physically disabled and unable to afford legacy health insurance
August 25, 2012 7:45 AM   Subscribe

My mother is physically disabled and unable to afford legacy health insurance. We need to reduce costs some how but don't know where to turn.

A few years ago, my mother (50yrs old) was injured while working at a govt job in New York City. Over the next two years she went through several surgeries to repair her condition. Unfortunately it was determined that she could never work again. My mothers health insurance provider at the time of her accident was GHI.

Unable to afford the costs of living in NYC, the family to Florida to live off Their Social Security/Disability/Pension.

In the past 2 years she has been through a spinal fusion, 25+ steroid injections, 10+ RFA procedures, constant therapy (psychological and physical), countless medication, and a spinal stimulator procedure/therapy.

She is still in a great deal of pain. Her morale is low and pain is persistent. In the next two years we expect a permanent spinal stimulator to be inserted, and a partial knee reconstruction to be performed. Once that is completed we expect her to go through additional therapy.

In Florida GHI isn't widely accepted so Medicare is her primary insurance provider and GHI is her secondary. My parents basic living expenses hovers around $60,000 – more expensive than the current income level. GHI insurance costs $900/month (automatically deducted from her $2800 pension check). This coverage also includes my father.

We’re looking for a way to reduce the monthly costs of insurance. I’d like to eliminate GHI completely, but was told that in Florida a “secondary” provider is required. I’m worried about affecting my mother’s coverage levels or putting her ongoing treatment at risk. Then there’s also my father’s situation – which is similar. I wouldn’t want to risk his coverage either.

Recently my father applied for Medicaid, but was declined because my mother’s income levels were too “high”. I don’t know if these applications requests current costs of living. There is a chance that he filled out the form incorrectly.

My father is also disabled and unable to work a full time job. He’s faced with challenge of caring for my mother and doing most of the physical work. On the weekends he runs a small business which nets around $1200yr. My mother recently fell in the house and broke a limb while he was working a year ago. He carries that guilt and burden and it’s affecting his mental state.

At this point we don’t know where to turn, who to ask, and what to do. So I figured I’ll start here and hope for the best. We have tried searching the web and were bombarded with scam attempts and cold calls.

We would appreciate any advice or guidance. Thank you.
posted by Highest_Of_Fives to Health & Fitness (12 answers total)
Best answer: I think you need to talk to an attorney and/or CPA in Florida who is a specialist in Medicaid, elder law, and financial planning. Your situation is way too complicated and too specific for a non-expert to be taking blind stabs at, and there's too much at stake to risk doing it wrong. It's better to pay a bit now up front to ensure that your parents' future is secure than it is to try to save a few bucks by doing it yourself. Please seek qualified expert help.

Here's MeFi's advice on how to find the best possible attorney for your needs. Best of luck to you and your family.
posted by decathecting at 8:15 AM on August 25, 2012 [3 favorites]

You need to talk with a FLORIDA legal expert in Medicaid, etc. The chances are great that your parents haven't maxed out their benefits, but it's very tricky to do this on your own even when you're young and healthy and confident and such.
posted by SMPA at 8:26 AM on August 25, 2012

Response by poster: I had no idea that attorney or CPA could even help in this situation. Amazing...!
posted by Highest_Of_Fives at 8:32 AM on August 25, 2012

I'd also consider contacting a civil litigation attorney who works on contingency (they get paid if you win), just to find out whether your mom might have a case against the workplace where she was injured.
posted by brina at 9:43 AM on August 25, 2012

This may only help cut costs if you can get it fairly cheaply, but: I have a spinal cord injury and am in frequent excruciating nerve pain. Marijuana has allowed me to a) avoid opiates and other surgeries that might or might not address the pain b) Have a morale that is sometimes goofy but definitely in the joie de vivre side of things. That last part is a bit tangential to your question, but I know that I can make decisions about finances and everything else much better when I am not FML 24/7.

I was going to the ER quite a bit when I was on opiates (breathing difficulties, falls), and that usually meant costs insurance wouldn't cover.
posted by angrycat at 11:59 AM on August 25, 2012

And yeah, consulting with an elder law attorney is a great step (and more germane to your question then my first post)
posted by angrycat at 12:00 PM on August 25, 2012

Check out an organization called Foundation for Health Coverage Education. If you go to the site, you can choose from a variety of low-cost plans based on several factors, including your state of residence.
posted by nubianinthedesert at 4:51 PM on August 25, 2012

More to the point, if the condition was caused by an on the job injury, she needs to talk with a workers compensation attorney, and it needs to be one who works in New York. That is where the injury occurred, so that is where the claim would be filed.

There are likely limitations periods, so the sooner the better.
posted by megatherium at 9:07 PM on August 25, 2012

Response by poster: "I'd also consider contacting a civil litigation attorney who works on contingency (they get paid if you win), just to find out whether your mom might have a case against the workplace where she was injured."

She has a on going case, but her health is on a continuous spiral downward so ensuring that she is insured is our biggest concern. Thank you.

I sent a e-mail to our county bar associations referral service.

Thank you for all of the responses. Ill be sure to provide a update.
posted by Highest_Of_Fives at 5:55 PM on August 26, 2012

Response by poster: Mefi Team - I've sent off emails to Lawyers but haven't received a response yet. I'll just keep trying...
posted by Highest_Of_Fives at 3:14 PM on September 3, 2012

Response by poster: So I've been emailing Elderly and Health Insurance Lawyers over the past few weeks. either we receive no response, or they reply saying they cant help. Ack..
posted by Highest_Of_Fives at 11:48 AM on September 12, 2012

Response by poster: I emailed the local Bar again and they responded with two names! Woof....
posted by Highest_Of_Fives at 12:25 PM on September 12, 2012

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