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    Bravo-Amerigroup (use to be Health & Human Resources)

    It's my Medicaid HMO. Does anyone else have them for their care? They're driving me crazy. They won't approve anything. Everything I ask for is deemed a luxury not a necessity. Even exam gloves. They said my pca's need to buy their own.
    Is this Obama Care?
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    #2
    It is not Obamacare. Why do you think it is Obamas fault that you have improper care?

    It is the fault of your HMO. Never sign up for an HMO. HMO's are notorious for poor care provided their clients. Do you have another choice for services? Do some research for the next sign up period and don't fall for an HMO if you have a choice.
    Anything worth doing, is worth doing to excess

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      #3
      It is really hard to get gloves covered. Most standard insurance companies will not. Medicare will not. It seems on this site that those on Medicaid get them most often.
      Last edited by hlh; 17 Feb 2012, 9:21 PM.

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        #4
        Most insurances, both private and public, are very resistant to paying for so-called "disposables."
        You will find a guide to preserving shoulder function @
        http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

        See my personal webpage @
        http://cccforum55.freehostia.com/

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          #5
          Nah didn't have a choice. The government changed Medicaid that use to be furnished through Human Resources to 2 HMO's called Bravo or Amerigroup. That's why I asked Obama care. They're government HMO's. It's not just gloves but everything I need is denied.
          sigpic

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            #6
            Since Medicaid is mostly administered on the state level, I suspect the issue is the terrible economy and that the states are trying to cut back on Medicaid to save money. It is a big problem where I live. So the "government" you are referring to is the State government - not Federal.

            Obamacare actually leads to an expansion of Medicaid!

            It is the individual states that are fighting this. Money is tight everywhere, and as we know, many individuals in the US are not sympathetic of people who have higher needs. There is a huge pressure to cut back on Medicaid, and I think Texas is moving to an HMO model for managing Medicaid in their states, with hopes to save money in the long run.

            http://www.hhsc.state.tx.us/medicaid...-tentative.pdf

            I know Obamacare is complicated, but all of us on this board should make an effort to understand it well, as it helps almost every single one of us. Especially those of us not lucky/fortunate enough to be working for a large employer with a group health insurance plan that accepts all.

            It is very frustrating when you received benefits previously and now they seem to have stopped. I encourage you to start gathering letters of medical necessity from your doctors and start fighting and appealing every denial. My guess is that they don't have an absolute policy for denying these items if they were covered in the past, but are using this transition to new HMO plans as an "excuse" to start denying items and hoping that people will giving up asking for coverage. Don't give up yet.
            Last edited by hlh; 18 Feb 2012, 1:59 PM.

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              #7
              Originally posted by hlh View Post
              Since Medicaid is mostly administered on the state level, I suspect the issue is the terrible economy and that the states are trying to cut back on Medicaid to save money. It is a big problem where I live. So the "government" you are referring to is the State government - not Federal.

              Obamacare actually leads to an expansion of Medicaid!

              It is the individual states that are fighting this. Money is tight everywhere, and as we know, many individuals in the US are not sympathetic of people who have higher needs. There is a huge pressure to cut back on Medicaid, and I think Texas is moving to an HMO model for managing Medicaid in their states, with hopes to save money in the long run.

              http://www.hhsc.state.tx.us/medicaid...-tentative.pdf

              I know Obamacare is complicated, but all of us on this board should make an effort to understand it well, as it helps almost every single one of us. Especially those of us not lucky/fortunate enough to be working for a large employer with a group health insurance plan that accepts all.
              Yes we should. We need to understand. Yeah they're saving by not spending ANYTHING.

              What does this mean?

              large employer with a group health insurance plan that accepts all
              Aren't the states governed by the President down the road?
              What I see is more for children & middle age. But less for the elderly & disabled.
              sigpic

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                #8
                OMGOSH! Thanks but NO thanks for that link!

                Bravo & Amerigroup that has ruined MY HOME HEALTH CARE is taking over MY MEDICINE March 2012 next month!!!

                So now I have that mess to look forward to also. grrrrrrr

                If you're not able to work & provide for yourself you've got trouble.
                Now how is this not the President? It wasn't this way before he became president.
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                Comment


                  #9
                  Originally posted by Mona~on~wheels View Post
                  OMGOSH! Thanks but NO thanks for that link!

                  Bravo & Amerigroup that has ruined MY HOME HEALTH CARE is taking over MY MEDICINE March 2012 next month!!!

                  So now I have that mess to look forward to also. grrrrrrr

                  If you're not able to work & provide for yourself you've got trouble.
                  Now how is this not the President? It wasn't this way before he became president.

                  What I was talking about in the other post was that those of us who are working, and working for a big employer, are the luckiest ones when it comes to health insurance. Typically, you aren't excluded for coverage by having pre-existing conditions, and your premiums are lower because your large employer is paying a larger portion of your health care. Many people in the US do not work for these employers, so they struggle the most. So I agree - if you are not able to work at a big company and provide for yourself, life is harder.

                  Yes, I know you are not happy about the changes in Texas with medicaid, and that's why I provided that link. It sounds like a lot of changes are happening. Keep speaking up, and appealing.

                  But remember, Medicaid is administered by the State. Not by president Obama. He is actually trying to salvage programs, find more fraud and methods of saving money, and expand health coverage for those who don't have sufficient care. Some of it will cost this country money. Since our country is unfortunately not based on a belief that everyone deserves equal and sufficient health care, this is not well received by all.

                  What could be done for Medicaid in the state of Texas? Well, things that people of the State of Texas do not want to do. For example, they could start a state income tax to start to pay for more social programs. But Texas is a more conservative state, and I don't think that would happen.

                  I have learned that most people who have not had a spinal cord injury happen in their family, do not have any idea what it means and the stresses it puts on you physically and financially. Similarly, people who have not had a health emergency/catastrophe in their family, do not understand the desperate need for better health insurance coverage - both in private and public policies.

                  Also, the 25 year old or 30 year old or 40 year old "healthy kids" who don't want to be "forced" to buy health insurance, don't understand that they are not indestructible. They could be hit by a taxi tomorrow, and become a quad. Then what? If they don't have health insurance, then they will exhaust their personal funds quickly and eventually be on Medicaid.... Only then will they understand. And that's unfortunate.

                  Comment


                    #10
                    I agree it's a mess. So the president has NO control over states?
                    sigpic

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                      #11
                      I believe it is the Republicans that want to reduce the size of parts of the public safety net (like Medicaid) so that for profit companies are free to do more of what they do best (make money).

                      Amerigroup is a for-profit company that is doing fantastic (and is expanding) helping to squeeze unnecessary costs from State Medicaid budgets. If you have any resources I would suggest that you offset your reduction in Medicaid coverage by investing them in AGP stock.

                      Comment


                        #12
                        Originally posted by Mona~on~wheels View Post
                        I agree it's a mess. So the president has NO control over states?

                        As I understand it, a large portion of funding for each state's Medicaid program comes from Federal government grants, but the majority comes from the State. There is supposed to be some additional amounts from the Federal monies if the state is particularly poor, but the distribution of money is not very "fair". States that have very large poor populations often struggle more to fund their Medicaid programs. These are often states with large cities that have more people using Medicaid, or states that are simply poor for other reasons.

                        There is supposed to be some general federal "oversight" of the Medicaid programs, but all program details are really negotiated within each state. So, I doubt that the Federal government is watching closely to see who covers gloves, and who doesn't, for example. It seems to me that even though Medicare and Medicaid share many aspects, there is more variation in Medicaid benefits on a state by state basis.

                        Comment


                          #13
                          Originally posted by Patton57 View Post
                          I believe it is the Republicans that want to reduce the size of parts of the public safety net (like Medicaid) so that for profit companies are free to do more of what they do best (make money).

                          Amerigroup is a for-profit company that is doing fantastic (and is expanding) helping to squeeze unnecessary costs from State Medicaid budgets. If you have any resources I would suggest that you offset your reduction in Medicaid coverage by investing them in AGP stock.

                          I have so much distaste for AGP even if I was going to make money from their stock I wouldn't invest in them.

                          I'm really going to have to do alot of praying over this.
                          They're ready to say no before you even get it out.

                          hlh I wish I understood more of government & what's going on.
                          Of course I wish it was good for everyone.
                          I have a 56 y/o pca that needs to see a Dr. & can't. No ins..
                          Works constantly. single mom putting son through college & daughter that's a Junior in HS fixing to start college.
                          Most of my pca's have no ins.

                          But right now I need gloves. lol
                          sigpic

                          Comment


                            #14
                            Mona, if you can't get reimbursement, you can buy a case of 10 boxes, $36 shipped, from Allegro:

                            http://www.allegromedical.com/person...s-p214276.html

                            Comment


                              #15
                              Mona,

                              In looking at Texas Medicaid I found a program called Star Plus: It seems to be a waiver program for the disabled and elderly.

                              Do you know if this is what you are already on? The second link shows all the coverages.


                              http://www.dads.state.tx.us/handbook...1000/index.htm

                              http://www.dads.state.tx.us/handbook...00.htm#sec1141

                              Services necessary for the individual to remain in or return to the community are identified from the array of services available through the 1915(c) STAR+PLUS Waiver (SPW) program. SPW services include:

                              Adaptive Aids and Medical Supplies — Medical equipment and supplies that include devices, controls or appliances specified in the plan of care that enable individuals to increase their abilities to perform activities of daily living or to perceive, control or communicate with the environment in which they live.

                              All of our insurances are making cuts so gloves may be what Texas Medicaid is cutting too for its patients. I just recently had to switch my insurance/drug plan.
                              Last edited by darkeyed_daisy; 18 Feb 2012, 8:00 PM.
                              T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

                              My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

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