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Perfectly Imperfect Life..........

Saturday, April 19, 2014

A Rare Appearance on the Soap Box!

I am SO fed up with this 'new improved health care system'. ..........After dealing with Medi-Cal & CoveredCA......there is not one person that knows their job or even cares to.
T turned 26 in Dec and went off biological fathers insurance. Since he is disabled he applied for Medi-Cal. Was told he did not qualify. And to apply for CoveredCa, he was accepted and signed up for Blue Shield. Everything was fine until mid February when he was told he did not qualify for CoveredCa, that he qualified for Medi-Cal and there would be a penalty come next year in taxes due to receiving CoveredCa when he didn't qualify. Huh??? Nothing had changed in 3 months in our household, wth?   He was told he would be receiving a letter in the mail, that by the time he received said letter he could call Medi-Cal and find out when his card would show up...My concern was he would run out of meds...you know how fast slow things move Letter arrived, he called Medi-cal, they said you do NOT qualify for Medi-cal, you have to use CoveredCA. Told them what he was told and he was told, he was told wrong. Called CoveredCA, he was told he did NOT qualify for CoveredCA, he qualified for Medi-Cal, that they were wrong. I could see a meltdown coming. That's when I took over....either that or the phone was going thru the window!  
 3 days later after waiting for 2-3 hrs. at a time and being ping ponged back and forth, I told Medi-cal that when his meds ran out I would not hospitalize him but bring him down to them and they could care for him while he was off meds and continue to care for him until he received them and once restarted, it takes approx. 6 weeks for his medications to build back up in his system to work. 
~~~~ He had a paper stating he was Medi-Cal eligible the next day in the mail. That the actual State card would arrive in 4-6 wks. Amen, finally we were done. Knew things had gone too smoothly back in Dec/Jan......ha!
March arrives, payment for CoveredCA was taken out of my account. I called Blue Shield, they had no idea that his policy had been cancelled. OK should have known the left hand doesn't talk to the right. I cancelled his policy stating he was told he did not qualify by CoverdCa. They wanted to know why...I said " I dunno, when do I get my money back?" Was told I would have a reimbursement check in 3-4 weeks. Of course, they just can't reverse the charges, that would be too easy now wouldn't it? I have yet to receive that check.
April comes. Another payment was pulled. I called Blue Shield who  again had no idea his policy was cancelled and wanted to know why. I asked why was it not cancelled when I called in March? Response: "I dunno". Asked when I would received my money back? Response: In 3-4 weeks. I waited 10 days and called back to check the status of his policy. I was told his policy was in full effect, payments were current and to use it without worry.
He went from not qualifying for Medi-Cal or CoveredCa to qualifying for both!
Now I have spent too many hours on hold for too many days to care anymore. It is not my job, I am NOT the professional, just a lowly housewife......scratch that. .....single Mom. I am Not the one being paid to keep Medical/CoveredCA Accounts up to date. So I guess he now qualifies for both???!!! I give! I have done my due diligence.
SO.....I figure T can go back to his regular Drs. that he has had for 20 yrs. His disabilities were severely exasperated due to having to lose his Psychiatrist and the thought of losing his Primary Care Physician due to the Insurance change. We are lucky enough to have a Primary Care Dr. who actually cares. He has been treating T and also acting as his 'Psychiatrist' due to the reasons stated above. And hey, with Medi-Cal his Rx's are free.
He lost his psychiatrist because she doesn't accept Medi-Cal. This has exponentially increased his symptoms. I called and made an appointment  with her since he is still ''covered'' by CoveredCa. Why does he have to suffer and degrade due to their incompetency. Oh and yes it much be those violent games that make people take their frustrations out in violent ways.
I have yet to receive any reimbursement for the months his policy was supposedly cancelled. Don't think I ever will.
OK, I'm stepping off my soapbox. I rarely step on to it and consider myself to be quite a patient person and always do what I am told, a BIG default in my personality. Example: my 39 year marriage.......
 I THINK I FINALLY FIGURED OUT HOW TO WORK THE SYSTEM ! albeit accidentally and unknowingly.

So when we end up in jail for using the wrong/right/wrong/right?? Insurance, can someone bake us a file in a cake!

Friday, April 18, 2014

Does the Roller Coaster Ever Stop?

Yes, I've been MIA.
Hoping things settle down now.
This is a long one so if you make it to the end you get a gold star! LOL
M had been having severe pain centralized on her belly button since April 1st. I got her into our Dr. that same day and after examining her he thought he could feel an umbilical hernia. He ordered a CT Scan and sent authorization for her to see the surgeon who removed her gallbladder 10 years ago. That night she was in such pain she curled up on the floor and couldn't move. I decided to call an ambulance since who knows what was exactly going on, I felt they were better equipped to care for her than me driving her.
She received Morphine on the way which knocked out the pain, thank goodness.
On arrival they got her into a bed and got an IV started. Then prior to doing anything else she was presented with "the bill" and was asked to pay. Needless to say we were both speechless. She has insurance so I couldn't fathom how or why they would even ask this. We told them we didn't have that kind of money. Welcome to our new improved health care! 
All ER did was run labs and urinalysis, same thing our Dr. did earlier in the day which I had told them. I knew they would come  back clean, what a waste of time and money.

And yes we told them what our Dr. felt the diagnosis was, thinking they would at least look into it. Since the labs came back OK, we were told there was nothing further they could do. Stomach pain  was no reason to go to the ER and that it was ''menstrual cramps''. Typical sexist comment. I would think he would know by now she was old enough to tell the difference, especially since hers 
ENDED the week prior. She was told there was not an umbilical hernia and they would not do any further testing. 

Fastest trip to ER EVER. In and out in 3 hours!!! Heaven forbid they actually search for what was wrong. Oh, he also said: "sometimes in life we all have to go through pain". Huh? Yeh, then you go home and die! 
We have had several friends sent home from the ER with stomach pain only to have their appendix or bowels burst, yes, they passed away.

 She was told to take Tylenol for the pain...I told him that would not cut it. He ended up writing her a script for Norco, 2 pills. Gee thanks. I guess we looked like were junkies looking for a fix, why on earth give her only 2. 

Since we couldn't pay the bill I asked for a hardship form. Was sent to Window A, then sent to someone to talk to only ending up at billing being told that since she had Insurance there was not any hardship. You only have a hardship if you have no Insurance...I thought we all HAD to have insurance now, that it was the 
  law?????   She is on SSI and used a hardship form just last month for lab work. So much for compliance regarding having medical  insurance. Might as well cancel it and save her $675 a month (which leaves her $25 for Rx's & Dr. visits and no it doesn't cover all her med costs) and file hardship...seems it'd be cheaper and there'd be no hassle.
Remember the signs in the ER stating that they wouldn't refuse care to anyone even if you could not afford it? Well, I looked on the way out of the ER....The sign is NO LONGER there! I practically lived in ER's with the ex...we'd wait our turn, he'd get mad, make a scene and we'd go to the next hosp., we'd wait, he'd get mad make a scene and we'd go back to the one we just came from, wait, repeat, wait, repeat, well you get the idea.....did this several times a month since '98.
He was never asked to pay prior to treatment, what has changed?..........hmmm....

Now we all know why there was a man in the waiting room demanding  "take me to the f****** morgue!"       
 Send me too!

April 2nd we received a call for her CT Scan that was scheduled for the next day at 9:30am. An hour later we received another call from them to remind her to drink the drinks 2 hrs. prior to appt. Drinks?? No one has ever mentioned drinks. So now she had to be there at 7am to drink said drinks then wait for her 9:30 appt. Called Drs. office to speak with auth. girl, it's up to the facility as to what/how they want to do CT. Why it took 2 calls to give her all info regarding appointment just proves what we have dealt with for so long....incompetence runs rampant.

That same day she had another severe attack, she couldn't get anything down, so was unable to swallow pain meds.

 Got CT Scan done. Our Dr. wanted it immediately. Dropped off the disk once we were back in town. He couldn't see anything  wrong but she sees surgeon on the 9th. She was still having severe  attacks that  seemed to get worse in the evening and last all night, which are now spreading from her belly button to each side.. Unable to eat due to nausea. More pain pills were prescribed by our Dr. ....we were on hold till the 9th.....

Saw surgeon, M needed surgery. Surgeon will be looking for an umbilical hernia but if that's not it then she will do exploratory surgery while she's in there. She's not waiting...hospital pre-registration the next day - the 10th and surgery on the 14th!

We received a call just prior to leaving for pre-registration ----
When does your hospital ask for payment prior to surgery? If you can't pay they won't do the surgery. Sorry just don't happen to have $3500 in my back pocket or anywhere else for that matter...neither does M or anyone else in this house! Then we're told we at least have to pay 40% which is $1500....I don't have that either!!! Who does??? She then says she will call the surgeon and see if this surgery is really necessary, if not it will be postponed until M can save the money???? Huh? this is not for a boob job!!! She calls back and says she spoke to the surgeon and it is mandatory for M to have the surgery and wanted to know how much we could put toward the bill. I am still in shock from the ER Dr. and now this? I said we could probably scrounge up $100 (there goes my gas and food money for the month). She said bring it to your pre-registration. I tell her to call them and tell them we will now be late due to this craziness! Yeh, they start this just before we need to leave to get to the hosp. And people wonder what makes others get a gun and shoot a mall up!
M had her gallbladder removed 10 yrs. ago at the same hosp. with the same ins! What we didn't know is that this hosp. is now the county/welfare hosp. Why do they switch them back and forth!? And what the heck does it matter? She has ins.!? 
Surgery went well, she is home. Surgeon found an umbilical hernia which was fixed and excessive scar tissue/adhesion's from an old infection which she removed.  She has her follow up with the surgeon on the 22nd. 

I'd like to take a copy of her records and shove them up the you know what of that ER Dr.!

If you made it through this rambling here is your star!
Hope to get back in the swing of things as I'm able.
I usually have Easter dinner but cancelled this year, just too much going on with M and felt we needed to have a quiet Easter. She's been spending most of her time in bed since it hurts worse when she is up. She is still on a bland diet 4 days after surgery. Her stomach feels icky and I'm sure the pain meds don't help. I'm sure she'll feel better as time goes on.


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