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Subductrssss -> RE: A personal dilemma (10/23/2008 12:34:39 PM)
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~ Some news for those who are following my case and for any that might need the information.
Medi-cal and Tri-West more or less only apply in California or the Western states. ~
1. Medicare.
Medicare will cover skilled nursing care - inpatient.
It will not cover custodial or long term care.
It will cover up to 100 days for each benefit period. (Benefit periods run from 1-100 days inpatient and then you must leave the facilit for 60 days and then the next benefit period starts and you can return to the facility or another for another 100 days).
For the first 20 days, Medicare covers 100% of the cost, from days 21-100 you are responsible for $100 co-pay per day.
Only covers facilities that accept Medicare.
Will not cover chemotherapy.
2. Medi-cal
Will cover 100% of contract price as long as the facility takes Medi-cal. (Meaning say the cash price is $1200 per month, Medi-cal will negotiage a contract with the facility for say like $700 as long as the facility takes Medi-cal).
You have to call your case worker and get a special code for inpatient nursing facility care on your Medi-cal card.
Will cover chemotherapy.
If any one happens to have Tri-Care West Prime (Active duty or beneficiary of active duty military)
they will cover a nursing home, skilled nursing facility, etc 100% as long as they are one of the contracted facilites with Tri-Care.
GOD BLESS THE US MILITARY!
For me this means I can go to a facility during chemotherapy and Tri-West Prime will cover 100% of the cost as long as I need it.
So now, my next step was to call the first (only) five facilities that were available within 30 miles of Fresno, there are more further away (50-100, etc miles) but I want to be close to my friend Mary so am starting out within the area.
Now I have to see if any will take me, left 2 messages, waiting for them to get back to me, am going to see one facility on Saturday and one on Sunday and the fifth one is a VA skilled nursing facility which I am not eligible for as my husband is still active duty.
If I exhaust these four I will continue to about a 50 mile radius, if any facility will take me then I will start the process when I see my oncologist next (November 19th) to get into that facility and start chemotherapy. We will see from there how the chemotherapy affects me and if I continue with it or not.
If none will accept me then my only course of action is to turn to Medi-cal and try again for facilites.
If still I don't find one I like and that will take me then I accept my fate and will wait out the time until I need to go to hospice and pass on.
Just an update as I said and hopefully this info helps someone else as well as myself.
Sincerely,
Marsha
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