Tuesday, December 9, 2014

More Adventures in Healthcare (The Medicaid Experiment)

When I started receiving medical bills from two-and-a-half weeks of hospital bed rest, an operating room delivery of twins, and two weeks of NICU, I knew something wasn't right. 

From what I'd been told, Medicaid patients aren't responsible for any part of their medical costs, and don't even see their bills, but in the few weeks since bringing home our twins, I received calls and letters from the hospital, my ob-gyn, and the anesthesiologist, informing me that Medicaid had denied their claims.

Up to this point, we'd been using a healthcare co-op of sorts that's great for minor emergencies, for childbirth, and even for catastrophic events, but I just couldn't imagine recovering from birth caring for two new babies as well as our other kids at home, while compiling and processing medical bills and reimbursement checks, which is part of the co-op process. 

So I looked up Medicaid -- mainly out of curiosity -- armed with the sudden free time of mandatory bed rest (which incurred the unexpected partial loss of salary that prompted the curiosity), and I came to find out that our modest income, combined with the unique ability of the American healthcare system to bankrupt anyone, qualified us for Medicaid. 

I called Amerigroup, one of the private health insurance companies through which Medicaid disperses coverage, and asked if there was a problem. Yes, they informed me, there was. 

Despite my indication otherwise on the 12-page application, supporting documents, and a follow-up phone interview, they had somehow dug up a record from 2012 that showed I was already covered with private insurance through Aetna. So rather than call me to check on the apparent disparity, they just denied all claims. 

I shook my head. Yes, in 2012, I was covered by private insurance through Aetna. But didn't their records also show that I was dropped from that coverage in 2012? No, they don't have that information. (But they can fill out an incident report and have their insurance team research it. Yes, please do that.

I called back the hospital, ob-gyn, and anesthesiologist to give them an update. They were surprisingly unsurprised. Apparently it's a thing for Medicaid insurers to automatically decline the first submission of bills. 

So while Amerigroup was working out whether they could dump financial responsibility on a two-year expired outside party, I tried to keep my blood pressure down as I read through the bills. Here are some highlights: 

Each day in the room: $2100.00
Each prenatal vitamin: $3.68
Each dose of Miralax: $25.00
Each time they listened to the babies' heartbeats: $766.00
The USE of the ultrasound machine: $1500.00
The doctor who used the ultrasound machine: $1500.00
A 10-minute consultation with a NICU nurse: $278.00
A 5-minute visit from my doctor to check my vitals: $275

The list goes on and on, mostly with coding and medical terms I can't interpret. But the Miralax is what I really can't get over. How did this 14-dose, $10 bottle of medicine get marked up 3500% when administered in a hospital? 

Did I do that math right? 71 cents per OTC dose versus 25 dollars per hospital dose?

I've been an advocate for a national healthcare system for years (note: not a national system that lines the pockets of private health insurance companies without providing any actual healthcare, which Obamacare seems to have inadvertently created, but an actual healthcare system). 

I was picturing something that could match the functionality of the postal service: slow, even when there's not a line out the door, but effective and affordable. And if you want something better, just stop by a UPS or FedEx store and pay a little bit more. 

But the bureaucracy we've discovered in Medicaid likens more to an unsolvable maze or never-ending roller coaster. 

It would seem I'm ungrateful, to complain about free medical care. But here's the problem, and why I have to validate my frustration and complain about Medicaid healthcare: it's not free. This crappy system is costing tax payers about 25% of our state budget! Our tax dollars are disappearing into a bureaucratic rabbit hole of paperwork, call centers, and ineffective checks-and-balances.

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We couldn't check out of the hospital until we scheduled pediatrician visits for our sons. It took nearly two hours of phone calls.

I called the pediatrician, but they needed the Amerigroup ID numbers for the babies. I called Amerigroup, since the twins had automatically been covered under me at birth, but they couldn't assign numbers. I called Medicaid, but the option to add a dependent to a plan wasn't in the five-minute options menu, so I waited in a 17-minute queue to speak with someone directly. I finally reached a representative who spent 20 minutes entering their names into the Medicaid system and adding them to the Amerigroup plan. I called Amerigroup back to confirm they had a record of the twins, and to get their insurance ID numbers. We spent another 15 minutes entering their pediatrician's information as the primary care provider on their account. I called back the pediatrician's office to provide Amerigroup ID numbers and schedule appointments. 

Two months later, I took the twins back for another wellness visit. Somehow, one of the twins had been dropped from Amerigroup and transferred to another insurer contracted by Medicaid. I hadn't even heard of this other insurance company, had received no communication from them, and worse yet, the babies' primary care pediatrician wasn't even in-network for this other company. 

Another hour working through the Medicaid roto-dial, calling Amerigroup then Medicaid then Amerigroup, and we get nowhere. The representative can't figure out how one of the babies was moved to a different plan, but they can't move him back, because there's a 90-day waiting period to change plans. (But they can fill out an incident report and have their special situations team research it. Yes, please do that.)

Two weeks later, I receive the first communication from Molina, this new insurance company that the baby was mysteriously and untraceably and irreversibly transferred to over six weeks earlier. It's a little paper insurance card that tears as I attempt to pull it from the perforations in the middle of the page. I give them a call. They won't reimburse me for the cost of the baby's two-month wellness check-up, because his pediatrician isn't in-network. 

I call Medicaid, work through the endless options menu, and wait for the next available representative. She pulls up our case, sees there's a problem, can't help me with it, but will file an incident report and have their special situations team research it. I let her know that an incident report was filed two weeks earlier, but she doesn't see any record of it in their system. She's unhurried and unapologetic, and tries to reassure me: don't worry, because she's creating a new incident report RIGHT NOW. When will it be processed? She doesn't know. Will I be contacted? She doesn't know, but I should call back in two weeks to check. Is there anyone I can talk to that could do something about this? No. Can I submit a written account to go with the incident report? No. 

I began this Medicaid experiment as a competent, resourceful woman. But the experience has broken me. Somewhere between their unaccountable happenings, endless phone menu options, piles of unsolicited mail directing me back to their phone menu options, and helpful representatives that can't actually help at all, I've realized that helplessness can be as learned a trait as resourcefulness. 

It's good to be back with Samaritan Ministries, our healthcare co-op. This option might be paperwork-heavy, but at least someone takes my calls at the other end, and I can rest assured our money is supporting a non-profit that's transparent, affordable, and effective. 


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4 comments:

  1. Wow! And I might add that using private insurance these days is not too easy, either. Spoken from one very familiar with the health care system....

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  2. Oh yes, I agree! I spent several days calling into Aetna's customer service line, a call center in India, back when our 3-year-old had health problems in 2011. It wasn't a good system either. And I felt guilty the whole time, trying to explain the difference between a pediatric neurosurgeon and pediatric neurologist to someone who probably doesn't have access to basic quality healthcare.

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  3. That's a lot of complaining from an individual taking advantage of free handouts paid for by the taxpayers. Be grateful and less whiny. Stop having babies and expecting medicaid to have your back.

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    1. Wow, I didn't mean to sound ungrateful at all. I was very grateful to have healthcare when it was needed, and amazing caregivers. I know there are many, many Americans with inadequate or nonexistent healthcare, and I wish they had access to a program like Medicaid as well. I don't think the Affordable Care Act has been as helpful as everyone hoped in providing affordable healthcare for everyone. As our country seems to be moving toward a single-payer healthcare system, I think it's important to point out the problems our government-run healthcare system is already having. We might realize, perhaps this isn't the best solution for affordable healthcare in America (or maybe it is, but could be run better).

      Secondly, I AM a taxpayer and pay into the system. I'm sorry if you feel some who receive tax-subsidized services are less deserving than others (presumably based on income and ability to pay into the system). If you have a serious problem with tax-funded public services, I hope you find ways to avoid public parks, driving on roads, emergency services, and public schools, especially specialty programs like Gifted & Talented, sports, music, or special education.

      Finally, this has nothing to do with the number of babies I have. Our babies are happy, healthy, and very well-loved. Our kids are awesome. This is a healthcare issue, and it's an important national discussion. The cost and access of healthcare in the United States is inexcusable, regardless of how large or small our family is.

      It seems you and your family have access to quality healthcare, and the jobs that provide this. Please know, as you enjoy those benefits, that this is not the case for the majority of Americans. It's not because our families aren't small enough, or we aren't hard-working, ambitious, or well-intentioned.

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