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...

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...

The Doctor Versus The Bureaucracy

I do not believe that I am an ignorant man. In many things, yes, of course. One can't know all about all, so I am ignorant in many things. But I can read, and I can generally comprehend an issue that affects my life as profoundly as my own health.

It just seems to me that if the government determines that you are disabled, and connects you with a Primary Care Physician that you select from a list of participating doctors [Approved to accept Medicaid], and you start the trek to discover what is wrong with you, evaluate treatment options, and establish a pro-active medically designed treatment plan... well, shouldn't Medicaid then support those efforts? One would THINK so, eh? Mr. Levine, any thoughts you'd care to share?

So let us review this trek and see, if we can; Why, in the middle of the doctors and tests necessary to determine a diagnosis, treatment plan, and prognosis, Medicaid cancels tests ordered by one of their own approved Neurosurgeons. The train gets knocked right off the tracks. I'm bewildered to be honest.

This little exercise begs the question: 'Is this the way to run an operation'? Because what Medicaid is saying to me is that I and the doctors I have been seeing at the direction of a Board Certified, Medicaid Approved Internal Medicine Specialist, AKA [Also Known As] my PCP [Primary Care Physician]... well, Medicaid says that we don't know what we are talking about. Wow.

I have no choice but to conclude that this entire exercise is futile. I am not going to get better learning what is wrong and treating it, according to Mr. Levine and his brainless bureaucracy.

I have no doubt whatsoever that Mr. Alan Levine is a much qualified administrator of large government operations: Alan Levine's Professional Summary

So why have we spent so much trying to discover what needs to be discovered on my case, yet Medicaid has not approved a single request from either myself or from health care professionals for any treatment other than medication?

I NEED something to transport me to the three bus stops within walking distance. Unfortunately I can no longer walk to these stops without major difficulty, plus the recovery time of a couple of days after each trip. Something like this would be fine, and I have a prescription for one written by my PCP at the time, but, like everything else they have denied, I expect this to be denied as well, and I believe I would have to present a prescription written by my current PCP:

The relief and benefits my life would experience would be life-changing. I would no longer be a shut-in, having transportation to reach the grocery store across the causeway, the three bus that can transport me anywhere. It would be a good move by medicaid. Mr. Levine?

Who's Who

Alan Levine

Secretary

Louisiana Department of Health & Hospitals
628 N. 4th Street
P.O. Box 629 (Zip 70821-0629)
Baton Rouge, LA  70802 Phone: (225)342-9500
Fax: (225)342-5568 dhhwebadmin@la.gov

Long Term Care
1-877-456-1146

All of the Time, Every Time with Medicaid

Monday 10/12 - 8 hours on medicaid related meetings, phone calls, and forms. Progress = ZERO

Tuesday 10/13 - 6 hours  on medicaid related meetings, phone calls, and forms. Progress = 1 form mailed.

Wednesday 10/14 - 2 hours.
Progress = Medicaid canceled Urodynamics test. Ordered by Neurosurgeon. Scheduled July 27, 2000 for test date of October 20th. Have waited 2 months for this test and Medicaid canceled it a week out. Shame on you, Mr. Levine. Shame.

Thursday 10/14 - 7 hours.
Progress = 1 Board Certified Internist Appointment as directed by Neurosurgeon @ 11am
bus to and from hospital
blazing sun
90+ degrees F
strength sapped while waiting for bus [10 minutes @ 1 end and 55 minutes on the return].
serious difficulty walking - Pretzel Legs.
major pain
very frank and honest discussion with Primary Care Physician, who wrote 6 Rx's.

Note: Pharmacy could not fill 1 of these because I currently have an 11 day supply. The number of treatment days provided by the prescription, generally 30 days, must pass before medicaid  will pick up the cost of a refill. Generally makes sense.


NOTE II -

Pharmacy could not fill a 2nd because medicaid "is requiring pre-approval." Pharmacy will manage faxes and other requirements, then notify me when prescription is ready for pickup.

PROBLEM =This  means a second bus trip on another day, just to pick up 1 prescription for medicine I have been taking monthly since late 2007, and has never needed Medicaid's 'pre-approval' before now. Second non-budgeted round trip cost $2.20. Won't be able to get there now until Sunday at the earliest because, as is usual, I am experiencing volatile lower bowel distress and will be a shut-in for 2 days while recovering from today's activities. Bear in mind also, that this 2nd trip for an issue that should have been resolved by today's series of events will result in more bodily distress and a 2 day layup because of that activity. 6 days of T-O-R-T-U-R-E accomplishing what should have been accomplished today.  Thank you Mr. Levine. I wonder what the total cost of that prescription ends up being after tying up all these professionals because of bureaucratic nonsense? Wasting [stealing] the taxpayers $$$, Mr. Levine. Any thoughts you'd like to share?

This is representative of most days on Medicaid. The incentive to remove myself from the dole is great. My goal is to get well enough to say thanks to Medicaid, and move on, providing for myself once again.

Mr. Levine and this bureaucratic nonsense is not helping. Shame, shame, shame...

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

All I Want For Christmas

When I fell into the steps and broke my teeth in May 2007, I thought maybe all I'd want is some teeth. Unfortunately, Medicaid can't provide medical related transportation. At least all of my attempts in the past two years have been fruitless. Plus, it takes 2 years to be seen by a dentist.

So, how about we shoot for something reasonable this year - RELIEF.

Whaddaya say, Mr. Levine?

Are ya up to it, or should I just hurry up and die?

PS - are you any relation to Dick Cheney? You both seem to favor torture.

Pain Management

NOT covered by Louisiana Medicaid. Anyone surprised by that? Can you spell T-O-R-T-U-R-E, Mr. Levine?

The ankle bone's connected to the what?

With genetics popping up all over the place in this medical exercise, this is the picture before me today:

Multiple Sclerosis is not fatal [but it sure is disabling], so I guess Mr. Levine wants me to hurry up and die. Can't let me cost Medicaid much money, ya know.

The Tethered Cord

Have you ever heard of an Obese Filum? Okay, the technical term is Fatty Filum, also known as Tethered Cord. Obese Filum just sounds cooler.

I had never heard of any of them until the Neurosurgeon told me that that was part of my problem.

Seems we all have this thing very similar to a rubber band in our spine that stretches when we bend in any direction. When you straighten back up, it pulls back into shape and helps to align your spinal cord. Another genetic thing, I understand.

Mine doesn't work. Knowing what it is now, I realize that mine hasn't worked in many years, if ever. I have ALWAYS had problems reaching down to tie my shoes, could NEVER do jumping jacks, certainly could not bend from side to side. Explains all those 'D's in gym class, why I couldn't play football, and why I never owned a Frisbee or climbed a ladder, eh?

There is a great rundown here: Tethered Spinal Cord

Again, the Neurosurgeon's request to do something about it was just DENIED by Mr. Levine's Medicaid.

Oh, and here I am. Essentially unable to move from where I sit and no relief from Medicaid. Does it help to say, 'Help, Mr. Levine. Help'?? Sorry, I forgot. I won't die from this, so It's benign.

Would it be fair to observe that you would like for me to hurry up and die Mr. Levine?

Oh, and I wet the bed until I was 14. I know why, now.

Bowel Incontinence, Diarrhea or Constipation are common. Urinary Incontinence, Frequency or retention are also common. Imagine that?

Thanks for all of your help, Medicaid.

It's The Economy Stoopid!

Chronic low back pain disability is the most expensive benign condition that is medically treated in industrial countries. It is also the number one cause of disability in persons under age 45. After 45, it is the third leading cause of disability. Disc disease costs the health care system more than $50 billion a year.

Did ya catch that? BENIGN. It means it is not going to kill me. Louisiana Medicaid has forced me to submit to torture for almost 4 years because my condition is not fatal. Should I equate Mr. Levine with Dick Cheney? They do seem to both favor torture.

To be fair... The Neurosurgeon ordered physical therapy. I am still working on finding one that takes Medicaid and that I can get to by bus. Oh, I forgot...  I can't take the bus anymore, and not once in 2 years has Medicaid been able to provide transportation to and from medical appointments for me. Everyone that I knew that had transportation, moved to other states after The Thing. Lack of transportation is a serious issue down here.

Hmmm... wonder what it costs us in GDP? Bet that's a lot more than $50 billion a year.

June 20, 2009

10 days after I fell out of bed [Which now has railings. Also known as Durable Medical Equipment. With NO thanks to Louisiana Medicaid, who DENIED my request]. That fall was the third time I had fallen out of bed since the stroke. The first requiring a hospital visit. Not that THAT did any good.

10 days out and the more active I am, the more I lose control of my bladder and my bowels. I have made messes for days and a person should not have to live like this, so friends took me to the Emergency room. They took a blood test, some radiology, told me I had gastroenteritis and sent me home with some anti diarrhea medicine.

The Neurosurgeon ordered up a Urodynamic [Urologist], and referred me to a Gastroenterologist. Finally, I thought, we shall get some answers. My mistake. Thought and Medicaid are like oil and water. At least here in Louisiana and under Secretary Levine's watch. Oh, and Medicaid does not seem inclined to give answers either.

Yesterday Medicaid canceled the urodynamics exam, which had been scheduled since 10 days after I fell out of bed. Medicaid told me that I have reached the limit for doctor visits. I've not yet determined if they mean ANY/ALL doctor visits, until when, or whether that includes other ordered and scheduled tests already on the books. Mr. Levine, care to answer, sir?

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

Fall Out of Bed - June 10, 2009

I remember the feeling that I was falling quite rapidly from a height. I was whirling my arms in that way we have when we're off balance and falling forward. I was dead asleep so I can't say whether hitting my head on the edge of the door woke me, or if I was knocked out when I hit. I remember the pain. I've been conditioned. The blood on the floor didn't phase me. I did upchuck a few times, but made sure I did not fall asleep. Been there, done that. Gave those details to Medicaid already though. Fill in the blank, check the box. Move to the right...

I should not have gone to the emergency room that day. I thought the pain wracking through my body was up there; It was NOTHING compared to the next week. But, test results that I have never been shown indicate no new damage I'm told. okay.

Let's see now... I had had to buy a new laptop while in exile following The Thing. I fell over with it and on to it so many times that my falling destroyed it. You will have to forgive me if I do not recall how many times I have fallen since the stroke. Nine times in the month of October 2008 I know.

I do remember kidney stone #27 passed later the same October day I fell on the outdoor steps and ripped off half the house on the way down. Hey, passing a kidney stone is a major event; ya take the benefits where ya can. No pain help there either. Do we sense a trend? Mr. Levine, can ya help us out here?? Are people that really need intelligent pain management being discriminated against here in New Orleans? Because of The Thing??

I apologize. I forgot that intelligent doesn't quite fit into the Medicaid lexicon.

Ten days later and I was in another Emergency room...

Back Story II - No Pun Intended

Going back to the blizzard of March 17, 1973 and pushing many cars out of snowbound ditches that week, I have had back problems. Anyone knowing me much of these past 36 years knows that my back has not been one of my strong points for many years, and in-fact, has been through more than a couple violent traumas.

Neurosurgeon ordered Durable Hardware to operate, but was DENIED by Louisiana Medicaid.

My thinking is that I put far more faith in what any Neurosurgeon says about a brain or spine over the bureaucratic nightmare named MEDICAID, eh?  
 
MRI May 8, 2009:

Should I only be told to, 'Take Aleve' for this? That's what Louisiana Medicaid says. You tell me...

 I'm working on an index of medical definitions for you. In the meantime:

Annular Bulge:

But you know, it wasn't until just this past May that turning to put that fork or spoon into the drawer that the sciatic nerve went bonkers [and hasn't stopped since]:

Spondylosis: (spinal osteoarthritis) is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual. The degenerative process of spondylosis may affect the cervical (neck), thoracic (mid-back), or lumbar (low back) regions of the spine.

A month after the MRI, I fell out of bed.

The Back Story

This sequence of events really starts with a series of heart attacks just before Christmas 2002. Over a 5 day period I suffered 7 heart attacks that I mistook [from past experience] as kidney stone attacks. The good people at University Hospital in New Orleans took their blood test and rushed me into two angioplasties over two days. Unfortunately there was a complication during the second procedure, and after a code blue in ICU which afforded me another near-death experience, I held on for the next week. After a month of recovery from the bleed-out, I was able to function well enough to return to part-time work. [Thank you, Leigh.] For the next 3 years I was actively involved in developing and managing a successful business operation. Life was good.

The morning of Monday, August 29, 2005 brought Katrina. The following days exposed the complete system failure of our own local, state, and federal governments. I returned to New Orleans 5 weeks later, and learned that I had lost my home.

Though I had plenty of the various medication I needed on hand for the duration, I was unable to obtain refills of my prescriptions in November anywhere in New Orleans, because not a single pharmacy had reopened. This, I realize now, was the beginning of the end of anything related to my own good health. On November 19th, I suffered a stroke while sleeping on the floor of my business.

The good people of The Spirit of Charity Hospital, operating out of tents in the now infamous Convention Center, brought in a mobile cat-scan and later transported me to Touro Infirmary. There, the medical staff of the destroyed Charity Hospital and the decimated LSU HealthCare Network, working in unfamiliar surroundings, guided me to improved functionality and gave me direction for follow-up care at a health clinic they were reopening some distance from my own location.

One was forced to do EVERYTHING differently than we have ever been taught or learned how to do on our own. The good folks at Touro evidently did not realize that patients could not get prescriptions filled ANYWHERE in the city. Due to the pharmacies being looted by the city's addicts during and following Katrina, we had no pharmacies. When eventually some did reopen, New Orleans' patients had to follow far more involved and strict procedures than ever before to simply get a prescription filled. Most of these rules have now been adopted nationwide, and I am certain many of you are now dealing with many of the same aggravations that we here in New Orleans have had to deal with since The Thing. If you are unfortunate enough to require pain management, that in itself is a whole new ballgame entirely.