BINGO!

The CATO Institute has published an opinion written by Michael F. Cannon that states, in part, "In fact, a body of literature suggests that the program exacerbates the problems of poverty and high health-care costs and points to a counterintuitive solution." *

And to that I say, BINGO! He wins the prize.

Listen, I am just one lowly Medicaid patient whose greatest wish is TO GET OFF MEDICAID. Why, you ask? Because of the very reasons above. On Medicaid I truly feel like an unwashed person. Doctors order tests that their office managers know Medicaid will not pay, so they are the ones who have to tell the patient. Office managers are not known for their tact [nor should they be], and to a Medicaid patient on the other end of the phone when the doctor's office calls to cancel an appointment they have had on the books for some months because Medicaid will not pay for the test, it is abundantly clear that the Medicaid patient is not equal to other patients.

Also, I truly feel Medicaid plays me for a fool. Allow me to share a personal experience:

Oct 15th I see my PCP. He writes 5 prescriptions for meds I have been taking for months & years. I take the prescriptions to the Pharmacy located just outside the hospital. They are able to fill all but one, which they advise, "This medication must be Pre-Approved by Medicaid". They will make all the calls and I can pick up the Rx tomorrow. Okay, great. Except I do not have transportation and it is unlikely that I will be able to pick up that prescription. And that is exactly what happened. They called and I was unable to arrange transportation to pick up the medication, so I was forced to go without it for an entire month.Thank you, very much Medicaid.

Now it is a month later. I've had time to arrange transportation and I call in the refills. Go to pick them up and they are sorry, but "one of the prescriptions requires pre-approval from Medicaid". It wasn't filled and I would have to go back to pick it up. Shades of a month ago, Medicaid! Now here's the rub; The Rx that required pre-approval in November did NOT require pre-approval in October, and the Rx that required pre-approval in October did NOT require pre-approval in November. Once again, thank you, Medicaid.

Again I must go without a medically necessary medication for 30 days. Not a wanted circumstance. That, I know, can not be Mr. Levine's mission. 

Each month a different Rx, or a different doctor's appointment, or a different test that everybody has known about for months, gets slammed by Medicaid. Each month the number of phone calls to try to get something done is staggering. The amount of time wasted is fiscally irresponsible.

Several months ago I realized that the only way I am going to get anywhere near healthy would be to GET OFF MEDICAID. I concluded that Medicaid is designed deliberately to short-change and confuse both patients & providers, with the bottom line being patient health getting no better, and, in fact, possibly worse.

Now I must find a new PCP because the one I had been seeing, can 'no longer meet [my] needs'. Quite a dilemma for a guy who has limited mobility.

Thanks, Mr. Levine! Have a nice Thanksgiving.

*  CATO Institute Article

Medicaid Hibernation

Until January. THANKS MR. LEVINE!

People Trying to Help

It is a shame when the first time you know anything about being cut off on the number of times a year you are allowed to be seen by a doctor, is when they cut you off without notice and embarrass you in front of the people trying to help you.

Of course I read every piece of material with regard to medicaid that came before me. I read about 12 visits. I interpreted that to be 12 visits to my Primary Care Physician [PCP]. My PCP makes referrals to specialists as he deems necessary. I was just following the road ahead.

I have an appointment next week with a Rheumatologist that's been on the books for 3 months. It's a shame I'm going to have to cancel it...

Unfortunate Needs

Each day is proving to be different, with some more difficult than others. Some days I awake more fatigued than I was when I went to bed. Others, I have mobility problems just getting from room to room, and I've adapted to using 2 canes to get around the house. Jaden's mom gave me these when her grandmother passed:

They have proven very helpful and have prevented me from falling many times, so if I've fallen 3 times this week, these have prevented maybe 10 times that number. The base of the quad cane is quite heavy for me, and I have difficulty using it but for short periods, and inside the house only. The walker is also cumbersome for outdoor use, and not much help if I'm traveling more than a block. A good friend gave me an offset aluminum cane like this [in all black], which I use for out of the house mobility:

I have what I call 'Unfortunate Needs'. There being more than one way to skin an animal, there are also more than one way to achieve outside the house mobility. I am desperate for something better than canes or a walker for getting to and from medical appointments, the grocery, local errands and such. The options are:

The adult tricycle. Allows me to not have to worry about my balance as I ride. Least expensive of the options. Unfortunately, even at $249.00, it is way out of my price range. I had ordered one of these just before The Thing in 2005. After The Thing, all UPS deliveries were cut off for some months and I have never had the $ to order another. I don't believe this would be a perfect solution because my strength gets sapped when I'm out in the sun. I'd have to see if I could ride to the grocery on the other side of the causeway. Regardless, it would allow me a real sense of freedom from this disease.

Next then are these, which would give me the power and the range to accomplish everything I needed to do. The chair is bus-friendly, the adult tricycle and the scooter are not. All are cost restrictive, but it is nice to think of the mobility either would offer.

I already have safe and secure storage here at the house. Kind of like a tiny garage. Unfortunately there is/will be no money for such a thing, thus, 'Unfortunate Needs'.

Nothing + Nothing = Nothing

So now we've seen what these past 3 months of effort brings to a Medicaid patient. Nothing.

It does not matter that a Neurosurgeon orders a test, that the patient then begins the process at a learned man's direction. Many, many phone calls. Excruciating pain. Doctor visits. More pain. Faxes. More phone calls. If it involves Louisiana Medicaid, it amounts to NOTHING AT ALL.

I am no closer to a diagnosis and treatment after 3 months of effort than I was 4 years ago, AND I must wait 3 more months, according to Medicaid, before I can see a doctor and we can start the dance all over again.

One must ask, Why Bother?

Fill in the blank, check the box. Move to the right...

Telephone Operator

So often during this trek I have felt like the overwhelmed old-time telephone operator during a national crisis, managing all these telephone wires, connecting the right Medicaid person with the right medical person so they can work things and I get the treatment I need for my medical conditions. It has been this way since I became a Medicaid 'enrollee' in January 2008. Here is just the latest:

The Neurosurgeon on July 27th, told me to go back to the Urologist and have a Urodynamics test, so, 

1] I called my PCP to get another referral to the Urologist.

2] I called the Urologist to set up the appt for the test.

3] was required to be seen by the Urologist prior to the test, scheduled regular appt.

4] seen by the Urologist and test was scheduled for 10/20.

5] 10/12 - Urologist's office calls to cancel Urodynamics because Medicaid has informed them that I have exceeded my visits and am told to have my PCP obtain the extension from Medicaid.

6] call my PCP with the info I'd been given.

7] PCP calls back and explains that the Urologist has to request the extension.

8] call Urologist's office back and pass along this latest information. Informed that the appointment then has been canceled and will be rescheduled if/when Medicaid gives approval. Does not sound hopeful as they make the observation that, 'Medicaid won't pay for it'.

9] out of total frustration, I declare war on the Medicaid Bureaucracy 10/13 and begin this blog.

10] seeing the need to review medical events from May when I last saw my PCP, I make an appintment to see him for 10/15.

11] I see PCP and review all with him on 10/15. He prescribes medications I require but have not been able to to obtain mostly due to transportation difficulties.

12] 10/15 [i presume following my visit] PCP writes letter to me, withdrawing as my PCP because, 'I believe that I am no longer able to meet your need[sic].'  Informs me that he 'will continue to provide care for [me] for 15 days'. So, I've got a PCP through October 30th.

13] 10/21 - I receive telephone call from a lady who identifies herself as with Medicaid. She is kind enough to confirm or enlighten  me on the issues before me:

               A.] Case Manager. Apparently, it is presumed that either the enrollee [me], or family/friends/support group[s], or whomever... is seeing to the overall management of things. I do need help in that area, because I appear to be wholly confused by all the data I am trying to deal with. Attempting to find my way around Medicaid's system is an advanced college course all in itself, and I am less able to absorb and navigate. Is my brain affected by this? It can be terrifying. One would think that Medicaid's organization would be much more humane. They call it 'intuitive' on the interwebs.

There have been occasions where, while trying to find my way through some other issue, I have stumbled across a valued nugget. Such was the case during a period while I was falling more than 3 times a month [still] and was looking at the different Medical Alert Systems out there. Totally by accident I learned that I am eligible to receive a system, with the monthly fee paid by Medicaid. Thank whatever god in which you have faith, because I could find the little around-your-neck systems easily enough, I just couldn't afford the recurring fee. I still don't have the thing. I can't find where I wrote the information down. Saves Mecicaid a couple of dollars a month, though.

The thing is that, no, Medicaid does NOT provide a Case Manager to ensure those kind of things get done.

               B.] It was my belief that I was eligible for 12 PCP visits a year. In reality my eligibility is limited to 12 visits per calendar year with ANY doctor, PCP or specialist[s]. Only took 2 years to learn this, and the need for more visits developed only because we are trying to determine what is wrong with me. This, my friends, is Louisiana Medicaid. Thanks, Mr. Levine!

               C.] Transportation. Medicaid has not a clue. For this past year I have attempted to arrange Medicaid provided transportation on 3 occasions. Two of those I have shared with you in Let's Talk Transportation.  I think we all will find this third of interest as well.

There came a time this past summer, where it became almost impossible for me to take the local bus system, with or without a companion.  Within the first block, most especially in the sun and heat, the strength is sapped from my legs. It's as if a drain-plug is pulled, the strength rushes out of me, I am light-headed and as useless as a rag-doll. I have greatly limited my outdoor activities to medically related excursions only.  

You may recall dear reader, that by my second intercourse with Medicaid transportation, I had found and spoken with a Medicaid approved transportation firm. With a much better idea of how things work, I called with confidence. Oops... I forgot rule one; 'never, ever expect ANYTHING to work correctly where Medicaid is involved'

I get all the facts, call Medicaid to make the transportation appointment and am told, "That account is full.' Excuse me, I don't understand. What does that mean? 'It means the account is full.'

The bottom line is that this company's account was full. I presumed, correctly it turned out, that meant Medicaid wouldn't be transporting me that day.

               D.] It is up to me to get the train back on the tracks. The Medicaid lady who called yesterday explained that it will be up to me to get the train up & running again toward diagnosis and treatment.

That was last evening, right before I received the letter from my PCP saying he could not meet my need. I presume he meant 'needs'.

So, anybody here think I am losing my mind? Is it me or is it Medicaid? Is the system itself designed to massively bungle and discourage proper medical care? Methinks so. Mr. Levine?

All of this effort over 3 months by Health Care Professionals and lay-people, accomplished NOTHING AT ALL, and in fact, lays out the roadwork for more months of navigation that will go nowhere. It is my opinion, and I believe that it will be the decision of the courts, that this kind of burden placed on the shoulders of Medicaid enrollees, constitutes TOTURE.

NOW, is it any wonder costs are so high, with no end in sight? 

Fill in the blank, check the box. Move to the right...

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Never say...

... because no sooner than you say it, whatever you are saying comes to pass. You see when I asked earlier today, rhetorically I might add, 'Did you ever just want to crawl into a hole and die', I truly did not expect to receive a letter from my PCP afterward telling me that he quits. He 'can no longer see to my need' [sic]. Letter was written on the 15th, postmarked on the 20th, giving me 15 days [til the 30th] to find another PCP.

NOW Fill in the blank, check the box. Move to the right...

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