FUCK YES

1/27/17     12:09pm

I am SOOO ANGRY. And I slept 22.5 hours last night so I have plenty of energy to direct that way. I managed at least to scream “FUCK YOU!” after hanging up the phone.

I called the Coordinated Care Initiative line for the State of California. They are supposed to handle the conversion to and exemption of dual eligibles (those of us eligible for both Medicare and MediCal) from the new managed care requirements in this lovely state. The only easy way out of this requirement is to have HIV/AIDS or be an American Indian. I’m tempted.

What am I talking about?

Medicare is the health insurance offered to most seniors and people on disability (after 2 years). It’s hard to find a specialist that takes it but there are many useful hospitals that take it for medical and psych. There is a 190 day inpatient limit for psych days at a free-standing hospital. (When I’m better I shall be tackling this.)

MediCal is California’s version of Medicaid (federal health program for poor people.) It is near impossible to find a skilled clinician, if they give you a doctor at all instead of an intern, on MediCal. It is a good net if you have non-specific or only emergency medical needs but if you have chronic medical conditions and/or psych needs and have only MediCal, you’re screwed. In some clinics it’s better to be completely uninsured and pay a sliding-scale amount and see a good doctor. Having MediCal (and Medicare for that matter) also usually exempt you from prescription discount programs offered by manufacturers, even though formularies are scant.

If you have both Medicare and MediCal, MediCal won’t pay for any fee that is above what Medicare determines they should be paying your clinician – no matter how far below industry standard or just human dignitiy would allow. Yet our great state of CA decided that being covered fully by both insurances was just too much. In Jan 2014 they started a “demonstration period” of what’s called the “Coordinated Care Initiative” and started forcing people into either CalMediConnect (a program that pushes you into an HMO that rolls your Medicare and MediCal into one, SIGNIFICANTLY limiting your benefits) or whatever Medicare you already have plus being forced into a MediCal Managed Care Plan HMO. I opted out of this “demonstration” in the very complicated and hard to find way they barely provided as I watched the change mess up countless lives.

Then a few weeks ago I got a similar packet in the mail. I did some research online finding that the demonstration period ended Jan 2017 but no info on what the outcome was, whether it saved money, links to the actions taken by our government to expand or make it permanent. Nothing. Someone from CCI called to enroll me in a plan Wednesday since I hadn’t mailed in the form. I explained that I had no intention of joining an HMO because it would complicate and jeopardize my care and she told me where to find an exemption form. But the form says it’s only for people who don’t have another insurance. So I called back today.

I won’t lie. I’d be happy if this man’s head exploded and a MediCal doctor was left to piece it back together. He tried to convince me I wasn’t being forced into an HMO. FALSE. Then he told me I’d qualify for a non-medical exemption but failed to mention the American Indian or HIV/AIDS part right away. I asked about the demonstration period and where I could find information. “We’re just the enrollment center. That’s the state… That’s not my department. That’s not my issue,” he said. He kept coming back to trying to tell me my doctors wouldn’t be affected by joining a Managed Care Plan. Then he went and said it. “Well, if the only reason your doctor won’t see you is because of the extra time it takes to do MediCal paperwork, is that really a doctor you want to be seeing?”

YES!!!

How much more of a fucking idiot could he be?!! Just how they want them at the CCI office I bet. I told him, “YES!” Those are the doctors who have time to hear what’s going on, who listen to my situation, who have experience and choose to actually get paid for it instead of working for free or just supervising 10 interns at a time as they run around the office “practicing” medicine. FUCK YES.

Aside from just being rich, Medi-Medi with fee-for-service MediCal was the best insurance one could get. MediCal pays my monthly Medicare premium, automatically qualifies me for Part D Extra Help (making my generic drugs about $1 and my brand name drugs about $3), and picks up the copay at any doctor I see or prevents them from charging me one. I’m not looking forward to this new world and what will be denied or changed. At least I can blame screaming “FUCK YOU” at them on being crazy.

TIP:
I run into doctors who take Medicare but not MediCal and if you tell them you have both they say they can’t see you as a patient because they don’t take MediCal and it’s considered fraud to charge me my Medicare 20% or anything else.
WRONG
Usually I just call back and don’t tell them I have MediCal. Then they take me but I guess it’s still fraud.
I learned this from HICAP when I called a few days ago: It’s not fraud if they give me a statement in writing that they don’t accept or bill MediCal and I agree to this in advance of treatment. Sweet! I’m on the search for a preformatted statement like this and will post it when I find it. Then I can blanket the city and my group with this new information. I even had a girl turned down by a Sharp Urgent Care the other day because they told her the same thing. I do have ins at Sharp…

Don’t fuck with a fucker. I’ll take you out. ;)

© Michelle Routhieaux 2017

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Man up, people

12/22/2013     10:22pm

I am SO frustrated by people complaining about the new healthcare mandate. Oh, poor you, now you have to pay for insurance and you think it’s SO expensive. Um, reality check. It’s no more expensive than it’s ever been. You just haven’t taken the time to learn about it, to care. Then you end up in the ER and want charity care for the tens of thousands of dollars of work you had done when you were there. Seriously? I hear employers lying to their people that Obamacare is the reason they chose to give their employees shitty insurance with higher deductibles and less coverage. It’s not true. I know people who want perfect doctors and miracle treatments for free even though they have money. They have thousands of dollars in medical debt in collections. They just see different doctors and move on. IT MAKES ME MAD. Man up, people. Be responsible. Take care of yourself. Learn the facts. Choose wisely. THEN feel free to bitch around me about your terrible healthcare plans and how they’ll keep you alive.

© Michelle Routhieaux 2013

Weary

12/30/11     3:53pm

(big sigh) I am so tired.
Not sleepy tired but weary.
I just spent an hour and 8 minutes on the phone with MediCal – the last 4 with an actual person. They have not processed my annual packet that I waited 3 hours for a receipt for and turned in on time and are therefore discontinuing my benefits as of Dec 31st. (roll my eyes) They did this last year too.

I posted on my FB that I was frustrated and this guy commented about how I should have private insurance and how it’s so much better. Really? I think not. Does he think I want to be a charge of the state? that I enjoy being tangled up in bureaucracy that dictates my life? I DIDN’T CHOOSE THIS! I didn’t wake up one day and say, “I think I’ll be sick for a living. That sounds fun.” I had a life. I’ve had private insurance. I have Medi-Medi now. And honestly, it’s the best of all the insurances I’ve had. Not just Medicare alone or MediCal alone, but both together. It is a magic combination that keeps me alive. I like being alive.

There are so many things wrong with these systems that I could write about if I had the energy, but I don’t. I’m tired. It takes so much work and knowledge and research to navigate the systems successfully. I am tired. I am tired.

My body is weak. My spirit is wilting. There is nothing to do in this moment but rest. Prepare for the fight.

© Michelle Routhieaux 2011