Guest guest Posted April 17, 2001 Report Share Posted April 17, 2001 In a message dated 4/17/01 10:11:24 PM Eastern Daylight Time, yoemoe@... writes: << She's also disabled but is on SSI. She has Medicaid rather than Medicare as I do. >> gobo, can you tell me what state she is in that Medicaid has given her the go ahead for this? I would love to know which states Medicaid pays for this. Lee Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 17, 2001 Report Share Posted April 17, 2001 In a message dated 4/17/01 10:11:24 PM Eastern Daylight Time, yoemoe@... writes: << She's also disabled but is on SSI. She has Medicaid rather than Medicare as I do. >> gobo, can you tell me what state she is in that Medicaid has given her the go ahead for this? I would love to know which states Medicaid pays for this. Lee Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2001 Report Share Posted April 18, 2001 Gobo, Who is your doctor now. Are you still seeing Dr. Welker and if so where is he practicing? I would like to find a doctor as soon as possible. I also have a supplemental insurance. Right now it is Anthem Option 2000 but will change to Humana in July. Sharon > ; > I know this can be incredibly confusing but MEDICARE > does not > pay any medical expenses for folks on SSI. Folks on > SSI have > their medical expenses covered by the State Welfare > program > where they live. In Washington State, the expenses > are paid by > the Department of Social and Health Services. The > Social > Security Administration has contracts with each > state to cover > this. > > MEDICARE pays for 80% of the covered medical > expenses for > disabled folks on Social Security which is a totally > different > program than SSI. > > SSI is a program that gives the recipient about $500 > per month if > the individual did not earn enough in their life > time (or never had > earnings at all) to provide the normal social > security income. The > State provided medical benefits are called, > " MEDICAID " , not > Medicare. > > Disabled folks on Social Security have worked enough > years and > earned enough to collect their own Social Security, > the same as > if they had retired at age 65. That is why people in > this group of > the disabled are entitled to MEDICARE. > > In general, MEDICARE is insurance, it costs $50 per > month and > the cost is usually deducted from an individual's > monthly social > security payment. MEDICAID is not insurance. It is > technically > welfare and the recipient pays nothing for it. > > I am disabled but am fortunate enough to have > Medicare. I met > with Dr. Welker at OHSU right before he was cruely > banished > from that facility. When he heard I had Medicare, he > exclaimed, > " oh, that's excellent. At least we won't have any > problem with your > insurance " . What he meant is this, Medicare does NOT > > pre-approve anything. Their position is that a > person must just > go ahead and have the surgery first. Then, IF the > person met the > Medicare guidelines, the bill is promptly paid. > > The Medicare guidelines are to be at least 100 > pounds > overweight (I am 185 pounds over) and to have a > minimum BMI > of 40 (mine is 55.5). In addition, I have multiple > co-morbidities. > > I'm fortunate to also have great insurance through > my previous > employer. Contractually, they MUST pay the balence > on anything > leftover. However, I've been in contact with another > fellow > disabled DS pre-op. She's also disabled but is on > SSI. She has > Medicaid rather than Medicare as I do. She's having > a heck of a > time finding a surgeon who will accept them. She can > go out of > state as long as the surgeon will accept them. If > you think of the > surgeon you were referring to, would you mind > emailing me? I > would love to help her out. Feeling powerless due to > all this > bureaucracy is so aggravating! > > Hope this discussion about the difference between > MEDICARE > and MEDICAID helps. > > gobo > pre-op DS > BMI 55.5 > > " Sometimes We Never Know How We Influence the Lives > of > Others, Yet We Touch Those Lives Just the Same " > > > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2001 Report Share Posted April 18, 2001 Gobo, Who is your doctor now. Are you still seeing Dr. Welker and if so where is he practicing? I would like to find a doctor as soon as possible. I also have a supplemental insurance. Right now it is Anthem Option 2000 but will change to Humana in July. Sharon > ; > I know this can be incredibly confusing but MEDICARE > does not > pay any medical expenses for folks on SSI. Folks on > SSI have > their medical expenses covered by the State Welfare > program > where they live. In Washington State, the expenses > are paid by > the Department of Social and Health Services. The > Social > Security Administration has contracts with each > state to cover > this. > > MEDICARE pays for 80% of the covered medical > expenses for > disabled folks on Social Security which is a totally > different > program than SSI. > > SSI is a program that gives the recipient about $500 > per month if > the individual did not earn enough in their life > time (or never had > earnings at all) to provide the normal social > security income. The > State provided medical benefits are called, > " MEDICAID " , not > Medicare. > > Disabled folks on Social Security have worked enough > years and > earned enough to collect their own Social Security, > the same as > if they had retired at age 65. That is why people in > this group of > the disabled are entitled to MEDICARE. > > In general, MEDICARE is insurance, it costs $50 per > month and > the cost is usually deducted from an individual's > monthly social > security payment. MEDICAID is not insurance. It is > technically > welfare and the recipient pays nothing for it. > > I am disabled but am fortunate enough to have > Medicare. I met > with Dr. Welker at OHSU right before he was cruely > banished > from that facility. When he heard I had Medicare, he > exclaimed, > " oh, that's excellent. At least we won't have any > problem with your > insurance " . What he meant is this, Medicare does NOT > > pre-approve anything. Their position is that a > person must just > go ahead and have the surgery first. Then, IF the > person met the > Medicare guidelines, the bill is promptly paid. > > The Medicare guidelines are to be at least 100 > pounds > overweight (I am 185 pounds over) and to have a > minimum BMI > of 40 (mine is 55.5). In addition, I have multiple > co-morbidities. > > I'm fortunate to also have great insurance through > my previous > employer. Contractually, they MUST pay the balence > on anything > leftover. However, I've been in contact with another > fellow > disabled DS pre-op. She's also disabled but is on > SSI. She has > Medicaid rather than Medicare as I do. She's having > a heck of a > time finding a surgeon who will accept them. She can > go out of > state as long as the surgeon will accept them. If > you think of the > surgeon you were referring to, would you mind > emailing me? I > would love to help her out. Feeling powerless due to > all this > bureaucracy is so aggravating! > > Hope this discussion about the difference between > MEDICARE > and MEDICAID helps. > > gobo > pre-op DS > BMI 55.5 > > " Sometimes We Never Know How We Influence the Lives > of > Others, Yet We Touch Those Lives Just the Same " > > > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2001 Report Share Posted April 18, 2001 Gobo, Who is your doctor now. Are you still seeing Dr. Welker and if so where is he practicing? I would like to find a doctor as soon as possible. I also have a supplemental insurance. Right now it is Anthem Option 2000 but will change to Humana in July. Sharon > ; > I know this can be incredibly confusing but MEDICARE > does not > pay any medical expenses for folks on SSI. Folks on > SSI have > their medical expenses covered by the State Welfare > program > where they live. In Washington State, the expenses > are paid by > the Department of Social and Health Services. The > Social > Security Administration has contracts with each > state to cover > this. > > MEDICARE pays for 80% of the covered medical > expenses for > disabled folks on Social Security which is a totally > different > program than SSI. > > SSI is a program that gives the recipient about $500 > per month if > the individual did not earn enough in their life > time (or never had > earnings at all) to provide the normal social > security income. The > State provided medical benefits are called, > " MEDICAID " , not > Medicare. > > Disabled folks on Social Security have worked enough > years and > earned enough to collect their own Social Security, > the same as > if they had retired at age 65. That is why people in > this group of > the disabled are entitled to MEDICARE. > > In general, MEDICARE is insurance, it costs $50 per > month and > the cost is usually deducted from an individual's > monthly social > security payment. MEDICAID is not insurance. It is > technically > welfare and the recipient pays nothing for it. > > I am disabled but am fortunate enough to have > Medicare. I met > with Dr. Welker at OHSU right before he was cruely > banished > from that facility. When he heard I had Medicare, he > exclaimed, > " oh, that's excellent. At least we won't have any > problem with your > insurance " . What he meant is this, Medicare does NOT > > pre-approve anything. Their position is that a > person must just > go ahead and have the surgery first. Then, IF the > person met the > Medicare guidelines, the bill is promptly paid. > > The Medicare guidelines are to be at least 100 > pounds > overweight (I am 185 pounds over) and to have a > minimum BMI > of 40 (mine is 55.5). In addition, I have multiple > co-morbidities. > > I'm fortunate to also have great insurance through > my previous > employer. Contractually, they MUST pay the balence > on anything > leftover. However, I've been in contact with another > fellow > disabled DS pre-op. She's also disabled but is on > SSI. She has > Medicaid rather than Medicare as I do. She's having > a heck of a > time finding a surgeon who will accept them. She can > go out of > state as long as the surgeon will accept them. If > you think of the > surgeon you were referring to, would you mind > emailing me? I > would love to help her out. Feeling powerless due to > all this > bureaucracy is so aggravating! > > Hope this discussion about the difference between > MEDICARE > and MEDICAID helps. > > gobo > pre-op DS > BMI 55.5 > > " Sometimes We Never Know How We Influence the Lives > of > Others, Yet We Touch Those Lives Just the Same " > > > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2001 Report Share Posted April 18, 2001 > > << She's also disabled but is on SSI. She has > Medicaid rather than Medicare as I do. >> > > gobo, can you tell me what state she is in that Medicaid has given her the go ahead for this? I would love to know which states Medicaid pays for this. > Lee Hi Lee; This person referred to in the quote above has yet to find a surgeon. The person I was writing in response to said that she knows someone who is on SSI and that Medicare is paying for her surgery. I was hoping to find out what surgeon that is in order to tell the woman I've been in contact with. However, upon rereading her original post, I see that she says she knows someone on SSI, yet she goes on to say the person's surgery was covered by MEDICARE. I don't actually work for the Social Security Administration but I don't believe this is possible as Medicare DOES NOT pay for any medical expenses for SSI recipients. Medicare only pays for Social Security recipients. My purpose in writing was to explain the difference between Social Security [which uses Medicare] and SSI [which uses Medicaid]. I wanted to make it clear that folks on SSI do not have Medicare; this is what makes it difficult sometimes to find a surgeon. It is also confusing because many on SSI do not realize that they don't have Medicare, thus they are bewildered when they face denial after denial. It's easy to see how mind boggling this can be isn't it? If I get more info about surgeons who will accept payment from MEDICAID I will be sure and post Loud & Clear!! ;-) Good luck and hugs~~ gobo DS pre-op BMI 55.5 " Sometimes We Never Know How We Influence the Lives of Others, Yet We Touch Those Lives Just the Same " Quote Link to comment Share on other sites More sharing options...
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