Medicaid etc.

dltnhm

My insurance coverage is just flying along with very few hiccups.

My friend just learned that she needs to have a double mx. Her husband is self-employed and they are self-insured. With all of this breast cancer business, she is now on medicaid. It took her six weeks to get a mammogram, two weeks after that to get the needle biopsies, and although they are sending her to a surgeon ... they are telling her everything else after this has to await some 'card' that needs to move through the system.

Has anyone navigated this system? We live in Illinois. Of course I want the absolute best for each and every woman and the government having its hand in all of this means bureaucratic red tape that no woman should have to go through.

Anyone have any advice? Or experience they can share?

Thanks in advance.

Diana

Bren-2007

Diana ... it isn't the "card" per se that needs to move through the system at this point.  It's the identification number on the card that needs to catch up with the services that have already been given to your friend.

Once she's approved by medicaid, it shouldn't take too long to have the card number reach the various providers.

Was she approved through the Breast and Cervical Cancer Screening Program?  Just curious, as I am self-employed and uninsured and I was a covered through this program.

Best wishes to you and your friend.

Bren

dltnhm

Thanks Bren.  I am not certain. I will ask her. I want to help her any way that I can. She is a go-geter and has spent hours and hours on the phone before this. She was told that there was no way that she could get Tamoxifen ... almost five years ago and she has not been on it for that very reason. She wasn't on medicaid then or until just recently, but how did mere $$ get in the way of some pharmaceutical company making certain that she have the drug. And if I'd have known her better then and her situation I would have done fundraiser after fundraiser to get her those drugs (I just learned this today and could not believe my ears that there wasn't a way to get that drug for her. I had no idea.

She has a strong faith that is incredible and we are both resting in the arms of our Lord. But at the same time I'm resting I know that He is guiding me to the answers that will help her by asking questions, making phone calls, and seeking out information on her behalf.

Thanks for the start.

Diana

cycle-path

Diana, I'm fairly surprised that Medicaid doesn't pay for Tamox, but I haven't navigated the Medicaid waters so my surprise may be naive. 

But anyway, I wanted to mention that Tamoxifen is generic and is a pretty inexpensive drug. I realize that to a person of limited means, any expense is an expense, but it looks to me as though you can buy it for about 30 cents a day or $10 a month. Or as low as 18 cents per day if you buy a 3 months supply ($16.00). Here's a thread where someone is tracking the prices. 

http://community.breastcancer.org/forum/113/topic/758296 

dltnhm

Well she wasn't on medicaid when she couldn't get on it.  They were self-insured and found it cost prohibitive. I would imagine that some of these drugs may have come down in price over the last five years or so ... but I believe that she tried everything she knew to try as did her health advocates at the time.

If I understood her correctly, the amount was somewhere along the lines of thousands. I will have to clarify with her. We're dealing with one smart cookie here ... it may have been an out-of-pocket issue with the insurance they being self-insured.

cycle-path

Oh, I guess I misunderstood. With my handy-dandy Google I found out that the patent on Tamoxifen ran out in 2002, and the price probably started falling then. 

BTW, my MO told me I could start taking Tamox any time I wanted to, and that whenever I took it it would give me protection. So if she should want to start now, and is able financially, it's still a possibility and apparently still worthwhile. 

dltnhm

Thanks so much I appreciate all the info that is out there and all the gals willing to look, research, and share their stories. So I appreciate YOU and your help. Keep it coming :-)



Diana

ibcmets

Diana,

It does take a lot to research all of this and is different depending on insured, under insured or not insured.  I know my oncology dept & hospital cover mediare & medicaid, some do not.  They usually have someone on staff at hospitals for social services who are very knowledgeable. 

Check with administration or social services at local hospitals.  Also, I found that Costco pharmacy are sometimes cheaper than reg pharmacies.  My oncolology dept has provisions for hormonals but not other prescriptions, but it was certainly helpful with me being on Femara.

Good Luck with your search.

Terri

dltnhm

Thanks Terri. I so want to help my friend navigate the system that she is a part of since it already seems so much different than mine. I am thankful that she and her family don't have to attempt to shoulder all of the financial matters themselves, but have learned with my own insurance that this is the case period for most women ... With copay assistance, transportation assistance, clinical trials, transportation assistance, etc. these are all areas that will benefit our family and we have what I would term 'excellent insurance'. I am learning so much from this experience and have found a new calling in life ...to be an advocate for women who need one - whether because they are overwhelmed with the entire scope of their cancer, don't have the energy or strength to navigate all the ins and outs, have no insurance or difficult insurance systems to work through, etc.



There have been times even in my short time since diagnosis (11/23) that I have been told 'no' when in reality the answer is a yes, it just takes a little perseverance. I was sharing with a friend one such example the other day when it came to quickly seeing a doctor. The scheduling person said one thing and my basic response was "you know my ears heard 'no' just now, but I know that what you really meant was 'yes' and that we just have to figure out how to make that 'yes' a reality for me." I would like to say that that particular day all I needed was to say those words. Wish that I had thought through to start with those words however .. The bottom line was that the receptionist/ scheduler at the desk really did have a 'yes' inner arsenal. And saying 'yes' to me and my circumstances did not mean bumping,inconveniencing, or denying anyone else what he or she needed. If I can help someone else obtain those 'yes' answers thoughtfully and successfully then I would love to help them do that.



Thank for your response.



Praying continued peace and recovery in your life.



Diana