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19 year old daughter, new SCI, no insurance

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    19 year old daughter, new SCI, no insurance

    Im not sure Im posting in the right thread or not.........

    My daughter was on her way home from work when she rolled her Jeep. Shes been in ICU for 34 days now with broken ribs, collapsed lungs and an SCI. They initially removed the C6 Burst Fracture and fused the C5 and C7. She was in a medically induced coma for 12 days due to the condition of her lungs. They think she may have aspirated some stomach acid during surgery so her lungs have had a very hard time healing. Just keeping her alive was our main concern. Now that she is beginning to breathe on her own and making great improvements, we need to start the Rehab process.

    Being that shes 19 and not a full time student, we could no longer carry her on our insurance. She had just started a job 5 weeks prior therefore not eligible for company insurance. Employees must pass a "probationary" period before the benefits kick in. She had about 6 weeks to go. Life insurance, short and long term disability, vision, dental and medical all part of same package that she isnt eligible for.

    We live in Nevada and have applied for SSDI and Medicare/Medicaid. My question is.... What do we do in the meantime? No Rehab facilities accept uninsured patients as a rule. What other resources are available to her? I can find basically nothing in our area in regards to SCI.

    The hospital she is at has a great Trauma center and she is receiving the best care we could hope for but it isnt Rehab. They are trying to help us by looking into places such as Craig and Santa Clara...Shriners..etc. But what can I do to help?

    We have already decided that I will be the one to go with Ivy wherever her Rehab may take her while my husband stays here and works and takes care of Ivys 3 year old daughter and our other daughter....so she wont be without family support..tho I know family support is secondary to the rehabilitaion process.

    So sorry to have rambled. I just have so many questions and have no clues! I found this website shortly after her accident and have found it to be very informative, supportive and friendly so I figured Id give posting a shot!

    Thanks in advance to all.
    Dianna

    #2
    I am so sorry to hear about your situation. The best thing is to get a case manager assigned to this to help your coordinate your benefits and figure out what your daughter needs to do. If she is ELEGIBLE for shriners, that might be a possibility. Either way, you need to figure out the first step. Good luck!
    Daniel

    Comment


      #3
      Thanks for the quick response!

      We do have a case coordinator as well as a Social worker looking at all angles. They are actually the ones who are looking into Shriners... Tho thats iffy due to her age and the fact she has a child. My fingers are crossed tho! We are also looking into VA assistance as she has a large military family background tho its Uncles and Great Grandpa and Great uncles..etc. None are last generation except my brothers..maybe helpful? I dont know but worth a try.
      What she does have going for her is that she has already made marked recovery on her own...can move both arms,wrists, has biceps and triceps ( this is how nurse explained to me....Im just learning here!) has pretty good strength in arms, can wiggle toes a bit. She has feeling almost everywhere and what the DR. called a good anal wink. ( I saw that here somewhere so I think thats a good thing) Her attitude is great...some depression but thats to be expected. She has fierce determination to walk again, if not that, to at least be independent enough to care for her daughter
      She does have a stage 3 pressure sore tho. This is from being on a rotorest bed to keep the lung secretions moving and being to unstable to move. That will mend in time Im hoping.
      I do know that the "Live for Today...Tomorrow may never Come" and "Why save it.. you cant take with you" theories have backfired. Kinda makes me feel that Ive let her down by not having a big ole secret stash to draw upon and whisk her away to the best rehab money could buy ya know?
      I have the utmost faith that something will work out tho...somehow. Shes to wonderful to be kept down for long!

      Comment


        #4
        In CA many rehab centers will take SCI patients "medicaid pending" and it will pay retroactive to the date of the injury once it is approved, but I haven't a clue if that also applies to Nevada. It doesn't hurt to contact your state legislators to find out if there is anything they can do to expedite her application.

        Unfortunately the VA will not be an option. VA healthcare is only available to the veteran themselves....not to family members.

        Good luck. She is fortunate to have you in here corner. I am going to move this over to the New SCI forum though as it is more appropriate there.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


          #5
          Watch that pressure sore. They can get serious fast. Nothing to mess with.
          Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

          Comment


            #6
            I think at this time there would be absolutely no shame in asking for a fundraiser. It's summer - outdoor barbecue, maybe a band volunteering their time, restaurant might cater at little cost. First responders (police, paramedics, fire) usually have generous hearts and wallets ... make the local media your friend as they love a good story ... I think summer is the perfect time for this! It's fun in Canada to poke fun at Windsor where I live, but what keeps me here is how people rally in support of their own when something terrible happens.

            Hmm .. but to find someone to help arrange it or I know there's been others here who have thrown fundraisers.

            I like the idea.
            Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

            T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

            Comment


              #7
              sorry to here about your daughter, i recenlty had an accident copressing at t12 - L1, very hard and tiring rehab, but well worth it in the end made me inderpendent again and ability to cope with any situations, there still is hope yet with anyone with sci, as they have only hit the first phase with stem cells, shouldnt be too much longer until they will be able to repair the spinal cord..... =)

              Comment


                #8
                sorry to hear about your situation. i went through a similar one less than a year ago. i had just finished my master's degree a few weeks before my accident, so i didn't have insurance either. i'd advise a couple things that helped in my situation.

                while i was in icu, my father got on the phone and made calls to medicaid. left a voicemail on every customer service reps machine. he got 1 call back, but that person helped push us along. so make some calls. make a lot of them if necessary.

                i have a great support network. family and friends have held fundraisers for me to help cover bills, equipment and care. couldn't do this without them...

                i'm a new sci as well, but those two things were necessary for me to get the care i need.
                working every day to get out of my chair.

                Comment


                  #9
                  My son's accident was in South Carolina; while he was in intensive care there, the caseworkers and insurance folks at the hospital worked with me to get him set up not only for Medicaid in SC, but also to start the application process for him to begin New Jersey Medicaid when he moved back home with us to attend Kessler Rehab. As someone else said, I think a lot of rehab centers as well as acute care hospitals do the 'pending' thing.
                  _____________

                  Comment


                    #10
                    Originally posted by SCI-Nurse
                    In CA many rehab centers will take SCI patients "medicaid pending" and it will pay retroactive to the date of the injury once it is approved, but I haven't a clue if that also applies to Nevada. It doesn't hurt to contact your state legislators to find out if there is anything they can do to expedite her application.

                    (KLD)
                    I agree.

                    I didnt have my insurance card with me, and I was in a coma, my mom didnt know my insurance info.

                    take her to Rancho Los Amigos (its where I was shipped for a couple of weeks), they will retro her and help a great deal with getting her what she needs. Most of their patients get approved for medical because the state works very close with this facility as it was deemed top 3 in the country, and is a county SCI facility. You're from Nevada but I would call them. They work magic and are very VERY knowlegable.

                    Comment


                      #11
                      I am sorry to hear about your daughter! I would think, she would qualify straight up for medicaid, is the little girl her's? I have not read all of the post, so, I might have missed. I would def. speak with the Social Worker where she is now.
                      If she is medicaid pending, due to the severity that seems odd, states may be different. I had a huge share of cost even with 4 kids however; that amount well, hit with just the helicoptor ride. I would get on the phone and push buttons to get this going faster for her to get what and where she needs to go/be.
                      I wish you well on the rode to recovery for your daughter!
                      "I've got to keep breathing. Because tomorrow, the sun will rise. Who knows what the tide could bring?"

                      Comment


                        #12
                        Careful holding a fundraiser for her. You don't want such funds to render her Medicaid ineligible.

                        Comment


                          #13
                          Unfortunately it is very unlikely that Rancho would take her. Rancho is a county hospital, and they generally will only accept Medicaid pending patients who are legal LA County residents, or at least state of CA residents. With your daughter being a NV resident, it is unlikely that Rancho would take her. Of course you could call and check, but it is very rare that NV Medicaid will pay for out-of-state care (I have only seen it once) and Rancho would not take her with no prospect of being paid at all. It is most likely that you need to get NV Medicaid and then try to get into one of the Sunrise rehab units in LV or into the rehab center at Washoe in Reno.

                          If you are planning any fund raising, I would strongly urge you to manage any funds through this organization so you don't jeapordize her eligiblity for either Medicaid (or if needed, SSI):

                          http://www.transplantfund.org

                          (KLD)
                          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                          Comment


                            #14
                            Originally posted by marmalady
                            My son's accident was in South Carolina; while he was in intensive care there, the caseworkers and insurance folks at the hospital worked with me to get him set up not only for Medicaid in SC, but also to start the application process for him to begin New Jersey Medicaid when he moved back home with us to attend Kessler Rehab. As someone else said, I think a lot of rehab centers as well as acute care hospitals do the 'pending' thing.
                            Does this mean that I am going to need to apply for Medicaid in whichever State she may be sent to for rehab as well as here in Nevada? Is there not a State residency qualification or something? The case coordinator and social worker are working with us to get everything worked out for Rehab referral as well as SSDI and Medicaid, so Im hoping it all falls into place.

                            "Careful holding a fundraiser for her. You don't want such funds to render her Medicaid ineligible"

                            We are from a very small community....approx. 4000 people. We all come together and try to help any and all in our town who is facing hardship. They have had a couple fundraisers for us which enabled us to be able to take off work to be with her for the first 21 days when we werent sure she was going to pull through. Without their help it would have been financially impossible for us to have done that. I will forever be grateful for that. With that being said tho, I believe that raising the funding required to pay for Rehab would be quite difficult in such a small community. On the same note tho... Do I have to report any donations made to us as an asset of sorts? I wouldnt try to hide anything or cheat the system so I guess that is something I should know as well. If they are donations or fundraisers for us to be able to be with her, is it considered her assets therefore possibly making her ineligible? Ive even looked into getting loans from our life insurance policies to help but unfortunately new policies so not enough built up to amount to a tank of gas these days!..lol

                            "It is most likely that you need to get NV Medicaid and then try to get into one of the Sunrise rehab units in LV or into the rehab center at Washoe in Reno."

                            We live about 2 hours away from Renown (formerly Washoe) in Reno which is where she is...and tho the Trauma unit there is great, they even suggest an actual Rehab for SCI as they are not equipped to work with SCI as needed for substantial recovery or education. I really hope and pray that we are not reduced to settling for just a generic rehab.

                            "I am sorry to hear about your daughter! I would think, she would qualify straight up for medicaid, is the little girl her's? "

                            Yes...Trinity is IvyJo's 3 year old daughter. They lived with us at the time of the accident so Trinity hasnt had to be uprooted or anything...shes still home so thats a plus....Missing her mommy tho. Ivy cant talk except for maybe 10 minutes at a time when they put the Passy Muir valve in her traech, so Trin thinks her mommy cant hear her. Should have seen her eyes light up when she heard mommy talk for the first time after such a long silence. Was beautiful!

                            Ok ..sorry this was another long one....but it has seemed to be helping my anxiety to be posting and reading here....so thank you all for your input, time and patience!

                            Dianna

                            Comment


                              #15
                              Yes, Medicaid is federal funds partially and state funds partially, so it is administered by each state separately, and most states will not allow Medicaid funds to be used nor will they authorize out-of-state care. In most states, you must be a resident for a minimum of 30 days prior to applying for Medicaid, and there are pretty strict definitions for what qualifies as residency (generally being in the hospital in another state is not a qualification). You can apply to NV Medicaid for them to pay for out-of-state care (Rancho in CA, Craig in CO, Santa Clara Valley in CA, for example) but as I said above, my experience with them has show they rarely approve this, and as a non-CA resident (or CO resident) she is not eligible for Medicaid in those states.

                              At this point, she needs the rehab she can get with Medicaid. The alternative is for her to be placed in a nursing home, and you want to avoid that with every fiber of your being.

                              There will be many things she will need that will not be paid for by Medicaid (a van for example, or home modifications, or a standing frame or gliders or FES bike). Fund raising for this is a very good idea, but you MUST be sure that no funds are put into her name or bank account. Medicaid allows her only $2000 and one vehicle and a home, and anything of any type as far as assets over this can make her ineligible, and trying to hide money is considered Medicaid fraud. She cannot give the money away (there is a 2 year look-back for this) either.

                              If you have used money yourself from fund raisers, you must declare this as income for yourself. See your tax consultant. This is why it is critical that you manage any donations or fund raisers and I strongly urge you to use the link posted above...they are a great organization and will steer you the right way to avoid these pitfalls.

                              (KLD)
                              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                              Comment

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