Monday, August 1, 2016

Health insurance

Over the last 3 years I have had to deal with many struggles and I wrote about them here. 






Having a disability and being in a wheelchair requires extra medical attention and care.  There are many things that are needed out of necessity on a daily basis that include, but are not limited to, my wheelchair, a shower bench, and other assistive devices for day to day living.



I was born with Spina Bifida and have been fortunate enough to do a lot in my life because of my disability from trying out for the Paralympic sled hockey team, traveling to Ireland with the New York State games for the physically challenged, being able to meet several celebrities and even getting to go on rides as many times as I wanted as a child.

I enjoy life as much as possible, but it isn’t always fun and games. Having endured 21 surgeries, and over the past three years  have been dealing with a significant medical issue that has left me unable to work.

Recently, I have had to deal with the not so pleasant side of private insurance, Medicaid and Medicare.

Over the past five weeks I started a new treatment for a pressure ulcer. This specific treatment involves platelet rich plasma. My insurance company did not cover these treatments and I am paying out thousands of dollars out of pocket. I still have private insurance to cover things that are necessary for everyday living through cobra coverage from a previous employer which is $300 a month and I have also had Medicaid and Medicare coverage due to my disability.

Over the last couple of months I had to renew my Medicaid coverage and the process has become a tiresome, stressful process. Medicaid is necessary to those who are disabled and need help with prescription coverage, medical supplies and durable medical equipment.  Medicaid is a secondary insurance and covers those things that my primary insurance has not covered. The applications for Medicaid had been approved in the past, but this year it has been increasingly difficult. I received the basic Medicaid application returned and then a few weeks later I received more forms to fill out including for my primary doctor to fill out verify my disability. All of those forms were then sent back and I then received what seemed to be an approval letter stating my coverage would then resume as it was but with a slight change because I am now eligible for Medicare prescription coverage. This past week I contacted Medicaid again because there had been denials from doctors' offices and for other services that are needed. Upon speaking with them, I was told that I make too much money on Social Security disability and will now have a co-pay of $117. This was astounding because previous to being on disability over the past year I had worked for several years and could still keep my Medicaid at no cost.

Social Security disability is based on poverty levels and those that need it are hurt because you are penalized for attempting to save money for emergencies down the road.

 I have recently also been enrolled in Medicare because of my date of “disability” from my last day of work. In looking over the coverage and ordering my necessary supplies it was sad to realize things that have always been a necessary part of my daily living and some that are necessary during my health problems were not covered or a medical supply facility not wanting to use my insurance because they lose money on a product. Medicare is also deducting over $100 from the disability check. My total insurance cost is over $500 or more than half of what I get on disability per month.


While I agree that Medicaid, Medicare and even social security need to be more stringent in their policies. I was born with a disability and am permanently disabled and that has not changed in the last 35 years. Those of us who need these programs are being hurt by those who abuse the system, making it much harder to get what is needed to have a better quality of life. There needs to be changes made for the better so that the disabled, the elderly and anyone who needs these programs can keep their head above water. This is something that needs to be investigated at local and national levels.  It is unfortunate that the political climate is and always has been involved in medical care instead of focusing on helping people in need.