To bring together patients for an overview of what Pulmonary Arterial Hypertension is. To highlight isues about this disease. To focus on concerns of patients with Pulmonary Hypertension. A place to ask questions and to find answers about issues relevant to our concerns such as dietary restrictions (Diet & Nutrition), travel and insurance issues (News & Views and off to the left~and your other left -->) or medication management (ask your doctor). A place to share ideas, concerns and helful hints. This site is a guideline to lead you to helpful sites for information. If you are uncertain about what you find, always ask your doctor for verification.
Please e-mail any ideas, concerns or hints to:
For Information on health plans and insurance issues go to: Department of Labor ~ for Healthplans & Benefits
Office for Civil Rights ~ about HIPAA TSA Transportation Security Administration
Q & A for disability and travel
Does the thought of performing a certain task fill you with anxiety?
First, try this: Inhale deeply while counting five heart beats (you may check this easily by feeling your pulse). Exhale as you count seven heart beats. :o
You should notice after each breath that your heart rate is actually slowing and you are feeling less tense. Now, do something, no matter how small. Just make a start. The very act of accomplishing something will ease your anxiety. + + + + + + + + + + + + + + + +
Q...I am trying to get on disability. I have tried and failed, they said that i had not earned enough in the past to qualify. The lady i spoke to however said that i did get approved for SSI and medicaid. Well i swear she also told me the labled me as disabled. What I dont understand is that the past three months we didnt qualify because my husband made too much money and his pay and hours got cut so now we do qualify. From my understanding if my husband were to get a new job...and made more money...we would be up a creek with no paddles. If he makes more money i dont qualify for any of it, but i didnt make enough to qualify for disability? And not many insurances will take pre-existing, right?
A...It is confusing but it's not a lost cause and you should not have to separate. How you need to work it all depends on your current insurance status. If you are currently insured by any plan at all, then you are in luck. If you don't have insurance, then it's still doable. Your husband may change jobs and you will be assured coverage under his new employer health plan, and most likely without being subject to a preexisting condition clause.
Normally, an employer's health plan would try to exclude a preexisting condition but no one can be denied coverage for a preexisting condition under the HIPAA rules. A preexisting clause is limited to no longer than 12 months (18 months if you are a late enrollee). You can reduce or even eliminate the time if you were covered by previous health insurance and if there was not a break in coverage between the plans of 63 days or more.
The rules say that you have to enroll in the new employer's health plan from the get-go. If you are allowed to enroll at a later date, you will be considered a late enrollee and you may be subject to the 18 month preexisting waiting period. There are some exceptions to this but it's not wise to test them. If you or your spouse gets a new job, make sure to immediately enroll in the employer health plan.
Whenever you obtain health insurance coverage through an employer group, you should submit a "Certificate of Creditable Coverage" for each insurance plan that you were enrolled in before. Creditable coverage includes almost any health coverages, including COBRA, a health insurance policy or an HMO, Medicaid, Medicare, the Indian Health Service, TRICARE, the Peace Corps, a state high-risk pool or a state or local governmental public health plan. You should receive a "Certificate of Creditable Coverage" whenever you lose health coverage for any reason. If you don't get one, ask for one.
The new plan has to give you credit for the time you were covered under any previous health plans so that if you had at least 12 months of creditable coverage without more than a 63 day break, no preexisting condition exclusion can be applied to your new coverage.
You shouldn't really have to worry that much about it. You just have to learn how to play their game.
LOSS OF HEALTH AND GRIEVING
Having a life threatening disease is very emotional. Many relate it to going through the grief process.
Grief is a somewhat commplicated and a misunderstood emotion. Grief is a process. Although emotionally painful, it allows a person to come to terms with a loss and to heal emotionally. It is a natural response, not only to the death of a loved one, but also to other losses regarding relationships, jobs, pets, miscarriages, friendships or health. Less significant events (moving, graduation, job change) may also trigger less-intense grief responses. The intensity of grief depends on the significance of the loss. Every person grieves differently. Grief has no rules and follows no timetable. Some people may recover in weeks, whereas others may grieve for years. Often, people will experience several stages in a "roller coaster" effect—switching between two or more stages, returning to one or more several times before working through it. There are five stages of grief. Not everyone goes through the stages at the same time. It is different for each person and you cannot force a person through the stages, they have to go at their own pace, and you may go one step forward then take two steps backward, but this is all part of the process, and individual to each person.
The five stages of grief are:
1-Denial-"this can't be happening to me", Not crying. Not accepting or even acknowledging the loss of what may have happened.
2-Anger-"why me?", feelings of wanting to fight back or get even with spouse of divorce, for death, anger at the deceased, blaming them for leaving; blame for losing your job, your health.
3-Bargaining-bargaining often takes place before the loss. Attempting to make deals or attempting to make deals with God to stop or change the loss. Begging, wishing, praying for them to come back or get back what was lost.
4-Depression-overwhelming feelings of hopelessness, frustration, bitterness, self pity, mourning loss of person or event as well as the hopes, dreams and plans for the future. Feeling lack of control, feeling numb. Perhaps feeling suicidal.
5-Acceptance-there is a difference between resignation and acceptance. You have to accept the loss, not just try to bear it quietly. Realization that it takes two to make or break a marriage. Realization that the person is gone (in death) that it is not their fault, they didn't leave you on purpose. You may find another job, there are treatments available for diseases. Finding the good that can come out of the pain of loss, finding comfort and healing. Our goal: turn toward personal growth accept the reality of the loss. . Stay with fond memories
Recovering From Grief
Grieving and its stresses pass more quickly, with good self-care habits. It helps to have a close circle of family or friends. It also helps to eat a balanced diet, drink enough non-alcoholic fluids, get exercise and rest.
Most people are unprepared for grief, since so often, tragedy strikes suddenly, without warning. If good self-care habits are always practiced, it helps the person to deal with the pain and shock of loss until acceptance is reached.
HAVING PROBLEMS WITH INSURANCE COVERAGE
When insurance companies don’t want to pay for your medications, ask your doctor to continue to fill out those forms and all the red tape that is involved. It seems persistence is the key to this horrendous issue that many of us face.
I have been known to contact my politicians whether it is at the local level or the federal level. They have aides who specifically work with this problem – insurance issues.
Does your insurance cover specialty pharmacy medications.
Does the patient have a WHO Group I Classification.
Do you have any other diagnoses such a sleep apnea, COPD or left sided heart disease? **
You could also be denied coverage if the proper paper work is not included such as a copy of a right heart catherization which shows a mean pap (pulmonary arterial pressure) greater than 25 and a wedge of less than 15 or if there is an improper diagnosis.
Medicare uses a set of service codes and sometimes providers accidentally use the wrong codes when filling out paperwork, which can result in denial. Denial claims can sometimes be easily resolved by checking with your doctor that it was submitted with the correct codes. If it was submitted with the wrong code, ask your doctor to resubmit the claim with the correct code.
Do you have a copy of the paperwork the doctor submitted?
** SEE: WHO Classifications on bottom of page 1
** Click on Medicare (above right) for prescription coverage
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Questions to Ask Your Doctor For medications, tests, and treatments, you may want to ask: • What's the name of the medication (or test, or procedure)? • Why do I need it? • What are the risks? • Are there alternatives? • What happens if I do nothing? • (For medications) How do I take this? • How often? (For tests) How do I prepare? At the end of the visit, ask: • Do I need to return for another visit? • Can I phone in for test results? • What danger signs should I look for? • When do I need to report back about my condition? • What else do I need to know?Ask the specialist to send information about any further diagnosis or treatment to your primary doctor. This allows your primary doctor to keep track of your medical care. You also should let your primary doctor know at your next visit how well any treatments or medications the specialist recommended are working.Are there any changes in your diet, medication, and lifestyle ~ are there changes in your health, aches, pains ~ your thoughts and feelings, have they changed ~ Concerns: At each visit your doctor will likely ask about your concerns. It’s a good idea to think about what you’d like to talk about before the actual visit. Be sure you have a list of all your medications ~ even over-the-counter which would include vitamins. Your medication regimen may change over time so be sure it is always updated.
Plan A ~ Hospital Coverage
Plan B ~ Medical Insurance
Plan C ~ Medicare Advantage Plans
Plan D ~ Prescription Drug Plans