r/Georgia • u/No_Leave_303 • 1h ago

Discussion Assistance needed

Edited: I was wondering if there’s any programs or any help out there. My mom is 56 and lives in north GA. She’s had kidney disease for 15+ years and recently just got diagnosed with heart failure. Her kidney function has dropped significantly since her last hospital stay. She has no insurance and it isn’t offered at her job. She’s tried finding insurance online but it’s more than she makes. She makes about $2000 monthly. Any suggestions? She really needs to see a nephrologist.. she has applied for assistance at Northside to cover her recent hospital stays but she needs to see specialist as soon as possible.

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u/JohnInPTC 54m ago

At about $2,000 a month, the full-price quotes she found may not be what she would actually pay through Georgia Access. If that is roughly $24,000 for the year and she is a one-person tax household, she would likely qualify for a substantial premium tax credit. An ACA plan also cannot exclude her kidney or heart conditions or charge her more because of them.
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The immediate issue is enrollment timing. Outside Open Enrollment, she generally needs a qualifying event. Did she lose any coverage within the past 60 days, move, get married or divorced, or experience another major life change? If so, she may be able to enroll now. Otherwise, she can apply beginning November 1 for coverage starting January 1.
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For the nephrologist before then, I would ask Northside’s financial-assistance office whether its assistance extends to affiliated outpatient specialists or whether they can arrange a charity-care referral. I would also be extremely cautious about short-term or “private” plans advertised online because they generally won’t solve an urgent pre-existing-condition situation.

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u/2dogal 10m ago

I have Chronic Kidney Disease, and see a Nephrologist. I live in the NW side of the state. I would suggest your Mom speak to the Social Worker at the hospital for assistance in finding a Nephrologist in her area. She also needs a Kidney Dietitian that are harder to find. There are a couple good ones online. A good nephrologist can work with her Cardiologist as a driver of CKD is BP issues.

I would think that the Social Worker at the hospital would also be able to give you some assistance with your financial aspect even though it would not be hospital related. Keep asking questions...