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The following letter is from Tammy Baldwin to Randa Gabel and offers some resources available to people in trouble.
Dear Ms. Gabel, Thank you for emailing to share Michelle Deininger's story with me. I found it of great concern and appreciate your advocacy on her behalf As you know, I believe much needs to be done to continue to improve access to quality, affordable health care for all Americans. Please know that addressing the shortfalls of our health care system continues to be one of my top priorities in Congress. Unfortunately, I sadly realize that currently problems in our health care system remain. With this in mind, I wanted to share with you some ideas that I had that I hope may prove to be of some assistance to Michelle, and perhaps others in your community. Please find enclosed packets of information on the Health Insurance Risk Sharing Plan (HIRSP) and information published by the Office of the Commissioner of Insurance on Managed Care Health Plans. In addition, I am including information on how disability determinations are made and how they apply to Social Security Disability benefits. The Wisconsin Health Insurance Risk Sharing Plan offers health insurance to Wisconsin Residents who, due to their medical conditions, are unable to find adequate health insurance coverage in the private market. While this plan does not come without costs, if Michelle were to be found eligible for participation, HIRSP may help offset the current out-of-pocket costs she is paying. After reading through the enclosed outline of coverage, the Deininger's may wish to contact (608) 221-4551 to apply or to obtain more information. A new state law passed in 1999 will provide people with an additional way to resolve some disputes involving medical decisions. Beginning in June of 2002, Wisconsin residents may request that an independent review organization review their health plan's decision. The independent review process provides consumers the opportunity to have medical professionals who have no connection to their health plan review the disputes. Four companies have applied with the state's insurance commissioner to mediate complaints. It is expected that this April 15 the Assistant Deputy Commissioner of Insurance will issue a public notice certifying two review panels and requiring insurance companies to start telling clients of their right to appeal to the independent bodies. For more information, please contact the Office of the Commissioner of Insurance at (608) 266-0103. I realize that you spoke with Sarah B. Anstaett in my District Office who provided you some information with regard to reduced cost drug programs offered through some pharmaceutical companies, and how Social Security might be of help. Private websites, such as www.needymeds.com can offer further information about such programs that may be interest. Doctors may have additional ideas with regard to this strategy to reduce out-of-pocket medication expenses. If Michelle were to apply for and found eligible for Social Security Disability, she may be able to receive both monetary and medical benefits. I have enclosed further information on Disability Determinations. For more information, the Deininger's should contact their local Social Security Administration office in Janesville at (608) 752-1399. Finally, I would encourage the Deininger's to contact their local county Health and Human Service Department to make sure that there is not some other state or county program that may be of some benefit to their family. The number in Green County is (608) 328-9393. Again, thank you for sharing Michelle's story with me. I will keep it in the front of my mind as I continue to work to pass legislation that will benefit people like Michelle who are struggling to receive quality, affordable health care. If I can be of further assistance with regard to this matter, please contact Sarah B. Anstaett in my District Office who is familiar with this case. If in the future, you have an opinion or another concern to share, please do not hesitate to contact me again. Sincerely, Tammy Baldwin Member of Congress
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Copyright 2002 Jim Salter
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