Understanding Insurance for Sickle Cell Care
More Programs Featuring Maya Bloomberg
In this program:
Sickle cell care can get complicated when navigating health insurance. Sickle cell disease patient advocate and care partner Carla Lewis, hematology nurse practitioner Maya Bloomberg, and Dr. Marwan Shaikh explain resources patients and care partners can utilize to take advantage of financial assistance programs and Medicaid and how to optimize financial assistance resources.
Transcript
Interviewer:
Many patients don't have insurance, or they just don't understand their insurance coverage plans. So, Carla, when you were first starting out with your son, what were some of the resources to help you understand your insurance?
Carla Lewis:
Say...what was good for me is that pretty much I had good insurance through my job. So I'm just calling in asking what I didn't understand at first was that someone told me about adding a Medicaid coverage to my insurance as a secondary, and I was like, “Well, how can I do that?” And then it was the social worker from the clinic that actually said, “Okay, here's the website, this is as you go on, and then acting primary insurance pretty much is this okay?” And just filling out paperwork, I've got...he had two coverages. So understanding that, just to make sure that if you have to get a resource there, apply for it, so sometimes it just takes talking to that basic social working in the hospital or at the clinic, that will definitely help connect to resources also we have our community-based organization, which is a great resource that will be able to walk you through and be able to help you ask questions with your insurance provider to see what coverage you have. And now we have healthcare.gov that patients can also go through and those that don't that may be less advantaged of being able to work or have had those insurance, sometimes even job insurance is just too costly, right? They can't afford it.
So there's another resource and then be applying for Medicaid, we know on Social Security benefits also connect to applying to Medicaid, so they may qualify to that also being able to have that coverage, but for myself, our coverage of health insurance and plus having the secondary coverage actually helped, and there was no question that was limited, that I didn't ask the insurance company that he needs an MRI, will that be covered and who's going to cover that? So basically, I got to find out the primary is covering mostly everything, and then the second are also assisted, but definitely as a caregiver, one of the things that I was concerned with, you hear that having a child, the chronic illness takes a lot as far as financial responsibility in having insurance coverage was so important, I always say to myself, but what if I'm not able to work? And then his coverage, he lacks coverage. We didn't have that situation, but I know that there are many families that do experience that, so what do you do? Definitely make those calls to your state health insurance, Medicaid to see what they will cover, and if you fall under some kind of coverage, there's also coverage called share of cost which goes through Medicaid also may not cover much like a full insurance does, but it is something that is available that will cover a hospital stay. And then some patients don't know are the insurance company insurance that they can apply through that our private that will…maybe there is a fee, but they may be more affordable that they can also apply for. So just learning the resources of your state sometimes is what they need to find out, and definitely, like I said, community-based organizations are able to help and social workers in the hospital and in the clinic are able to help as a resource.
Maya Bloomberg, APRN:
If I can elaborate just a little bit on the insurance, just because the insurance landscape is so complex and will take advantage of this video and try to help everybody that’s listening. And so you mentioned so many different aspects, so what I want to say, if you do lose insurance, certain hospitals and settings, they might have package prices, in which case you can then go to your CBOs (community-based organizations) and see is there any type of assistance that can be provided to help cover your appointments. Different drug manufacturers have patient assistance programs where it's so backwards, and sometimes it's easier getting patients medicine when they don't have insurance than it is to deal with the prior authorization aspects of insurance to different drug manufacturer programs. So you can get it that way. There are different charity cases you could potentially apply for the Medicaid share across that you mentioned, there are ways that you can use that to your advantage so you can get more covered than just hospitalization. So say you make too much money to qualify for Medicaid, you can then qualify for a share of cost, which essentially will give you an X dollar, sometimes I've seen it $600, sometimes I've seen it up $1,500 that you have to meet each month in order for your insurance for the Medicaid to kick off.
So say you were to clump together your echocardiogram, a lot of your lab results, you're eye exam, your hematology appointment, you can try to clump all of that together in one month, and that will bring that amount up to whatever your dollar amount is for Medicare share of cost, so you get that covered for that month. So there are different ways that you kind of use the resources, you already said it, living with sickle cell is already hard as it is that take advantage of the resources that you have, whether through insurance, through the employer, through your school, and just make your life a little bit easier living with sickle cell and also for caregivers too. And then you're covered for different resources through your employer to cover if you needed to take time off for a doctor's appointment for your son or if your son was hospitalized, and you needed to take time off, there are different resources for the caregivers as well.
Dr. Marwan Shaikh:
But the one quick, easy to have patients who lose their insurance like halfway through treatment or something like that, and so they lose their job or something, so getting medication refills for 90 days, it's just a really quick, easy way to make sure you're covered thing by you sometimes.
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