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outlines in broad strokes Medicaid qualifying for the self-employed aka 'business owner.' For those who don't care to click on the link and scroll down the page, this is what it says:
Quote:
Income Source
Self-employment income
Medicaid RulesMAGI SE income counted - with deductions for most expenses, depreciation, and business losses
Knowing as little as we do about subject's exact circumstances, no can say definitively at this point what his best option would be, but Medicaid - either now or in future - cannot be ruled out, either.
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Originally Posted by Qwerty
and it still won't address the bills he has already gotten
Subject just got sick last week, per this:
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Originally Posted by PatanjaliTwist
I'm asking these q's on behalf of a 55-yr old, self-employed, CA friend, who was admitted to hospital last week
Should he meet CA's guidelines for Medicaid - per above link - Medi-Cal might, indeed, cover some of these expenses under the three-month lookback.
Quote:
Originally Posted by AnonChick
I went to healthcare.gov and ran a search on self-employment and medicaid, and didn't see anything suggesting that business owners were treated any differently than non-business owners.
Ariadne22, since you obviously are well-versed in this and know all the right places to look, would you help me find a link that explains how it's different?
I'm not well-versed on Medicaid at all, but from the link posted upthread, clearly the self-employed can qualify for Medicaid - depending on the variables and formula used by California.
Quote:
Originally Posted by Qwerty
His eligibility is based on his income, his business generates income when he is not working...unless he sells his business or dissolves his business for no money, he will not be eligible for Medicaid. Given his current health status, neither is going to happen.
The only way his business won't be considered for Medicaid is if he is an C-Corp or S Corp and if he is an C-Corp or S corp, his business is big enough that it will generate income without him working and preclude him from Medicaid because of his income.
We don't know that his business generates income when he is not working. That's for California to determine should he decide to apply for a different ACA plan or apply for Medicaid.
Second, we can't assume there is any "business" to sell. All the guy owns are his tools and vehicle.
Quote:
Originally Posted by PatanjaliTwist
he owns nothing (besides a car & work tools)
lost his house in foreclosure.
Building contractor/business owner can mean a lot of things - like one guy picking up a remodeling job here and there. If the subject is a one-man band, when he stops working, his income also stops - except for outstanding receivables, if any.
Which is why he needs to report his change in income to Covered California. He may also be disallowed from further ACA subsidies - especially if his income to date has been low and there is no prospect of future earnings.
Fwiw, back in the day I was self-employed doing business as xyz. Had to file a Schedule C on my 1040, pay SE tax. Some years I earned a lot, other years, I didn't. My 'business' didn't own a single hard asset, and I functioned as an 'business owner'/independent contractor.
When I stopped working as a self-employed business owner/contractor, I had no business, no income, and absolutely nothing business-related to sell.
OP could very well be in the same situation.
Anyone can call themselves a contractor or business owner. How rich or poor they are, whether or not there is residual income, has no connection whatsoever to the nomenclature.
Quote:
Originally Posted by Qwerty
But, hey, feel free to send the poor guy on a wild goose chase when he could spend his time investigating real options for his friend....like hospital foundations and county services that help people with unexpected medical bills.
This poor guy is not going on a wild goose chase. All the work is is being done by family, friends, and the hospital as stated by OP, per these:
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Originally Posted by PatanjaliTwist
I'm still info gathering as much as possible,
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Originally Posted by PatanjaliTwist
I told them I'd help find financial help,
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Originally Posted by PatanjaliTwist
so I'll gather whatever info I can & pass it along.
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Originally Posted by PatanjaliTwist
His brother appears to be taking the lead in trying to find the best care...
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Originally Posted by PatanjaliTwist
I'm just remaining on the sidelines, waiting to be asked to do something or offering to do small things, if I can, from cross-country.
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Originally Posted by PatanjaliTwist
I know they're working with the Financial Dept at the current hospital,
Quote:
Originally Posted by PatanjaliTwist
his brother, who seems to be taking the lead, is doing everything he can to find out as much as possible.
In the end, subject's family, hospital, and social services will probably be the deciders.
Last edited by Ariadne22; 05-29-2015 at 05:50 PM..
It's a shame PatanjaliTwist, that some people here are interjecting possible circumstances that were never even mentioned, and basing their advice to you on the conclusions of those circumstances. Don't lose heart though, it sounds like you're getting some good advice from those who haven't tried to create a situation that doesn't exist, for who knows what reason.
It's a great education for me too. I used to have my own business too. And like your friend, had only my car and a few "tools of the trade," no employees, and if I wasn't working, then I wasn't generating any income. I might go into consulting at some point between now and when I'm eligible for social security, so it's good to know that there are accommodations and criteria for business owners in regards to medicaid.
It's a shame PatanjaliTwist, that some people here are interjecting possible circumstances that were never even mentioned, and basing their advice to you on the conclusions of those circumstances. Don't lose heart though, it sounds like you're getting some good advice from those who haven't tried to create a situation that doesn't exist, for who knows what reason.
It's a great education for me too. I used to have my own business too. And like your friend, had only my car and a few "tools of the trade," no employees, and if I wasn't working, then I wasn't generating any income. I might go into consulting at some point between now and when I'm eligible for social security, so it's good to know that there are accommodations and criteria for business owners in regards to medicaid.
I laughed at this too. I am a business owner and my business actually loses money when I am not there because I am the only one that can produce. But I still have to pay staff salaries, utilities, rent, etc.
I laughed at this too. I am a business owner and my business actually loses money when I am not there because I am the only one that can produce. But I still have to pay staff salaries, utilities, rent, etc.
But since you collect your bills in arrears...you still have money coming in for how many months after the work is performed....
again---they need to look toward hospital foundations and such for assistance.....
I'm asking these q's on behalf of a 55-yr old, self-employed, CA friend, who was admitted to hospital last week to begin immediate, aggressive chemo for small cell lung/liver/bone cancer, which dr's fear may spread to his brain. His prognosis is not good & there's only a slim chance he will live... I don't know if that means he has months left or if it means 5-yrs or less. He also may be one of the lucky ones to beat it... given the fact that he's always been a fighter, I wouldn't be surprised by the latter.
Just so it's not misunderstood or comes across as cold, I'm not seeking treatment info, as his family is handling that & he's made up his mind that chemo is the method. I told them I'd help find financial help, so that's why I'm asking those types of q's. With his situation, he'll be sacked with debt once out of the hospital or should he not respond to treatment, his extended family will be.
I'll list known details via # so it's easier to follow:
1. He has Obamacare. He lives in L.A. County.
2. He'd always been healthy, but was suddenly wracked with pain & went to his primary care dr for blood tests. After 2-wks, they gave him his cancer diagnosis & told him to go to the hospital. I do not know if the dr recommended the hospital he's in... or if he chose it as it's a good hospital for cancer treatment... or if it's the closest to him... because apparently, this hospital is not in his network.
3. Apparently, his insurance company (don't know which) insisted repeatedly that he be sent via ambulance to a nearby in-network hospital, but the attending ER dr refused, saying he was too ill to be moved. After a multitude of tests, he was admitted 8-hrs later & is still there, getting chemo everyday. He was admitted 1-wk ago.
4. His family has since been told that the insurance co will not pay for any of the bills he's currently accrued or will accrue while in this hospital.
*** I know he can work with the hospital's Financial Dept for pmts (which will surely take a decade to pay off), but I also know that there are small companies (oftentimes set up by a former patient who was burdened with high bills), which help sift through bills to find over charges & often reduce bills by 50%. I saw a 20/20 (or other news program) about such a company about 10-yrs ago, so I'm sure they still exist, but upon searching, I don't find anything. I don't know what search terms to use.
*** Also, since it's the dr who refused to send him to another hospital, is there any recourse for having the hospital reduce or cover his costs or work on his behalf with the insurance co?
5. Complicating matters, his family is considering sending him to a hospital in AZ for treatment. I don't know at which stage, meaning before he finishes his chemo in CA or afterwards. They were told he'd be completely financially responsible (& need to pay cash pmts upfront, from what I understand) as he wouldn't be able to get AZ insurance for several months.
6. My friend has no savings & in fact, just lost his house to foreclosure after a divorce a couple of years ago. He has his own small contracting (building) company. As far as assets, of course he'd have his own tools & he has a vehicle, so there's not much which could be taken from him.
I don't know the legalities, but it seems unfair that his brothers & sisters be financially devastated (they all are married with kids & homes), particularly should he not live (again, I'm not being cold... this is what I was asked to find out by the family). Couldn't he just claim bankruptcy once it's all said & done? Let them take the car & sell his tools... he probably couldn't continue with his type of work afterwards anyway. Of course, they should try to get him proper insurance coverage, etc., but he doesn't have the luxury of time to wait months for it all to come through... for instance, if they do transport him to AZ.
BTW, this is all I know, so should anyone have q's on why AZ & not CA (if that does in fact happen) or why don't they take him to another CA in-network hospital, I don't know & won't ask. It's been decided. He has a very close family, which is fortunate for him, but they're all devastated. He also has 3 teenaged daughters, so he's determined to live.
In any event, should anyone be able to guide me in the right direction, with any of the above, I sure would appreciate it & so would he & his family.
Thanks for listening.
If he has no savings they will probably just take what the insurance covers. One way he can find out what is a reasonable rate for the services are he's receiving are to research the "Medicare Reimbursement rate for CPT code _ _ _ _ _ _" That will show when they are willing to take from someone with Medicare. If his charges are higher he can argue that he shouldn't have to pay any more than someone on Medicare.
If I were him, knowing that chemo is an acid and cancer is also the result of an over acid system and I know that you don't make something that is too acid less acid by adding more acid, I would be up and out of that hospital AS FAST AS WAS HUMANLY POSSIBLE. The chemo will kill him faster than the cancer.
Think of all the famous people out there that had cancer and were alive with their cancer and as soon as they started chemo usually because their family stupidly thought it would help, they died. Tony Snow and Steve Jobs come to mind.
A better thing would be for him to eat nothing but fresh raw organic fruit and or green vegetable drinks. There are many herbal formulas that work. Essiac tea is a famous one. He can find many people who got rid of their cancer doing this kind of thing on YouTube. There are plenty of books out there too. He shouldn't have let his doctors frighten him into chemo.
Not sure if this has already been brought up, but just in case it's helpful, all CA hospitals are required to post a charity policy/plan here for no-pay and low-pay insured's to get assistance according to each CA hospital policy. You can search by CA county and/or by hospital name. Policy guidelines vary.
Healthcare Financial Assistance Policies and Application Forms for California Hospitals
"Need help paying your hospital bill?
You may be eligible for financial assistance. Most hospitals offer discounts and sometimes free care to those who cannot afford to pay. Your eligibility usually depends on your household income and the number of people who live in your household. This is compared to the federal poverty level and is referred to as the "percent of federal poverty level" (% FPL).
To determine your % FPL, use the quick and easy calculator to the right.
To learn about your hospital's discount policy:
Find your hospital in the list below (shown alphabetically by county).
In the column POLICY, click on the icon to view, download, or print the hospital policy.
In the column APPLICATION, click on the icon to view, download, or print the application form you may need to complete.
Contact the hospital to find out what you need to do to qualify (contact information is usually in the DETAILS)."
If he has no savings they will probably just take what the insurance covers. One way he can find out what is a reasonable rate for the services are he's receiving are to research the "Medicare Reimbursement rate for CPT code _ _ _ _ _ _" That will show when they are willing to take from someone with Medicare. If his charges are higher he can argue that he shouldn't have to pay any more than someone on Medicare.
Right now, insurance isn't paying anything because he is out of network. Did you read the post?
Quote:
Originally Posted by emilybh
Think of all the famous people out there that had cancer and were alive with their cancer and as soon as they started chemo usually because their family stupidly thought it would help, they died. Tony Snow and Steve Jobs come to mind.
A better thing would be for him to eat nothing but fresh raw organic fruit and or green vegetable drinks. There are many herbal formulas that work. Essiac tea is a famous one. He can find many people who got rid of their cancer doing this kind of thing on YouTube. There are plenty of books out there too. He shouldn't have let his doctors frighten him into chemo.
Holy Christmas!!!! Totally wrong.
Steve Jobs did alternative juicing/herbal, etc. for NINE MONTHS - before finally seeking conventional treatment.
Steve had an operable tumor and would have had a much better chance of survival had he had surgery immediately as the doctors urged, instead of trying herbal/juicing/broccoli and all other manner of treatments - which he continued until the cancer had metastasized beyond all hope. Steve later said he regretted this decision.
Read this:
Quote:
According to Steve Jobs’ biographer, Walter Isaacson, the AppleAAPL -0.36%mastermind eventually came to regret the decision he had made years earlier to reject potentially life-saving surgery in favor of alternative treatments like acupuncture, dietary supplements and juices.
Though he ultimately embraced the surgery and sought out cutting-edge experimental methods, they were not enough to save him.
Jobs’ cancer had been discovered by chance during a CT scan in 2003 to look for kidney stones, during which doctors saw a “shadow” on his pancreas. Isaacson told CBS’ 60 Minutes last night that while the news was not good, the upside was that the form of pancreatic cancer from which Jobs suffered (a neuroendocrine islet tumor) was one of the 5% or so that are slow growing and most likely to be cured.
But Jobs refused surgery after diagnosis and for nine months after, favoring instead dietary treatments and other alternative methods. Isaacson says that when he asked Jobs why he had resisted it, Jobs said “I didn’t want my body to be opened…I didn’t want to be violated in that way.”
His early resistance to surgery was apparently incomprehensible to his wife and close friends, who continually urged him to do it.
But however well his intuition and “magical thinking” may have worked for him at work, Jobs’ postponement of surgery in favor of alternative means was a bizarre executive decision. “We talked about this a lot,” says the biographer. “He wanted to talk about it, how he regretted it. …
I think he felt he should have been operated on sooner.”
The type Steve had was an "islet cell neuroendocrine" tumor, a somewhat less aggressive type that is more responsive to early treatment.
When Mr. Jobs was first diagnosed in 2003, he chose to pursue alternative therapies, including acupuncture, herbal, diet and fruit juice therapy and spiritual consultations. Many of these therapies he found on the Internet.
Despite pleading from his distressed family, friends and physicians, Steve chose to delay surgery and chemotherapy for 9 months.
According to today's reports, Steve's wife said that he feared of being "opened up."
I read somewhere (NYT, I think) that doc who read the scan actually cried at Steve's good fortune to have the type of operable/potentially curable pancreatic cancer he did.
Steve should have followed an integrative approach. An excellent commentary by Dr. Andrew Weil on Steve Jobs - and integrative oncology, here:
Quote:
I have looked at many alternative cancer treatments and found none of them to be effective.
I would urge patients and families not to reject surgery, chemotherapy, or radiotherapy but to seek and demand integrative treatment.
Read the entire article. It covers herbal therapies as a means to reduce toxicity resulting from chemotheraphy/radiation, etc. Problem w/Steve was he focused on only the one least effective avenue in the early critical stages - instead of integrating both.
Last edited by Ariadne22; 06-02-2015 at 03:27 PM..
If he has no savings they will probably just take what the insurance covers. One way he can find out what is a reasonable rate for the services are he's receiving are to research the "Medicare Reimbursement rate for CPT code _ _ _ _ _ _" That will show when they are willing to take from someone with Medicare. If his charges are higher he can argue that he shouldn't have to pay any more than someone on Medicare.
There is no reason for someone to "just take what insurance covers" and you miss the big picture. When I as a provider sign up for an insurance plan, I am trading lower reimbursement for "free" marketing done by the insurance company. In other words, they add my name to their list of providers and that's the most common way patients find me. For someone without insurance, I will gladly give them the same discount as the insurance company if they can provide me at least 10 new paying patients per week like the insurance company does.
There is no reason for someone to "just take what insurance covers" and you miss the big picture. When I as a provider sign up for an insurance plan, I am trading lower reimbursement for "free" marketing done by the insurance company. In other words, they add my name to their list of providers and that's the most common way patients find me. For someone without insurance, I will gladly give them the same discount as the insurance company if they can provide me at least 10 new paying patients per week like the insurance company does.
But wouldn't you appreciate that an uninsured patient is saving you time (and thus money) in the "insurance reimbursement" part of your transaction?
I don't know how if you ever run into roadblocks from the dental insurance side, but on the medical insurance side, as a patient, a provider and while working for the insurance company, (not even working in the claims department!), i've wasted hours fixing problems with claims, auths and denials. For this, i would definitely "reward" a self-pay patient.
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marketing done by the insurance company. In other words, they add my name to their list of providers and that's the most common way patients find me. For someone without insurance, I will gladly give them the same discount as the insurance company if they can provide me at least 10 new paying patients per week like the insurance company does.
