Worst case scenario in Maryland

[bpomy]

My sister chose not to have health insurance and now is faced with the worst case scenario possible. Her husband (only 48) was just diagnosed with brain cancer and has been given 36 weeks to live. Needless to say, when this is all said and done, its going to be quite expensive. She makes a good income as a high paid consultant so she may not qualify for some assistance. What can she do to mitigate the financial impact this will have on her and her family? - lives in Maryland

[cbg]

I'm so sorry to hear about your brother in law.

Is is safe to assume that he does not have health insurance either? The fact that SHE opted out does not necessarily mean that he did with his employer.

I know, it seems very simplistic, but just to clear up the point for certain...

(I'm not trying to be a smartass, honestly.)

[ecmst12]

I went here:

[url]http://www.dhmh.state.md.us/mma/mmahome.html[/url]

Maryland does have a category for "Medically needy" people and they have higher income requirements for eligibility for Medicaid. The category is defined as, "people 65 years old or older, blind, disabled or with an illness that is expected to result in death." He seems to fit into this last category. There are phone numbers listed on that page to call to see if he qualifies for assistance. Hopefully they will find something to help them.

[lealea1005]

I'm sorry to hear about your brother-in-law.
Also try contacting your county department of Social Services. Some counties have programs such as Mission or Mercy which provides healthcare and medications to the terminally ill and uninsured. I'm not sure if there is an income requirment, but Social Services or the county health department would know.

Can I ask which county your sister and brother-in-law are in?

[cbg]

lealea' suggestion is similar to what I had in mind. Assuming that some of his treatment will be rx therapy, some of the pharmaceutical companies have special programs to assist with the cost of the drugs. They are more likely to be available if the patient is completely uninsured. There may or may not be income limitations.

[bpomy]

Thank you very much for the responses. My sister lives in Montgomery County. I should have been more clear in that they both opted for no insurance.

I am very sorry to hear about your brother in law. I am insurance broker in MD and have dealt with similar situations.There are two things that you can do. The 1st is to somehow have your sister get onto a group health policy through an employer, this will give immediate coverage for all pre existing conditions. This may not be practical but it is worth mentioning.

The second option is to join the Maryland Health Insurance Plan, (MHIP), this is a high risk pool for the state of MD where normally uninsurable individuals can get coverage. The premiums are a bit expensive but given the situation that you are facing that should not be a factor.

[cbg]

Just a point of reference regarding group health insurance;

Under the law, an employee may only join a employer-sponsored group health insurance plan either when they first become eligible for it or during the group's open enrollment plan. This is in part (but not entirely) precisely to AVOID people signing up for insurance only when they have a major claim. The other reason is that the large majority of group health plans nowadays are under Section 125, which means premiums are taken pre-tax, which means that the gov't is heavily regulating additions and deletions from the plan.

Even if this is one of the few plans which is not under Section 125, the insurance plan would require medical underwriting before allowing someone onto the plan outside of open enrollment.

Additionally, the poster above is wrong that a group plan will automatically cover all pre-existing conditions. That is only unconditionally true when there has been prior creditable coverage, not when the employee/dependent has been uninsured. SOME types of group plans, in Maryland, must automatically cover all conditions but that is only true for HMO's and small group plans. Without knowing what kind of plan the poster's sister's employer has in place it is impossible to conclusively say that pre-existing conditions will unquestionably be covered.

Don't get me wrong; if there should be an open enrollment period in the next few weeks or months, or if the poster's sister should change jobs and become eligible for a new group plan, this would almost certainly be the best solution. Even those group health plans which are legally allowed to have exclusion periods do not all do so, and the husband may live longer than anticipated, exceeding any exclusion period that may exist. But there is no guarantee that she will be able to join a group plan, or that pre-existing conditions will be covered if she can.

NOTE: My answer is based on my experience administering employer sponsored group health insurance plans - 26 years worth. And including Maryland.

[TIMMAAYY]

cbg is correct. In most cases, if you do not have 18 months of creditable coverage with no gap of more than 63 days with NO coverage, a condition can not be pre x'd. It sounds like even if you were to get a job tomorrow, your employer's plan would not cover the condition or anything related to it directly for 18 months.

Sorry to hear of your misfortune. It's always sad to hear a case like this.

[ecmst12]

Why on earth are you bumping up resolved threads just to agree with someone???

[lkc15507]

I too am terribly sorry to hear of your brother in law's diagnosis. I simply want to offer what may be considered out of line. This in no way implies that my suggestion will result in anything but the same prognosis he has already been given. Ossama Al-Mefty, University of Arkansas for Medical Sciences in Little Rock, AR. Probably the (or one of) premier brain surgeons practicing in the world today. Who would figure Arkansas? Do a Google search. A second premier neurosurgeon is at UAMS as well--Gazi Yasargil--he is elderly but a (one of the) true pioneer(s) in brain surgery. Columbia University in NY is also a premier neurosurgical facility. I do NOT want to offer false hope, but I had a client 3 years ago who had a malignant astrocytoma encompassing nearly the entire left hemisphere of his brain. He saw Dr. Yasargil. He is still alive and well. Multiple patients with "iffy" prognoses referred to Dr. Al-Mefty. Most have no long-term sequelae or morbidities. Best to you and God Bless, lkc15507

[lkc15507]

Okay, I have to continue to qualify my post. Of course the type of tumor and length of time from diagnosis as well as previous treatments are paramount. I didn't intend this to be a long-winded medical reply as this isn't the correct forum, but I got myself in it. Gliomas, glioblastomas, high grade astrocytomas have poor prognoses. Once again, I do not want to offer false hope, only what I am acquainted with as the best surgical care for these diagoses in the US. If I had a brain tumor, given my experience personally as a neuro ICU RN, I would see Dr. Al-Mefty at UAMS, be it in or out of network. (And I belong to a high deductible, high co-insurance plan. To the tune of $10,000.00 + for out of network.)