Quote:
Originally Posted by Kutless
I had an elderly lady in my office yesterday desparate for help. She is on 2 different kinds of insulin. They are the expensive ones, obviously. Lantus and Novolog/pen to be exact. She just happens to be in the "GAP" or as they were calling it last year "DONUT HOLE" Isn't medicare wonderful? 
Here med's are costing her well over $1000 per month. Because of her husbands VA pension and the sum of there SS check they are just a couple hundred $ above the federal poverty guidlines. Yes, just around $200.
Since she is a Med Part D. eligible she does not qualify for any of the Pharmaceutical Assistant programs. If she wasn't Part D eligible even though she was over the $ limit PAP's would still review her case. And if I submitted Dr or Hosp bills they would more than likely help.
Whats the solution? She needs her insulin but can't afford it or get help. The solution, from her mouth is divorce. By doing this it would decrease her income to the point of eligibility. Yeah she's probably going to lie about her household size, but can you blame her? 
Thanks alot George Bush. |
What's George Bush got to do with it???
Unless this person has property or savings, she should qualify for Medicaid to supplement the Medicare and take care of this. I guess the amount she brings in can depend upon the state she lives in, but she would most definitely qualify for Medicaid. Usually in our state if you don’t qualify for Medicaid or have a spendown (like a deductible) that has to be met is when you own property.
Also, I don’t know of any physician that would let their patient go without the supplies she needs for her diabetes. Drug reps keep those offices supplied with all kinds of drugs… express the need and they will get it for you. Also, our local hospital has a program available for people struggling needing medications or supplies. Again, it is funded mainly from local pharmacies and companies. She needs to call the hospital near her and ask for social services.
I deal with this day in and day out with my job. I just told two patients today where to go and apply for Medicaid. I also offered them financial assistance but only for six months… we can’t do this on a continual basis…. Although our doctors would gladly keep seeing them regardless.. you will find most of these docs have a heart.
I have seen where two people do get divorced to beat the system… and that is exactly what they are doing, trying to get around the system. I am not saying all do…but many do this to live better.
I just told a lady this week that we couldn’t offer her assistance that she applied for. She claims to be single/divorced, retired with just low SS as her income. Through her documents provided and the release she signed for me to do my investigating…. I found she had $52K in her savings and was living with her lifelong mate that she divorced so she could get better benefits. Her ex paid all the bills and basically took care of her needs, but she was crying poor. I told the patient what I had found and she paid me the $3 thousand for her bill the next day after withdrawing it from savings.
There is help when you need it.. you just have to go ask for it.