Ask Jennifer: Week ending 4/12

Posted at: 01/04/2010 9:04 AM
Updated at: 03/25/2015 5:44 PM

Dear Jennifer, 
My aunt is on an anti-fungal medication that is about a hundred dollars a pill! She has to take 4 a day. The pill isn’t covered by insurance which I think is awful. She is in the hospital because she had a heart attack. She wasn’t getting well like she should and the tests came up with a fungal problem in her blood. If that isn’t terrible enough, the hospital doesn’t want to keep her and no nursing homes want her either because she is too expensive for them. 
We are scrambling to make arrangements to bring her home and cover the cost of the medicine. Her insurance is going to cover 4 hours of aide service three times a week. That’s it! She’s a widow. She never had any kids of her own. She’s always been good to me and my brother so we will do what we can, but we both work and have spouses and kids to attend to. 
This just doesn’t seem right!!!  How can the system desert her like this? Can we appeal this? We called the insurance company and they said there is nothing we can do. 
Dear Jennie, 
These situations are uncommon, but they do occur. It is unfortunate, but some medications are just not covered. And an appeal will be a waste of time. You might try contacting the manufacturer of the medication: they may be able to offer a reduced fee. Also call Lifespan. They will review your situation and link you up with any other assistance programs that might help with this or other bills. Also if your aunt or her husband were in the military during wartime, she might be in line for the Veteran’s Aide and Attendance program. Again, Lifespan will guide you for a sliding scale fee. 
I have also known families to run fundraisers, either as a function (spaghetti dinner or music event etc.) or online. See www.carepages.com or consider creating a Facebook account for your aunt. Don’t be shy asking for donations. If I may get on a soap box for a moment: we are at a tragic point where we need to have bake sales to pay for our health care. (I recall some years ago when Rochester was the model city for health care/ insurance.)  We should not stop healthcare reform, we should encourage more. See today’s article. 
Good luck. Your aunt is lucky to have you.