Personal experience: my father ended up in the hospital without insurance. How we got MedicAid and closed accounts for $200

Imagine that you transported your parents to the USA, gave them green cards, but did not have time to issue medical insurance. And then one of them suddenly becomes seriously ill, he is given help and everything ends, one might say, safely, except for bills from the hospital for $ 200. Represented? Scared? Went to google information about bankruptcy? Do not hurry! There is a way out of this situation.

ForumDaily reader Svetlana fell into such a story, and thanks to a little luck and the help of social workers, she managed to solve everything without much financial loss. As explained to us in insurance company FidelisCare, in America there is medical insurance that is retroactive and, if done correctly, the new insurance can cover the costs incurred before it was issued. Let's see how it works.

A hung system turned into unexpected problems

Svetlana, who has been living in the United States for a long time, knew what documents her parents needed to complete and did not put off the process, but everything went a little bit wrong.

“Two days after receiving the green cards, we went to the Social Security office to apply for the SSN (social security number). We live in Upstate NY and our application process took literally 30 minutes with waiting time in line. I pre-filled out the forms at home (you can find the requirements and the application form for SSN here to register:). Even when submitting the application, the employee warned that the system had malfunctioned, and my mother's documents had passed, and the father's application had not been completed. And therefore, we should receive our mother's card within a week, and the father's SSN - a little later, ”recalls the woman.

And so it was - her mother's social security card arrived within a week, but her father's card had to wait a month and a half.

“During this time, my father had a stroke and he ended up in the hospital without any documents with him, except for a green card (we could not get insurance without SSN),” Svetlana shares her feelings.

Got sick without insurance? There is an exit!

But then they were just lucky and they ended up in the State Hospital (a hospital organized and run by the state government), which saved the situation, although at that time the family did not understand this.

“We were immediately provided with a social worker who took from me all the data of my father (and mother, since she is also a member of the family and also without insurance) and promised to take care of us,” says Svetlana, although she admits that then she did not have much hope inspired.

Representative New York insurance company Fidelis Care advises: if you do not have insurance, we strongly recommend that you contact the State Hospital (a list of such hospitals in New York can be found here). These hospitals have social workers who will help you communicate with the government when the bills start coming in. If you match MedicAid requirements and your case can be qualified as an emergency, then the insurance will cover all expenses that occurred 3 months before the opening date of the insurance plan.

The New York City Department of Health divides potential MedicAid recipients into two groups. Some make out this preferential insurance through NY State of Health and must meet Modified Adjusted Gross Income (MAGI) requirements.

And others - and this is just the case of Svetlana's parents - can apply for MedicAid through Local Department of Social Services (LDSS). In this case they must meet the following requirements (non-MAGI):

• be aged 65 years and older;
• have blindness or a disability, including individuals in need of personal care services (PCS) or personal assistance services (CDPAS);
• live in a nursing home;
• be eligible for the following health insurance programs: Medicare Savings Program (MSP), COBRA, AIDS Health Insurance Program (AHIP), Medicaid Buy-in Program for Working People with Disabilities, Medicaid Cancer Treatment Program.

Other factors will also be considered when considering applications for MedicAid:

• residence in New York State;
• immigration status;
• family size and income.

More details about the requirements can be found at NYC Department of Health website.

If you are confused and not sure if you qualify for this insurance, we advise you to contact the Social Services office or call the Russian-speaking representatives of the insurance Fidelis Care call (347) 642-2993.

almost happy ending

“After a while (when we still didn't have an SSN) my father came out of the hospital and we got bills for almost $200. Thanks to the social worker assigned to us, who was always in touch and patiently reassured me, emphasizing that we would not be abandoned, ”says Svetlana, even now still visibly nervous because of the experience.

After leaving the hospital, her father was assigned to see a cardiologist and very desirable to the one who led him in the hospital. It wasn't easy without insurance. The cardiologist reluctantly made an appointment for him and asked for a receipt that the patient would pay for this visit out of his own pocket. Settled, paid.

While this whole epic lasted, Svetlana's father finally received the SSN, and with the help of social workers, they were able to apply for MedicAid.

“The long-awaited insurance (for father and mother) we received 3 months and 2 weeks after my father was admitted to the hospital. During the whole time of waiting, we constantly received bills from the hospital and SMS with a request to pay the debt. The social worker at the hospital advised us to be patient, not to pay the bills, but also not to be nervous until we received insurance. Parents received straight medicaid and the hospital, as promised, closed all our accounts,” Svetlana noted.

Clarification Fidelis care: Straight Medicaid is not the final insurance. It is given as bridging insurance to those who meet medicaid's citizenship and income requirements. Straight Medicaid is Medicaid coverage, but without the HMO (Health Maintenance Organization). An HMO is a type of health plan that gives you the choice of a specific local network of doctors and hospitals that work with your benefit coverage. That is, Straight Medicaid does not have a network, except for doctors and agencies who themselves decide to work with this plan, and there are usually not many of them.

“Finding a doctor who takes Straight Medicaid has been such a challenge. 90% of doctors don't work with him. Helps a lot in searching. ZocDoc website - enter insurance, enter the doctor's specialization - and you get a list, ”advises Svetlana.

According to her, they were promised that an offer to tie her parents to some kind of final insurance plan would be sent in the near future, but 5 weeks have passed since then, and there are still no offers.

The woman noted that the new insurance, despite the fact that it saved her family almost $ 200, still created some problems: we can't get to him even for cash now. Physician's offices are prohibited from accepting for cash a patient who has medicaid. We'll have to look for a new specialist."

If you find yourself in a difficult medical situation or are just looking for profitable insurance for yourself or your family, contact Fidelis care. The specialists of the company will definitely help you. Phone: (347) 642-2993, e-mail: [email protected]... Consultation in Russian is available.