Breast Cancer and Soon-to-be Uninsured in TN

June 12, 2013 11:26 AM

Asking for a friend. Her mom lives in Nashville, Tennessee. "My mom was just diagnosed with  a rare and aggressive type of breast cancer.  She will need both chemo and surgery. In addition to the physical, medical, and emotional toll treatment will take, we need to figure out how to pay for this.

My mom's COBRA insurance runs out in July, and she is not allowed to extend it. She is now deemed uninsurable by other insurance companies since the cancer is a pre-existing condition. She does not qualify for Medicare because she is not old enough. She does not immediately qualify for Medicaid/TennCare because, while she has been unemployed for 1.5 years and has a spouse that is unable to work, she still has substantial assets (a house and some retirement savings). She will need the bulk of her initial treatment for cancer before Obama's Affordable Care Act goes into effect until 2014. Right now it looks like the out-of-pocket costs over the next five months could effectively bankrupt them.

Other options we've looked at:

My mom can apply for a Medicaid/TennCare exception since she has breast cancer, but she has to wait until her COBRA expires in July before they'll look at her case, and there's no guarantee that she'd get it. Also, after COBRA expires, she could try to get insurance under HIPAA. For that, she'd pay about $2000/month for some form of health care and that doesn't even count the thousands of dollars of out-of-pocket co-pays she still be responsible for each month.

If any of you have experiences with these type of issues, have ideas, or know of any resources that might be helpful, please let us know."

posted by anonymous to Health & Fitness (11 answers total)

Has she discussed this with the diagnosing physician yet? That person may have suggestions. If not, start calling the local hospitals, cancer centers, women's health centers, breast centers, etc. when a similar situation happened in my family, my relative found a hospital-based charity program that paid for a lot of treatment. The rest was put on a payment plan, and as long as she paid $25-50 each month they didn't care how much the balance was. Good luck.
posted by BlahLaLa at 11:38 AM on June 12, 2013

Vanderbilt University Medical Center is apparently very proud of how much they spend on care for patients who cannot otherwise pay.

Here is a brochure that I found online describing their Financial Assistance Program. I'd recommending calling the number on there NOW and maybe finding someone who can help Friend's Mom navigate what her options are and plan a strategy.

I would guess that for this to work, Friend's Mom will be required to spend down her retirement savings -- but I could see how there could be exceptions, depending on how those are saved (401k, etc).

Good luck. Fuck cancer.
posted by sparklemotion at 11:40 AM on June 12, 2013 [3 favorites]

Tennessee looks like it has a high-risk pool that accepts people who cannot qualify for coverage elsewhere, it's called Access Tennessee. Cancer is one of the conditions that gives you presumptive eligibility, which means she doesn't have to apply for other insurance policies and get turned down to prove she's uninsurable--her diagnosis alone should be proof of eligibility. Premiums aren't subsidized, but it looks like she'd be paying $1,000 per month or less (depending on age) for a $1,000 per year deductible. Usually you have to be uninsured for 3 months to qualify but they note that people coming off COBRA do not have to meet that criteria.

$1,000 per month plus a deductible or copays is a lot, but she only needs to stay there until October of this year (so 2 months--August & September), since the new health care exchanges under Obamacare open to enrollment in October. Those are community-rated which means she can't be denied due to her cancer, and her premiums will be set based on her age only (so probably MUCH cheaper than either HIPAA or Access Tennessee). I'm not sure when the premium subsidies from the federal government kick in--perhaps not until January--but she can certainly enroll in a plan through the exchange before she qualifies for a subsidy.
posted by iminurmefi at 11:51 AM on June 12, 2013 [2 favorites]

In some cases, if there is continuous medical coverage, pre-existing conditions are not considered. Your state has an insurance commission; they may be helpful.
posted by theora55 at 11:54 AM on June 12, 2013 [1 favorite]

Also, Tennessee Medicaid (TennCare) has a special eligibility category under the Breast and Cervical Cancer Prevention (BCCP) program--you might want to check with a Medicaid caseworker about that specifically. It looks like it might cover any uninsured woman below 250 percent of the poverty level who needs treatment for breast or cervical cancer. If that program doesn't have asset limits (not clear from the TennCare website whether it does), then she should be able to get onto TennCare really quickly--"presumptive eligibility" means they treat you as eligible and start giving you treatment even before you've finished all the paperwork.
posted by iminurmefi at 11:56 AM on June 12, 2013 [1 favorite]

Make sure her doctors know the date her insurance runs out, and do everything you can do to get the surgery done before that date.
posted by yohko at 12:44 PM on June 12, 2013

Talk to a hospital-based social worker, they should know about programs available locally.
posted by yohko at 12:45 PM on June 12, 2013

Please call your state's health insurance commission and make sure that pre-existing conditions only refer to conditions that were diagnosed while the person had no insurance. If she had insurance when diagnosed, I don't believe that counts. This is the purpose of COBRA.

Also, certain types of cancer make you automatically qualify for social security disability.

There's also the possibility of selling her house and "spending down" (giving to you for safe keeping) her assets.
posted by bleep at 12:51 PM on June 12, 2013 [2 favorites]

One small correction to iminurmefi's comment - while the Obamacare exchanges will open for enrollment in October, coverage won't actually start until January 1, 2014.
posted by ChrisHartley at 1:27 PM on June 12, 2013

Go down and file for SSI Disability so your mom can have an income while she's fighting.
posted by Ruthless Bunny at 1:40 PM on June 12, 2013 [2 favorites]

As a note about Social Security Disability, they have a habit of trying to "save money" by denying claims the first go around, unless the claim is written in a manner that emphasizes the need to approve the claim quickly. Of course, you must be truthful in your claim, but make sure that you make your evidence, 3rd-party testimony, etc. communicates to the case worker that your case is of top importance. For example, this is not the time to "be modest" and minimize the disability (a single "I could tough it out" statement could lead to a denial of a valid claim, a need to appeal, and a year+ delay in benefits.)

You could either have an attorney assist in filing the claim (for a cut of the benefits), but a good doctor and some knowledge of the process can make the attorney unnecessary. Usually SSI Disability eligibility is determined with the same paperwork (main difference is that SSDI is reliant solely on premiums paid to Social Security, while SSI relies on assets/income. You can often get both SSI and SSDI depending on your financial situation, even to the point where SSDI benefits might be reduced because SSI covered at some point, go figure.)

Finally, SSI/SSDI will generally start from first day of disability (NOT the date of application or approval), so your first payment will likely be a large lump sum.

Being on SSDI gives you access to Medicare as well, or at least it did in my case. Definitely ask about this.
posted by tservo at 7:18 PM on June 12, 2013