Share of Cost???? what does this mean?

[Mariposa Bella 3]

So unfortunately last month I lost my job making over $40k, was barely making it. Now cannot find a job, Florida in a very dark place..so I applied for Medicaid, didn't have benefits at job so thought time to get up to date on medical for my kids and I while I find a job. Kids were approved but I was given Share of Cost. $881 a month..Which I couldn't afford with my job, so out of the question now. I put the cart before the horse and was sure I'd get Medicaid and found a great Dr in Miami who I was ready to start all steps towards getting sleeve...(Band eroded read my previous posts).....I was stressed sleeve would not be covered. So I called surgery coordinator, he said Sleeve could be paid by Medicaid, to call him tomorrow (Fri) to make appt.....So I called Medicaid to see if I was approved and was told I have Share of Cost.....because my income is too high... because I just got unemploment (What a blessing) $275 wk.....not enough to cover my bills, and cover the first $881 before they will pay any medical....wtf???? I've paid thousands of dollars into system for others and when I need it, I get slapped in the face. Any suggestions??? Are there bariatric doctors in central or south Florida that do Share of Cost??? Don't even know how program works (need to research)..... I need to get this surgety and get healthy for my 3 kids sake, I need them but most importantly they need me....help me, what

Do I do?

Depressed tonight, drank half a bottle of wine, can't live this fat unhealthy life anymore........:'(

[Mariposa Bella 3]

Okay I forgot to tell you, woman that I spoke to said, most ppl on share of cost, go to hospital (ER) on the first of the month then have full Medicaid coverage for the rest of the month....does this make any sense? So if I do that, which I have horrible back problems how would that work??; yesterday I fell and am black and blue all over, ankle all swollen, scratched everywhere, sprained wrist....maybe I should go to ER? Ugh. Well going to call coordinator tomorrow to see what he says, hopefully ill drink rest of wine out of happiness not depression...but if you know of a bariatric dr who takes share of cost, please share info....thank you.

[Rev Me Up! 75]

Not sure about the ER thing - certainly there should be some website or something that could explain it? If your band is giving you problems, then you should visit the ER. You don't want to have it erode too much further - that can be very dangerous. My reply will bump this message back to the top and hopefully someone with some medicaid experience will reply.

What about the county you live in? I live in California and found out that the county government also has a medical program. Contact your local county government office and see if there are additional resources available to you - especially for emergency situations.

And take it easy on the wine :-) Can't be good for a damaged tummy... or maybe I am just jealous because I can't really drink it anymore :-)

good luck---

[feedyoureye 3,087]

I would call Meidcaids customer service and see what they say.

[Mariposa Bella 3]

Not sure about the ER thing - certainly there should be some website or something that could explain it? If your band is giving you problems, then you should visit the ER. You don't want to have it erode too much further - that can be very dangerous. My reply will bump this message back to the top and hopefully someone with some medicaid experience will reply.

What about the county you live in? I live in California and found out that the county government also has a medical program. Contact your local county government office and see if there are additional resources available to you - especially for emergency situations.

And take it easy on the wine :-) Can't be good for a damaged tummy... or maybe I am just jealous because I can't really drink it anymore :-)

good luck---

My band eroded and was removed back in May of 2009, don't have it anymore, wish I did. i want to get sleeve as weight plus dome has come back.

[MeMeMEEE 206]

When I was on it years ago they called it a spend down - basically you have to spend that amount first before you have coverage that month. So it's sort of like a monthly deductible. If that happens to be the same thing.

[~winecountrygirl~ 3]

I work for the welfare department and give people medicaid daily. This is how it works: there are programs for children that have a higher income limit so kids can have medicaid without a share of cost, in other words, free medicaid. This is so children can get medical care more easily. Now the way they figure out an adult's share of cost is like this: Total income to family per month minus the maintenance need determined by the federal government for a family of 3 which is $930 (approx) then anything left over is your share of cost. So in other words the standard that is in place currently set by the federal government expects a family of 3 to live on approx $930/mo and be able to put ALL the rest of their income toward their medical bills. There is NO way around this. So, I know what the lady meant when she told you about the ER but first let me explain how share of cost (SOC) works. It is like a MONTHLY deductible, it is NOT like a monthly premium. You only pay $ out of pocket when you receive medical care. So for example, you go to the ER on the first of the month and your bill is $5000.00, you pay your SOC, in your case $881 and medicaid pays the rest. So for that month you can get unlimited medical care the rest of the month and pay nothing more because you have met your monthly deductible (SOC). Now in this case the $881 is a blessing, so much better than the $5000 ER visit or God forbid something worse and more expensive. This is not a great thing if you only go to your PCP for a check up and a RX refill because unless they add up to over $881 you will be paying the doctor and pharmacy out of pocket and medicaid pays nothing. So bottom line, you pay the first $881 each month out of pocket and medicaid pays the rest no matter how much, but your SOC re-sets the first day of the next month. I know it's a huge hurdle but $881 is better than $15000 the surgery likely costs. Sometimes doctors or hospitals will let you work out a payment plan but if not just save your pennies until you have the money. The other thing is if you think the amount is wrong you can have the medicaid department re-evaluate your share of cost. You said you have unemployment and said how much and so you SOC seems a little high based on just that income but if your kids are receiving child support or there is any other source of income it will all count. Let me know if you have any more questions.

Tanya

[Mariposa Bella 3]

I work for the welfare department and give people medicaid daily. This is how it works: there are programs for children that have a higher income limit so kids can have medicaid without a share of cost, in other words, free medicaid. This is so children can get medical care more easily. Now the way they figure out an adult's share of cost is like this: Total income to family per month minus the maintenance need determined by the federal government for a family of 3 which is $930 (approx) then anything left over is your share of cost. So in other words the standard that is in place currently set by the federal government expects a family of 3 to live on approx $930/mo and be able to put ALL the rest of their income toward their medical bills. There is NO way around this. So, I know what the lady meant when she told you about the ER but first let me explain how share of cost (SOC) works. It is like a MONTHLY deductible, it is NOT like a monthly premium. You only pay $ out of pocket when you receive medical care. So for example, you go to the ER on the first of the month and your bill is $5000.00, you pay your SOC, in your case $881 and medicaid pays the rest. So for that month you can get unlimited medical care the rest of the month and pay nothing more because you have met your monthly deductible (SOC). Now in this case the $881 is a blessing, so much better than the $5000 ER visit or God forbid something worse and more expensive. This is not a great thing if you only go to your PCP for a check up and a RX refill because unless they add up to over $881 you will be paying the doctor and pharmacy out of pocket and medicaid pays nothing. So bottom line, you pay the first $881 each month out of pocket and medicaid pays the rest no matter how much, but your SOC re-sets the first day of the next month. I know it's a huge hurdle but $881 is better than $15000 the surgery likely costs. Sometimes doctors or hospitals will let you work out a payment plan but if not just save your pennies until you have the money. The other thing is if you think the amount is wrong you can have the medicaid department re-evaluate your share of cost. You said you have unemployment and said how much and so you SOC seems a little high based on just that income but if your kids are receiving child support or there is any other source of income it will all count. Let me know if you have any more questions.

Tanya

I don't receive any other source of income at this time. Seems a bit ridiculous to expect someone that is jobless to pay such a high amount. You know what probably really happens, people go to ER, for either minor or major and if they can't afford their share, they are not paying anyways. So it comes back to the taxpayers again. And yes I've always been a working taxpayer, so it bothers me. I certainly cannot afford to live on $275 week with 3 kids, but I am very grateful that I am receiving the unemployment. Even when I worked I couldn't have afforded that. With my children and I being self-pay until now, going to Dr is a luxury and must be extremely necessary. Everyday I'm out looking for a job, have callled numerous contacts, have been on tons of websites and nothing. Yet there are ppl that get cash assistance, food assistance and full Medicaid and sit on their a** and get it all even housing. They event want McDo nald's too, lol...I'm glad they are going to start drug testing, so these lazy a**es can get clean or stop mooching. When someone like me that has always worked tries to get help, you get a slap in the face. Sorry to vent, but thanky you for the information, I really appreciate it.

I did call and speak with someone yesterday and they said the amount was correct with that amount of income. :'(

[Mariposa Bella 3]

Tanya, Congrats on all the weight you'be lost. Maybe I should try getting on that phentermine stuff and see if I get results....oh yea, I forgot I'm poor, can't pay $75 Dr visit....ugh,

[feedyoureye 3,087]

Tanya, Congrats on all the weight you'be lost. Maybe I should try getting on that phentermine stuff and see if I get results....oh yea, I forgot I'm poor, can't pay $75 Dr visit....ugh,

I have insurance and even with that I had to pay $3000 for my surgery plus drs visit co-pays. Save a little bit every month, and you will make it to your surgery goal. Your food costs will go down after that! And your future medical costs will be statistically much lower. Most likely you will save a bunch of cash on pharmaceuticals in the long run as well.

Good luck with your goals. ask your Dr if he can fit most of your tests and surgery into one billing cycle so you only have to pay your share once...