Ten Days Later

Ten days ago I posted a complaint, “Ask for a Social Worker, Get a Nurse,” so let’s do an update and see how things are going.  (https://annecwoodlen.wordpress.com/2012/08/12/ask-for-a-social-worker-get-a-nurse/ )

I filed the complaint against the Visiting Nurse Association (VNA) and its top administrators and a couple of nurses with the NYS Commission on Quality of Care.  Ten days later, it has been opened, read and assigned to someone, and I have left that someone a voice mail.

I filed the complaint with the NYS Office of the Medicaid Inspector General which replied, like, immediately:  “This letter is to acknowledge receipt by the NYS OMIG Bureau of Medicaid Fraud Allegations of your complaint by US Mail dated August 13, 2012 regarding The Visiting Nurse Association. This matter has been evaluated and unfortunately it has been determined not to be a case we can proceed with as it is a case of Quality of Care and not Medicaid Fraud. We have referred your complaint to the NYS Department of Health [DOH] Home Health Care Complaint Unit. You can feel free to follow up with them.”

So I followed the bouncing phone number and landed in the NYS Dept. of Health’s Regional Office, about six blocks from my apartment.  I talked to someone who was determined to be immediately helpful.  He said a letter would go out to the VNA and they would have 48 hours to reply.

Meanwhile, someone at Enable had told me that, as a Medicaid patient, the VNA was required to give me a written letter of termination, stating the reason for termination, and notice of the right to a fair hearing.  When requesting a fair hearing, I would have the right to request continuation of services pending the outcome of the fair hearing, which would take about six months.  The VNA has not put anything in writing.

And the man from DOH said, well, he didn’t know if I was on Medicaid and he would have to wait for written confirmation from the VNA.  Now, here’s what OMIG would have done with that:  the investigator would have tickled his computer, gone into my Medicaid file and seen everything that was billed to Medicaid.  In fact, that’s what an investigator dude did while sitting next to my bed a few years ago and it was kind of freaky.  A guy I’d only known a couple of hours was telling me about every appointment I’d had with doctors.  This almost-complete-stranger is telling me when I went to the gynecologist and why I went to the psychiatrist and so on.

All you folks who are healthy, work for a living, and have private insurance—Big Brother is not tracking you.  Because a doctor mistreated me, complete strangers are now keeping written records of all my health problems.  You want to live my life?

So why is the DOH guy waiting for the VNA woman to tell him if my services were being billed to Medicaid?  Why is he asking the subject of the complaint?  Why isn’t he asking Medicaid?  And the problem is that if I was getting Medicaid services but didn’t get a legal termination notice then my services should still be in force, right?

Well, we just don’t know because the DOH guy—oh, no, it’s not the DOH guy.  He’s referred it to a DOH woman, who tells me today—ten days after filing this urgent complaint that needs immediate attention (there’s mold in my catheter bag)—that she did send the VNA a letter, and it did have a deadline for replying, and she should get the reply, well, soon.

She asks if I’ve spoken to the VNA.  Well, no.  Not since I filed the complaints and left a voice mail message for CEO Mary Kate Rolf.   Mary Kate, by the way, did not return my call.

So the DOH woman says she will call the VNA and call me back, which she does.  She tells me that they are still repeating their version that I was terminated so I could get Hospice—which is not true—but now they are also saying I’m on Medicare, not Medicaid.  Well!  How badly can this agency be run?

I was discharged from the hospital in August 2011 and admitted to the VNA on Medicare.  Then, a few months later, the nurse came, said I was no longer classified as homebound, therefore I was being moved from Medicare to Medicaid, and because I no longer was on Medicare, the VNA no longer would provide my catheter supplies; I would have to order them myself.

It would appear that the VNA doesn’t know what it’s doing.  Instead of looking at current billing, they are looking at admission information.  And I’m being denied a social worker to help me get into a skilled nursing facility.

I had a visitor for about an hour yesterday.  Other than that, I’ve been alone in bed for two days.  I’m hungry but it just takes too much energy to get up and go to the kitchen.  I would cry but I can’t stand it.