Indwelling catheters have to be changed every four weeks to prevent infection. I have such a catheter and last week—only three weeks after insertion—it sprung a leak. Neither the nurse nor I could figure out the source or cause of the leak. Sometimes shit just happens or, in this case, piss. That’s life, and you deal with it.
So I called the visiting nurse. He came and changed it then told me I needed to order an insertion tray. Indwelling catheters require a bunch of stuff, all unknown to me. I call the supplier, give them my name, rank and serial number, they look up the doctor’s order, pull stuff off the warehouse shelf and ship it by UPS.
UPS delivers the carton to my door and my aide unpacks the stuff and puts it in the appropriate supply container (also known as “the blue bin in the bathroom”). Then the nurse comes, takes the stuff out of the blue bin and puts it into me. I never see it. There’s a system and all I do is follow directions.
The nurse says “order an insertion tray” so I call the supplier and do.
And the supplier says no. Say what? The supplier says my insurance does not permit “overages.” My insurance is Medicaid.
The supplier guy says that I am scheduled to get a full shipment of supplies on December 7 and he can’t send me anything else before then. Maybe he can’t send it but I need it. You always need a full set of backup supplies because these things can go haywire and you have to deal with it immediately.
Boy, could I tell you scary stories from the first month I had the catheter. Like the day I wheeled down to the farmers’ market, dropped the tote carrying the catheter bag, ran over it, bent the metal clip that seals off the tubing, then fell out of the wheelchair in the process of trying to retrieve the tote. It took two strong men and a cooperative woman to set things to rights, and when I got home I found the tote awash in urine. Sheesh.
So you gotta have backup at all times, and somehow I seem to have acquired backup on everything except the insertion tray because the nurse had to make two tries to insert it properly, and Medicaid won’t let me get another insertion tray to have on standby for an emergency, such as the emergency I had last week.
So what do we do, I ask the supplier guy. He just keeps repeating the same thing over and over again, so I ask to be transferred to Customer Service, where I talk to the supplier girl, who wants to send me two catheters and two insertion trays. Well okay, I say doubtfully. She cuts out then comes back on the line to tell me that the computer system won’t even let her put in the order. Because my insurance is Medicaid and I’m only allowed to get supplies once every four weeks and I’m scheduled for a shipment on Dec. 7.
But, I say, I need an insertion tray.
At which point the supplier girl tells me that they can’t even sell me one on a private-pay basis. Say what? It’s because of your insurance, she says. You have Medicaid so we can’t ship you an “overage” and we also can’t sell you one.
Why in hell not? By what right does Medicaid block a businessman from selling me his product? Look, we are talking about catheters here. There is no hot black market in these things. I can’t go to a liquor store and get them to accept it in exchange for a bottle of peppermint schnapps. I can’t sell them for profit. I can’t stockpile them and use them for some off-label purpose like stuffing cannoli.
Every doctor, nurse, and daughter who takes care of her mother will tell you that you need to have backup supplies in the event of an emergency, so why can’t I get one replacement part? And how dare the government’s insurance company restrict free trade between me and the guy who sells the stuff?
So I ask how much this costs, expecting it to be large. Any product that is preceded by the word “medical” immediately becomes ten times more expensive than if it is preceded by the words “road repair.” The supplier girl tells me it only costs $16 and I am totally shocked, nevertheless, this is still a problem.
The basic Social Security Disability payment, which is what most of us get, is $782 a month. That has to cover rent, utilities, groceries, the Time Warner bill, transportation and everything else. If you are on Disability, you have to give up driving, drinking and smoking because you can’t afford them. Sixteen dollars is about what it costs in a HUD-subsidized property to do your laundry for a month.
So, I say to the supplier girl, what do people do if they have an accident and no backup supplies?
She says, “Admit to hospital.”
So I call my nearest hospital’s Urgent Care and ask what they charge.
The answer is $220.
Medicaid will not pay for a $16 backup supply but it will pay for a $220 visit to the hospital (plus about $50 for transportation thereto).
We do not need to cut Medicaid. We need to get rid of the idiots who run it.