Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 18:13:03 GMT
I'm about to dig in and pull out my paperwork to begin asking questions, once again......... I'm on Foodstamps (don't judge--I'm disabled), and they said I'd qualify for Medicaid's "Share of Cost" program. I'm on Medicare b/c of my SSI (or is it SSDI--I don't even know!). I make only a piddly amount with my SS, and DH is retired and has his earnings. We come out with nothing after paying for rent and our car, etc........ Copays for doctors and procedures are increasing and we really can't afford them. I'm having another surgery next week, and the surgeon's coordinator spoke with me to arrange everything. She mentioned just a "small" copay for the hospital (this should be only a 90 min surgery at a hospital) of $180. Nice, but I don't have it. I told her that I have that Share of Cost and I should get my paperwork together and fax it in & I'll meet the requirement. My share of cost is just over $1800/mo. She said that that seems very wrong and that I should check it. She said that $400/mo is the most she's ever seen. Makes sense!! $1800 is about $500 more than our rent!!! DH and I *each* have this $1800 share of cost thing! Heck, if we could come up with $1800 each month to pay out, we'd be okay! The issue is that I never get to see anyone here in person. I met with someone in Family Services and waited 2 hours. He finally came out and discussed my personal info in the waiting room, not even showing me his spreadsheet, while explaining that, "It's right--that's your share of cost". WTF?  ?? We have no bank accounts, no houses, no income, nothing...... I need the explanation of how they come up with that amount. My last resort would be to call the hospital's finance dept and go over this with them and agree to some payout, but right now, we have meds on hold because we can't even afford them. Ugh! I just want to be "put back together" so I could figure out a way to keep us afloat. Figuring out this Medicaid thing would help. I REALLY don't see why we don't qualify for full Medicaid here (FL), but according to them we're doing FINE. Ugh. Any info or help is greatly appreciated. I'm coming off of a horrible migraine (sinus/allergy related) and could barely see straight today. And, PLEASE, no lecturing--keep it nice. I'm not ripping off the gov't. I've worked since I was 13 (and honestly disabled back then, but forged through!). TIA! |
|
|
|
Post by ntsf on Mar 14, 2018 18:16:35 GMT
you might write a letter to your local congressperson.. asking for help in navigating.. my dd is on ssi.. and gets medicaid.. and pays for nothing. no copays, etc. but it is complicated.. your state health dept might also be a source for help.. use your politicians to find help.
|
|
|
|
Post by librarylady on Mar 14, 2018 18:16:43 GMT
In our part of the world (your state may be different) if you can't pay, the hospital writes if off as a case where the hospital is helping out the poor.
Talk to the hospital finance dept.
|
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 18:27:37 GMT
Thank you both!!
librarylady & ntsf : The thing is that where we are in FL, we're not considered quite "poor"! It's frustrating. DH is a Veteran who served our Country, plus he's disabled and now retired. I'm disabled, but we are only entitled to Foodstamps as far as governmental programs. I keep checking but the State says they're "too poor" (which is why my adult children never qualified for Obamacare here). I WILL call the hospital and see what they could do. I already owe them $194 copay for my head CTscan back from October.... I hate that it goes to collection and ruins my credit, but I can't even pay $1 when our expenses are going up but our SS is the same!
I will also contact my congressman. They're extremely conservative and don't seem to care about the disabled or even about Veterans, but I'll give it a whirl. I'm sure they'll tell me, "Call 211 and see what's available," and nothing ever is here!!!! But, I'll try! Thank you both!!
|
|
|
|
Post by Darcy Collins on Mar 14, 2018 18:41:37 GMT
|
|
MerryMom
Pearl Clutcher
Posts: 2,615 
|
Post by MerryMom on Mar 14, 2018 18:50:39 GMT
I think your husband’s income is why you have a higher amount: it’s your household income. www.verywell.com/florida-medicaid-share-of-cost-how-does-it-work-1738835Rather than complaining to a legislator, make an appointment to the JFS supervisor. Your benefits come from that agency, not the hospital. I wouldn’t go by what one person at a hospital said. That person only knows what he/she knows and has no part in determination of benefits |
|
pridemom
Pearl Clutcher
Posts: 2,843
|
Post by pridemom on Mar 14, 2018 19:13:10 GMT
It sounds like what my state calls a monthly spend down. If you have Medicare, do you only use your Medicaid and pay the Share of Costs in months where you really need it? Many of the peopke I worked with in a previous job had to pay a monthly spend down that was equal to the amount their SSDI exceeded SSI, the amount used by my state. I honestly think a Medicare Supplement would be much cheaper even with copays at your income level.
|
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 19:17:19 GMT
I think your husband’s income is why you have a higher amount: it’s your household income. www.verywell.com/florida-medicaid-share-of-cost-how-does-it-work-1738835Rather than complaining to a legislator, make an appointment to the JFS supervisor. Your benefits come from that agency, not the hospital. I wouldn’t go by what one person at a hospital said. That person only knows what he/she knows and has no part in determination of benefits MerryMom: Except that we EACH have separate accounts for this "Medicaid Share of Cost" program. It makes no sense......... In looking back, we probably shouldn't have legally got married. I'll bet I would have gotten more in benefits being single. What is a JFS supervisor. I don't even know..... Is that FL services?? |
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 19:21:28 GMT
It sounds like what my state calls a monthly spend down. If you have Medicare, do you only use your Medicaid and pay the Share of Costs in months where you really need it? Many of the peopke I worked with in a previous job had to pay a monthly spend down that was equal to the amount their SSDI exceeded SSI, the amount used by my state. I honestly think a Medicare Supplement would be much cheaper even with copays at your income level. YES, that's exactly what it is, and I've only used it once before ( for a surgery), because I submitted all paid & unpaid bills for that month and met the $1869 amount. There's no way in the world I could afford a Medicare Supplement, although it's a GREAT idea! I can't even pay for copays at this point..... It's rough when I can't find a way to sell anything off, etc...... My SSI is only $600/mo, so I can't see why the Share of Cost is so high. If we combine both of our Share of Costs for 1 month, it's almost triple what our SS is. Makes no sense........ |
|
|
|
Post by christine58 on Mar 14, 2018 19:22:39 GMT
How old are you?? The reason I ask is because I would check with your county's office of the aging. They know these things inside out--forward backwards. Just a thought
|
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 19:41:21 GMT
ONE MORE THING: (I'm reading those links, which helps greatly--thank you both!!). We both have Medicare. The Medicaid Share of Cost is because we are "medically needy". In the examples used on 1 link, it sounds like "Cindy" got a physical bill for services. It says nothing about Medicare covering the majority of the bill. If I can use the receipts we do get from Humana for the total costs that we've incurred per month, I could submit that and be covered. Maybe I should begin asking for raw bills at each doctor's office or radiology, etc........ and put it under Medicaid's info now (even though we don't have a card, just an acct # and pin #'s).
I'm happy to read that we could put each other's info on the monthly expenses towards our share of cost.... We should be able to meet it if we just have the physical bills..... Thank you.
|
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 19:42:13 GMT
How old are you?? The reason I ask is because I would check with your county's office of the aging. They know these things inside out--forward backwards. Just a thought 57. DH is 71. I will check. Thank you!! |
|
|
|
Post by christine58 on Mar 14, 2018 19:52:39 GMT
How old are you?? The reason I ask is because I would check with your county's office of the aging. They know these things inside out--forward backwards. Just a thought 57. DH is 71. I will check. Thank you!! Where I live, your DH could go in and get some info. A dear friend works for them here and she was a tremendous help when my teaching assistant needed help for her mom. Can't hurt. |
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 20:28:30 GMT
christine58 : Thank you. I wish we lived where you live! I've gone to a physical location for Children & Family Services. I waited forever and finally met with someone who went over my personal expenses and information IN THE WAITING ROOM in front of people. He had his pad and calculator and stood over me and claimed that the figures were correct. He didn't have time for my other questions. It answered NOTHING.
I've been reading the 2 links forwarded, so, thank you!! There was information in there that I didn't know. The only thing I'm confused over is if I should just use this straight Medicaid (share of cost) and not my Medicare (Humana). This scares me to no end. I've gone through hours and hours of getting certain meds and procedures approved with Humana. I'd hate to think that I'd have to begin again with Medicaid, and I doubt I'd get things approved. It's scary!!
I'll take a break and read more, and call around tomorrow to get more info. Thank you all again! They really shouldn't make it this difficult on people. I'm having a hard time reading because of my surgery, and this makes it even more difficult. Ug!
|
|
AmandaA
Pearl Clutcher
Posts: 3,502
|
Post by AmandaA on Mar 14, 2018 20:34:40 GMT
Just wanted to add that in my state the agency that is the council on aging actually deals with the elderly AND the disabled. It is a bit of a confusing misnomer. When I was still case managing in Neonatal ICU, they were a very helpful resource in getting children through the Medicaid disability process. You might investigate that further as suggested.
I would also see if the hospital has an outpatient social worker or even one that will work with you in advance of your procedure. There can be a lot of crossover in the roles of social workers and case managers depending on how each institution uses them, but they are experts on these kinds of programs and helping patients navigate or referring out to the appropriate community agencies that offer similar services.
|
|
MerryMom
Pearl Clutcher
Posts: 2,615
|
Post by MerryMom on Mar 14, 2018 20:37:38 GMT
I think your husband’s income is why you have a higher amount: it’s your household income. www.verywell.com/florida-medicaid-share-of-cost-how-does-it-work-1738835Rather than complaining to a legislator, make an appointment to the JFS supervisor. Your benefits come from that agency, not the hospital. I wouldn’t go by what one person at a hospital said. That person only knows what he/she knows and has no part in determination of benefits MerryMom: Except that we EACH have separate accounts for this "Medicaid Share of Cost" program. It makes no sense......... In looking back, we probably shouldn't have legally got married. I'll bet I would have gotten more in benefits being single. What is a JFS supervisor. I don't even know..... Is that FL services?? Your state social services department; who determined your Medicaid Even if you have separate determinations: you are sharing a household. |
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 20:42:35 GMT
Just wanted to add that in my state the agency that is the council on aging actually deals with the elderly AND the disabled. It is a bit of a confusing misnomer. When I was still case managing in Neonatal ICU, they were a very helpful resource in getting children through the Medicaid disability process. You might investigate that further as suggested. I would also see if the hospital has an outpatient social worker or even one that will work with you in advance of your procedure. There can be a lot of crossover in the roles of social workers and case managers depending on how each institution uses them, but they are experts on these kinds of programs and helping patients navigate or referring out to the appropriate community agencies that offer similar services. Thank you so much. I'm going to this hospital as an outpatient so I'll call and see if I could speak with a social worker before Tuesday. My last surgery was covered 100%; no copay required. I don't know why this one has a copay. I'll figure it out. I appreciate your suggestions. |
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 20:47:46 GMT
MerryMom: Except that we EACH have separate accounts for this "Medicaid Share of Cost" program. It makes no sense......... In looking back, we probably shouldn't have legally got married. I'll bet I would have gotten more in benefits being single. What is a JFS supervisor. I don't even know..... Is that FL services?? Your state social services department; who determined your Medicaid Even if you have separate determinations: you are sharing a household. Thank you for that explanation!! We got this share of cost Medicaid via Foodstamps, online when we renewed one month. Here in FL, you don't meet personally with your caseworker--you do everything online and initially you speak on the phone to verify facts. It's very difficult to meet with any caseworkers even at Children & Family Services here. I'll keep trying though. For anyone else sending me private messages, questioning my finances, PLEASE make sure you gather the facts better first!!!!! I've been quite honest about how dire our financial situation is (not to complain, just to be real!). If I've bought or done anything, it's been in the past, and not in the time since my divorce and my financial ruin due to that, and then my medical condition getting much more severe. I work HARD every single day to juggle bills, make sure we're all working when we can, sharing ONE car for 4 people, etc...... Please don't judge until you've walked in my shoes. It's not cool. |
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 20:54:12 GMT
Your state social services department; who determined your Medicaid Even if you have separate determinations: you are sharing a household. Thank you for that explanation!! We got this share of cost Medicaid via Foodstamps, online when we renewed one month. Here in FL, you don't meet personally with your caseworker--you do everything online and initially you speak on the phone to verify facts. It's very difficult to meet with any caseworkers even at Children & Family Services here. I'll keep trying though. For anyone else sending me private messages, questioning my finances, PLEASE make sure you gather the facts better first!!!!! I've been quite honest about how dire our financial situation is (not to complain, just to be real!). If I've bought or done anything, it's been in the past, and not in the time since my divorce and my financial ruin due to that, and then my medical condition getting much more severe. I work HARD every single day to juggle bills, make sure we're all working when we can, sharing ONE car for 4 people, etc...... Please don't judge until you've walked in my shoes. It's not cool. I'm sorry if people are being nasty. That's horrible. I don't have any advice for you but I want to send some (((HUGS))) and I hope you can get some help soon. |
|
|
|
Post by sillyrabbit on Mar 14, 2018 21:25:19 GMT
You may want to give Medicare and/or your state Medicaid program a call and ask about the Qualified Medicare Beneficiary Program. It is a State Medicaid benefit that assists low-income Medicare beneficiaries with Part A and B with premiums and cost sharing. It won’t hurt to call and see if you qualify. Good luck!
|
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 14, 2018 21:46:08 GMT
iluvpink : Thank you. That was sweet!
sillyrabbit : Will do. It's now on my list for tomorrow! I appreciate it!
|
|
MerryMom
Pearl Clutcher
Posts: 2,615
|
Post by MerryMom on Mar 15, 2018 1:34:57 GMT
Thank you for that explanation!! We got this share of cost Medicaid via Foodstamps, online when we renewed one month. Here in FL, you don't meet personally with your caseworker--you do everything online and initially you speak on the phone to verify facts. It's very difficult to meet with any caseworkers even at Children & Family Services here. I'll keep trying though. For anyone else sending me private messages, questioning my finances, PLEASE make sure you gather the facts better first!!!!! I've been quite honest about how dire our financial situation is (not to complain, just to be real!). If I've bought or done anything, it's been in the past, and not in the time since my divorce and my financial ruin due to that, and then my medical condition getting much more severe. I work HARD every single day to juggle bills, make sure we're all working when we can, sharing ONE car for 4 people, etc...... Please don't judge until you've walked in my shoes. It's not cool. I'm sorry if people are being nasty. That's horrible. I don't have any advice for you but I want to send some (((HUGS))) and I hope you can get some help soon. I wasn’t being nasty to the OP nor sent her any messages |
|
|
|
Post by hop2 on Mar 15, 2018 1:51:45 GMT
Thank you for that explanation!! We got this share of cost Medicaid via Foodstamps, online when we renewed one month. Here in FL, you don't meet personally with your caseworker--you do everything online and initially you speak on the phone to verify facts. It's very difficult to meet with any caseworkers even at Children & Family Services here. I'll keep trying though. For anyone else sending me private messages, questioning my finances, PLEASE make sure you gather the facts better first!!!!! I've been quite honest about how dire our financial situation is (not to complain, just to be real!). If I've bought or done anything, it's been in the past, and not in the time since my divorce and my financial ruin due to that, and then my medical condition getting much more severe. I work HARD every single day to juggle bills, make sure we're all working when we can, sharing ONE car for 4 people, etc...... Please don't judge until you've walked in my shoes. It's not cool. I'm sorry if people are being nasty. That's horrible. I don't have any advice for you but I want to send some (((HUGS))) and I hope you can get some help soon. People send PM’s to question you asking for information??? I don’t get it, what does it cost anyone for you to get advice? Geez Weird OP I have no information I’m hanging medical billing issues myself but nothing like you. Hang in there. You’ll uncover your answers |
|
|
|
Post by megop on Mar 15, 2018 2:05:31 GMT
Obviously I have no idea where you are receiving your services, but you mentioned hospital. If you were in my area receiving outpatient services within the health system I work for, I would strongly suggest you contact financial services. Some most certainly are better than others, but if you were here, a financial counselor would help you navigate this system in tandem with you. Yes, we have persons inside clinics as well, but they are only armed with "this is your portion." Should you require further assistance that would be an escalation to someone more equipped with information to your unique situation and how to help you navigate through it. Hope you are with a progressive system focused on population health. Hugs!
|
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 15, 2018 2:06:03 GMT
I was reading this:
It sounds like you rack up bills that is your shared expense. Every time you get a bill you notice some office. When you hit the shared expense, Medicaid / Medicare kicks in and starts paying those bills ( new ones plus old ones)
It resets every month.
|
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 15, 2018 17:39:46 GMT
Obviously I have no idea where you are receiving your services, but you mentioned hospital. If you were in my area receiving outpatient services within the health system I work for, I would strongly suggest you contact financial services. Some most certainly are better than others, but if you were here, a financial counselor would help you navigate this system in tandem with you. Yes, we have persons inside clinics as well, but they are only armed with "this is your portion." Should you require further assistance that would be an escalation to someone more equipped with information to your unique situation and how to help you navigate through it. Hope you are with a progressive system focused on population health. Hugs! Thanks. It's on my long list today. That'll be my 1st call for this whole mess. What's strange is that I had MAJOR surgery with this same surgeon in January (different hospital though), both as an outpatient, and I didn't have a co-pay with the last surgery. Wondering why I have it with this one..... I'll find out. (I feel badly that I already have a $194.10 outstanding bill since October at this hospital for a necessary CT scan. I was trying to figure out why the copay for a CT scan increased from $40 to random high amounts. I'll check it out when I have a pain-free slice of time.). Thanks again! UPDATE: Regarding the msg I got here from the Pea seemingly admonishing me, it's all be cleared up. No names, but she explained her stance and I accepted her apology. Deal done. |
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 15, 2018 17:45:05 GMT
I was reading this: It sounds like you rack up bills that is your shared expense. Every time you get a bill you notice some office. When you hit the shared expense, Medicaid / Medicare kicks in and starts paying those bills ( new ones plus old ones) It resets every month. Thanks (again). I was reading the links posted here + more re: Share of Cost/Medically Needy. It sounds like we'd have to go in to all doctors and appts with just the special Medicaid Share of Cost program (we don't even have ID cards--just #'s), and submit EACH expense either via fax, mail or in person. Scares me not to use my Medicare (Humana) since I've gone through so much to get them to understand my particular medical situation. They've accepted surgeons not in their plan. They've approved of certain Rx's that were not in their drug list. It's taken a lot. I'll call and ask more questions and figure this out. |
|
|
|
Post by megop on Mar 16, 2018 2:27:38 GMT
Obviously I have no idea where you are receiving your services, but you mentioned hospital. If you were in my area receiving outpatient services within the health system I work for, I would strongly suggest you contact financial services. Some most certainly are better than others, but if you were here, a financial counselor would help you navigate this system in tandem with you. Yes, we have persons inside clinics as well, but they are only armed with "this is your portion." Should you require further assistance that would be an escalation to someone more equipped with information to your unique situation and how to help you navigate through it. Hope you are with a progressive system focused on population health. Hugs! Thanks. It's on my long list today. That'll be my 1st call for this whole mess. What's strange is that I had MAJOR surgery with this same surgeon in January (different hospital though), both as an outpatient, and I didn't have a co-pay with the last surgery. Wondering why I have it with this one..... I'll find out. (I feel badly that I already have a $194.10 outstanding bill since October at this hospital for a necessary CT scan. I was trying to figure out why the copay for a CT scan increased from $40 to random high amounts. I'll check it out when I have a pain-free slice of time.). Thanks again! UPDATE: Regarding the msg I got here from the Pea seemingly admonishing me, it's all be cleared up. No names, but she explained her stance and I accepted her apology. Deal done. Different hospitals and surgery centers can have differing levels of financial assistance. Surgeons can have privileges at a number of different hospitals depending on practice area. Fees can be separate as well, meaning surgeon's fee, facility fee, lab etc. etc. Medical billing is one complex beast for sure, and one that any progressive system trying to survive from closing, is committing great resources to make more consumer friendly and transparent. I often comment in my role during meetings, "seriously people, I have an MBA and work here, this is even confusing to me! WTH?" |
|
|
|
Post by iamkristinl16 on Mar 16, 2018 2:39:58 GMT
If you qualify for food stamps, I would think that you would qualify for Medicaid. I that Medicaid had a lower income threshold than food stamps but I could be wrong. I googled Florida income limits for Medicaid and found this website. Some good info there and it sounds like they will have someone call you to talk about options after you fill out the info on the page. www.medicaidplanningassistance.org/find-a-medicaid-planner |
|
Deleted
Posts: 0
Aug 18, 2025 19:48:10 GMT
|
Post by Deleted on Mar 16, 2018 5:45:23 GMT
Thanks. It's on my long list today. That'll be my 1st call for this whole mess. What's strange is that I had MAJOR surgery with this same surgeon in January (different hospital though), both as an outpatient, and I didn't have a co-pay with the last surgery. Wondering why I have it with this one..... I'll find out. (I feel badly that I already have a $194.10 outstanding bill since October at this hospital for a necessary CT scan. I was trying to figure out why the copay for a CT scan increased from $40 to random high amounts. I'll check it out when I have a pain-free slice of time.). Thanks again! UPDATE: Regarding the msg I got here from the Pea seemingly admonishing me, it's all be cleared up. No names, but she explained her stance and I accepted her apology. Deal done. Different hospitals and surgery centers can have differing levels of financial assistance. Surgeons can have privileges at a number of different hospitals depending on practice area. Fees can be separate as well, meaning surgeon's fee, facility fee, lab etc. etc. Medical billing is one complex beast for sure, and one that any progressive system trying to survive from closing, is committing great resources to make more consumer friendly and transparent. I often comment in my role during meetings, "seriously people, I have an MBA and work here, this is even confusing to me! WTH?" Ha! This is true--my sister is an attorney and she handles my mom's estate work for her, including her Share of Cost receipts. She said that she needed to speak to a specialist so that she understood it more clearly before she helped her! She also gave me kudos for fighting Medicare and Humana to include procedures, surgeries, surgeons and especially certain meds that they insisted were out of their norm. It takes a lot of work and a very clear head. Hard to do lately with sinus headaches. Ooy. I called the hospital--waiting for a call back...... Thanks again for explaining things!! |
|
