Yesterday I had an utterly unbelievable experience: the government told me that I could not spend my cash on what I wanted to. Honest to God, I wheeled into a store, went up to the counter, put down a $20 bill and said, “I want [x-y-z]” and the shopkeeper said, “I can’t sell you that because the government won’t let me.” The shopkeeper can’t sell and I can’t buy because the government won’t let us. My cash is no longer good for a purchase. And I wasn’t trying to buy a gun or alcohol or pornography. I was trying to buy a catheter.
Back in August I was discharged from the hospital with an indwelling catheter. Once a month the nurse from the home health care agency would come and change the catheter. She would bring with her the necessary insertion kit, catheter, drainage bag, and tube holder. (This cracks us up: the “tube holder” is a strip of elasticized material, two inches wide and about 18 inches long that goes around the thigh and has a little Velcro thing that you wrap around the catheter tube. Normal people call this “a leg strap”; the medical supply industry calls it a tube holder.)
My insurance is Medicare primary and Medicaid secondary; the provider who sells me something bills Medicare first and whatever Medicare doesn’t pay gets rolled over and billed to Medicaid. The home health care agency billed Medicare for the nurse’s services and the equipment she brought for a couple of months while I was really wrecked and recovering from the hospitalization.
Then one day the nurse comes and tells me that I no longer am classified as homebound so they can’t bill Medicare for services and supplies. Now, the nursing visits will be billed to Medicaid and I will have to get my own supplies. The nurse tells me that I should call Byram Healthcare, which sends supplies from South Bend, Indiana—that is the “local” vendor whom we are supporting with our business.
It’s at this point that things start to get crazy. I placed the order but didn’t get any supplies, or something. Byram told me Medicaid wouldn’t let them (see also https://annecwoodlen.wordpress.com/2011/11/30/medicaid-and-the-idiots/ ) So I tracked that down and it turned out that the problem wasn’t Medicaid; the problem was that the agency had wasted two entire months sending the prescription request to the doctor at the wrong address (see also https://annecwoodlen.wordpress.com/2011/12/10/the-idiots-are-not-at-medicaid/ )
So Byram finally sends me supplies and they’re crap. The stuff the nurse brought from the agency worked fine; the new stuff doesn’t. There are several problems but the worst is that after two weeks of use then the tubing starts to kink up, which means that urine is backing up into my kidneys. Three o’clock in the morning, the pain forces me awake, and I discover that more than a pint of urine is backed up inside me. Not good.
So I tell the nurse that I need the catheter and drainage bag that I used to have. She gets me the precise ordering information and tells me to call Byram, which I do. Byram is asking me all kinds of things that I don’t understand, and telling me things that I understand even less.
I say, “I need a 540211.”
Byram says “Did you used to have an 820577?” How should I know, and what does it matter?
I say, “I need a silicone catheter.”
Byram says, “Is that silicone and latex?” All I know is what the nurse has written on a Post-It—a Post-It, for Pete’s sake!
I say, “What you have sent me is endangering my health; I need these other products.” At which point the Byram lady starts lecturing me on how they negotiate with insurance companies for what they will supply and the insurance will pay for. What she does not say is, “We’re out to make a profit, lady, and if we actually sent you good stuff then we wouldn’t make a profit for our shareholders.” Go Occupy yourself.
By now I am have been reduced to tears, so I call my nurse, who’s a really nice person and can do this stuff without crying. Among other things, I tell her that part of the problem is that Medicaid won’t pay for what I need—not even with a doctor’s prescription. It used to be that if you had a problem with the generic drug or product then your doctor could write a prescription that you, individually and specifically, needed the name-brand. Not any longer. Byram told me that even a doctor’s order can’t override the insurance system. You will get what the taxpayers will pay for even if it is dangerous to your health.
So the nurse says she’ll take care of it but later that night it dawns on me: why am I being forced to use inferior Medicaid supplies when I have superior Medicare insurance? This precipitates another flurry of phone calls the next day, which get me more upset. I do not know how Byram does things, nor do I know the systems and processes of the health care agency. What I know is that my insurance is Medicare primary and Medicaid secondary and it’s been that way since 1991, and that I used to get satisfactory supplies but no longer do. I also know that I am the patient who is waking up in pain at three o’clock in the morning with stale urine backing up into my kidneys and I am trying to parse the inner workings of a national supplier and a departmentalized agency. I feel like a surgeon operating in the dark while wearing mittens and the results are just as bad as you’d expect.
Finally the agency’s billing manager asks if I’d like her to take care of it. “Yes, please,” I sigh, adding that I have a doctor’s appointment Thursday afternoon and need to know in advance if I should ask him to write a new prescription.
That was Tuesday. Yesterday, Wednesday, I decided to hell with all this—I would wheel down to the medical supply company that is three blocks away from my home and get the right stuff myself. This is the old fashioned way and I’m an old fashioned kinda girl. I wheel into the store and up to the counter. I tell the clerk I have Medicare primary and Medicaid secondary and I need specific catheter supplies. She tells me they don’t bill Medicare or Medicaid directly. Okay, I say, what would it cost for me to buy these things, cash on the counter?
And the clerk says I can’t. My money is no good. By government edict, I no longer have the discretionary right to spend my money the way I want to. My insurance is Medicaid, therefore the government has decided that I am too poor to buy medical supplies.
Where the fuck does the government get the authority to tell a businessman what he can’t sell for cash and a citizen what she can’t buy for cash?