Insurance

[Cross-7]

I'm needing some info and really don't know who to ask, so I'll start here.
I don't need to hear what shoulda, coulda and etc. I can't go back in time and change the past.
I'll condense this as much as possible.

I have a friend that is type 1 diabetic.
She lived a normal life, had a good job that provided insurance.
She developed gastroparesis and became very ill and almost died.
She was in the hospital for very long time and her employer kept insurance on her till sooner care took over.
She had an operation and has recovered somewhat, mostly just grateful to be alive.
She recovered enough that she is allowed to work 25 hours a week with a long list of " do nots" .
She lost everything and exhausted her savings during her illness.
She gets a very small disability check. It equates to about 15 hrs a week at 7.00 per hr.
It's not much but with her job she can pay rent and has a little used Toyota car that gets her to and from work, but is just happy to be alive and no longer hurting.

She was on sooner care and went to fill her prescription for insulin and was told she no longer has insurance.
Sooner care said that is correct that she makes too much money( 500 gross every two weeks, disability brings the total to around 1500.00 a month gross, taxes take about a 100.00)
So she lives on 1400 a month, rent, car, car insurance, utilities and etc.
Insurance just isn't in the budget.
Obamacare enrollment is available next month but it takes awhile to get approved and etc.

Problem is she is out of insulin and doesn't have the money to pay for it and can't get insurance.

Anyone have a solution?

 

[slick4591]

In Texas you can buy insulin over the counter. I think Wal Mart charges around $25 per vial. Check OK because it's probably the same.

As far as insurance she's probably out of luck until she can get on the ACA insurance.

 

[midTN_Brangusman]

Cross this recently happened to a good friend of mine. After they dropped him and he scrounged to make ends meet for over a year. To make a long story short, disability and social security does not count toward income. Only the amount she is receiving from her employer. I would think an attorney would jump on this case if the insurance company doesn't want to cover.

 

[Cross-7]

Cross this recently happened to a good friend of mine. After they dropped him and he scrounged to make ends meet for over a year. To make a long story short, disability and social security does not count toward income. Only the amount she is receiving from her employer. I would think an attorney would jump on this case if the insurance company doesn't want to cover.

I don't know if they accounted for disability. I was just showing that at 1400.00 a month there wasn't anyway to purchase insurance.

I really don't have an answer to her problem.
I've always been opposed to Obamacare as I don't feel like I should be responsible to supplement someone else's insurance.

Her dad gets his through the VA.
I know some others that get medical care through the Cherokee nation.

She told me her prescription cost 700.00 to fill.
Surely it doesn't cost that much to produce and make a profit.
Seems like that is an inflated price because they know insurance will pay it.

This is all new to me and I can't make sense of it.

She's at work and I'll talk to her and see if she can go to Walmart after work

 

[1982vett]

Not strait on facts...but:
Doesn't a "change of life event", such as loosing a job which provided insurance, open the door for special enrollment obummer care?

https://www.healthcare.gov/get-coverage/

With as little income at this point, I'd think it would almost be free....depending on how much was made before loosing job/insurance.

I'd dig a little bit, but not going to trigger 60 phone calls a day......

 

[Cross-7]

Thanks Vette
That's exactly why I asked
I'm m out of my league here

 

[D2Cat]

She can go to her local Wal-Mart and get their brand of Regular insulin for @24.88 a bottle. In a pinch she can reuse the syringes until they are no longer comfortable, and doesn't loan them out!

You got to do what you got to do.

Drs and nurses tell you you can't do this. I once asked my endocrinologist if it was OK to reuse a syringe. His answer was, "You asked the question wrong." I must of had a puzzled look on my face, because he soon said, "If you asked me if I had patients who reused their syringes, I'd say yes."

 

[sstterry]

Cross this recently happened to a good friend of mine. After they dropped him and he scrounged to make ends meet for over a year. To make a long story short, disability and social security does not count toward income. Only the amount she is receiving from her employer. I would think an attorney would jump on this case if the insurance company doesn't want to cover.

If you are receiving SS Disability, you are only allowed to earn $1,170 per month from any employment. Otherwise, you are disqualified from the SS benefits. She should go to her local SS Office and there is a form that can be filed to request an extension of her health coverage. It is not fair, but that is the SS requirement.

 

[bball]

There are varying types of insulin at varying prices. Regular insulin may not be what she needs. Immediate solution(because she needs help now with insulin) is to go to her PCP, explain her situation(should help her get a month supply to tide her over until it can be figured out). We do things like this daily for people in need. PCP can help get her covered and steer her to any social services provided by hospital or community available. There are several programs out there. Most social services are so undermanned and overworked that they are often overlooked...if she can't get into PCP, local minute clinic or ER can help, but most ERs will not have a social services person available after hours..hope this helps.

 

[Cross-7]

My understanding is ER will give her immediate need a prescription, but it goes back to not having insurance or 700.00 to fill it.

I feel the price is inflated.
I truly believe it's price gouging.

Edit to add
Idk anything about it but she takes a long acting and a short acting it her blood sugar get elevated

 

[sstterry]

My understanding is ER will give her immediate need a prescription, but it goes back to not having insurance or 700.00 to fill it.

I feel the price is inflated.
I truly believe it's price gouging.

Edit to add
Idk anything about it but she takes a long-acting and a short acting it her blood sugar get elevated

That is a big hit on her income. I would suggest she go to her PCP and ask for help. Many drug companies offer programs where they provide drugs at a steep discount for the less fortunate.

 

[Nesikep]

Work less to keep the benefits?
I'm sure that's often done!

Crappy situation, hope you and her find a solution and it doesn't drive you bananas talking to 50 agencies to get it

 

[bball]

My understanding is ER will give her immediate need a prescription, but it goes back to not having insurance or 700.00 to fill it.

I feel the price is inflated.
I truly believe it's price gouging.

Edit to add
Idk anything about it but she takes a long acting and a short acting it her blood sugar get elevated

They(hospital/community) have social programs to help cover the cost. For example, for someone in need, I can get them virtually any medication for $4.00..excluding narcotics, chemo, and some other 'rare drugs'..they have folks the hospital or PCP that specialize in getting her the assistance she needs..just got to find them. Believe me, they're there. Just have to let staff know that she can't afford to fill the prescriptions and needs some help. We also have discount prescription cards we give to some people that cover 80% of the prescriptions. I promise you, there are things in place to help here, just a matter of finding the people who know at the PCP or hospital.

 

[Jogeephus]

Insulin has increased in price 1000% in the last 20 years in the USA. She can get the old formula at Walmart like someone suggested for around $26.00. If she cannot use that formula she might want to look to Canada. While the FDA would have you believe the Canadians somehow water down their insulin and its not as safe a American insulin its all made by the same company. Granted, for her "protection" the FDA has made it illegal for her to buy insulin from Canada BUT it IS LEGAL for a Canadian pharmacy to ship her the insulin to her home and what costs her $500 here she can buy for $75 in Canada.

Here is a link she might want to view.

http://www.wgrz.com/news/local/verify-i ... /434153171

 

[melking]

Isn't it sad that we have to have this conversation for an American worker, through no fault of her own, has fallen on hard times. I do not like ambulance chasers but in this instance I would sure as hell be calling one.

 

[melking]

Stupid be nice crap

 

[Cross-7]

I wanted to add her employer is a retired army colonel and has done all he could. They paid her insurance for over 6 months while she wasn't working and gave her a job that suited her when she was able.
I've never met him but I but I hope to.

 

[sstterry]

Isn't it sad that we have to have this conversation for an American worker, through no fault of her own, has fallen on hard times. I do not like ambulance chasers but in this instance, I would sure as be nice be calling one.

Ambulance Chaser here: We do not advertise nor chase ambulances. But we do try to help those who cannot protect themselves against corporate America and the big Insurance Companies!

 

[Bestoutwest]

I really don't have an answer to her problem.
I've always been opposed to Obamacare as I don't feel like I should be responsible to supplement someone else's insurance.

Since the dawn of insurance, you have been supplementing those that can't/won't/refuse to pay for insurance. Example: my foot got infected after the surgery I had last November. After numerous tests it was never determined what bug was in there, only which family it was from. I have had heart surgery and have a patch, so I needed to have all bases covered incase the infection spread and then I'd be toast. So, every week I went to the infectious disease folks and got my shopping bag full of medication. I was able to see a bill for it, and my insurance was being charged $8,300 a week, A WEEK! I was talking to a pharmacist later on and he was telling me that the only reason it was that expensive is that others can't/won't/refuse to pay for that.

On a side note, I had a patient that worked for a large pharmaceutical company from the mid 80's up to the 2000's. He was telling me that by the time we see something, the process has cost the company close to $100M and at times closer to $1B, and those are only the ones we see. If you were tell the local man on the street that at $1.15/lb (an arbitrary number) for your calves, he'd probably call you a liar like everyone does the pharmaceutical companies. But think of the infrastructure you have, and the money you have tied up, in just taking your calves to the salebarn.

 

[melking]

Isn't it sad that we have to have this conversation for an American worker, through no fault of her own, has fallen on hard times. I do not like ambulance chasers but in this instance, I would sure as be nice be calling one.

Ambulance Chaser here: We do not advertise nor chase ambulances. But we do try to help those who cannot protect themselves against corporate America and the big Insurance Companies!

If yo
u do not advertise nor chase ambulances, wouldn't it stand to reason that you are not an "ambulance chaser"?