Henning's Headquarters

[Ghost of Baron Scarpia]

Classical Music Guide is another forum with a very hands on approach from the moderators. Like someone said, there are very fine people on both sides  , so it's a good idea to let them know about Karl's condition and the funding drive.

I used to be a member. It used to be run by a rabid right-wing lunatic. She banned me because I didn't agree with her politics. She receded into the distance, and now it is just pretty dormant board which doesn't get any new members, I think because the new administrator is a kindly old codger who who nevertheless guards the door like a rottweiler.

[Gurn Blanston]

It is clear that Karl's stroke has been very severe and debilitating, but it is too soon to loose hope for significant recovery. There is a huge range of possible outcomes, which may range from severe permanent impairment to close to normal function. It is too soon to judge.

I sympathize with Maria's frustration, but benefits depend on rules, not any bureaucrat's sympathy. She needs the advice of someone who can hep her navigate the system, which may be harder in her case since she is an immigrant to the US and may not be familiar with the resources available and the culture.

Karl needs to be classified as disabled, which will give him access to support similar to what a retired person receives from Social Security and Medicare or Medicaid.

Absolutely right. There are certainly people who perform this service, I am ignorant of who they are due to a lack of necessity up till now. But she should be able to go to the local Social Security office and if it is not something they handle directly, they can tell her exactly who to see to submit a claim and get things rolling. If anyone has any solid information on this service in the US, please put it out there, Leo can send it to Maria.

[André]

Just my two cents, but I think that in order to "fit" into a box and be categorized as impaired or disabled, a period of rehab of a few months and subsequent exams is required. Whether it's the social services or the insurance companies, that kind of decision is generally made only once a fair assessment of the patient's condition can be made.

[Ghost of Baron Scarpia]

You are certainly right about that. But I think they need to start building the case for that right away, so that he can be classified as soon as he is eligible if it comes to that.

As far as what he is entitled to now, someone has to studying what is probably a 40 page document detailing the precise terms of his insurance plan to find out what is covered and what is not. Even if they will curtail his treatment in the acute rehabilitation center, he may be entitled to coverage for a longer term in another type of facility. When my mother had a medical emergency she started out in the ICU and was filtered through different rehab and nursing facilities until she ended up with visits from an RN at home.

[Cato]

You are certainly right about that. But I think they need to start building the case for that right away, so that he can be classified as soon as he is eligible if it comes to that.

As far as what he is entitled to now, someone has to studying what is probably a 40 page document detailing the precise terms of his insurance plan to find out what is covered and what is not. Even if they will curtail his treatment in the acute rehabilitation center, he may be entitled to coverage for a longer term in another type of facility. When my mother had a medical emergency she started out in the ICU and was filtered through different rehab and nursing facilities until she ended up with visits from an RN at home.

Right!  And I believe Maria is convinced that he will absolutely be disabled for the long-term, and therefore why are the bureaucrats not listening to her?

The fund is nearly at $3,000 right now, so ten percent in a day: not bad!

Again, if anyone just wants to send a gift card, pre-paid credit card, etc.  let me know via Personal Message.

I used to be a member..... the new administrator is a kindly old codger who who nevertheless guards the door like a rottweiler.

Well, I have registered, but have not yet received my visa and entry papers! 

[André]

Agreed on all counts. Maria and Karl will need to be patient, diligent and persevering. Going through the intricacies of the system and bureaucratic indifference can test even the most hard-nosed individual.

[Gurn Blanston]

Just my two cents, but I think that in order to "fit" into a box and be categorized as impaired or disabled, a period of rehab of a few months and subsequent exams is required. Whether it's the social services or the insurance companies, that kind of decision is generally made only once a fair assessment of the patient's condition can be made.

Yes, for a final decision (permanent disability), but they can also get immediate help just on the basis of his current medical record (temporary disability). Certainly Karl would be qualified for that.

[Florestan]

Is Obamacare fully operational in his case --- and producing the sad and almost unbelievable results we witness? If and only if yes, then it's not worth half of the cost of the paper it was printed on.

[Ghost of Baron Scarpia]

Is Obamacare fully operational in his case --- and producing the sad and almost unbelievable results we witness? If and only if yes, then it's not worth half of the cost of the paper it was printed on.

Obamacare's main benefit is subsidies for low income people who have to buy their own insurance. It appears that Karl has insurance from work. If Karl benefits, it would be indirectly, from revisions in the regulations dictating terms of coverage, etc. For instance, of Maria wouldn't be blocked from getting future coverage due to Karl's pre-existing condition.

[Cato]

Is Obamacare fully operational in his case --- and producing the sad and almost unbelievable results we witness? If and only if yes, then it's not worth half of the cost of the paper it was printed on.

Obamacare's main benefit is subsidies for low income people who have to buy their own insurance. It appears that Karl has insurance from work. If Karl benefits, it would be indirectly, from revisions in the regulations dictating terms of coverage, etc. For instance, of Maria wouldn't be blocked from getting future coverage due to Karl's pre-existing condition.

Yes, I would suspect that he had (better) private insurance from his employment, which is a fairly large and well-established Boston firm.  One can always buy insurance for "long-term care," or for "catastrophic illness."  It would seem that Karl did not invest in such a policy.

As mentioned earlier, when it becomes clear whether or not Karl will be able to return to work, whether he is permanently disabled, etc.  Social Security Long-Term Disability Insurance  can "kick in" at that time.

See:

https://www.disability-benefits-help.org/content/about-ssdi

[Florestan]

Obamacare's main benefit is subsidies for low income people who have to buy their own insurance. It appears that Karl has insurance from work. If Karl benefits, it would be indirectly, from revisions in the regulations dictating terms of coverage, etc. For instance, of Maria wouldn't be blocked from getting future coverage due to Karl's pre-existing condition.

Good grief! Just how can one assess "pre-existing conditions" after one had a severe stroke?

Look, much as I do think 71dB is dead wrong about any other aspect of US, he might be spot on about the US medical system, which in light of Karl's case seems to me best described as follows: if you can afford to live, good luck, if you don't, tough luck!

[Ghost of Baron Scarpia]

Look, much as I do think 71dB is dead wrong about any other aspect of US, he might be spot on about the US medical system, which in light of Karl's case seems to me best described as follows: if you can afford to live, good luck, if you don't, tough luck!

We don't have to take 71dB's word for it that health insurance in the US is a morass. Social Security and Medicare benefits for retired and permanently disabled people do not compare unfavorably what what is provided in other developed countries, I believe. At this point we hope Karl does not qualify for these benefits.

[Florestan]

Social Security and Medicare benefits for retired and permanently disabled people do not compare unfavorably what what is provided in other developed countries, I believe. At this point we hope Karl does not qualify for these benefits.

I hope, and pray, for it as well. The description so far is not very optimistic but it certainly leaves room for hope. One of my wife's aunts had a similar stroke, after which she recovered quite well* --- it all depends on the goodwill and commitment of the doctors and the medical personnel.

* so well as to recover from yet other two strokes and she lived for several years more in quite a good condition --- the fourth stroke was fatal, but this is just an example, I hope and pray Karl will once again post here on GMG his usual witticism.

[vandermolen]

The most recent medical bulletin is indeed concerning but it is still relatively early days and I'm not giving up hope of significant further improvement.

[Ken B]

The most recent medical bulletin is indeed concerning but it is still relatively early days and I'm not giving up hope of significant further improvement.

Nobody knows nothing. And sadly, won't for some time. Stroke damage is hard to assess. Scarpia is right. It's too early to tell, and therefore it's too early to jump to conclusions. So far Karl has had excellent medical care.

[Cato]

We don't have to take 71dB's word for it that health insurance in the US is a morass. Social Security and Medicare benefits for retired and permanently disabled people do not compare unfavorably what what is provided in other developed countries, I believe. At this point we hope Karl does not qualify for these benefits.

One of my best friends is a doctor, who severed his connections to all insurance companies and government agencies: $20. for a visit!  He has many patients who prefer it!

He became tired of being told by bureaucrats when and - worse! - how to practice medicine.  Government interference, he says, is a disaster.

Concerning long-term and permanent disability in America: both my sister and her husband went from long-term disability to permanent disability.  He had a brain tumor 15 years ago, and is crippled, has double vision, and cannot concentrate for too long on individual subjects.  After 6 months he was placed - at age 45 - on permanent disability, and receives a not bad welfare payment per month.  My sister two years ago contracted a recurring infection, which has caused her to resign from her well-paying position.  Two weeks ago she had a toe amputated because of the effects of this infection: she has also been placed now on  permanent disability.

They take vacations now and then, and have no money problems, since the government payments suffice.  To be sure, the paperwork and bureaucrats were a hassle, but...the welfare checks are deposited monthly. 

Nobody knows nothing. And sadly, won't for some time. Stroke damage is hard to assess. Scarpia is right. It's too early to tell, and therefore it's too early to jump to conclusions. So far Karl has had excellent medical care.

True: we continue to hope that Karl will not need any long-term or permanent care!

[springrite]

I used to work for the Disability Evaluation Division of the State of California Department of Social Services. I know in every State the rules are different, but in California, to apply for State disability benefits, you can apply 6 months after onset. You need medical records since onset and a recent exam in accordance to the disability criteria. For that purpose Karl may be sent for a Neurological Exam.

[springrite]

Yes, for a final decision (permanent disability), but they can also get immediate help just on the basis of his current medical record (temporary disability). Certainly Karl would be qualified for that.

Again, if California rule is any reference, the assessment can be made AFTER 6 months and, if the condition persist and the prognosis is that it is permanent, then disability is established. If the condition is expected to last at least a further year or more, then it may be granted with a future reassessment date (say, in two years), at which time it will be determined if it will be made permanent or terminated.

[Ghost of Baron Scarpia]

Good grief! Just how can one assess "pre-existing conditions" after one had a severe stroke?

The stoke would be the pre-existing condition.

The considerations may seem odd to a someone living in a country with universal coverage, but imagine a rational person in a country with private insurance. The person decides, "I'm healthy, I'll save money and skip health insurance." Then that person's doctor tells him, "you have advanced coronary artery disease, you need surgery. "Ok," our rational person decides, "I'll sign up for health insurance today, and after they pay my $50,000 bill for surgery, I'll cancel it." To avoid this situation, insurance companies in the US were allowed to specify that they do not cover a medical condition that the person already had at the time they sign up, or they are allowed to charge more for a person who has a know pre-existing condition. In such a system, the only way a person with a chronic condition can reasonably get insurance is through their job, where their employer negotiates terms of insurance.

But what if you have an existing condition, and you loose your job and find yourself needing new health insurance? You're in a bad situation.

The Obamacare solution was to require everyone to carry health insurance all the time (and subsidize those who legitimately couldn't afford it). This way insurers can be required to cover pre-existing conditions without allowing people to game the system by signing up only when they are sick. Obamacare also set up "markets" where people could buy insurance, hopefully setting up competition which would keep rates reasonable.

It's a sort of half-assed solution, and I think the best thing you can say about it is that it is better than what existed before. Trump has been trying to destroy the system for two years, but it has proved more resilient than people expected. People hated Obamacare (mainly because they didn't like being told to buy insurance) until someone threatened to take it away.

[Florestan]

The stoke would be the pre-existing condition.

The considerations may seem odd to a someone living in a country with universal coverage, but imagine a rational person in a country with private insurance. The person decides, "I'm healthy, I'll save money and skip health insurance." Then that person's doctor tells him, "you have advanced coronary artery disease, you need surgery. "Ok," our rational person decides, "I'll sign up for health insurance today, and after they pay my $50,000 bill for surgery, I'll cancel it." To avoid this situation, insurance companies in the US were allowed to specify that they do not cover a medical condition that the person already had at the time they sign up, or they are allowed to charge more for a person who has a know pre-existing condition. In such a system, the only way a person with a chronic condition can reasonably get insurance is through their job, where their employer negotiates terms of insurance.

But what if you have an existing condition, and you loose your job and find yourself needing new health insurance? You're in a bad situation.

The Obamacare solution was to require everyone to carry health insurance all the time (and subsidize those who legitimately couldn't afford it). This way insurers can be required to cover pre-existing conditions without allowing people to game the system by signing up only when they are sick. Obamacare also set up "markets" where people could buy insurance, hopefully setting up competition which would keep rates reasonable.

It's a sort of half-assed solution, and I think the best thing you can say about it is that it is better than what existed before. Trump has been trying to destroy the system for two years, but it has proved more resilient than people expected. People hated Obamacare (mainly because they didn't like being told to buy insurance) until someone threatened to take it away.

A most illuminating post, thank you. Initially I inferred from your previous remark that the insurance would not pay if Karl had some pre-existing conditions which (might have) caused the stroke, hence my astonishment.