How come there is special medicaid assistance for women with breast & cervical cancer but not other types?
My art teacher told me that she got diagnosed with breast cancer at a time when she didn't have health insurance, but she was able to apply for Calcaid (or something like that - I don't know what it's called, but it's like Medicaid for people in California), and it completely covered the cost of her treatment. She never paid for anything, and she got excellent care because she was able to get one of the few oncologists at Cedars Sinai (hospital in Beverly Hills) who accepts Calcaid to treat her. I adore her and am happy she didn't have to suffer with the financial devastation a lot of people do with an illness like cancer, but I'm confused about the way the aid works. Why is there special aid given to women with breast and cervical cancer but not to kids with leukemia and sarcoma and adults with pancreatic cancer? One of the girls from my support group died in January from AML and her sister said that their parents are over a million dollars in debt from all her medical bills. They aren't getting help because apparently they fall in the middle ground where they make way too much to be qualified for aid, but they aren't loaded. They had insurance, they did everything they were supposed to do to be responsible, but they're stuck with the bills on top of the loss of their daughter. This seems to be very unfair to me.
What gives?
Thank you for your exceptional answer, Animal Luvr. : )
- ♥Animal Luvr♥
To be honest I have no idea, and I think it's really sad. I was LUCKY to have cervical cancer and fall into the BCCCP program (Medicaid for cancer patients in Michigan) and all of my treatments were either paid in full or I had a $ 1-$ 3 co-pay which is nothing. My total bill has added up to $ 389,000 as of right now. I am scheduled for another PET scan in a few days which will tack on another 6k, then another pap and office visit which will add on a few hundered, then if I need biopsies and anesthesia in the OR we're talking another 7-8k, and then *god please don't let it come to this though* if I need surgery to remove the bit of cancer showing on my last scan, I imagine that would be really expensive at least 10k but probably wayyyy more. By the time its all said and done I am thinking I will have racked up somewhere between $ 400,000 and $ 500,000. My treatment was short in comparison to a lot of cancer patients too. I only had actual treatment for 2 months, now I have been getting scans and paps and playing the waiting game for 3 1/2 months. I cannot imagine the financial hardship that many families go through.
I almost did not qualify for treatment based medicaid based on my income. I was just a few hundred dollars away from not qualifying. I did not have health insurance. I was turned away by the hospital I am being treated at now because I was uninsured at that time. I was referred to the local downtown Detroit county hospital for treatments, and this is a place that no cancer patient really wants to go to for treatment. There are no "cancer experts" or enthusiastic caregivers there. It would be devastating to have gone thru this experience in a hospital which I had no confidence in. And on top of it, I would have a huge medical bill to pay for those services from the crappy hospital. Thank god I qualified.
I think you should contact members of the government, including President Obama and your state Governer. I am also contacting my state representatives because I think its really sad that as soon as I get a clear pap test and clear pet scan, my Medicaid will be dropped right away. This means that even though most cervical cancers recur within 7 months-2 years, I will no longer have insurance or medical care with the doctors who really know what they are doing. Since I am also a victim of this horrible economy, I will not be able to afford to go to my good docs because as of now I was lucky to find a decent paying part time job, and that doesn't even cover my regular bills completely. It's really sad, we need a breakthrough in healthcare in this country. I hope Obama gets this right soon!
ADD: One more big problem with healthcare in the US- I have checked into buying my own insurance since my job does not offer insurance for part-time employees. I have been told by several insurance companies that there is a waiting period which I must wait (between 3-10 years depending on the company) and if I am still cancer free for that length of time I can buy their insurance then. The alternative is Blue Cross which accepts cancer patients but it costs as much as I make in the entire month since I had cancer, which would leave me homeless and broke. The only way I can get health insurance right now is through a group policy, which may mean that my bf and I are going to get married sooner than planned so I can be insured under his group policy from work.
ADD: All states handle their Medicaid and insurances differently...My friend in Minnesota had stage 2b cervical cancer just like me. They don't have special medicaid for cervical cancer there. She was eligible for some financial assistance through the county health program in her area. She was not eligible for Medicaid. She made substantially less money than I did as well, so I know money was not the issue. Also my medicaid social worker and hospital social worker have both ensured me that if I join a group policy regardless of my cancer status, I cannot be denied, there is no waiting period, so if I get married or find a job with group plan insurance they tell me I will be covered instantly. Maybe thats just MI but I was told that this is part of the HIPAA compliance laws.
- april
It's based on income, not which cancer you were unlucky enough to be diagnosed with.
If someone has cancer or any medical problem when going for any insurance, whether group or individual, you will have a waiting period of up to one year. If you had previous insurance and did not have a lapse before joining a group plan, you will not be subject to a pre existing condition clause. I've just gone through the same situation myself.
Yeah, about the group insurance...I've always been told the same thing. However, when I had an actual medical condition, I would have been subject to a waiting period for a pre existing condition had I gone ONE DAY uninsured! I know this for a fact because bcbs sent me a notification that I was insured, but would NOT be covered for ANY dr consultation relating in ANY way to my pre existing condition for a certain period of time. Mine was not to take effect till june of this year, however, they were mistaken and I had not been one day uninsured. Now, had I broken my leg, under the waiting period, I would be covered because it wouldn't have been related to my cancer. The shortened waiting period is in effect, if at all, for employer group insurance, as per HIPAA regs...from hipaa site: Can a plan deny benefits for chronic illnesses or injuries, like carpal tunnel syndrome, diabetes, heart disease, and cancer using a preexisting condition exclusion?
It depends on whether you received medical advice, care, diagnosis, or treatment within the 6 months prior to enrolling in a new employer's plan. If you did, you can be subject to a preexisting condition exclusion.
Although HIPAA adds protections and makes it easier to switch jobs without fear of losing health coverage for a preexisting condition, the law has limitations. For instance, HIPAA:
Does not require that employers offer health coverage;
Does not guarantee that any conditions you now have (or have had in the past) are covered by your new employer's health plan; and
Does not prohibit an employer from imposing a preexisting condition exclusion period if you have been treated for a condition during the past 6 months.
States don't have special insurance for certain cancers. It is income and asset based. Each state has the option of adding a "medically needy" program. That's where the differences in eligibility come in.
Are you both single, married, one of each? Do you have more in assests than her, or does she have more than you? Many things are taken into consideration when applying for medicaid. But again, there is no difference in qualifications by disease.
- BSherman
You have asked a fair question. Why does the American health care system have so many failures? Many Americans do not have access to health care, the care costs too much, and the health status of the average American is poor by global standards.
The U.S. is the only developed country that does not offer 100% of its citizens government-managed health care. Perhaps as a result, Americans have the shortest average life expectancy among people in all industrialized nations. Globally the U.S. ranks 49th in average life expectancy. (see weblink)
* 50 million Americans have no health insurance whatsoever.
* Another 50 million are seriously under-insured, but will only discover that unfortunate reality in the event of a catastrophic illness.
* The 100 million Americans on Medicare, Medicaid, and V.A. Medical will eventually face massive reductions in health care because the U.S. government cannot afford to fund these programs.
* The 100 million Americans with private health insurance are seeing rapid premium increases coupled with higher co-pays, excluded services, and other limitations.
- Denisedds
In California it is called Medi-Cal in every other state it is Medicaid. They do not have special programs for breast and cervical cancers. It is a program for people who need medical treatment and do not have a way to pay for it. Your friend had insurance so she would not qualify and her insurance paid far more than Medi-Cal ever would. If she did not have insurance she may have qualified for Medi-Cal if her parents did not own property or made too much money. The people who fall into this category are the ones who really get screwed. Why do you think the number one reason for individuals filing for bankruptcy in this country is the cost of healthcare after major illness?
This is nothing new it has been getting progressively worse for the past 25 years. Cedar's only takes a certain number of Medi-Cal patients because they have to. They are a teaching facility. They can also afford the loss. There is a reason they are located at George Burns and Gracie Allen Way. Why they have the Mark Tapper Imaging Center and the Ray Charles Cafeteria. Your friend was very lucky to be treated there as most Medi-Cal patients are not so lucky. It is a well known fact the majority of these patients gets substandard care. A stage one colon cancer patient on Med-Cal will not do as well as a stage two patient with private insurance and this is not fair either.
Most private hospitals in Los Angeles County do not accept Medi-Cal, as they can't afford to. Why do you think we have had 10 hospitals close in the last 15 years? Have you been in an ER lately? They are packed and you can wait days for a bed, because now we don't have enough hospitals.
Meanwhile, there are people in this country who believes it is every person for themselves and the only people without medical insurance are the lazy, irresponsible, unemployed unable to manage their money well enough to get their own insurance and they should not have to be forced to pay for them. Failing to understand they already are while the entire system is falling apart. Take a look at the politics or government section of YA if you don't already know people like this.
Then we have our politicians playing their usual games, telling us one thing and doing another, arguing over crap, pointing fingers, bringing up irrelevant bull shit and pretending to be working in our best interest. They have great medical insurance. They never have to worry about going into debt, hitting their lifetime maximum benefit, delays, cobra, wondering if their doctor is on their plan, getting authorizations or worrying what to do if they lose their job, because they are insured for life and guess who pays for it? - Now that is not fair.
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