The Idiots are not at Medicaid


On November 30, I posted “Medicaid and the Idiots” (https://annecwoodlen.wordpress.com/2011/11/30/medicaid-and-the-idiots/) which told the story of my attempt to get additional catheter supplies.  The medical supply company told me that I could not get a backup insertion tray because Medicaid wouldn’t pay for it, and that if I had a leakage then I could go to the hospital.  The tray costs $16 but the trip to Urgent Care would cost close to $300 with Medicaid still footing the bill.

As is my wont, I don’t just write about stupidity; I try to figure out why the system is being stupid, so I sent “Medicaid and the Idiots” to Greg Allen, chief financial officer at the NYS Dept. of Health.  He passed it on to the director of Medical Prior Approval, who called the medical equipment supplier, talked to somebody in Customer Service, and then called me.

She said that, according to the medical supplier, I was on Medicare, not Medicaid.  She also said that Medicare will only pay for one set of supplies per month but that Medicaid will pay for as many as ten per month.  That strikes me as kind of strange.  Why would there be such an enormous disparity in the patient’s need as perceived by Medicaid versus Medicare? 

When the woman from DOH called me, I had just settled down for a medically necessary nap and was not in a position (said position being flat on my back with my glasses off and my BiPAP on) to get into a major discussion with her, but the question remained:  If her contact in Customer Service/billing said I was on Medicare then why did the guy I was talking to deny me on the basis of being on Medicaid?  The director has solved her problem but not mine.

I had been discharged from the hospital to the home health care agency with an indwelling catheter.  I have Medicare primary and Medicaid secondary.  The catheter business was on Medicare so the agency nurse was bringing the catheter supplies.  Then one day she told me that I no longer was classified as homebound, therefore I no longer was eligible for catheter supplies under Medicare.  I would have to get them myself from a medical supply company with Medicaid paying for them, which is what I’ve been trying to do.

So this week I called the home health care agency and talked to a girl in the billing department who wouldn’t shut up and listen to me.  Every so often you get one of these people who think they know everything and you know nothing.  If you will just listen to them, they think, then you will know what’s going on.  In fact, I am the patient, I know at least half of what’s going on, and if the employee won’t shut up and listen to me half the time then I’m going over her head, which is what I did.

And her boss, the manager of the Billing Department, cheerfully told me that the problem was that they’d sent the orders transferring me from Medicare to Medicaid to the doctor and he hadn’t signed them.  They have sent the orders several times, and called him several times, and he is noncompliant.  They have been sending the orders since September 30; it is now December 8.

WTF?  For over two months they have been banging on a door that doesn’t open?  I think they are the idiots.  Who does that?  Medical billing does that.  Years ago, I told an ex-Army guy that I give anyone in the system three tries to get it right, then I go over their head.  He said he only gives them one try.  Now I only give them one try, too, before seeking an alternate route.  How is it humanly possible that this billing department has sought no alternate route for over two months to get their orders signed?  Why didn’t they talk to their nurse?  Why didn’t they call the patient?  And what did they think the patient was doing for supplies during the two months they weren’t getting their paperwork signed?  Oh—it was medical billing; that doesn’t have anything to do with patients, does it?

The Billing Department manager is very insistent that the next day she will kick the problem up to their senior patient services person.  I am more insistent that I will take care of it.  I have the doctor’s email address.  When I send him a message he generally replies within a couple hours, not a couple months.  So I contact him, including the address and phone number where the Billing Department has been trying to reach him.

He replies that the address and phone number are for his administrative office at the hospital, not his medical office in suburbia, and that stuff directed to the hospital frequently gets lost.  It is now after five o’clock.  Early the next morning the nurse calls me, saying that the doctor called the agency billing person even earlier.  And then the nurse blames the hospital, saying “Wouldn’t you think they would have had the sense to tell us the doctor’s correct address?”  Everybody wants to pass the blame around; nobody wants to accept responsibility.

The problem, ladies and gentlemen, is not Medicaid, the hospital, the health care agency or the doctor.  The problem is Factory Medicine, and nobody’s talking to the patient.  The nurse doesn’t talk to the doctor, the billing department doesn’t talk to the nurse, the insurance carriers don’t talk to anybody, and nobody talks to the patient. You and I—we, the patients—are the reason the entire system exists, but nobody’s talking to us.

Let me tell you how it was fifty years ago.  Doctors practiced alone, not in groups.  They had their offices in converted houses, not enormous Physician Office Buildings.  The secretary/receptionist also did the billing and you talked to her on your way out of the appointment.  If there was a problem, the doctor came out and looked over her shoulder.

Hospitals were small and churches were large.  We accepted the fact that our bodies would die and our spirits would continue.  We sought salvation in God, not medicine.  The idiots are not at Medicaid.  They sit in your living room every night.

About annecwoodlen

I am a tenth generation American, descended from a family that has been working a farm that was deeded to us by William Penn. The country has changed around us but we have held true. I stand in my grandmother’s kitchen, look down the valley to her brother’s farm and see my great-great-great-great-great-grandmother Hannah standing on the porch. She is holding the baby, surrounded by four other children, and saying goodbye to her husband and oldest son who are going off to fight in the Revolutionary War. The war is twenty miles away and her husband will die fighting. We are not the Daughters of the American Revolution; we were its mothers. My father, Milton C. Woodlen, got his doctorate from Temple University in the 1940’s when—in his words—“a doctorate still meant something.” He became an education professor at West Chester State Teachers College, where my mother, Elizabeth Hope Copeland, had graduated. My mother raised four girls and one boy, of which I am the middle child. My parents are deceased and my siblings are estranged. My fiancé, Robert H. Dobrow, was a fighter pilot in the Marine Corps. In 1974, his plane crashed, his parachute did not open, and we buried him in a cemetery on Long Island. I could say a great deal about him, or nothing; there is no middle ground. I have loved other men; Bob was my soul mate. The single greatest determinate of who I am and what my life has been is that I inherited my father’s gene for bipolar disorder, type II. Associated with all bipolar disorders is executive dysfunction, a learning disability that interferes with the ability to sort and organize. Despite an I.Q. of 139, I failed twelve subjects and got expelled from high school and prep school. I attended Syracuse University and Onondaga Community College and got an associate’s degree after twenty-five years. I am nothing if not tenacious. Gifted with intelligence, constrained by disability, and compromised by depression, my employment was limited to entry level jobs. Being female in the 1960’s meant that I did office work—billing at the university library, calling out telegrams at Western Union, and filing papers at a law firm. During one decade, I worked at about a hundred different places as a temporary secretary. I worked for hospitals, banks, manufacturers and others, including the county government. I quit the District Attorney’s Office to manage a gas station; it was more honest work. After Bob’s death, I started taking antidepressants. Following doctor’s orders, I took them every day for twenty-six years. During that time, I attempted%2
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2 Responses to The Idiots are not at Medicaid

  1. tonisaman says:

    Anne, once again, you state the insanity of it all so clearly. I ran into a similarly frustrating experience when it came to a government agency called Insure Oklahoma. The clerks there were trained to not give out the extension number or name of the person to whom they were transferring me. Invariably, the call would not go through and get dropped. Or you would get through and they weren’t the correct person so they would transfer you to another mystery person with a mysterious extension. I found myself right back at square one with a different person and having to explain my lengthy situation all over again. I was told I could not speak to a higher up. I had to write a letter. I didn’t want to wait the one or two month letter review and probably denial after 2 months. I miraculously found a woman who was intelligent enough to understand my situation and even though she couldn’t help me directly knew exactly who to put me through to. And it worked. The guy, who apparently was heavily involved in the formation of this agency and all the procedures, was very helpful but even he was stumped by the conflicting nature of my problem with regard to their rules. Government – what can I say? Too lengthy to really give you the blow by blow but essentially if I did it their way it would cost me less money and the tax payers more. I didn’t want to do that because of two reasons. It was an inferior insurance and it would cost the taxpayers for something I was willing to pay for. Common sense and government are dynamically opposite.

  2. Kate says:

    I can’t imagine that you’re the only patient from this doctor who has had this issue; an address snafu? REALLY?

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