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Medicaid/medicare

Disability Insurance News & Discussion

Medicaid/medicare

Postby Doughlas » Fri Jun 10, 2016 1:10 am

Hello Tricia, I'm hoping that you can lead me in the right direction.  I have pulmonary fibrosis, Rheumatoid Arthritis and 4 years ago I had kidney cancer.  I'm 41 years old and I now am at home since I've been put on oxygen 24hours a day.  My pulmonary doctor wants me to get a lung transplant, but I've been turned down by Emory since my case is too complex for them.  I've tried at 5 out of state facilities who told me that I need to be 5years cancer free before the will take me.  My illness will not allow me to wait that long. UPMC is the only hospital that has the expertise to perform my lung transplant, but now Georgia Medicaid will not pay for it because they are not a provider.  I only applied for Social Security Disability in May so I probably won't be eligible until Sept/Oct of this year.  I was told by UPMC to apply for Medicare but I have no idea how long this will take go through.  Is there anyway around this situation.  It's a life and death situation and medically necessary.

Andrea

ANSWER: Hi Andrea!

I would find out if you can do an appeal with Georgia Medicaid explaining why you need to use an out of network provider.  Sometimes they will allow this but it is rare but worth a shot.  Call Medicaid or go on their website to find out how you can appeal a denial.

Usually you have to be disabled for 24 months before you can apply for Medicare in most states........if you have been disabled for the appropriate amount of time, Medicare is usually fast.  My brother is disabled and as soon as he hit the 24 months of being on disability, his Medicare went into effect----he had no waiting time at all.  

If you do not have the appropriate time for Medicare, there is not much you can do........but if you have the time, you can try calling them and asking for a rush/emergency to push them to process.

Good Luck!

Tricia

---------- FOLLOW-UP ----------

Thank you for your quick reply.  I will try to appeal my case.  I have been disabled for a lot longer than 24 months, but I only put in my claim for disability in May 2007, do you think that counts?  I will call Medicare in the meantime.
Doughlas
 
Posts: 53
Joined: Wed Feb 26, 2014 2:02 am

Medicaid/medicare

Postby Espowyes » Fri Jun 10, 2016 8:57 pm

Usually most states require you to be on/collecting disability checks for 24 months.  In NJ they require SSI for 24 continuous months before you can apply for Medicare...my brother was on short term disability for 3 months and on long term disability for 3 months and they did not take this time towards the 24 months.  

However each state is different so look on Medicare's website for your state to see if it differs.

Good Luck!

Tricia
Espowyes
 
Posts: 41
Joined: Fri Jan 31, 2014 4:11 am

Medicaid/medicare

Postby Burrell » Sat Jun 18, 2016 12:24 pm

Hello Tricia, I'm hoping that you can lead me in the right direction.  I have pulmonary fibrosis, Rheumatoid Arthritis and 4 years ago I had kidney cancer.  I'm 41 years old and I now am at home since I've been put on oxygen 24hours a day.  My pulmonary doctor wants me to get a lung transplant, but I've been turned down by Emory since my case is too complex for them.  I've tried at 5 out of state facilities who told me that I need to be 5years cancer free before the will take me.  My illness will not allow me to wait that long. UPMC is the only hospital that has the expertise to perform my lung transplant, but now Georgia Medicaid will not pay for it because they are not a provider.  I only applied for Social Security Disability in May so I probably won't be eligible until Sept/Oct of this year.  I was told by UPMC to apply for Medicare but I have no idea how long this will take go through.  Is there anyway around this situation.  It's a life and death situation and medically necessary.

Andrea

ANSWER: Hi Andrea!

I would find out if you can do an appeal with Georgia Medicaid explaining why you need to use an out of network provider.  Sometimes they will allow this but it is rare but worth a shot.  Call Medicaid or go on their website to find out how you can appeal a denial.

Usually you have to be disabled for 24 months before you can apply for Medicare in most states........if you have been disabled for the appropriate amount of time, Medicare is usually fast.  My brother is disabled and as soon as he hit the 24 months of being on disability, his Medicare went into effect----he had no waiting time at all.  

If you do not have the appropriate time for Medicare, there is not much you can do........but if you have the time, you can try calling them and asking for a rush/emergency to push them to process.

Good Luck!

Tricia

---------- FOLLOW-UP ----------

Thank you for your quick reply.  I will try to appeal my case.  I have been disabled for a lot longer than 24 months, but I only put in my claim for disability in May 2007, do you think that counts?  I will call Medicare in the meantime.
Burrell
 
Posts: 46
Joined: Sun Jan 12, 2014 7:22 am


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