The Roller Coaster ride of Medicaid.

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Well to say that there have been ups and downs this week would be a huge understatement. Got myself set up for my procedure only to get a letter saying that it was not approved by my insurance. Had to call and get doctors to send more information to the insurance to get it approved.

Today got the call while out with family that it was approved.

Even the lady that I talked to was like this is crazy that you have to go through this process to get stuff done. She had to look at my records before sending them off so now understands how bad things have been for me.

Lucky now it seems like things should move better but I guess this is the norm for people on Medicaid.

It is crazy that a non-medical person can stop you from getting the care that your doctor says you need.

 

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Sorry I got similar crap thought workman comp

 

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Geeez Fl Guy, I agree 1000 percent that it is strange and other-worldly that a non-medical person has the power to stop you from getting care that your doctor says you need!!!
But I'm glad that after fits and starts you are now approved!
And doesn't it seem that for every step you take forward, you have to take two steps backward??? It feels like that old myth or fable about the man who was punished eternally by rolling a boulder up a hill only to just about reach the top and the boulder rolls back down the hill and the man has to roll it back to the top. But you will get to the top of the hill and step onto the summit and you will have made it to the top without having to look back!! Just keep on keepin' on!!!

 

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Glad to hear from you. As usual you worked through this road block.
Be well

 

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I am having Botox injections to paralyzed the muscles in my bowel that are not working right and I have no feeling in... But the Botox was not approved for what the doctor said I have so they had to put together everything else going on and update my dignosis finally and it got approved then.

 

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It comes down to the almighty dollar. They want you to try a lesser cost procedure first to save money. If it works, the insurance companies save money, if not, it costs them more in the long run. It seems they would like to spend 10dollars here to save 5dollars later.
It's like a company that I retired from. The design engineers saved money by using less expensive parts, but the labor costs more than doubled in the end product

 

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I have Medicare and Medicaid. Actually, I think Medicaid might be better than some insurance. Sure wish I could get adequate incontinence supplies, tho. You are allowed a certain number of pull-ups/diapers and of booster pads. That is further defined by how they come packaged. So the boosters come twelve to a package and the pull-ups so many to a package and you can only get full packages. The pull-ups come 25 to a package. So I get 50 pull-ups, even tho I request two a day, because 50 is too few but 75 it too many… so 100 pull-ups only leave 12 full packs of boosters. I can’t add more pull-ups unless I add another package of 25 and that kills two packs of boosters. Add to that the company chooses what products to offer for what they get from Medicaid. Suffice to say they aren’t top quality…

Also, Medicare mails my drugs to me. You know, huge amounts of $$ in drugs, just going through the mail and into my mailbox, but they insist that I have to SIGN ft the thins I’m going to pee on. It boggles the mind!

 

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It comes down to the almighty dollar. They want you to try a lesser cost procedure first to save money. If it works, the insurance companies save money, if not, it costs them more in the long run. It seems they would like to spend 10dollars here to save 5dollars later.
It's like a company that I retired from. The design engineers saved money by using less expensive parts, but the labor costs more than doubled in the end product

Agreed, but my colorectal surgeon only gave me three options... Do nothing, Try botox or/and might still end up with a colostomy.

Yeah I will try the Botox and hope for the best.

 

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FLGuy: How are you stocked up on Aspirin?
I'm not sure what we expect. Look at the evidence. I have a CPAP machine for a fairly serious case of Sleep Apnea. The maker of 60+% of the machines in this country just had to put out a recall. Not some of the machines, but all, for the last 5 years. Private Insurance sent me to Medicare. Medicare sent me to the maker. "Buy a new machine, with your own dime. Or rent the machine, with your own dime. Send it in for repairs, but you don't get a loaner. Oh, and by the way, there is a nationwide shortage of the machines and we are waiting for the FDA to approve the replacement part."
Now I find out the maker - a super big, super rich, super diversifed company - wants government to pay for all those new or repaired machine "so they don't go broke." With our tax dollars.
It isn't safe to drive a vehicle, operate heavy equipment, operate dangerous tools, with untreated sleep apena. It does nothing good for your incontinence, either. The hazard? I'm told you will be breathing particles and a gas, both hazardous.
When will we see resolution? The providers (the one that prescribe or provide the CPAP machines & supplies) say they are told 9 months to a year. If translated from Medicare language, that's 3 years.
That's the medical system, in the good old U.S. of A.
Take 2 aspirin and call me Monday morning.

 

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FLGuy: How are you stocked up on Aspirin?
I'm not sure what we expect. Look at the evidence. I have a CPAP machine for a fairly serious case of Sleep Apnea. The maker of 60+% of the machines in this country just had to put out a recall. Not some of the machines, but all, for the last 5 years. Private Insurance sent me to Medicare. Medicare sent me to the maker. "Buy a new machine, with your own dime. Or rent the machine, with your own dime. Send it in for repairs, but you don't get a loaner. Oh, and by the way, there is a nationwide shortage of the machines and we are waiting for the FDA to approve the replacement part."
Now I find out the maker - a super big, super rich, super diversifed company - wants government to pay for all those new or repaired machine "so they don't go broke." With our tax dollars.
It isn't safe to drive a vehicle, operate heavy equipment, operate dangerous tools, with untreated sleep apena. It does nothing good for your incontinence, either. The hazard? I'm told you will be breathing particles and a gas, both hazardous.
When will we see resolution? The providers (the one that prescribe or provide the CPAP machines & supplies) say they are told 9 months to a year. If translated from Medicare language, that's 3 years.
That's the medical system, in the good old U.S. of A.
Take 2 aspirin and call me Monday morning.

I wish I could take anything for pain.

The goal of this pressured is to give my messed up muscles time to relax. Two weeks after the Botox I have follow up and at that time the doctor will decide on what is next as well as coordinating with my Gastroenterologist about one other tests that has been needing to be done for a while now. After that then a determination will be done and they will let me know if I will be needing surgery for a colostomy or ilostomy.

 

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The VA is another example of a fun trip on the crazy train!

 

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And to think, @LeeC, somebody actually gets paid good money to dream up all of this crap to allow you only so many pull-ups per day!!! Obviously I've been in the wrong business!!! So, you should be allowed as many pull-ups and booster pads as you need in a day to keep you comfortable!! But get the government involved and it becomes.....hoo boy!!! much more complicated that need be!!!~

 

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@billivesere-the government involved in anything is awful. I did not go to the emergency to get everything checked over and this was a big big mistake. If any of you every fall, have them check everything. Here I thought I was doing the right thing, well I wasn't. there better never ever be a next time, if there ever is, emergency room it is.

 

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@thatflguy-so glad I got a new machine last year, was not aware of all these issues. Mind is paid under Medicare. This was my first replacement. The whole country is going down the tubes. There is no customer service anymore, not even in the medical community. IT is just awful. I am tired of being my own advocate all the time. IF I laid down this evening and the Lord called me home, I would say Thank You for your blessing. I know he is not done with me yet. Take heart, keep up the fight as Paul suggested, know when you close your eyes for the last time, that you put up a good fight. Have to go do my therapy exercises and get off the computer. Blessings-be grateful for what we do have and don't forgot to pray for yourself.

 

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Medical decisions are being made by beaurocrats & secretaries. If you ask where they got their medical degree, they say they didn't, but say, "oh, we have a doctor who reviews such thing." Yeah, right - one doctor for 100,000 (or 500,000) patients. Bet he has a fabulous salary & benefits - but of course, that doesn't influence his decisions. Does he even come in to "work"?

 

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@AlasSouth-I agree with you, Medicine has become a big business and it is hard. They have so much to do and not enough time to it. I know, I have a couple of really good doctors and some so so. I been gathering my reports from some of the stuff. They have stuff in there that is just not right and not complete. For an example. the doctor put down I had a cast on, she didn't say it was on the right arm. so they are assuming everything was on the left arm. Until one gets their reports-cone cannot correct it and if one is not thinking at that time to correct when one is in shock from the trauma. From now on I am going to the emergency room and hope they do a better through job. Urgent care does not. Sure they have x-rays but not access to MRI's which sometimes one needs right away. Just my opinion. There seems to me there is not enough time and dedication for them to do a good job. Besides some of them do not belong in the medical field. Just my opinion. There are Doctors and there are Doctors. The routine stuff they can handle but our bodies are not routine. We wouldn't be having all this crap if they were.

 

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Here is the thing that makes me go WTH.... My Medicaid is through the Department of Human Services Pennsylvania who subs it out to Geisinger Health Plain which is through the hospital that I go to. There should never be an issue because their doctors are the ones ordering tests/labs/procedures, but I still have to deal with the business side of things.

When I talked to the appeals lady (who is not an MD, RN or anything) about everything going on with myself it was like I was speaking another language. After passing all my stuff off to their team of MD, PA-C then things got changed.

The worst thing is that this is just the first step in the process of what my doctors want to try this year so there is likely going to be more of this dealing with the appeals.


After my Botox on 8/6, the goal is to do two more tests and maybe one more procedure to finally get an idea as to what we are going to have to do.

The sad thing is nothing talked about will get me back to even 50% of what I was before all of this started.

The work-life that I thought that I would have is over and I can only hope that this covid-19 crap goes away so I can get back doing some of my hobbies and keep my sanity.

Right now I have been playing a lot of Xbox and taking a few photos of the family to keep my head not stressed out about everything.

Next week with be crazy and it looks like my Grandmother is going to be the one taking me for my procedure so I hope it goes well and I am okay after. I am going very prepaired.


I have gotten use to wearing my Gary wear pul pants all the time when I am out of the house and it has helped a lot.

Now to just get throught next month.

 

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I have been using 1X pull-ups. I ran out of the 1X and used some 2X I have gotten from a friend. I’m right in between the two sizes but find the bigger ones more comfortable. At the same time, I have to wear a pair of underwear over them so that my booster pads don’t FALL OUT once they get full. Ok.

I call the distributor to go up a size. In NY for Medicaid, I have to jump through hoops because the 2X is bariatric. Now I need extra paperwork from the doctor to go up to bariatric. I panicked and asked them to send me the old order, which they agreed to do for one month.

The paperwork all got in! Yay! Ordered the new size. They told me it would ship a week ago. When it didn’t arrive, I called back. Oh. Now my “insurance” has to ok the size change. So apparently Medicaid. So we are approaching the third month f the process. With no product in sight. I have bought some of the the right size pull-ups to keep me going, but the booster pads will be gone soon. Grrrrrrrrrrr!

 

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I've been trying for two weeks to get my insurance to approve cortisone enemas for my ulcerative colitis. The pharmacy didn't even send in the request for a prior authorization for almost a week, then it took my doctor's office several days to get the paperwork done. Now I'm waiting to see if the insurance will approve it. I'm not all that hopeful.

What's funny is that this insurance is usually really good about approving other things. Botox? No problem. Oral meds? No sweat. But when it comes to rectal medications, I've never gotten anything approved - they've turned down two different suppositories, and now they're dragging their feet on these enemas. Maybe whoever does the approvals thinks rectal meds are too icky to approve.

Then again, they never did approve my bladder insulation meds, either. Maybe that's too icky, too!

 

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@itapilot-try finding out the state agency which regulates the insurance and complain. IF you have an issue-talk to your state rep or senator. Their staff need things to do for sure. Good Luck-there is no customer service anymore. In the medical field this is not acceptable behavior. People have forgotten what it is like to work hard. I just had to file a complain against a therapy company for not obeying doctor's orders or telling them they were not going to do it. This is not acceptable. Life is hard, I have so much stuff to get done and waiting on people to do their job is frustrating but I find other things to do and keep their stuff in a file or on paper. Keep a journal, we need to otherwise we forget important stuff. Everything is done verbal so there is no documentation at all.