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? 

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