TJC Story Blog

July 2021

Anonymous

TJC spoke with a mother of two children who lives in Cosby, Tennessee. She has worked since she was 15 years old and had previously had health insurance through her work. Recently, the program she had been working with through Lowes was cancelled, and she was let go. She began working for a contractor doing homebuilding projects, but she could not afford health insurance for her family given her income and the high cost of health insurance. On August 18, she went into the hospital to have a tumor removed from her spine. She expected to walk out of the hospital two days later, but due to a mistake by the surgeon, the surgery left her paralyzed. She had been the sole provider of her household and now can no longer work.

She had applied for TennCare prior to her surgery and was denied. She had also called the hospital to talk about coverage before her surgery and did not receive any assistance. After her surgery, she ended up staying in the hospital for two weeks and was heavily sedated, often not knowing where she was. Due to the Covid-19 pandemic, visitors were very restricted at the hospital, and she could only see someone for about an hour a day. In her state, there was no way she could have applied for TennCare, and she shared that no one at the hospital helped to apply for her. She was transported by ambulance to a skilled nursing facility because the rehabilitation unit she would have gone to was closed due to the Covid-19 pandemic. She was at this facility for about two and a half weeks, and they applied for TennCare for her the day she arrived which she was approved for. She was later moved to a rehabilitation facility at Vanderbilt.

This mother is now home and is still receiving bills from her time in the hospital and for the ambulance that transported her to the skilled nursing facility. So far, her bills are totaling over $30,000. She has tried to appeal the effective date of her TennCare coverage but learned that Tennessee does not have retroactive Medicaid coverage, so her effective date cannot be pushed back to when she had her surgery and became disabled. She says that TennCare has been helpful with covering her medical bills for the time after she was approved for coverage and that they did deny one of her medications. However, she contacted her doctor’s office and they helped get it straightened out.

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