I'm reaching out to fans and friends for help in raising money to offset the out-of-pocket expenses for an upcoming surgery requiring a double-hip replacement. Thanks to Obama's Healthcare Reform Act, I've found a plan that accepts patients with pre-existing conditions. I've had a year of palliative care with medications whose side effects rank right up there with the benefits of pain management, and an intense relationship with chronic pain for several years. I'm very glad to find a solution, but I need your help to help make it happen. The cost of this surgery by itself is $55K per hip. I'm grateful to have found a low-cost option, but it's going to be tough to come up with the funds for my deductible. Any sum of support will be greatly appreciated. I'm thrilled to live in a community and count many among you as friends. Thanks for considering pitching in to help me get my mobility and sanity back. A music benefit is also in the works. For more information and details, please read on.
How it works:
For those of you who would like more information about the Pre-existing Condition Insurance Plan (PCIP), it was created under the Affordable Care Act. It's provided through the U.S. Department of Health and Human Services and administered by GEHA in more than 20 states. It was set up for people without insurance, specifically those with pre-existing conditions. If you know someone that might need catastrophic or other costly medical help, it may be a good option for them. Their website is www.pciplan.com, and phone number for PCIP/GEHA is [phone redacted]. To apply for this insurance plan contact the Pre-Existing Condition Insurance Plan at [phone redacted].
To be eligible for this insurance you have to meet three criteria: Can show you've been denied coverage by an insurance company, have been without insurance for six months, and are a U.S. citizen. HAAM, the Health Alliance for Austin Musicians, has been overseeing my health care for the last several years. It is not considered health insurance. It is charity-based care though the Seton Hospital Network. So if you're a musician in Austin, you can apply for PCIP coverage, suspend HAAM, and then restart it when you need to.
PCIP has three different plan options. I've applied for the Standard option, which gives me a lower deductible and cap, but more limited access to physicians of my choice. However, I've found the list of MDs in this option to include highly regarded, nationally recognized Orthopedic Surgeons that are on the cutting edge of this type of surgery in their field, with dozens of years of experience, right here in Austin.
How I calculated my needs:
My deductible is $2,000 and the total amount I'll pay for all services in a calendar year is $4,000 - the cap (which includes the $2,000). The monthly premium for my age bracket is $426. The cap ($4,000) covers all expenses related to my hip surgeries: hospital stay, doctors fees, anesthesiologist, Nursing care, Home Health care, home Nursing visits, medications, Physical Therapy, let's see -- what else -- basically every type of care I could possibly need. I don't have to stay on the plan. Once the surgery is over and I've gone through recovery, I can opt out of it. If I need to come back, I can do so after 6 months.
I calculated my need for assistance based on three expenses: my deductible and out-of-pocket yearly cost ($4,000), three to four months of premiums ($1,278 to $1,604) -- I'm not sure how long I'll need to stay on the plan for aftercare and follow up - and loss of income for one month (approximately $500). The estimate for returning to work is 4-6 weeks. I have shows in November and December. I'll have to suspend playing at Linda's but can't afford to be gone more than a month.
If I'm graced with enough money to cover these costs, I'll be very lucky and grateful indeed. If there is any money in excess after my surgery and related expenses are taken care of, I plan to donate that money to another individual, either locally who needs this kind of help, or to someone within the GoFundMe community that's struggling with a similar medical problem.
Someone made the comment that my explanation was "short." I wanted to explain the details for anyone who would like to pass this info along to someone in need, and be accountable for all the goodwill I'm receiving.
Thanks for being here, and thanks so much for your help.
- Alison Lumley
- Jimmy Ash
- The Natolis
- Dan Weber
- Bob Alvord
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