Financial crisis in the family, what can we do?
December 4, 2009 4:06 AM Subscribe
My mom was diagnosed earlier this year with diabetes, and thats where things started getting really bad. The insurance we have won't cover anything she's needed for it.
She's doing tremendously better now, but it's been replaced by a deep depression because the extra costs are just too much.
She resorted to using credit cards to pay for her medication and supplies, and now that those are maxed we're even worse off because of those bills. She's been trying so hard to find some help but theres been nothing out there.
We applied for food stamps, but got turned down. She's looked for different insurance companies, but none will cover her because of the diabetes. She's been denied for loans to try and consolidate her debt. Even the debt consolidation companies she called won't help because theres no money to pay their fees. We can't even get a first mortgage because we don't have the money to pay for the application.
It's really hard seeing her so upset, and blaming herself for everything. I've gotten her to agree with my helping her budget to try and keep some safety nets, but that doesn't really help us until we get out of this hole.
She's a pretty timid person and I don't know if she's not being aggressive enough with the people she's been in contact with for help or what. She's been trying to find a new job too on top of all that because her boss has been treating her pretty badly and has recently cut her hours. It's been pretty rough in Michigan though as far as jobs come.
I thought I'd come here to seek out any suggestions to try to get us out of this mess. Any information on insurance companies that won't deny us for preexisting illnesses, any advice on getting ourselves out of this debt, even some budgeting tips for when we're in the clear would be greatly appreciated.
She's doing tremendously better now, but it's been replaced by a deep depression because the extra costs are just too much.
She resorted to using credit cards to pay for her medication and supplies, and now that those are maxed we're even worse off because of those bills. She's been trying so hard to find some help but theres been nothing out there.
We applied for food stamps, but got turned down. She's looked for different insurance companies, but none will cover her because of the diabetes. She's been denied for loans to try and consolidate her debt. Even the debt consolidation companies she called won't help because theres no money to pay their fees. We can't even get a first mortgage because we don't have the money to pay for the application.
It's really hard seeing her so upset, and blaming herself for everything. I've gotten her to agree with my helping her budget to try and keep some safety nets, but that doesn't really help us until we get out of this hole.
She's a pretty timid person and I don't know if she's not being aggressive enough with the people she's been in contact with for help or what. She's been trying to find a new job too on top of all that because her boss has been treating her pretty badly and has recently cut her hours. It's been pretty rough in Michigan though as far as jobs come.
I thought I'd come here to seek out any suggestions to try to get us out of this mess. Any information on insurance companies that won't deny us for preexisting illnesses, any advice on getting ourselves out of this debt, even some budgeting tips for when we're in the clear would be greatly appreciated.
Sorry if this is totally obvious, but you can get a lot of generic medications at Target and Walmart for $4. That won't help with you syringes and test strips and things like that...I'm not sure if they have insulin either. But if she is currently paying out of pocket, it may be cheaper there than at a regular pharmacy. Also...check out mail order, that may be a better bet too.
I'll put this link up with the caveat that I haven't really researched it and not sure if it has any validity at all. But it points to a non-pharmacological diabetic treatment. Not sure what your mom's diabetes situation is. Anyway, please take it with many grains of salt.
Sorry this is happening to you...that sucks.
posted by sully75 at 4:49 AM on December 4, 2009
I'll put this link up with the caveat that I haven't really researched it and not sure if it has any validity at all. But it points to a non-pharmacological diabetic treatment. Not sure what your mom's diabetes situation is. Anyway, please take it with many grains of salt.
Sorry this is happening to you...that sucks.
posted by sully75 at 4:49 AM on December 4, 2009
How old is she?
posted by availablelight at 4:55 AM on December 4, 2009
posted by availablelight at 4:55 AM on December 4, 2009
Here's a list of resources on Financial Help for Diabetes Care from the National Institutes of Health. I hope some are useful.
And, jon1270, that page mentions the staggering statistic that people with diabetes spend an average of $11,744 a year on health care expenses - certainly enough to max out a couple of credit cards.
posted by pants at 5:02 AM on December 4, 2009
And, jon1270, that page mentions the staggering statistic that people with diabetes spend an average of $11,744 a year on health care expenses - certainly enough to max out a couple of credit cards.
posted by pants at 5:02 AM on December 4, 2009
people with diabetes spend an average of $11,744 a year on health care expenses
Yes, but very little of that is spent on basic maintenance supplies. Since the OP's mom was recently diagnosed, I'm assuming that treatments for complications are years down the road.
posted by jon1270 at 5:07 AM on December 4, 2009
Yes, but very little of that is spent on basic maintenance supplies. Since the OP's mom was recently diagnosed, I'm assuming that treatments for complications are years down the road.
posted by jon1270 at 5:07 AM on December 4, 2009
To the best of my knowledge Blue Cross is the only insurer in Michigan that is legally mandated to take everyone regardless of preexisting conditions. One can get access to Blue Cross by joining the Greater Detroit Chamber of Commerce among other ways. Has she talked to a social worker connected to where she's being treated for diabetes? They might have some suggestions about how to get coverage. Good luck - it's a scary situation to be in, especially in this lousy economy.
posted by leslies at 5:08 AM on December 4, 2009
posted by leslies at 5:08 AM on December 4, 2009
Response by poster: jon1270 - Well we started the year with flood damage to our basement. We haven't spent much rebuilding yet but we had to spend some extra to put in a sub pump. Insurance wouldn't cover it, in fact we aren't even able to get flood insurance where we live because we're in a 'no flooding zone'.. go figure? Mostly it's just tiny income. She works a retail job for just above minimum wage, and my step dad works for full-time for about 11/hr. The only truly bad spending habits would be the decision to use the credit cards when we were already in the hole every month.
As for the supplies and the cost, I have to agree with pants, as I've not met one person with diabetes that hasn't complained of the costs. She was taking a generic pill for it but she had a rare reaction to it that almost killed her. The insurance covered the generic pill but not the more expensive one she has to take because of her reaction. The pills alone are now an extra $100/month.
sully75 - She's actually done pretty well the last month or two just following her diet, and she's had to go without checking her blood. The diet alone keeping her in check gives me reason enough to check out the link for more information, it seems to be talking a lot about just eating better.
availablelight - She's 41, still pretty young. I really can't believe how hard it is to find a better insurance plan. Our current one pays for only a few doctor visits per year and they have her in at least once a month.
Thanks with everything so far, I'll check out the links posted.
posted by jrdnbaade at 5:27 AM on December 4, 2009
As for the supplies and the cost, I have to agree with pants, as I've not met one person with diabetes that hasn't complained of the costs. She was taking a generic pill for it but she had a rare reaction to it that almost killed her. The insurance covered the generic pill but not the more expensive one she has to take because of her reaction. The pills alone are now an extra $100/month.
sully75 - She's actually done pretty well the last month or two just following her diet, and she's had to go without checking her blood. The diet alone keeping her in check gives me reason enough to check out the link for more information, it seems to be talking a lot about just eating better.
availablelight - She's 41, still pretty young. I really can't believe how hard it is to find a better insurance plan. Our current one pays for only a few doctor visits per year and they have her in at least once a month.
Thanks with everything so far, I'll check out the links posted.
posted by jrdnbaade at 5:27 AM on December 4, 2009
I really don't know anything about insurance companies in Michigan, but if she needs help paying for medications, you could try contacting the manufacturers directly. I know Eli Lilly has a patient assistant program where they provide free insulin for those who qualify (I believe your income can be up to 300 percent of the poverty level). Has she discussed this with her doctor or a diabetes educator? They may be able to point her in the direction of other agencies or hook her up with free stuff. I have no experience with the ADA but she may want to contact the local office in her area to see if they have any advocacy programs. You might also try Islets of Hope.
posted by cottonswab at 5:33 AM on December 4, 2009
posted by cottonswab at 5:33 AM on December 4, 2009
Response by poster: Leslies - That's actually the insurance that we have. I was just talking to my mom about it and I guess we get shitty coverage because my step-dad pays for the insurance himself and it's not through the company he works for. They pay for 2 doctor visits a year, and will cover 70% of the costs for the basic supplies. However, my mom went to turn in the receipts for those items and they told her they don't accept store receipts? They'd require her to purchase through a certain supplier that we don't have anywhere around here. Theres still the insulin and her pill to pay for.
We actually might lose the insurance too. While it's under my step-dad's name, his boss pays for it. Some arrangement they came up with since he's worked there so long, instead of getting a raise. He just turned 50 though and they upped it by a lot so his boss might stop paying for it. Kind of stupid since he's the healthy one, haha.
posted by jrdnbaade at 5:47 AM on December 4, 2009
We actually might lose the insurance too. While it's under my step-dad's name, his boss pays for it. Some arrangement they came up with since he's worked there so long, instead of getting a raise. He just turned 50 though and they upped it by a lot so his boss might stop paying for it. Kind of stupid since he's the healthy one, haha.
posted by jrdnbaade at 5:47 AM on December 4, 2009
So this is Type II diabetes? I can't think of any pill that you would take for insulin dependent diabetes.
posted by COD at 5:49 AM on December 4, 2009
posted by COD at 5:49 AM on December 4, 2009
jrdnbaade,
The drug companies often have assistance for diabetics, I have no idea what medication your mom is taking, but as an example, here isa starting point for Pfizer.
A close friend of mine was diagnosed with juvenile diabetes at ~60 years old (a virus damaged his pancreas) and he's talked to me about it a lot and he also travels and puts on presentations to help new and old diabetics understand their disease.
It sounds like your mom is doing well on controlling it which is really important. If she keeps it under control she can prevent or delay the debilitating and deadly circulatory problems which often accompany diabetes. Add exercise to the mix and she'll do very well. Walking happens to be a fine exercise, she doesn't need to take up marathons or anything. Get her a pedometer, they're often available for free, and have her start doing 5000 steps a day.
Blood work is terribly useful for determining how well you've really been behaving and how well your efforts are controlling your sugar levels.
I will ask my friend for information on finding the seminars. They're put on by one of the drug companies but they're about managing the disease, not a sales show for medications. They can be found all over the place, from small towns to large cities.
posted by substrate at 5:50 AM on December 4, 2009
The drug companies often have assistance for diabetics, I have no idea what medication your mom is taking, but as an example, here is
A close friend of mine was diagnosed with juvenile diabetes at ~60 years old (a virus damaged his pancreas) and he's talked to me about it a lot and he also travels and puts on presentations to help new and old diabetics understand their disease.
It sounds like your mom is doing well on controlling it which is really important. If she keeps it under control she can prevent or delay the debilitating and deadly circulatory problems which often accompany diabetes. Add exercise to the mix and she'll do very well. Walking happens to be a fine exercise, she doesn't need to take up marathons or anything. Get her a pedometer, they're often available for free, and have her start doing 5000 steps a day.
Blood work is terribly useful for determining how well you've really been behaving and how well your efforts are controlling your sugar levels.
I will ask my friend for information on finding the seminars. They're put on by one of the drug companies but they're about managing the disease, not a sales show for medications. They can be found all over the place, from small towns to large cities.
posted by substrate at 5:50 AM on December 4, 2009
I can see how even the basic expenses would be a problem on a near-minimum wage, let alone with reduced hours. Ouch.
The thing about not being able to get a mortgage is confusing in light of the fact that there's a basement to repair.
Were you involved with the homeowner's insurance negotiations related to the flooding? The storm sewers in my neighborhood backed up a few years ago, and a couple of basements filled with water. I would've called it a flooding, which insurance would not have covered, but my neighbors' insurance companies classified it as something else - sewer backup? - which was covered. Maybe there's an appeal process?
The impending health care legislation may improve things in a few years, but for now I don't think insurance is a great fit for what you're up against. Insurance is built for coping with risk, not paying for known expenses. Reducing expenses, increasing income and public / charity /drug company assistance may be more fruitful.
Have you looked into negotiating lower rates on the credit cards?
posted by jon1270 at 5:57 AM on December 4, 2009
The thing about not being able to get a mortgage is confusing in light of the fact that there's a basement to repair.
Were you involved with the homeowner's insurance negotiations related to the flooding? The storm sewers in my neighborhood backed up a few years ago, and a couple of basements filled with water. I would've called it a flooding, which insurance would not have covered, but my neighbors' insurance companies classified it as something else - sewer backup? - which was covered. Maybe there's an appeal process?
The impending health care legislation may improve things in a few years, but for now I don't think insurance is a great fit for what you're up against. Insurance is built for coping with risk, not paying for known expenses. Reducing expenses, increasing income and public / charity /drug company assistance may be more fruitful.
Have you looked into negotiating lower rates on the credit cards?
posted by jon1270 at 5:57 AM on December 4, 2009
Response by poster: COD - Yes, it's type II
substrate - She's doing extremely well. She's lost over 70 pounds and has cut out a lot of the bad eating habits that probably got her there in the first place. I wonder sometimes if she'd be fine without the medication now that she's eating healthier. She was walking about 30-60 minutes every day at the start, but she's stopped since it's been colder. I'll have to offer to go walk with her if she'll start up again.
posted by jrdnbaade at 5:57 AM on December 4, 2009
substrate - She's doing extremely well. She's lost over 70 pounds and has cut out a lot of the bad eating habits that probably got her there in the first place. I wonder sometimes if she'd be fine without the medication now that she's eating healthier. She was walking about 30-60 minutes every day at the start, but she's stopped since it's been colder. I'll have to offer to go walk with her if she'll start up again.
posted by jrdnbaade at 5:57 AM on December 4, 2009
Response by poster: jon1270 - Yeah, not only have they cut her hours but they've given her a real hard time lately. Teasing her and just being unbelievable. I wasn't around for any of the talks but we live in a rural area and have no sewer system. The water table just climbed over 8 feet since we built the house, I guess.
Like I said she's pretty timid. I doubt she's tried to talk the credit card rates down with much force. I'll have to talk to her about it though and let her know she needs to call them up and try to work something out.
posted by jrdnbaade at 6:07 AM on December 4, 2009
Like I said she's pretty timid. I doubt she's tried to talk the credit card rates down with much force. I'll have to talk to her about it though and let her know she needs to call them up and try to work something out.
posted by jrdnbaade at 6:07 AM on December 4, 2009
Unfortunately you're going to run into a lot of trouble trying to get help for low-income. I'm going to make the assumption that since they denied you food stamps, the combined income of your mother and step-father is high enough that they figure you can pay your expenses.
Apply for the state funded health care (medicare, I believe). There's no harm in giving it a shot. Especially if your step-father loses his insurance and she's no longer covered.
posted by royalsong at 6:10 AM on December 4, 2009
Apply for the state funded health care (medicare, I believe). There's no harm in giving it a shot. Especially if your step-father loses his insurance and she's no longer covered.
posted by royalsong at 6:10 AM on December 4, 2009
Please consider talking to your mom's doctor about the insurance's refusal to cover the more expensive medicine. When the more expensive medicine is medically necessary, often it will be covered. You just have to explain to the insurance company what is going on. Doctors are generally used to do this and will help, in my experience.
posted by dpx.mfx at 6:10 AM on December 4, 2009 [1 favorite]
posted by dpx.mfx at 6:10 AM on December 4, 2009 [1 favorite]
Ouch - that's pretty miserly coverage. I think finding better insurance - different policy from BC/BS will be tough given their work situation. I know Michigan has cut the amount of aid available on healthcare thanks to dire budget situation - just when people need it most. I don't get the not accepting store receipt bit - worth calling them. And worth checking out their required supplier - might be mail order and cheaper as well as covered. It does sound like they're doing the standard ugly insurer thing of turning stuff down the first time you ask - if you're persistent you may get more things covered. I think insurers often figure if they turn you down the first time most people will give up and pay the bills themselves.
Here's the link to Novo Nordisk's patient assistance program. They're one of the major producers of diabetes treatments.
posted by leslies at 6:18 AM on December 4, 2009
Here's the link to Novo Nordisk's patient assistance program. They're one of the major producers of diabetes treatments.
posted by leslies at 6:18 AM on December 4, 2009
I'm gonna throw a wildcard out here that might exercise a loophole depending on your state. It might work in mine.
Apply for disability.
Bear with me. Even if she can get a small % approval for disability, she can potentially get Medicare and access to new programs. She can also, depending on her state, approach the state's DRS or equivalent agency (Division of Rehab Services) and tell them she wants to return the work. Most states REALLY want you to return to work so you'll stop leeching public money. Many will assist with medical costs, purchase durable medical goods, etc.
I am not from Michigan, I know nothing about michigan, and some states do not recognize obesity related diabetes as a disability provoking condition in its own right--however most recognize complicating conditions (loss of circulation, renal failure, etc.)
posted by TomMelee at 6:32 AM on December 4, 2009 [1 favorite]
Apply for disability.
Bear with me. Even if she can get a small % approval for disability, she can potentially get Medicare and access to new programs. She can also, depending on her state, approach the state's DRS or equivalent agency (Division of Rehab Services) and tell them she wants to return the work. Most states REALLY want you to return to work so you'll stop leeching public money. Many will assist with medical costs, purchase durable medical goods, etc.
I am not from Michigan, I know nothing about michigan, and some states do not recognize obesity related diabetes as a disability provoking condition in its own right--however most recognize complicating conditions (loss of circulation, renal failure, etc.)
posted by TomMelee at 6:32 AM on December 4, 2009 [1 favorite]
Please consider talking to your mom's doctor about the insurance's refusal to cover the more expensive medicine.
Yes, do this. Her doctor may not even know how much the medicine is costing her, or that she's paying for it out of pocket.
It does sound as if your mom is getting in deeper because she's afraid to stand up for herself or question authority. The depression only makes this worse. (Exercise is good for the depression as well as the diabetes, BTW.)
You can certainly help by advocating for her, but you'll all be better off if you can teach her how to advocate for herself. Encourage her to be a pain in the ass when dealing with doctors and insurance companies. After all, they're working for her.
posted by jon1270 at 6:35 AM on December 4, 2009
Yes, do this. Her doctor may not even know how much the medicine is costing her, or that she's paying for it out of pocket.
It does sound as if your mom is getting in deeper because she's afraid to stand up for herself or question authority. The depression only makes this worse. (Exercise is good for the depression as well as the diabetes, BTW.)
You can certainly help by advocating for her, but you'll all be better off if you can teach her how to advocate for herself. Encourage her to be a pain in the ass when dealing with doctors and insurance companies. After all, they're working for her.
posted by jon1270 at 6:35 AM on December 4, 2009
Response by poster: TomMelee - She sought out applying for disability but they won't accept her until she's been hospitalized overnight because of the diabetes. Some of her friends suggested she just take a chance and go off the medicine and diet and go low to get her into the hospital. I don't think she's really too willing to chance that though.
posted by jrdnbaade at 6:40 AM on December 4, 2009
posted by jrdnbaade at 6:40 AM on December 4, 2009
Yea, don't go off the medicine and diet. Not a good idea. I am, however, sure that she could find a way to get herself admitted.
That's crazy though, that they'd make her be admitted for acceptance. Michigan is weird. Has it in any way affected her ability to work? I mean, if she had the opportunity right now, could she go work a 40 hour week?
posted by TomMelee at 6:52 AM on December 4, 2009
That's crazy though, that they'd make her be admitted for acceptance. Michigan is weird. Has it in any way affected her ability to work? I mean, if she had the opportunity right now, could she go work a 40 hour week?
posted by TomMelee at 6:52 AM on December 4, 2009
Check with local hospitals to see if they have a Diabetes Management Program or some such. Often those programs will offer reduced rates or free supplies.
Definitely ask the doctor for free samples when you visit and be plain and pointed about the financial problem. Most are willing to help out somehow.
posted by Brandon Blatcher at 7:07 AM on December 4, 2009
Definitely ask the doctor for free samples when you visit and be plain and pointed about the financial problem. Most are willing to help out somehow.
posted by Brandon Blatcher at 7:07 AM on December 4, 2009
Response by poster: Alright I talked with her some more. She's already had the rates reduced on the credit cards. She's only having problems with Chase. They lowered the payments but if she doesn't pay the full reduced payment they're upping it back up to the original amount. She told them either way she only has 200 to pay them every month.
She is talking to another bank about a mortgage. They don't require money down for the application so if she gets approved for that it'll be a big help.
The pill she's on is Actos and BC BS does cover a lot of it but since it's such a high cost pill her copay is $100.
Her case worker did say they made too much combined and told her she couldn't get medicare because she has insurance. It's weird though because my sister is covered by two insurances and gets medicare too. The case worker had told her they could deduct the cost of what they pay for the insurance but didn't do it, so she's reapplied for that so we'll see.
It hasn't really affected her ability to work. That's of course if she's allowed to break and eat at the times her diet calls for. This actually applies to what I was talking about with her boss being unbelievable. They constantly harass her and say that she's making up the details of her diet plan. It seems to me that they're trying to get her to quit by the way they treat her but she's been strong about it. A couple times they didn't let her take her break right away to eat and she got really low and even passed out once. Since then she's made it clear that they have to allow her to eat when she needs to by law. They do now, but they make it hard on her.
I apologize for not giving many details in the beginning. I often have trouble sleeping and with the conversation I had with my mom I was just up all night thinking about it, so I'm pretty tired.
Thanks for all the input. :)
posted by jrdnbaade at 8:21 AM on December 4, 2009
She is talking to another bank about a mortgage. They don't require money down for the application so if she gets approved for that it'll be a big help.
The pill she's on is Actos and BC BS does cover a lot of it but since it's such a high cost pill her copay is $100.
Her case worker did say they made too much combined and told her she couldn't get medicare because she has insurance. It's weird though because my sister is covered by two insurances and gets medicare too. The case worker had told her they could deduct the cost of what they pay for the insurance but didn't do it, so she's reapplied for that so we'll see.
It hasn't really affected her ability to work. That's of course if she's allowed to break and eat at the times her diet calls for. This actually applies to what I was talking about with her boss being unbelievable. They constantly harass her and say that she's making up the details of her diet plan. It seems to me that they're trying to get her to quit by the way they treat her but she's been strong about it. A couple times they didn't let her take her break right away to eat and she got really low and even passed out once. Since then she's made it clear that they have to allow her to eat when she needs to by law. They do now, but they make it hard on her.
I apologize for not giving many details in the beginning. I often have trouble sleeping and with the conversation I had with my mom I was just up all night thinking about it, so I'm pretty tired.
Thanks for all the input. :)
posted by jrdnbaade at 8:21 AM on December 4, 2009
The insurance company needs to be held accountable. Find a lawyer who will help draft a letter to appeal the rejection of the store receipts.
Insurance companies are evil scum sucking bastards. They will reject anything they can get away with because they know most people won't fight it. Don't let them get away with it. Fit the rejection and get them to reimburse you.
Make sure that the medication she's on is bought through the insurance company's preferred supplier, so they cannot reject more reimbursements in the future.
posted by camworld at 8:24 AM on December 4, 2009
Insurance companies are evil scum sucking bastards. They will reject anything they can get away with because they know most people won't fight it. Don't let them get away with it. Fit the rejection and get them to reimburse you.
Make sure that the medication she's on is bought through the insurance company's preferred supplier, so they cannot reject more reimbursements in the future.
posted by camworld at 8:24 AM on December 4, 2009
As is my default answer to anyone in Michigan with financial problems: consider moving. Seriously. I realize that they have many ties, but it is not IMHO worth all the financial suffering to maintain those ties.
Your step-dad's medical coverage sounds terrible. They need a long-term solution to your mom's medical issues and moving to a place with better jobs and better insurance is a real solution.
posted by k8t at 8:47 AM on December 4, 2009
Your step-dad's medical coverage sounds terrible. They need a long-term solution to your mom's medical issues and moving to a place with better jobs and better insurance is a real solution.
posted by k8t at 8:47 AM on December 4, 2009
However, my mom went to turn in the receipts for those items and they told her they don't accept store receipts? They'd require her to purchase through a certain supplier that we don't have anywhere around here. Theres still the insulin and her pill to pay for.
Usually insurance companies who require you to buy supplies or medications through a certain supplier allow you to mail-order supplies--that's something to look into. Don't assume that she'd necessarily have to drive across the state to get supplies.
Also, you should encourage your mom to pull out all the paperwork she has from her insurer and get familiar with the appeals process. You're never going to get anywhere just calling up the company and asking them to bend the rules (like covering her medication at the lower copay because it's medically necessary); you have to go through the appeals process that the insurance company has set up. They're legally required to have a process in place and to give their customers info about it, and she has nothing to lose by appealing all the things they're turning down. She could start by appealing the decision to not reimburse her supplies because all she has is store receipts.
Lastly: have her talk to her doctor about the high costs of her medication and supplies and how tough that is for her financially. Doctors often have lots of samples they get from pharmaceutical companies, so her doc may be able to give her a bunch of free medicine to help cut the costs; alternatively, it may be that the medicine she's on can be prescribed at twice the dose and she can use a pill-splitter to get twice as many doses for the same price.
posted by iminurmefi at 9:57 AM on December 4, 2009
Usually insurance companies who require you to buy supplies or medications through a certain supplier allow you to mail-order supplies--that's something to look into. Don't assume that she'd necessarily have to drive across the state to get supplies.
Also, you should encourage your mom to pull out all the paperwork she has from her insurer and get familiar with the appeals process. You're never going to get anywhere just calling up the company and asking them to bend the rules (like covering her medication at the lower copay because it's medically necessary); you have to go through the appeals process that the insurance company has set up. They're legally required to have a process in place and to give their customers info about it, and she has nothing to lose by appealing all the things they're turning down. She could start by appealing the decision to not reimburse her supplies because all she has is store receipts.
Lastly: have her talk to her doctor about the high costs of her medication and supplies and how tough that is for her financially. Doctors often have lots of samples they get from pharmaceutical companies, so her doc may be able to give her a bunch of free medicine to help cut the costs; alternatively, it may be that the medicine she's on can be prescribed at twice the dose and she can use a pill-splitter to get twice as many doses for the same price.
posted by iminurmefi at 9:57 AM on December 4, 2009
Are there any patient assistance programs out there for her medication? I get my medication through GlaxoSmithKline's "Bridges to Access" program. It did take a visit to the doctor (which sounds prohibitively expensive for your mom) to submit the application and get the nurse to become my "advocate" and get the initial prescription, but it's been so. so. so worth it.
I've heard some of these patient access programs also don't check your insurance status very hard. cough cough. (if you have to pay $350 out of pocket for your pills each month and maybe get reimbursed maybe in a few months with a lot of wrangling ... that's not insurance. bah.).
this sounds like a really tough, crummy situation, and I hope you all manage to find your way through it. I think that being under-insured feels almost worse in a lot of ways than no insurance.
posted by circle_b at 10:24 AM on December 4, 2009
I've heard some of these patient access programs also don't check your insurance status very hard. cough cough. (if you have to pay $350 out of pocket for your pills each month and maybe get reimbursed maybe in a few months with a lot of wrangling ... that's not insurance. bah.).
this sounds like a really tough, crummy situation, and I hope you all manage to find your way through it. I think that being under-insured feels almost worse in a lot of ways than no insurance.
posted by circle_b at 10:24 AM on December 4, 2009
Contact your local food bank and ask them about where you get energy assistance. I think most towns have a state funded program that helps pay your heating costs in the winter. That may take some pressure off your budget. And it seems like they are not as hard to get as food stamps. And they should take in the unpaid medical bills in their calculations where I don't know if the food stamp program does. But my point is that the people who give out energy assistance know about all the programs like that and they will let you know how to apply. They might even know of programs that would help with one mortgage payment a year. And also Salvation Army or Catholic Family services may know about programs that help the working poor. And there is a lot of respect by these people for working people who are not making it right now so don't worry about being embarrassed. It's different from the food stamp office where they treat people like losers (in my experience) and won't tell you about community programs.
In this economy, in this country, timid women are dieing, so you are right to stand up and be an advocate.
You should sit down and write out every single dime you spend. You may be spending too much money on food. You may want to eat things like whole grains, beans, fish, six days a week and then processed and more expensive foods only on Saturday. That would also help the diabetes. You need to start a program to prevent diabetes in yourself. My BF's father died from diabetes when he was only 50. So BF does everything he can to prevent it. Meaning he never, ever eats sugar and he drinks apple cider vinegar every day. I know, the vinegar idea sounds stupid but there is more and more science backing it up these days. Google it. I don't know if it could help your mom at this point though.
posted by cda at 11:27 AM on December 4, 2009
In this economy, in this country, timid women are dieing, so you are right to stand up and be an advocate.
You should sit down and write out every single dime you spend. You may be spending too much money on food. You may want to eat things like whole grains, beans, fish, six days a week and then processed and more expensive foods only on Saturday. That would also help the diabetes. You need to start a program to prevent diabetes in yourself. My BF's father died from diabetes when he was only 50. So BF does everything he can to prevent it. Meaning he never, ever eats sugar and he drinks apple cider vinegar every day. I know, the vinegar idea sounds stupid but there is more and more science backing it up these days. Google it. I don't know if it could help your mom at this point though.
posted by cda at 11:27 AM on December 4, 2009
This doesn't address the short term issues, but I'd emphasize that for many people type II is entirely controllable through lifestyle changes. If she changes her diet - gradually - and introduces significant exercise - again gradually, she stands a good chance that she won't need medication (assuming no co-morbidities). There are a lot of resources out there (google) on how to structure such diets and exercise, but briefly, cut down on calories (gradually over time) down to a level of maybe 1500 cal/day or so (use nutrition tracking software to make sure the diet remains nutritionally complete). Do this by cutting back on carbohydrates, especially simple ones; cut out all sugar - period. Generally tilt the C-P-F (carbohydrates, protein, fat) macronutrients to something like 45%-30%-25%. Exercise at least 60 minutes aerobic a day, 7 days a week, plus 4 weekly 20 minute sessions of anaerobic. Do 5 minute bursts of intense squats before eating a meal (prime the muscles to soak up glucose).
This will stand her in good stead down the road, even if it doesn't immediately offer financial relief. We live in America. That means, we cannot count on being able to get medical help. In this scenario it is extra important to stay healthy - because there is no safety net. I'm quite healthy, but I still do everything in my power to stay that way even though I have good insurance - you never know when you may lose that insurance. The fact that you'll have lower medical bills if you stay healthy should really not be a consideration, but unfortunately it is. Good luck!
posted by VikingSword at 12:42 PM on December 4, 2009 [1 favorite]
This will stand her in good stead down the road, even if it doesn't immediately offer financial relief. We live in America. That means, we cannot count on being able to get medical help. In this scenario it is extra important to stay healthy - because there is no safety net. I'm quite healthy, but I still do everything in my power to stay that way even though I have good insurance - you never know when you may lose that insurance. The fact that you'll have lower medical bills if you stay healthy should really not be a consideration, but unfortunately it is. Good luck!
posted by VikingSword at 12:42 PM on December 4, 2009 [1 favorite]
As others have said, appeal the fact they won't pay for the brand name pills. Over the phone and in writing, and submit the documentation about the reaction as well. The doctor who prescribed it can help, but since it is your mother's insurance, they can only do so much. If the insurance company denies for some stupid reason, go to MI Dept of Insurance and tell the insurance company you're doing that in writing certified. 9 times out of 10, the insurance company will buckle.
posted by Attackpanda at 1:21 PM on December 4, 2009
posted by Attackpanda at 1:21 PM on December 4, 2009
There's been some great suggestions already. Here's what I could track down for you.
The company that makes Actos has a $50 rebate offer right now. I think your mom qualifies since she isn't on state insurance but double check me.
http://www.actos.com/actos/specialoffers.aspx
They also have a Patient Assistance Program
(cut and pasted from the previous link, bottom page)
* The Patient Assistance Program gives patients who would otherwise find it financially difficult to receive type 2 diabetes treatment access to a free year of ACTOS therapy.
o You must meet the required income level, not have medical insurance coverage for prescriptions and/or be ineligible for government or private programs, and must be a legal resident of the United States.
o If you have Medicare Part D coverage, you may also be eligible to receive assistance.
* For information on how to enroll, call 1-800-830-9159.
If your mom is ok with it, try to go to her doctor appointments with her. It really helps to have someone to stand up for you when you're tired and to bring up anything you may forget. It also makes more of an impact on the doctor to have someone verify how much of a financial burden your mom is having.
Doctors are given tons of samples free so they're usually glad to help if you tell them you're having a hard time. Ask if it's necessary to see the doctor every month. Why is she having to go so often? Are they adjusting medication or something? I use to date someone who was a type one diabetic and he never was told to go that often.
It might be possible to go to a lab and have the results sent to the doctor sometimes. Labcorp is an independent lab that's often cheaper than one's affiliated with a private practice. Your idea that she might be able to cut back on medication after weight loss is a good one. Bring it up at the next visit.
Best of luck to your mom. Good for you for looking out for your mom and helping her stand up for herself.
posted by stray thoughts at 4:36 PM on December 4, 2009
The company that makes Actos has a $50 rebate offer right now. I think your mom qualifies since she isn't on state insurance but double check me.
http://www.actos.com/actos/specialoffers.aspx
They also have a Patient Assistance Program
(cut and pasted from the previous link, bottom page)
* The Patient Assistance Program gives patients who would otherwise find it financially difficult to receive type 2 diabetes treatment access to a free year of ACTOS therapy.
o You must meet the required income level, not have medical insurance coverage for prescriptions and/or be ineligible for government or private programs, and must be a legal resident of the United States.
o If you have Medicare Part D coverage, you may also be eligible to receive assistance.
* For information on how to enroll, call 1-800-830-9159.
If your mom is ok with it, try to go to her doctor appointments with her. It really helps to have someone to stand up for you when you're tired and to bring up anything you may forget. It also makes more of an impact on the doctor to have someone verify how much of a financial burden your mom is having.
Doctors are given tons of samples free so they're usually glad to help if you tell them you're having a hard time. Ask if it's necessary to see the doctor every month. Why is she having to go so often? Are they adjusting medication or something? I use to date someone who was a type one diabetic and he never was told to go that often.
It might be possible to go to a lab and have the results sent to the doctor sometimes. Labcorp is an independent lab that's often cheaper than one's affiliated with a private practice. Your idea that she might be able to cut back on medication after weight loss is a good one. Bring it up at the next visit.
Best of luck to your mom. Good for you for looking out for your mom and helping her stand up for herself.
posted by stray thoughts at 4:36 PM on December 4, 2009
jrdnbaad, if your mom is interested, the number for the Patient Mentor Institute is 866-741-7047.
Like I said, my friend is one of the presenters. The presenters get a small stipend to do the talks, he's well off enough that he does this as community service. If it was a sales pitch he wouldn't do it.
posted by substrate at 7:01 AM on December 6, 2009
Like I said, my friend is one of the presenters. The presenters get a small stipend to do the talks, he's well off enough that he does this as community service. If it was a sales pitch he wouldn't do it.
posted by substrate at 7:01 AM on December 6, 2009
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I don't think of basic diabetes supplies as being all that expensive, though my experience is with the juvenile, insulin-dependent variety. They're not cheap, but not credit-maxing expensive. Is she on some name-brand medication for which a generic exists?
posted by jon1270 at 4:42 AM on December 4, 2009