More threads by chooseLife

chooseLife

Member
I am on medicare. have been since I was 23. my "main" diagnosis is a psych one since the lawyer at the time thought i could get it easier if I only had the psych diagnosis rather than physical as well. My issues are both. my "breakdown" came after my physical injury. Anyway, I was one of those people who was diagnosed as a "bad borderline" back in the 80's when the false memory people were suing a lot of T's. I was in and out of the hospital constantly and even kept for a year once while they kept changing my dx. each month/week to get more "days" from my insurance company.

Nobody ever asked me if I had ever been abused because I guess they were afraid to "place memories into my mind" as the FMS folks said. Funny how the word "syndrome" can be added to things to make them sound like real disorders without medical backup - much like what prolife folks are saying about post-ab. syndrome....not real either. Maybe as opposed to PTSD or CPTSD - we need an "acute post R syndrome" so that what you feel after R can be valid instead of waiting months before you get the official PTSD diagnosis. but I digress...

anyway, because I was on medicare and because medicare is illegally allowed to use disparity when it comes to separating psych from medical (which is illegal for any other insurance company except the government issued one) ...those on medicare have 190 lifetime days for private hospital psych admission regardless of what age you are when your psych stuff starts. That was allllll used before I hit 40 yo. It's like being disabled for cancer and saying I can't get "specialized" cancer treatment. It's just wrong.

so, now, for the rest of my life, I can not get into a private hospital that actually treats PTSD/CPTSD. I get put on a mixed ward - with inappropriate men...and told to heal/feel better in 3 days and I can only get inpt help if I am sui. which removes any focus on any of the rest. I just got out of the hospital after being out for over 14 years and one of the men on the unit kept going into patients rooms during the night and taking down his pants. That meant I was not going to sleep of course and i had already only had like 14 hours sleep the previous 7 days. what a mess. I finally got my room changed to across from the nursing station so i could feel safer. then just the noise of the nurses kept me awake! :facepalm:

John Kerry and someone else has a bill in congress to undo medicare parity but it's stalled like so many other things. It's hard to know for the rest of my life, I can't get appropriate care. AND my co pay for T is 45% instead of 20%. T is the only treatment I am allowed and I can't afford it. Why can't NAMI get behind this and why can't something big start so that this is done. psychiatric parity for all insurance is the federal law. why NOT for medicare?

but they want me to heal and not hurt anyone else. Think about the amount of harm done in this nation by undertreated or NOT treated folks with psych disorders. Fortunately for society, all of my stuff is self directed. I will always hurt myself before I hurt anyone else.

and medicare counts on that. so does society.

I went a little off the beam...but it's frustrating. I so wish I could find a good woman's program who could do intensive treatment so that I have a chance to have a good life at some point. My "days" were used up before I ever got the correct diagnosis.

be. chooseLife.
 

Daniel E.

daniel@psychlinks.ca
Administrator
John Kerry and someone else has a bill in congress to undo medicare parity but it's stalled like so many other things. It's hard to know for the rest of my life, I can't get appropriate care. AND my co pay for T is 45% instead of 20%. T is the only treatment I am allowed and I can't afford it. Why can't NAMI get behind this and why can't something big start so that this is done. psychiatric parity for all insurance is the federal law. why NOT for medicare?

As you may know, the copayment will be eventually 20 percent, though not until January 2014.
 

chooseLife

Member
maybe it's time for ME to get behind this and see what I can make shift? would be a great use of energy that's for sure. thanks, be. chooseLife!
 

Daniel E.

daniel@psychlinks.ca
Administrator
BTW, I called a psychologist's office today, and the Medicare copayment for the first visit (which is usually more expensive) would only be $32. That is just an example, of course, but it seems much lower than most psychologists would charge, so calling around may help.

Also, as you may know, Medicaid can serve as a secondary insurance for individuals with Medicare: https://www.cms.gov/apps/firststep/content/medicare_dualelig.html
 

chooseLife

Member
yeah, I live in NC. and had a good job. in nc if you make more than $1000/month, you are on your own. period. i don't even qualify for disabled housing here. in say MA, I would quality for a lot, i just would be in too much pain with the cold and very long winters. although I love the 4 seasons. the winter is short and sweet here. although cold.

I just got out of the hospital last week. my decuctable for inpt is $1200 per admission. I dont' have that kind of money. at the end of each month, I have $30. and that's with NO enteratainment budget, NO home phone and NO tv service. I am right now not paying credit card bills as well. It's kind of a mess. my copay for T every single week is $32. that's over $1200 a year not including psychiatrist - who i dont' even have because I can't afford one. but because I have medicare, i don't qualify for a case manager, low cost Therapy etc.

it's quite a mess. I also don't have part D because I was paying them $60/month, they were paying $10 towards meds last year and I was paying over $100. AND because I had part D, even tho they refused to pay for the meds my dr. wanted me on, I couldnt' get help from the drug company because I "had" insurance.

it's broken. very broken. and illegal. My disability is mental illlness and the copay for mental illness is higher than if I had cancer. yet, MI is my illness. and I have no inpt days left for actual treatment.

it's just very broken. thanks for thinking more about what could help. I don't qualify for any kind of help in NC except for stuff that is not income related. I always thought if you ahve low income, you should live somewhere with a lower cost of living. I am wrong. go to ca. you will get help. there is none in NC - except I am very grateful for the medical care and low cost scripts I get but that's not related to income. It should be, but it's not.

thanks, chooseLife!
 

Daniel E.

daniel@psychlinks.ca
Administrator
if you make more than $1000/month, you are on your own.

That is basically the situation in Florida as well, I believe, regarding Medicaid. In case you haven't seen this already, there are three dual-enrollment programs in North Carolina, with cutoff thresholds from $908 to $1,228 for the monthly income of a single-person household: NC DMA: Medicaid for Medicare Recipients



---------- Post added at 10:42 AM ---------- Previous post was at 10:23 AM ----------

I also don't have part D because I was paying them $60/month, they were paying $10 towards meds last year and I was paying over $100.

Of course, there are a variety of Part D plans by different insurance companies that work with Medicare and have different deductiables, but I don't know much about them and they vary by location:

https://www.medicare.gov/find-a-plan/questions/home.aspx

(It seems enrollment in a new plan ends December 7th.)
 
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