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.