Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)

No insurance for a month

Posted by on Mar. 22, 2013 at 1:02 PM
  • 5 Replies

I am not sure if anyone else is in this position or not. If you are, what do you do?

My son receives Medicaid because he gets SSI. Twice a year, he loses his SSI which means he loses his medicaid. The reason he loses it is because my husband is paid bi-weekly. So 2 times a year, he recieves 3 checks in one month so it pushes us over the limit.  

My other children are on CHIPS because we make so little that we qualify for them. My husband and I have private insurance. His work reimburses him to a point. And we reached that point with just him and I on the insurance. I can't add him to CHIPS during those months because he can't receive both Medicaid and CHIPS. Even when we send a letter from SSI saying he will not have insurance for the month of *****. They can't add him because we have to apply the previous month. And when they check the previous month it shows that he has Medicaid so they can't add him to CHIPS(even with the letter from SSI). And if I apply during the month he loses it, they can only start him the next month when Medicaid kicks back in. 

It is way too expensive for him to be added to my private policy. Yes they can't deny him for having pre-exsisting conditions but they can charge so many I forget the word but it raises his insurance to more than my husband and mine combined. He is on 5 meds as well. 

What do you do if you are in a similair situation? We are in Texas if that helps. I am really close to seeing what I can do to stop SSI completely so we dont run into this any more. I would rather have a year of insurance from CHIPS with all the copays, even if it means getting another job. Rather than having no insurance 2 months a year. 

by on Mar. 22, 2013 at 1:02 PM
Add your quick reply below:
You must be a member to reply to this post.
Replies (1-5):
by on Mar. 22, 2013 at 1:30 PM
We are in texas too. Sorry you have to go through this. My son receives a grant for the United Healthcare Children's Foundation. You have to apply and its not immediate, but we were approved and it helps out.

Also, is there an Any Baby Can in your area. They have a ton of resources for parents who have children on the spectrum. They might be able to give you some resources.
Posted on the NEW CafeMom Mobile
by on Mar. 22, 2013 at 3:47 PM

We have been without insurances for alittle over a year now and pay out of pocket. My husband just got back with his Union so as of May 1st we will have insurance again and it couldnt have come at a better time. We are at the 15% bracket for DDD pay scale ( we pay 15%) so that isnt bad BUT his apt with developmental ped in June is $600 an apt so with ourinsurance we will pay nothing. I can not imagine how much this would all cost if we didnt get the ins back. We dont qualify for state help except DDD which isnt a qualifying thing is you pay the percent in your income bracket.

For his meds maybe talk to the pharmacy. I know Walgreens has a discount program for certain meds. You pay like a $20 one time free and then you get a discount on the meds. Also try contacting the meds manufacture companies. They can sometimes get you free samples with prescription.

As far as any other medical cost Im not sure. Maybe explain the situation to the doctors and see if the can hold the payment until its reinstated. I know here in AZ state ins will back pay like 3 months.

by on Mar. 22, 2013 at 4:32 PM
Insurance makes me cuckoo!! We are with it, without it, half with it... Sigh.

I wish I had an answer for you or could be of some help!
Posted on CafeMom Mobile
by Jen on Mar. 23, 2013 at 12:44 PM
I would start writing your story to different legistatures in your state. Tell them what a mess they have created! I'm sorry that sucks. Maybe switching him to chips is the best plan.
Posted on CafeMom Mobile
by on Mar. 23, 2013 at 12:51 PM

Thank you for all the suggestions. 

I am going to talk to DH tonight about pursuing dropping SSI. When I get my degree and go back to work we will lose it any way. The system is completely messed up with the way they don't communicate. 

It is better to pay the almost $1000 in copays for meds and doctor's appointments throughout the year than be expected to pay almost that much for his meds and if he gets sick for the one month we lose it. And it is not like that 3rd check is extra money. It is my rent money given to use a few days early. And we are only losing $190 in SSI payments. I never did it for the payments just for his Medicaid because it got to where we had to choose between meds for my son so he could function normally and a bill. It just sucks when you want to help your child and you meet barriers that shouldn't really be there.

Add your quick reply below:
You must be a member to reply to this post.
Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)