My take on the Health 'Care' situation in the USA

[Sweater Cows!]

A few months ago I put in an application for medicaid and MIChild knowing full well that we would not qualify for MIChild. What I did know is that we would qualify for what is called a spend down on the medicaid program. The Spend Down (SPD from here on out) is a monthly deductible like co-pay that anyone with any amount of income can apply for and receive through medicaid.

 

Well, Since my kid needs her tonsils out. They don't get infected but annoy her because they are quite large. I believe they block the Eustachian tube at times and make her ears pop. Although we were referred to a ENT I was waiting on the medicaid app to process to find out how to handle the situation.

 

Finally after I made two calls to the case worker (who never once returned my call) I found out from the front desk lady(on the third call) how much our Spend Down would be. I was still waiting for some form of verification to come in the mail before starting the process and digging the debt bed out of my own pocket. Finally after two more calls to the case worker and stopping in once to let the front desk lady know that I still had not received any notice of services(or lack thereof) I did get  a notice in the mail.

 

Here is where things get really screwed up (the front desk lady had told me these numbers but I waited for the letter from the caseworker to verify).

 

I did fill the app out for everyone in the family since I was having to fill the whole thing in anyway.

 

For myself they gave me a monthly spend down of $1366 . For her Dad they gave him a SPD of $1025.00

 

The 9 year old CHILD who actually needs some care done had a spend down of $3645.00

 

Now if anything is screwed up why is the child having a SPD of roughly TRIPLE an adult.  Is it because I stated on the app that  she needed services? Is it because I marked her as 'caucasion' but her dad as half hispanic that HE got the lowest spend down. Should I fill it out again and put her as hispanic(as she is partial obviously and a person can pick whichever suits them.)

 

So, considering her tonsillectomy would be about $7000.00 plus pre and post care costs and I have to meet the 3645 each month then to be to my benefit the entire process must be done in a month.

 

Do you think the DR. would set everything up so we could get the pre -op appt, surgery and postop done in a month, oh heck no.

 

But to conclude why is a child being given the largest "Spend Down"? Shouldn't each person in the family have an equal ' Spend Down'?

 

masonco do you have any insight on this?

[masonco]

I have no idea. I know that the hospital would not work with me regarding assistance to pay for Hubby's medical bills. I too have been with insurance company and got nowhere. No one told me to go to social service to check for help.

 

Based on the way I understand it, I do believe that hispanics, African Americans, Native Americans, all get special breaks when it comes to government assistance and automatically more help. I wonder why since the census shows that Caucasians are not longer the majority we can not be considered minority now...but it won't happen.

 

Anyway, I'd suggest you go to the MI state website and see if you can get information on Medicaid there. I also would reccomend you appeal the decision.

 

This is all part of the Obamacare package that I do know. Everything this year so everyone is green at the new requirements and policies. I heard that there will be a higher requirement this year, but based on previous income tax requirements. I recommend the following be kept track of for income tax.

Durable medical supplies including vaporizor, hearing aid batteries, etc. You can find that list on the tax software.

Mileage to and from doctor, hospital, getting prescriptions, therapy, etc

prescriptions-get the doctor's prescriptions. If you are there try to get prescription for over counter stuff like cough syrup, allergy meds, I even saw someone requesting prescriptons for tylenol cause then it counts for medical bills since the flex spending no longer applies for over the counter meds this year. Only co-pays I believe.

 

Based on the costs, you might be able to claim a HEFTY amount come tax time. Last year with mileage, hospital bills, doctor co-pays, medical equipment including cane, eyeglasses, and my  monthly health care premium costs were deductible so we ended up with medical expenses of $18,000. Our taxable income was $5000.

 

I would reccomend an appeal. I'm not sure which lawyers work with that type of situation, but if you can find a lawyer to review it, that might be worth it.

[masonco]

Check my post in Dave's thread. I posted here, but perhaps more information can be gleaned over there.

[XLFD]

Lando, have you investigated a procedure called somnoplasty, a safer and cheaper way to alleviate tonsil problems.  With your kid's problem being mostly just an inconvenience at this point, you may wish to investigate this, as it seems to avoid some of the problems of traditional tonsillectomies.  Here's a link, but you can find a few more on the web: 

Somnoplasty