Tips on Receiving Assistance

TIPS ON RECEIVING ASSISTANCE FROM VARIOUS SOURCES

These tips are provided by various professional individuals. Please understand that the information is meant to provide ideas as to where you might obtain some assistance for your needs. Actual assistance is dependent upon the state/city involved and the application/ qualifications of the individual situation.

Government Sources

The first thing to remember is that you have paid taxes for most of your life. Much of these monies are put into funds to assist those in need. The people you will be requesting help from have families of their own and usually, somewhere in that family is a person who has needed help from somewhere. Many of us are a paycheck away from needing help, it is not any thing to feel ashamed of. Most of the people you will talk to have volunteered for the job simply to offer their help.

While all of us have our pride, we many times overlook the fact that over our lifetime, we EARNED the right to receive assistance from our government on a local, State and Federal basis. The contents of this page is for your benefit. While we cannot guarantee any benefits you might be entitled to, this will help you get to the right facilities to determine your qualifications for assistance.

If you happen to come across a worker who is unpleasant, remember that you definitely are their customer, ask for their supervisor or call the local official in charge, or even your Senator or Representative, many of them will have their aides call the local office and find out why you can't get help ( it really shakes up the supervisors ).

Qualifying for Disability

Clicking on DISABILITY EVALUATION UNDER SOCIAL SECURITY displays the qualifications for receiving Disability Benefits for Pulmonary Disease. In particular, Section 3.02 lists the FEV1 and/or ABG values which apply for COPD patients.

To read the entire Disability Law, click on PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- )

HOSPITAL INFORMATION

The absolute worst thing that someone can when they get their hospital bill is to decide that the insurance company has already paid the hospital enough money or that your care wasn't worth the price on the bill; and choose to ignore it.

You may be surprised by the relatively small payments most hospitals will accept to allow someone a reasonable chance of paying their bill.

There are some important things you need to know about hospital billing:

1. By law, the hospital is required to attempt to collect the bill. This is especially true of Medicare. Medicare's rationale being that if you accept the percentage that Medicare pays as payment in full, then your total reimbursement will be reduced to that 80% level, because Medicare is only obliged to cover 80%. Therefore the hospital will still be left with the responsibility to collect the 20% of the new lower rate.

2. Most insurance companies, Medicare included negotiate for prices which are far below those that they are required to reveal to the beneficiary (a loop hole which is still acceptable by the Insurance Board). In the facility in which I work....the average reimbursement to the hospital from an insurance company is 0.56 on the dollar. So in fact, you really end up paying more than 20% of the total amount actually paid, because the insurance company rarely pays a full 80% even though that is how it appears on the beneficiary's transmittal.

3. You are entitled to an itemized bill upon request. That should mean one phone call to the billing office after you are discharged. Different insurance companies require the hospital to bundle or unbundle charges so what you read may not make sense. It is okay to call and ask for an explanation of a charge. * The billing rules change often and the people who enter the codes are human so mistakes do occur. Most of these are honest or careless errors not malicious efforts to defraud the system.

4. Most facilities have social workers or case managers who can help someone apply for assistance if there is a real need. Many people are embarrassed to talk/ask about it... but that is what it is truly there for and there are people available to help walk someone through the whole process.

5. Not for profit hospitals must provide a certain percentage of charity care in order to maintain there tax exempt status, so most are willing to negotiate.

Many times people get a denial from an insurance company and go ahead and pay for the uncovered services. There are two things to try first:

1. Call the insurance company and see if it was a mistake. Many times resubmitting the bill gets it paid. Call the hospital and ask them to resubmit the charges.

2. If the charges were really for something that you will need to pay privately, remember that all of the insurance companies (and the Amish who pay cash for everything) are negotiating with the hospital and so can you.

The most important thing to remember is that you must not ignore the bill. Call the billing department and make an honest attempt to address your issues or negotiate a fair payment schedule.

*It is important to know that with the new Medicaid back to work rules which cut coverage, charity care is on the rise. The cuts by the federal government are deep and most hospitals not the deep pockets that everyone thinks they are. Most successful hospitals operate with a 2-3% profit margin....I know of very few businesses that can make it with that kind of profit line. Hospitals are expensive places to run.

Healthcare dollars are a limited resource; and although most of us expect the latest and greatest, no one wants to pay more taxes assist hospitals in this effort. It is sad to say that although most insurance companies talk about the importance of wellness....few will pay for the programs that are developed to keep people well and the hospitals can't afford to run wellness programs when the only thing that is reimbursed is taking care of illness. This is a cause that should be addressed by
all of us!*

Submitted by Kimberly R. Hunchuk, M Ed/RRT
Western Pennsylvania
(Kimberly also is Assistant Hospital Administrator)

Social Services

May offer homemaker or personal care assistants. Some programs have provisions that will pay a caregiver some very minimal amount per month for the care they provide to the person. ....again, this is very individualized from state to state.

Medicaid. Medical insurance for those who are in the poverty level. The rules differ from state to state. Medicaid often pays for a set number of prescriptions per month.

Food Stamps: May help a lot if person is spending all money on medications.

Church: Churches often provide assistance for their own members when the need is brought to the attention of the church. This assistance may be in the form of
(1) collections of Love Offerings" to meet specific one time needs. (i.e. broken furnace)
(2) volunteer work such a mowing lawns, grocery shopping, etc. for disabled members
(3) respite "sitting" for caregivers, so they may occasionally get out of the house.
(4) Help with occasional meals provided by the church lady's groups.

Churches: Local churches often have programs that provide assistance for the needy community at large.....not only their own members. Some services provided in some areas include: (note these services are highly individual, depending on church's program)

(1) Fuel assistance programs
(2) Food banks
(3) One time financial assistance for medications, outstanding bills, and other emergency situations.
(4) Occasionally a church that provides community service will have a store room of donated medical equipment.

Local Electric Company: Local electric companies usually have a provision that will they will not turn the electricity off for lack of payment if an individual in the home is on life support. Most seem to accept oxygen as life support if the doctor says it is required.

Veteran's Administration: All vets who are not receiving services from the VA need to call and see what is available.   VA may provide assistance to vets, not only for medical care, but in some cases, for medications and medical supplies. VA often works in conjunction with other agencies, such as social services to assure the VET has needed assistance.

Community Food Banks: Many communities, (almost all large cities) have a community based Food Bank. They usually provide assistance on a one time basis to individuals or families who need emergency assistance with getting food for the family.

Community Crisis Centers: Some communities have "Crisis Centers". They may provide a variety of services on a one time emergency basis. The services are different from town to town.   Some possibilities are :

(1) Fuel and electrical assistance
(2) Food Bank services
(3) Pharmacy services
(4) Clothing, household item donations
(5) Storerooms of donated medical supplies
(6) Air conditioners for those who suffer from medical conditions that may cause them to be more vulnerable in extreme heat (heart disease, lung disease)

Community-Based Transportation services: Most communities have this service. It normally will provide transportation for the elderly and disabled to get to medical appointments.

Disease Associations: Some towns have their own local groups dedicated to helping those with certain diseases or conditions. Often these groups have donated medical equipment.

Drug Assistance Program: Many pharmaceutical companies have "indigent medication" programs. Don't let the word "indigent" throw you. That only means that your income is not enough to cover all your needs and that you do not have the money or insurance coverage to pay for your medications. See these sites:

Partnership for Prescription Assistance
http://www.medicarerights.org/rxframeset.html

http://www.needymeds.com

Senior Services Programs: Most communities of at least moderate size have a Senior Services Program: This program often helps to coordinate all the other services in an area. Also, many Senior Services Programs have their own assistance programs, such as provision of personal care assistants.

Legal Assistance for the Elderly: Many communities have this service. It is often under the auspices of the local Senior Services Program.

Salvation Army: The Salvation Army has locations in many cities. The Army provide special assistance, at their discretion, in some cases of need.

Home Health Services: If you qualify for home health services and are being visited by a nurse on a regular basis, you may also qualify for the services of a personal care assistant, or nurses aide, to help with personal care. Make sure to ask.

Hospice Home Services: This program is available for those who have limited life expectancy. Services provided include nursing visits, nursing assistance visits, social worker, (also volunteer, chaplain if desired). The Hospice programs differ from city to city, but most pay for the medications related to the covered illness, and all medical supplies needed.

Submitted by:
Brenda Hoilman, RN

10/17/2007

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