3 October 2007
Wednesday
[Journal not posted until 8:00 AM on Thursday. I called a good friend last night. It was her birthday!]
High-Level Journal Summary: An expanded network of supporters to help guide me through the world of brain cancer. This time, a woman named Trish, also a brain tumor survivor, reached out with her professional experience within Medicare and Health Insurance Plans.
In this spirit, two excerpted messages are shared which both prompt great questions. The bottom line to each message is that they reveal potential areas of risk when making Medicare and Health Insurance decisions over the next month. As such, these messages prompt action and the need for very specific research. Thanks to Trish, I took a leap forward this evening, all because of her good will!
Countdowns:
1.) Day 3 of 28 in my 26th 5/23 Temodar chemotherapy cycle. Fatigue hit me today. After my afternoon nap, I felt especially tired. My afternoon walk was at a much slower pace than yesterday, and my mouth started tasting metallic. I took my first punch by chemo today, if you will.
2007 Seizure Activity:
1.) Last Simple Partial Seizure, or SPS, was today. I had two SPS's. One was at 12:20 AM, not too long after going to bed. It was a medium SPS that lasted for about 15 seconds. The next SPS was at 5:20 AM and took me out of a deep sleep. I leaned over, breathed hard, and drooled into the trash can that I keep next to the edge of my bed ONLY during chemo week -- when clustered seizures are more likely. This SPS ended after 60 seconds, so Ativan emergency anti-seizure medication was not needed. But, I felt the post-ictal phase of that SPS for a few hours later this morning. It was a very strong SPS, without doubt.
2.) In 2007, I have had 67 SPS's in 276 days. This is an average of 1 SPS every 4.1 days.
Actual Journal: I can hardly believe the support I get vis-a-vis 38 Lemon. It is a healthy mix of emotional, logistical, and intellectual support. Specialists in certain areas just seem to pop out of the woodwork. It happens across so many areas -- lawyers, neurologists, graphic designers, patients (of course!), caregivers, surgeons, national press, members of Congress, artists, nonprofits, thought leaders...the list goes on. And now, I can add another health care specialist to this list.
Another brain tumor patient named Trish happens to specialize in the world of Medicare. Trish read my 7/27/07 online journal ("Medicare 101") and my 9/11/07 online journal entry (timeline and tasks for Medicare coverage). At that point, she reached and and told me about her area of specialty and offered to help in any way that she could. Amen! It did not take me long to accept her generous offer.
So it is that I sent Trish a link to my 9/29/07 online journal entry. I wanted to get her professional opinion about my notes from Jim McIntyre regarding Medicare and Personal Health Insurance. Why? I wanted to get a second opinion, just like I get when it comes to my health decisions.
Trish was kind enough to send several messages about the above journal entries. She reviewed the material and provided things I had not thought to ask. I view her input as "questions to ask" more than anything else, but these are questions that could indeed be critical items. With that, here are some excerpts from her notes to me, which I consider important prompts for action:
10/1/07 e-mail
Heya David, I read your notes about your insurance...it reminded me of "training" when I started with (my nationally-known health insurance company) 18 yrs ago.
It looks to me like you have all of your ducks in a row. I really didn't see anything lacking in your plans and it looks to me like you are going to have your bootie well covered...and your noggin' too!
The biggest problem I see in dealing with Medicare patients on a daily basis is the lack of what their secondary coverage picks up. Medicare is what it is, and there is not much you can tweak with that, it's pretty cut and dry. But the secondary coverage is what is really going to save your pocket book.
A few good questions regarding the secondary coverage:
• Will it pay Medicare's deductible? 2007 Part B deductible is right around $133.00, that will go up on 01-01-2008.
• If Medicare's allowable amount is less than the secondary plans allowable amount will secondary pay at all?
• Medicare will not cover anything they consider "routine" for the most part. Does your secondary plan cover routine services?
If I think of any other question to shoot your way I will let you know. If you think of any other questions please feel free to let me know.
10/2/07 e-mail
Okay David, one more thing here catches my eye. You say your COBRA expires 11-23-07 and you don't plan on picking up your secondary or Medicare supplemental plan until 12-01-07. I assume the supplemental plan will supplement not on your prescriptions (Part D Medicare) but also your medical (Part A and B) as well?
If that is the case the only thing you should touch base on is the supplemental plan's pre-existing condition rules and make sure there will be no restrictions.
Commercial insurances often have a 18 month waiting period for any pre-existing conditions. (During that 18 months they will not pay anything relating to any pre-existing condition.) They especially kick in when there has been a lapse in coverage (i.e., 11-23-07 to 11-30-07 without commercial coverage). But I think with your Medicare in place that will override that lapse in coverage stipulation.
I think you would be wise to inquire with the secondary plan regarding the pre-existing condition clause in the plan. It would be well worth paying the one month of premium versus 18 months of no coverage for any pre-existing condition if the limitations would apply.
If you find you are still having a lot of out of pocket expenses you may even qualify for Medicaid. It would kick in as the third payer if you are still having a lot of out of pocket expenses. I believe if you have qualified for Medicare due to disability there is a pretty good chance you would qualify for Medicaid as well and it should pick up any leftover out of pocket expenses.
Hope this helps. Take care and keep in touch David.
A leap forward
As Jim McIntyre told me on 9/29/07, selecting a Plan D and personal health insurance company/plan is not a "skimming" exercise. I need to be studying all the information he gave me in great detail. No doubt about it.
So, I think I did my studying for the night. Incremental progress has been made. The thing that I learned tonight that is of most importance is that I may have to have all this in place by 10/31/07. Trish posed some critical areas of risk that must be properly managed. Thank you, Trish!
