough to give free medical coverage to ALL seniors - the state would go bankrupt. I would guess the majority pay their own way.

Original it was called The Elder Service Plan. Now it is called Pace. I have no idea what that stands for, nor do I care. But I do know that it encompasses ALL seniors. Even healthy ones who just need a PCP. About six or so years ago, I was promoted from the ESP and Pace came to my home to talk to me about switching over. I seriously considered it. The way it works is:

Medicare is billed first. What they don't pay for;
Then Medicaid picks up the cost. And then;
Any insurance you may have. What that doesn't cover, then;
The Pace program picks up the balance of any medical expenses you may have.

 

[Cooking Goddess]

My point, Addie, is that all seniors in MA DO NOT qualify. A senior citizen has to be below a certain money limit. They have to be poor. If they aren't poor, they do not meet the requirements for that plan no matter how old they are.

I'm glad for you that you have great medical coverage. Some of us seniors in MA pay out of pocket for all coverage and still end up with out-of-pocket bills. Just thank your lucky stars you don't have to. Some people go bankrupt paying for their medical care.

 

[Caslon]

My point, Addie, is that all seniors in MA DO NOT qualify. A senior citizen has to be below a certain money limit. They have to be poor. If they aren't poor, they do not meet the requirements for that plan no matter how old they are.

I'm glad for you that you have great medical coverage. Some of us seniors in MA pay out of pocket for all coverage and still end up with out-of-pocket bills. Just thank your lucky stars you don't have to. Some people go bankrupt paying for their medical care.

It's not that they have to be poor necessarily. They don't check your bank account. It's about income and how much of it you have.

 

[GotGarlic]

Original it was called The Elder Service Plan. Now it is called Pace. I have no idea what that stands for, nor do I care. But I do know that it encompasses ALL seniors. Even healthy ones who just need a PCP. About six or so years ago, I was promoted from the ESP and Pace came to my home to talk to me about switching over. I seriously considered it. The way it works is:

Medicare is billed first. What they don't pay for;
Then Medicaid picks up the cost. And then;
Any insurance you may have. What that doesn't cover, then;
The Pace program picks up the balance of any medical expenses you may have.

Nope. There are income requirements and the primary eligibility criteria appears to be that the person is deemed to be eligible for nursing home care but with help, can live safely in the community. It is definitely not for healthy elders.

Who is Eligible for PACE?
Program of All-inclusive Care for the Elderly (PACE)
https://www.mass.gov/service-details/who-is-eligible-for-pace

 

[Caslon]

GC, I ended up having to see a state office worker and explain my situation to receive Medi-Cal. It was up to her whether or not to approve me. She did after the interview. I'm just saying, I didn't get approved with just mouse and keyboard clicks.

 

[GotGarlic]

GC, I ended up having to see a state office worker and explain my situation to receive Medi-Cal. It was up to her whether or not to approve me. She did after the interview. I'm just saying, I didn't get approved with just mouse and keyboard clicks.

No one does, Caslon. The eligibility requirements and benefits vary by state, though.

 

[roadfix]

I'm researching whether or not to dump California's Medi-Cal and go with Medicare.

If you qualify for both why not have both? There should be no co-pays if you enroll in a Medi-Medi plan. I know SCAN and Kaiser, just to name a couple, offer medi-medi plans.
It doesn’t have to be one or the other.