What to Do in a Health Insurance Emergency
Volume CIX, No. 2February, 2009
I’m a Local 802 member who was recently involved in a health insurance emergency. I had a critical medical condition and no way to pay for it. My medical bills on leaving the hospital totaled just under $150,000, not including numerous follow-up visits, medication and ongoing blood tests.
I didn’t qualify for the Local 802 health plan and had no private insurance. Luckily, I found out about Emergency Medicaid. I’m writing this article so that other members may find out about it.
Emergency Medicaid may be available for those with sudden catastrophic medical needs. The requirements are stringent, but the financial relief can be great. Also, I found that the caseworkers are sympathetic and non-judgmental.
Your hospital helps you apply for Emergency Medicaid. The procedure for applying may vary from facility to facility, but the Upper East Side’s Lenox Hill Hospital refers its patients to an outside agency, Jzanus Ltd. In essence, Jzanus made the application to the New York State Department of Health on my behalf.
I was required to furnish the following:
- A copy of my most recent federal income tax return;
- A copy of the bank statement corresponding to the time of my hospitalization;
- Proof of identity (a passport or birth certificate, which I had to present in person at the hospital); and
- Proof of residence (copies of monthly bills such as rent, utilities, or cable).
I was also required to fill out a number of waivers allowing Medicaid to inspect my financial records.
Here’s the tough part: In order to qualify, you must have a current income averaging approximately $900 per month and must be able to show total assets of less than $4,000. (In my case, having been sick and reducing my work schedule significantly for some time before my hospitalization actually helped me to qualify.)
You can expect to wait from 45 to 60 days to learn if you have been accepted. If you are successful, you will receive notification and a Medicaid ID card by mail.
Once you have been accepted, you will have 90 days to choose a permanent health plan. Here’s a list of plans currently available in New York State: Affinity Health Plan, AmeriChoice By United Health Care, AmeriGroup Community Care, CenterCare Health Plan, Fidelis Care, New York, GHI HMO, Health Plus, Health First PHSP, HIP Health Plan of New York, Metro Plus Health Plan, Neighborhood Health Providers, New York Presbyterian Community Health Plan and WellCare Of New York.
One thing to bear in mind, however, is that many doctors will not accept Medicaid, complaining that the service pays only a fraction of the average claim. Also, if you must deal with more than one doctor (say, a cardiologist and an internist), don’t be surprised to learn that one accepts only Health Plus while the other will take only GHI.
If you find yourself in a medical emergency without health insurance and you need more information on Emergency Medicaid or other health insurance options, one place to go for help is Local 802’s Musicians’ Assistance Program. Contact Cindy Green at (212) 397-4802 or e-mail Cgreen@ActorsFund.org