How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dimitry K., Esq. Your Own Question

Dimitry K., Esq.
Dimitry K., Esq., Attorney
Category: Legal
Satisfied Customers: 36936
Experience:  Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.
Type Your Legal Question Here...
Dimitry K., Esq. is online now
A new question is answered every 9 seconds

Question for an attorney knowledgeable in disabled adults (not

Resolved Question:

Question for an attorney knowledgeable in disabled adults (not seniors) on Medicare who can't get services they need on Medicare.

I have a 37 y/o Daughter who suffered an anoxic brain injury in 1996. She has the need for sophisticated cognitive rehabilitation and mental health services the vast majority of mental health care providers of the quality she needs and the brain injury rehabilitation centers qualified to treat her are not Medicate providers and the out of pocket expense to go to them effectively preclude their care. This is an astonishing discrimination against the disabled and low income people. Why should they not have access to the very best care that people with superior financial resources can get?

My questions are two;

1. Will disabled people with Medicare have access to mental health providers and brain rehab centers facilities that are "not Medicare providers" under ACA?

2. Will people on Medicare who have pre-existing conditions as above and who have family or Special Needs Trust resources to be able to buy private insurance under ACA (even though they have Medicare) that will give them access to mental health providers and brain injury rehab centers who "aren't Medicare providers". My discussions with these non Medicare providers is they will take private insurance, but private insurance won't pay unless Medicare refuses to pay in writing and Medicate won't do that because the request for that written denial is coming from a non Medicate provider. What a colossal snafu. Can our health care system really be this dysfunctional?

How can this barrier to care for the disabled on Medicare be solved by ACA

Thanks,
Submitted: 1 year ago.
Category: Legal
Expert:  Dimitry K., Esq. replied 1 year ago.
Thank you for your questions. Please allow me to assist you as best as I can.


1. Will disabled people with Medicare have access to mental health providers and brain rehab centers facilities that are "not Medicare providers" under ACA?
Medicare and the ACA are unrelated. For all practical purposes the new policies pt in place under the ACA will be a different option for paying citizens, but this new policy will not be Medicare. As a consequence Medicare access will not change (at least as far as the current law is written) and the same limitations that exist with service would exist under the ACA. So no, disabled people with Medicare will not be given covered access to non Medicare related services unless they are willing to pay for them themselves and out of pocket.

2. Will people on Medicare who have pre-existing conditions as above and who have family or Special Needs Trust resources to be able to buy private insurance under ACA (even though they have Medicare) that will give them access to mental health providers and brain injury rehab centers who "aren't Medicare providers".
The short answer to that is 'No". The reason being is because the disabled here with pre-existing conditions are already covered under Medicare. There may be options to purchase supplemental insurance but at least so far it is not yet law or is really funded, but it is an option that was discussed in the past.

My discussions with these non Medicare providers is they will take private insurance, but private insurance won't pay unless Medicare refuses to pay in writing and Medicate won't do that because the request for that written denial is coming from a non Medicate provider. What a colossal snafu. Can our health care system really be this dysfunctional?
Unfortunately, yes, there are quite a few bureaucratic barriers to coverage and most medical providers believe that the concerns will only become more difficult to overcome once the ACA is fully implemented. This is why the state of California is going to hire about 20,000 employees whose sole job it would be to explain and facilitate the CA and other medical requirements to local residents who are seeking treatment.

Good luck.
Customer: replied 1 year ago.
I'm sorry, you didn't answer my question because your answer is flawed.
You indicate the disabled in Medicare can't get private insurance coverage
Because they are already "covered" by Medicare. That is not even remotely
true. People who need mental health and brain injury
rehab are not "covered" because the providers any
discerning person would go to do not take Medicare.

Can a person who has Medicare cancel or reject it in favor of private
Insurance?
Expert:  Dimitry K., Esq. replied 1 year ago.
John,

That is not quite what I stated. Medicare covered parties can still obtain additional coverage on their own, I was referring to the fact that this is not part of ACA regulations, nor is it a requirement that those under Medicare coverage have services of procedures covered that aren't listed under Medicare obligations. A person who has Medicare can ALWAYS choose to cancel Medicare, or become ineligible, and seek private coverage instead.

Good luck.
Customer: replied 1 year ago.
Thanks, XXXXX XXXXX getting closer. I need clarification
references to sources or verification of your
answers

1. When you say Medicare recipients can receive
additional coverage, do you mean supplemental of
full policies from private insurers. Does supplemental
mean "Medigap" coverage?

2. What do you mean by "nor is it a requirement
that those under Medicare coverage have services
or procedures covered that aren't listed under
Medicare obligations"? I don't get this at all.

3. How does one cancel Medicare and seek private
coverage? Where are the rules or regs for this?
When I talk to private insurers, the minute they
hear Medicare they say you can't get private
policies.

I'm in CA, what resource can I go to for help
with this? My need is urgent. I want an authority
or advocacy agency who can help us get somewhere.
We want an Aetna PPO policy as our first choice.

As soon as I get your clarifications, references to support your opinion and
direction of where to get competent, knowledgeable
help in northern CA, SF Bay Area I will give you an
Excellent rating and release payment.

Thanks
Expert:  Dimitry K., Esq. replied 1 year ago.
Thank you for your follow-up, John. To ensure I do not miss anything I will respond to each question listed.

1. When you say Medicare recipients can receive
additional coverage, do you mean supplemental of
full policies from private insurers. Does supplemental
mean "Medigap" coverage?
Part of it is Medigap, but other potential options exist. Here is a link to a governmental pamphlet defining what options exist for additional coverage:
http://www.medpac.gov/publications/congressional_reports/Jun02_AppB.pdf

2. What do you mean by "nor is it a requirement
that those under Medicare coverage have services
or procedures covered that aren't listed under
Medicare obligations"? I don't get this at all.
That simply means that if Medicare covers procedure A, B, E, & G, medical facilities are not required under Medicare to provide coverage for procedure D. Medicare only covers what is listed under the policy limitations and no more. The remainder is covered under private insurance or additional coverage, or out of pocket.

3. How does one cancel Medicare and seek private
coverage? Where are the rules or regs for this?
When I talk to private insurers, the minute they
hear Medicare they say you can't get private
policies.
You can follow the link below to get started:
http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/1499/~/terminate-enrollment-with-medicare-part-b

I'm in CA, what resource can I go to for help
with this? My need is urgent. I want an authority
or advocacy agency who can help us get somewhere.
We want an Aetna PPO policy as our first choice.
Please consider this link below:
http://www.cahealthadvocates.org/

As soon as I get your clarifications, references to support your opinion and
direction of where to get competent, knowledgeable
help in northern CA, SF Bay Area I will give you an
Excellent rating and release payment.
I appreciate that. We here cannot direct refer you to specific attorneys but I can suggest you browse the listings at www.avvo.com or www.martindale.com should you later decide cto retain counsel.

Good luck.
Dimitry K., Esq., Attorney
Category: Legal
Satisfied Customers: 36936
Experience: Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.
Dimitry K., Esq. and 3 other Legal Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
< Last | Next >
  • Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises! Gary B. Edmond, OK
  • My Expert was fast and seemed to have the answer to my taser question at the tips of her fingers. Communication was excellent. I left feeling confident in her answer. Eric Redwood City, CA
  • I am very pleased with JustAnswer as a place to go for divorce or criminal law knowledge and insight. Michael Wichita, KS
  • PaulMJD helped me with questions I had regarding an urgent legal matter. His answers were excellent. Three H. Houston, TX
  • Anne was extremely helpful. Her information put me in the right direction for action that kept me legal, possible saving me a ton of money in the future. Thank you again, Anne!! Elaine Atlanta, GA
  • It worked great. I had the facts and I presented them to my ex-landlord and she folded and returned my deposit. The 50 bucks I spent with you solved my problem. Tony Apopka, FL
  • Not only did he answer my Michigan divorce question but was also able to help me out with it, too. I have since won my legal case on this matter and thank you so much for it. Lee Michigan
 
 
 

Meet The Experts:

 
 
 
  • Tina

    Lawyer

    Satisfied Customers:

    8436
    JD, BBA Over 25 years legal and business experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/MU/multistatelaw/2011-11-27_173951_Tinaglamourshotworkglow102011.64x64.jpg Tina's Avatar

    Tina

    Lawyer

    Satisfied Customers:

    8436
    JD, BBA Over 25 years legal and business experience.
  • http://ww2.justanswer.com/uploads/RA/ratioscripta/2012-6-13_2955_foto3.64x64.jpg Ely's Avatar

    Ely

    Counselor at Law

    Satisfied Customers:

    19941
    Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
  • http://ww2.justanswer.com/uploads/FL/FLAandNYLawyer/2012-1-27_14349_3Fotolia25855429M.64x64.jpg FiveStarLaw's Avatar

    FiveStarLaw

    Attorney

    Satisfied Customers:

    8189
    25 years of experience helping people like you.
  • http://ww2.justanswer.com/uploads/jespoag/2008-12-17_222355_jessepic.jpg JPEsq's Avatar

    JPEsq

    Attorney

    Satisfied Customers:

    2132
    Experience as general attorney, in house counsel, SSDI, Family Law attorney, and law professor
  • http://ww2.justanswer.com/uploads/gsenmartin/2008-04-22_214950_me1.jpg Guillermo J. Senmartin, Esq.'s Avatar

    Guillermo J. Senmartin, Esq.

    Attorney

    Satisfied Customers:

    110
    7+ years of experience handling various legal matters.
  • http://ww2.justanswer.com/uploads/PA/PaulmoJD/2013-10-10_195858_JAImage.64x64.jpg Law Educator, Esq.'s Avatar

    Law Educator, Esq.

    Attorney

    Satisfied Customers:

    31621
    JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
  • http://ww2.justanswer.com/uploads/dkaplun/2009-05-17_173121_headshot_1_2.jpg Dimitry K., Esq.'s Avatar

    Dimitry K., Esq.

    Attorney

    Satisfied Customers:

    15975
    Multiple jurisdictions, specialize in business/contract disputes, estate creation and administration.