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Thread: Recent Accident to My Son

  1. #371
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    Roger, I am sure you have already done this, but check with the Cobra people at Brian's old employment place. They always say it is a set number of months (can't remember anymore what it is) but they granted me a several month extension specifically because I left on disability. I think it is talked about as 24 month coverage, but they granted me 29 months, which is the maximum. It brought me right up to the Medicare date, literally. I had Cobra till the last day and the next day got Medicare after the proscribed wait period.

  2. #372
    Senior Member reedyd's Avatar
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    Best of Wishes to your son and family. May the SCI be temporary.


    In my prayers


    David

  3. #373
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    Eileen

    The COBRA coverage does run right up to when Brian is eligible for Medicare. The problem is that Anthem Blue Cross only covers 24 rehab sessions per year. If Brian was eligible for Medicare starting in July then all of the Kennedy Krieger rehab would be covered by Medicare at 80%. The Blue Cross rehab limit of 24 sessions was a benefits change that occurred when Brian's former employer changed their medical insurance carrier from Blue Cross Blue Shield of California to Anthem Blue Cross.

    Roger
    Last edited by Roger; 07-04-2009 at 10:28 PM.

  4. #374
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    Oh, sorry. That stinks at being limited to 24 sessions!

  5. #375
    Senior Member reedyd's Avatar
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    Quote Originally Posted by Roger View Post
    Yesterday, Brian told me that he is going to run out of insurance paid rehab benefits prior completing the rehab at Kennedy Krieger. At the moment he has Blue Cross coverage sponsored by his previous employer. We pay the monthly premium payments as part of the COBRA program. The Anthem Blue Cross medical insurance rehab benefit pays for 24 sessions per year. Brian has been using Blue Shield to pay for the hand therapy rehab. There are 6 sessions left. On August 1 Brian will be eligible for Medicare which pay 80% for rehab. It's to bad that he wasn't eligible for Medicare July 1. When he starts medical school his medical insurance will be Medicare primary and Hopkins medical secondary. The bottom line is it looks like 24 of the 30 rehab sessions that Brian will have at Kennedy Krieger from July 13-July 31 will be self pay. I asked Brian to talk to Kennedy Kreiger to if KKI will accept the same payment from us what they would receive from Blue Shield. That seems reasonable to me I hope they agree.

    I looked up on the Internet how long the waiting period is before Brian is eligible for Medicare, the waiting period is 29 months Medicare coverage start the beginning of the 30th month after a permanent injury. Brian was injured on Feb 9, 2007, twenty nine months would be July 7, 2009, so he is eligible for medicare at the beginning of the 30th month which is August 1, 2009.

    The rehab benefits were reduced from what Brian originally had when his medical insurance was provided by Blue Cross Blue Shield of California. The company Brian worked for changed insurance companies last year. I feel a little stupid here that we didn't keep track of this better.

    Roger
    Can't he qualify for medicaid until the medicaire kicks in? Are is his assets or income too high? I qualified for a program called Crippled Chidrens fund or something to that effect. The name has changed now, Also I had to sign up for a research program through Baylor Research Hospital in order to pay for my rehab at TIRR back in the 70's. John Sealy at Galveston developed some new medication by experimenting on me. It was neo-phosphate or something to that effect. My blood calium level was sky high. My para-thyriods went out of whack. You might ask if their might be any grant money available.

    Don't hurt to ask.

    God Bless

    David
    Last edited by reedyd; 07-05-2009 at 01:00 PM.

  6. #376
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    David

    Thanks for the suggestion we will check it out. In the past Brian has not been eligible for Medicaid because of his disability insurance payments. Right now Brian has some very high expensives, moving to Baltimore, buying a condo, modifications to the condo, transporting his car to Baltimore, traveling to Baltimore, tuition, books and other school expenses. We were taken by surprise when we found out that the rehab at KKI will not be covered by his medical insurance. We'll get through it.

    Roger

  7. #377
    Roger: Have Brian apply for MD Medicaid thru KKI as soon as he arrives. He needs to request a "spend down" that will use his out of pocket expenses to reduce his income. This process will also help with MD Voc Rehab since services are based in part on income.
    Every day I wake up is a good one

  8. #378
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    Thank Cheesecake

    I forwarded this to Brian he'll talk to Jody or Fred at KKI. Brian also has a meeting setup with the Maryland Voc Rehab.

    We got everything packed over the long weekend. I'm glad that we had the extra day because Phoenix was hot and humid this weekend. A couple hours of work and I was beat. The movers came about 10:00 this morning and loaded all of Brian's things into a van. Next up is putting any left over items in the Honda Element that's going to be shipped to Baltimore on Thursday or Friday. We fly to Baltimore on Saturday morning. Getting everything packed was the big step, I think that the rest is downhill.

    Roger

  9. #379
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    Brian talked to the financial counselor at KKI about the BCBS rehab limit. His reply is shown below. He was optimistic that the KKI rehab would be covered by BCBS.

    " We do not need to discuss our rates for self-pay just yet. Yes, you do have a maximum of 24 visits per year and yes, you have 6 visits remaining...but we can obtain additional visits through authorization, once you have used 24 visits. If that fails, then we would be in the realm of self-pay -- however, keep in mind that this is not an uncommon practice among insurance companies and so long as the medical necessity exists for your therapy, authorization is usually not a problem. However, all the same you should be aware of the possibility that an authorization may be unobtainable, and at that time you would indeed be self-pay."

    Roger

  10. #380
    Roger:
    Another possibility would be exchanging benifits to cover rehab. AN example would be to switch long term nursing (nursing home) for rehab days. I have seen CA BCBS do this negotiation previously.

    Which MD VR is he going to?
    Every day I wake up is a good one

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