Transitions: finding funding

Transitions: finding funding

Posted by AskNurseLinda on Oct 8, 2018 11:00 am

9cd26e44bff8705f683295a69345f9f9-huge-isMoney makes the world go around and it makes living much easier. It is one of the most significant factors in making your life easier. Getting the right supplies, equipment and therapy can be a challenge. However, there are ways to obtain these items, but it does take some effort.

The health insurance policy that you purchased will have specific information about what is authorized in your individual policy. Policies within companies can vary significantly. If you have an insurance policy and the person in the next room has a policy by the same company, the individual benefits can vary greatly. Most people think they have insurance, so everything will be paid only to quickly find out this is not so.

Only the specifics of your individual policy matter. I have met very few people who read their policy entirely through. Even if someone does, they don’t know the financial needs to deal with any particular diagnosis especially one that is long term. What seems like a great policy might not be so when actually needed.

In general, most insurance policies provide for two weeks of inpatient rehabilitation. As everyone reading knows this is not enough time to learn to care for yourself. Your body has gone through catastrophic change, either from trauma or disease. Feeling well enough to participate is a challenge, the psychological impact is overwhelming and physical ability is probably not at your best level. Now, on top of all of that, you need financing for everything just to make your daily living manageable.

If you have no insurance, you can apply for Medicaid. The application will begin from the time of the current hospitalization even if it takes a few weeks to get it submitted. Be sure to do this right away so your hospital bills will be covered. Once approved, you will not face the full cost of admission. There are many people who find themselves without medical coverage for a variety of reasons. This is a method to assist you with support for bills that will be so huge, a normal human cannot afford it. Spinal cord injury is a diagnosis that is typically accepted by Medicaid without a legal battle.

In the hospital or rehabilitation setting, you might meet someone called the case manager. The case manager you meet in the hospital or rehabilitation setting works for the hospital or institution where you are admitted. The job for this person is to monitor your progress and care and to report this information to your payor (insurance or Medicaid.) They are your first line of connection to your payor while as an inpatient. While in the rehabilitation setting, you should work with the hospital case manager to obtain equipment and any home care that might be needed.

The hospital case manager or perhaps a discharge planner will be the person who is setting up your initial supplies and equipment for home. They will order standard equipment for you. Ask to speak to them about what they are ordering. You might find you want a commode that can be rolled into your bathroom if the doorway is wide enough and your bathroom floorspace can accommodate it. The more you know about what they are ordering as well as the dimensions of your home, the better situated you will be when you get to your home.

The hospital case manager will be talking with your payor’s case manager. Find out from the hospital case manager who your insurance case manager is and their contact information. Once discharged from the rehabilitation setting, the insurance case manager will be your long-term case manager. The insurance case manager can assist you with getting supplies and therapy as your needs change. If you have been discharged for a while, you can call the number on the back of your insurance card and ask for your case manager. If you do not have one assigned, it is your right to request one.

It is much easier to work with just one person from your payor than to start anew with each request or question. Most companies have people who just do case management, so they are familiar with the process. The case manager can make decisions about authorization of treatment and equipment, so you might not have to go through the call center. Sometimes, they will have to make decisions with the medical director, but you cut through a lot of red tape by working with your payor’s case manager. Sometimes, they can move funds around in your health insurance plan that will fit your needs better.

When you develop a relationship with your payor’s case manager, they begin to think of you as a person and will become familiar with your history and needs. They will be able to explain what your coverage is and will be able to do some adaptions for your individual needs. For instance, they will be able to explain the policy for upgrading catheters or use of therapy hours. Most coverage allows two weeks per year for reevaluation and fine tuning of your therapy which will be called mobility training. This is an excellent resource for progression of your recovery as you can be reassessed. New therapy might be initiated every year with this two week maximum.

If you have Medicaid, there will be a case manager for that payor as well. The process is the same. There are restrictions with Medicaid such as receiving care only in your state of residence as Medicaid is funded by your state. Medicare has case managers, also. Medicare is federally funded so there is some additional flexibility for treatment out of state, especially if you live on a state line where going to the next state is much closer to your home. Medicare has two programs, one for individuals over the age of 65 and one for younger people who have been disabled for a minimum of two years.

If just home or if you have been home for a while, be sure to phone the number on the back of your health payor’s card and request a copy of your health insurance policy. The policy maybe online. You can look up policies but be sure you are reading the policy with your policy’s title or number. There are many issued by the same company. For example, if you look up Blue Cross, be sure you have your policy number, so you are reading about the correct benefits. The Medicare and Medicaid policy manuals are online and are searchable. Read only the policy from your state for Medicaid. Understanding your benefits will help you negotiate better with your case manager. The first time you read your policy, it will be extremely confusing. Keep at it. The policy becomes clearer the more you read it.

A healthcare payor, either Medicaid, Medicare or insurance is going to be your primary source for healthcare coverage. However, especially for individuals with spinal cord injury, you will find there are equipment or supplies that you feel would make a difference in your daily living or recovery that are not paid by your payor. This is when you need to become innovative.

There are opportunities for external support. For instance, you might need an accessible vehicle to get around. Insurance is not going to cover this. Some organizations in your area might be willing to assist you with this large financial need. These groups might include fraternal, community or faith-based organizations. Even if you are not a member, you might know someone who is, or you can call and make a request. It might take several contacts to get to the right person or a person who is interested in your story. Making the connection is key. If you are turned down after one call, wait a bit and call again. Your first call might have set in motion the idea of supporting someone in the community. Give time for your idea to grow. You will need to find a person who would like to and is able to set a plan in motion.

Private businesses also support various charities. There might be a business or family of means that is donating to charity so why not let that be you. It is a bit more difficult to ask individuals directly. Be sure to have your specific need identified as people like to donate things, not ideas.

You might have someone offer to hold a fund raiser for you. This will be a great opportunity to obtain therapy or equipment that your payor will not cover. It can be hard to be the center of attention if you are not that type of person. However, if you can, attend the fund raiser and thank everyone. If you cannot attend, send a family member(s) or a representative.

As much as you may not really like it, if you can, connect with the media. Telling your story as a cautionary tale gathers notice. You will see stories on TV so try to model yours in the same format. The media picks up stories that have a lesson for their listeners or an outcome that is of interest. You will need to express why you need the equipment you desire and how it will help you. Your story might not be about your needs but having your image on the news is a good way to move forward with organizations.

Start a ‘gofundme’ webpage. Many individuals have done this sort of online fundraising for big ticket items. You provide your story, a photo and why you need the item. People might donate a part of the funds needed. Collectively, you might be able to then purchase the item. Remember, you are competing with many individuals who have the same or similar needs. Be honest about your situation. Thank your donors.

There are many ways to obtain funding. Some can be quite unique. One person I know had a huge extended family. They had many car washes and bake sales to get an enormous amount of funding. That is one dedicated family. Another gentleman started his own business. Part of his business plan was to fund extra therapy. He intrigued a donor with his explanation that he would be the business, so he needed the therapy to stay healthy. You will come up with ideas as unique as you are an individual.

In countries outside of the United States, individuals think we have therapy throughout the lifespan. Of course, living here, we know that is not true. However, we do have opportunities that can be harnessed. The generosity of our fellow citizens goes a long way. Be creative and innovative. The idea for fundraising might not come to you in a flash. It may take weeks or months to come up with a unique idea. Keep at it. Let us know some of your ideas. That would be helpful to everyone. And Thank YOU for supporting the blog.

Nurse LindaI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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Re: Transitions: finding funding

Posted by Kathy on Oct 11, 2018 4:27 pm

Dear Nurse Linda,

Thank you for this informative piece.   

Information Specialist
Christopher & Dana Reeve Foundation Paralysis Resource Center
636 Morris Turnpike, Suite 3A
Short Hills, NJ 07078
Toll-free: 800-539-7309 x7205
Phone: 973-467-8270 x7205


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