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NotElvis

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Warning - some of the descriptions may get somewhat unpleasantly graphic.  And, this post is going to be something of a downer.

I live in NJ, my friend used to live here, but now lives with his GF in North Carolina.

He grew up under, shall we say, less than ideal circumstances.  Oldest of 3 kids, dad left when he was in his early teens.

He'd always been overweight, though his dad was as well.  Never been a junk food eater, though.

And, well, as he'd admit, he'd been a little stupid with money, what little he had, in his younger days.  Tried to be responsible with that later in life.  Oh, dad's got money, by the way, but dad couldn't even be bothered to keep insurance on his kids, etc.  Unfortunately, mom never went after him for **09** support.


In any case, fast forward at least a decade or two.  Over the course of his late 20s, definitely by the time he hit 30, he developed Crohn's disease.  Not just "annoying Crohn's" but at a level that a leading specialist on the disease told him that he was one of the top 5 worst cases he'd ever seen of it.

He tried to continue to work, but eventually had to stop  - yet still had to fight with the state to be considered disabled (that problem was solved when the state made him see particular doctors they chose to "prove" he wasn't disabled... within 5 minutes, those doctors rushed him to a hospital)

His life can sometimes devolve into throwing up blood/acid a dozen or more times a day.  What comes out the other end is no better, nor is what comes out of his back or abdominal wall, as his intestines have decided to create fistulas running from them to his skin.

So, in essence, he cannot lift heavy weight anymore (he used to be really strong), and he cannot sit in one place for more than 30 minutes, as his intestines get irritated and start leaking blood through said fistulas.

In other words, he's screwed.  He eventually DID get approved for disability, though.

Oddly, in the last year or two, he's developed diabetes.  This is odd because he doesn't drink, he doesn't eat sugary foods, etc., in fact, his diet is mostly limited to very plain boiled chicken, or plain boiled fish.  Sometimes he can have a SMALL amount of things outside of that, but he's usually taking a gamble with pissing off his Crohn's when doing so.  Also, ginger seems to sometimes help relieve the pain - the zillion pain killers and medications he's been prescribed don't seem to have a particularly noteworthy effect.

Strangely, it seems that if he eats what is recommended to soothe the Crohn's, it makes diabetes worse (not sure why), and if he tries to eat to balance out the diabetes, well, then the Crohn's gets set off.

I've actually seen a photo of his abdomen being extremely swollen on the left half only, due to having flown in a plane for an hour.  ONE hour.

Now something's up with his spine - I'm not real clear on this, but the doctors might be talking fusing two of his vertebrae.

Now today - he's been having issues.  Bad ones.  As in, his girlfriend told me the doctor's expression was absolutely horrified, and she wanted him to go to the hospital ASAP.  He sort of backed off, saying he'd go if he started feeling worse.

His girlfriend is worried, and stressed.  He obviously cannot pay for doctors, hospitals, etc.,  In fact, he now owes over $10K for what Medicaid would NOT cover.

I'm not sure how they expect him to pay that.  Will they dock his disability checks?


What can he do?  He will never be able to work, and he will never be able to pay off what he owes already, yet his doctor thinks he should go to the hospital NOW.  This is something that is probably NOT going to stop.

He's 40, by the way.


I'm at a loss, and so is his girlfriend.  The mounting medical bills stress him out.  Stress is, naturally, one of the things that can exacerbate Crohn's.

What can he do to get his medical costs covered?  I wouldn't even know where to begin to ask around, and his girlfriend is only familiar with dealing with Medicaid.  She's supposedly talked to the various doctors, and hospitals, and they've helped out, but that still leaves them with over $10K in bills, and he worries about that being multiplied with all the care he's going to need.

I just have no idea what to do to see that he can get fully covered - that's really the only option for him.  Either that or suffer.  Or rack up medical bills until he has to declare bankruptcy, then start the process of racking up medical bills all over again.  Apparently he's done that twice already... doesn't seem like a real long term solution.


This all sounds like a major downer, but is there any way he has to ease this burden financially? Any other resources he can use to help with the medical costs?  I'm really completely out of my element here.

Any sort of guidance would be VERY greatly appreciated.
« Last Edit: February 03, 2014, 05:21:21 PM by NotElvis »

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Palomine

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Re: A friend, not me - HOW does one get medical procedures covered...
« Reply #1 on: February 03, 2014, 07:56:09 PM »
Sorry to hear about your friend's predicament NotElvis.

I am NOT an authority on any of this. With that said, please don't think my response flippant, but here's my suggestion: https://www.healthcare.gov/

You didn't mention whether he's availed himself of this: the Affordable Care Act (aka Obamacare) has provisions that can provide co-pays for health insurance premiums for low-income folks AND specifically provide insurance to people with pre-existing conditions without penalty. I used it to get a new policy (from my the same exact HMO I've had for a decade; but the new AFA-compliant plan is much less costly than the previous plan I had with them) myself and it works as advertised. I used my local state-run exchange to sign up (and yes, it took a bit of patience, but most of the website kinks should be worked out by now) and that may be a possibility for your friend (I don't know if NJ has their own exchange or not... as it's a usually-blue state, I expect that they probably do) though he can go through the federal site instead/if NJ doesn't have a local version (the available coverages should be the same either way).

NOW, my finite knowledge about how all this works forces me to point out that if he's already on Medicaid, most or all of his health care expenses should already be free. That doesn't mean that if he racked up $10K of debt before he was on Medicad it now magically disappears... of course it does not. From what little I gather, Medicaid is cheaper (free or almost free to the end user) but sometimes not as good (in terms of coverages) than the kinds of plans insurers are offering via the Affordable Care Act. That is to say: an AFA-compliant plan from Aetna, Blue Cross, Cigna or Kaiser will probably be better/easier to use than would Medicaid coverage. For a very-low income person (such as your friend if he's not working) the federal copay should cover the entire premium cost for a cheaper "Bronze" AFA-compliant plan, or most of it for a fancier "Silver" AFA-compliant plan... leaving a monthly balance due of between $25. and $125. approximately (ballpark numbers based on my own recent shopping and reading about how the sliding-scale copay works... his exact numbers may differ of course).

As I understand it, a person can't be in both Medicaid AND a regular AFA-compliant plan with an HMO at the same time. That is to say, if he already qualifies for/is in Medicaid, he shouldn't need a AFA-compliant plan. Though you didn't say so, I gotta assume he's already looked into this... maybe even gone through the healthcare.gov thing already or been told he doesn't need to since he already has Medicaid coverage. Again, his Medicaid now should cover most all of any new healthcare costs he incurs... though (as mentioned) it doesn't erase previously-acquired debt. Regarding that (a subject for a whole 'nother discussion) he does have some options to consider there too: re-negotiating the outstanding debts (which can sometimes be done for pennies on the dollar), setting up long-term low-or-no-interest payment plans for the remaining debt, or (if worse comes to worse) declaring bankruptcy.

I'll say it one more time: I am NOT an expert on insurance or personal finance or dealing with bureaucracies, though as an adult American, I have some experience with all those things. Your friend should have options available to him and IMO, he shouldn't let financial worries or the confusion surrounding such things keep him from getting the help he needs. I hope this might be of some help.
« Last Edit: February 04, 2014, 02:59:08 PM by Palomine »

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gonZo

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Re: A friend, not me - HOW does one get medical procedures covered...
« Reply #2 on: February 04, 2014, 10:17:34 AM »
I agree that your friend should file an application at Healthcare.gov (takes about an hour) to see if they can provide any additional help. But if he's jobless, on disability, and already has Medicaid, the Affordable Care Act probably can't do much more for him in North Carolina. The ACA doesn't provide healthcare or subsidies for people with incomes below the poverty level, and recommends to the states that they extent their Medicaid programs specifically to provide coverage for those people. The NC state legislature (currently dominated by a political party that loudly preaches its Christian values but wouldn't practice them if you held their beloved guns to their heads) refused to extend Medicaid to cover the gap, so the poorest people in the state have been institutionally condemned to seek free care at emergency rooms and public clinics.

Best of luck to your friend and his girlfriend,
_
gonZo

Pal says: how did I confuse North Carolina with New Jersey? My mistake... as gonZo says, NC likely won't have a state exchange but it's still worth it for your friend to go through the Fed healthcare.gov portal. As mentioned, Medicaid is supposed to be 'below' an AFA-compliant plan from an HMO via healthcare.gov, but if the state where he lives is actively resisting Medicaid expansion to cover people just like your friend, it's unfortunate (whatever happened to Christian charity? Aren't supposedly religious people supposed to care for the less fortunate/their fellow man? What about basic human decency?).

If all else fails, and your friend is too poor for AFA and not getting some or all of the Medicaid coverage he ought to because of North Carolina legislators, perhaps he could move to the nearest state where the AFA and Medicaid expansion aren't being so fervently opposed? I'm not positive, but I don't think there are any applicable residency requirements... i.e.: I don't think he has to have lived in a state for a certain amount of time before applying for help (of course, he should check first before moving). While moving might seem drastic, IMO it makes sense as a last resort: he's got a chronic condition and is likely to need care for years to come, so he might as well settle someplace where there's at least a chance of getting some of the affordable health care that he's rightfully entitled to as an American citizen and taxpayer.
« Last Edit: February 04, 2014, 02:58:21 PM by Palomine »

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pedonbio

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Re: A friend, not me - HOW does one get medical procedures covered...
« Reply #3 on: February 04, 2014, 02:51:21 PM »
Thank you, gonZo. I drafted three or four versions of that information, but none so temperate as yours.

The best advice I could offer would be to move back to New Jersey or, better yet, go a few extra miles where the ACA has been full implemented, and you don't have to worry about paying off the governor.
Someday, chi1dren, this entire fuck-up will be yours.

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rtpoe

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Re: A friend, not me - HOW does one get medical procedures covered...
« Reply #4 on: February 04, 2014, 07:55:14 PM »
Your friend is a perfect example of why the Affordable Care Act is useful and necessary.

Coverage CANNOT BE DENIED due to pre-existing conditions.

And if he can't get anything, he should show up at the state capitol and ask the governor and state legislature why....make sure the media is there, too...
rtpoe

Gently I stir a white feather fan,
With open shirt sitting in a green wood.
I take off my cap and hang it on a jutting stone;
A wind from the pine-tree trickles on my bare head.

-  Li Po, Summer in the Mountains

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gonZo

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Re: A friend, not me - HOW does one get medical procedures covered...
« Reply #5 on: February 08, 2014, 08:32:34 AM »
Thank you, gonZo. I drafted three or four versions of that information, but none so temperate as yours.

The best advice I could offer would be to move back to New Jersey or, better yet, go a few extra miles where the ACA has been full implemented, and you don't have to worry about paying off the governor.

I'm not sure that temperance is what's really needed in a state (or country, for that matter) where amoral politicians are legislatively telling the disadvantaged to fuck off, but I don't intend to try to start a civil war right here in the BEA forum. ;)
« Last Edit: February 08, 2014, 05:56:36 PM by gonZo »

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NotElvis

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Re: A friend, not me - HOW does one get medical procedures covered...
« Reply #6 on: February 08, 2014, 05:16:02 PM »
All,

Thanks for the info - I know his girlfriend has looked into things, and I know as well moving back to NJ is a possibility (especially since the owner of the place she had JUST gotten a job at decided to sell and is going to lay everyone off)....

Some clarifications - from what I understand, the $10k he owes currently is from the period that he was on Medicaid, but that Medicaid did not cover.  I don't know if it's because it's "unapproved" or because they just don't cover 100%.

Pal:  I'm with you on this - he shouldn't let the costs worry him.  If the system is rigged such that he has to go into debt to survive, I'd gleefully tell him to abuse that broken system again and again with bankruptcy filings.  (oh, and you probably confused NJ with NC because I live in NJ, but my friend moved from NJ to NC a few years ago).

All - you all HAVE been temperate, and I am constantly on the edge of a full-fledged rant-bordering-on-fury about it - and with my native born-and-bred-in-Central-NJ linguistics.... well, I joke that swearing is really just a form of punctuation where I come from, but . . ack!  Well, I'm in agreement with the holier-than-thou politicians not practicing what their holy book preaches.

I'll definitely pass on info to him.


Latest update - the doctors are now recommending having about 10 feet or so of the worst part of his intestines removed....  ugh.


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MasterDragonfly

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Re: A friend, not me - HOW does one get medical procedures covered...
« Reply #7 on: February 23, 2014, 11:14:23 AM »
This will be a terse answer, which is not to suggest that I think I have the magic bullet for your friend.

At the one end of the spectrum, the Paleo diet:

http://robbwolf.com/2013/02/11/healing-chrohns-disease-feel-absolutely-normal-time-10-years/

http://thepaleodiet.com/can-the-paleo-diet-treat-crohns-disease/

At the other end of the spectrum, fresh fruit/veg juice fasting:

http://www.fatsickandnearlydead.com/

Either way, I'm curious if your friend has kept a diet journal or not. I mean, record *everything* he puts into his mouth. It's been my observation that people trying to get a handle on some aspect of their health (typically obesity) is that they are frequently **94** sodas. Sugar-based sodas are bad, but the artificial sweetener sodas are a chemical soup of fuck-up.

A pretty reasonable solution seems to be: get carbonated or sparkling water, add some fresh-squeezed lemon juice to taste, add some ice. The mouthfeel of the fizzy water should go a long way to helping to control the soda jones.

I mention diet since this is the one thing he still has control over. And I urge your friend to watch that movie, Fat Sick & Nearly Dead. Because of his diabetes, he might need to stick with the veg end of the juice spectrum, as anything too heavy on the fruits (at least apple, orange, and the like) could end up spiking his blood sugar. Yeah, the more I think about it, the more I think the safer bet (to start out with) is to go the Paleo route. I haven't researched to find out whether the fresh fruit/veg juice fasting is still considered 'safe' for diabetics.

(If I'm sounding scatterbrained, it might be because I'm 2 days out of surgery and still on meds to control the pain.)