I really need some advice right now. My family is really panicking about this.
My Diabetic sister just turned 21 years old, and she has been cut off of medical (Mainecare). I would like to know if anyone has lost their medical? How they were able to find a doctor who would prescribe their medicine? And if they were able to get assistance for their medical expenses?
As Diabetics we are all in the same boat. We are very dependant on Medical insurance to just stay alive. We don't ask for much all we want is to live healthy lives. DHS said, that "she wouldn't be covered unless she had a disability". My mom told them, "she is going to have a disability if she can't get her insulin". We pay taxes, she is a college student and is working full time. She might be able to pay for some of her medicines, but how is she supposed to get the medicine if she doesn't have a doctor to prescribe it?!
I really appreciate any advice you guys could give me and my family. Thank you! :)
Its not a perfect solution...but in most states NPH and R insulin is available at Wal-Mart for around $25.00 a vial AND no prescription required. The Wal-Mart Relion brand also has their own brand of meters and strips that are MUCH cheaper. I might suggest she try applying for Medicaid, as that is income based, BUT there is no guarantee she will qualify. Several of the insulin manufactures offer assistance programs for those with financial needs. If she goes to a universtiy perhaps a student health center can be of some assistance, also the local health department might be able to provide her with some low cost health care.
I would also suggest talking to her current doctor about her lack of insurance, they might work out some kind of payment arrangement with her.
I would check where she goes to school. They may have a very low cost insurance policy that she can qualify for as a student. I know I have to "waive" insurance for my kids every semester because they already have health insurance through our family plan. Also, in our state, full-time college students are covered up to age 26. You don't say whether your sister is a full-time student or a part-time student. I would definitely see what the school has to offer, if anything.
Also, I second what the other poster said about buying NPH and R over the counter at the pharmacy. I did that for many years without a prescription. I just paid cash for it. Again, it's not a solution to the core of the problem, but it might be a bare-bones emergency plan in case nothing else works out. Best of luck with it.
She should talk to her endo immediately. There are some low-cost programs people with diabetes can access. If you have a local children’s hospital, she should check there too because she might be eligible for one of their assistance programs (they frequently provide services to people up to the age of 24 or so). Finally, if you think her coverage was wrongly terminated, you should contact every policitican representing your jurisdiction at the state and local level. I am assuming your sister is a type 1; unfortunately, most people are completely unaware just how dependent we are on the medical system. It’s really frightening.
My question for DHS would be" If diabetes is not a disability then why is is illegal to discriminate against a diabetic under the Americans with Disabilties Act" I know it would be just howling at the wind but at least it would give them something to think about.
If employers cannot discriminate against her then why should the state of Maine be allowed to. I know that this offers no solution but it does show the outrage I feel over such situations.
For purposes of caring for and safeguarding my son at school, as a diabetic, he is covered under section 504 of the Rehabilitation of 1973. Although I do not consider Caleb someone who is disabled, this Act protects him because he has diabetes and specifically defines diabetes as a disability. This federal legislation is applicable to institutions which receive government funding, like a public school.
So although this law may not address your sister's insurance issue specifically, it is at least a point of reference to how the federal government defines diabetes as a disability and may help in your fight.
Seems to me that a condition that is fatal without Insulin would be a disability. The doctor may be able to fill out disability paperwork and get her covered.
Do your parents have insurance? If so your sister should be covered under your parents plan until she turns 26. Our son is and he is 21. Goes to college and works also.
This is true a lot of policies are now doing that, allows you to cover your children up to 26 and a lot of them you don't even have to be enrolled in school to do so. Most of the times plans have when there is a "life changing" situation, you can add someone right at that time. Losing your health insurance would be a "life changing" situation. I'd recommend looking into that.
While people with diabetes are covered under the American with Disabilitie Act, being declared disabled and receiving SSI or SSDI (if you have worked) is a whole other ball game. Usually people with diabetes cannot collect SSI or SSDI unless they have suffered complications or have lows that place them in the hospital a number of times or their diabetes keeps them from working or holding down a job. One would need their medical records plus a lot of other evidence to be declared disabled enough to receive SSI or SSDI funds. SSI is for those who have not been able to work and SSDI is for those who have worked for a period of years and is based on the person's income while they worked. Hope this helps.
