Medicaid is being held hostage, new insurance company

Well , here is some more busy body bureaucratic bullshit, sticking their noses into my business. Just recently I learned that Medicaid is being handled by some new insurance company. I thought, okay, I really don’t care, as long as they do not mess with my care. I spoke too soon.

As if the GI docs, messing up my insides, were not enough. As stands right now, a medication my Doc had a hissy fit over, when I did not get it last time, due to my IBS.. well it’s being held up again, not for lack of a script, as it has refills on it,  but the new insurance company has up and decided, they will not pay for it, as written, unless the Doc explains to them, why I need it twice a day, instead of once. 

Now, I ask you, since she wrote it that way to start with, does that not assume, that is how she wants it ? And up to now, Medicaid has been paying for it. My phamacy guy has faxed over a request, twice and Doc office has not been answering the phone. yet. I’ve been off a medication that already has refills, for a week now and suffering for it. ( I did not realize how well they were working, till they are not there )

Now we have to prove to some faceless bureaucratic board, that I need, what my Doc has already ordered for me ? What a damn chock… on the war path here on this one, this is the frist time and it had better be the last time they interfere, or I will have someones head.

Going to put my War paint on and sic my Doc on them while I am at it.. as she is gonna have a Cow over this one !

Medical frustration’s continue and day to day life with FMS

Gurrr.. had to call my doctors office.. yet again yesterday. No less than 3 of my medications have to have pre authorization now ( thanks to medicaid changes) and as yet, nothing had been done on them. In fact, when I called the woman was reciting requests that had already been completed, and only one of them that had been faxed. So had to have my pharmacy re fax the entire lot.

And get this, the woman insisted that anytime something like that comes in, they get on it right away. Well, if that is the case, why do you have only one in front of you, when 3 have been sent in the last week ? 

But, the good news is, the bath chair I FINALLY got, works like a charm. It is amazing the little things, that we did not even realize were such a pain, like washing ones feet, that suddenly one can so, without having to worry about falling down. It was very relaxing in point of fact, as up to this moment, I did not quite grasp, just how tense I was in the bath, just to keep from falling out of the thing. So score one for me.

The rollenator thing, is gonna take some getting used to but I think it will serve very well, when its time to do the marathon walk about, like at my doctors office for example. I never can just sit there, as my feet have to be up. But, as my mate pointed out, I could just as easily take the rollenator, put it in front of me and use IT to prop my feet on.  🙂

The heat is still trying to murder us all, and is zapping energy like crazy. As there is only so much AC can do, to handle triple digit heat indexes. The hurricane Irene ( blessings on all in her path ) brought us just a dash of rain and a few days of slightly cooler temps for a couple days. 

Just a minor side note: Our TV went out,  for no particular good reason, but thanks to Freecycle, we were able to get a replacement in pretty fast. I am not a huge TV buff, but two things. One we pay a good deal for that aspect bundled with our phone and internet and Two, it’s the only the thing that saves me from going right up the wall some nights when I cannot sleep or the pain is too great for the wimpy PK’s my doc gives me, to handle and I desperately need a distraction.

It’s the weekend again, which means I cannot do a thing about riding herd on the grasshoppers I am trying to direct in the medical profession, so I refuse to even bother my brain about it.. at least until Monday 🙂

More soon…



Doctor’s/Goverment who can’t seem to do their jobs and FMS

Ready to scream here. Recall that surgical consult I had to all but brow beat outta the doctor ? Well the silly woman screwed that up, and it was denied and now I have to backtrack the whole mess, to get it sorted out. Why, for the love all that is Holy, can’t people just DO their jobs ?

On a good note, the business with my hardware, that was ordered over 2 mts ago and its paperwork that was trashed almost beyond repair, is finally over. In fact, they are supposed to deliver them to my door, any time now. But I mean really, two months !!! For one lousy piece of paper.

It seems I no more than get one issue nailed, and up jumps another one, to take its place. It is a never ending battle, for healthcare. All I want to know is why ? As nine times outta ten, it is someone, somewhere, not doing their job !

Example: Have tired for weeks to get through the referral center, to get an appointment with my PCP. Finally gave up on that, as usual, and called her office, directly. Only to be told I can get in to see her in in Oct. Mind you we are still in Aug. here. 

What is up with these people to think that making an appointment, for a new issue I might add, can just wait for mts ?? That whatever I am suffering from, can just go on hold, until they get around to it ?

Another example: One of my medications, is no longer covered by medicaid. Ok, so that means that they have to order something else to replace it, right ? Well that was over a week ago and I and my pharmacy  are still waiting. Likewise I requested a referral to an ENT, over a mt. ago.. I am still waiting. 

All of the above, are people not doing their jobs here. Simple things, fill out the paperwork right for the most part, and make a few phone calls. Ya would think this would be easy. But no, I have to ride herd on the lot of them, calling and going over heads, and in short making a right pest of myself, to get dang near ANYTHING done.

Now, I know that most people can relate, when it comes to insurance of any kind, but can someone please tell me, why it has to be such a pain in the butt ? I mean really ? To basically ask people who are already sick, to have to deal with such crap, is beyond any standard of reasonable, yet, they do it.

It seems like if you stick the words medical or state run, in front of something, you can just about expect it is gonna be a nightmare of mis-fires and mistakes and we wonder why our government is broke ?

Seems pretty simple to me, if dang near every single thing they do, has to be done, 2-3 or four times each, since they cannot seem to get it right the first time, the cost factor, doubles in size for every time they screw it up.

Example: My mate finally got funding for schooling, which he is attending, however, there is yet to be anyone to even be working on it seems, the funding for the certifications at the end of the class, without which, I must hasten to add, makes the classes themselves, useless. No Cert means, you cannot DO the job you are being trained for. They already know we cannot afford to pay for a half a dozen certifications at 200 bucks or so a pop. Which brings up the second issue.

Nor have any of them got off their duffs and even try to work on funding for maintenance. Meaning funds to take care of house and home, while he is going to school, As we are talking almost a years worth of school here. Just as a note, he has already been off work for two years now, and the insurance money stopped coming, over a year ago. So we are living on our savings and borrowed time here, trying to get him trained to do a job he is able to do now.

I mean consider it. Fat lot of good it does to fund the schooling if A: No certs at the end of it all, meaning he couldn’t legally USE the training and B: He can’t attend the classes anyway, as we are homeless for lack of money. So it would be a case of both money, theirs and time, ours, down the drain.

This is the kind of mentality we fight everyday, the people that only do a half assed job and have the nerve to pat themselves on the back, that they do that much.

Makes me wanna limber up my wand, turn the lot of them into Toads, so they have to replace them all and maybe, just maybe, their replacements, knowing the fate of their predecessors .. might try and do a better job !

Welcome to my nightmare



At War with my HMO.. again !

Well, back to a war with my HMO. After taking two mts to bloody find me a Chiropractor, allowed 3 “office visits” only, which means no X rays, no therapy etc. Now they dare refuse to permit anymore as the file doesn’t show it’s medically necessary !

Now mind you, I have no doubt he would have dearly loved to X ray me up one side and down the other, but they would not have paid for that, so can hardly blame him for the lack. He did give me some minor treatments anyway, even though he was not really being paid for that. Yet when he asks for more… they say no, because no proof of need has been show.

This is a real cart before the horse situation here, in that they will NOT pay for the diagnostic workup, yet will deny me seeing him, for lack of it. So its war, yet again, from his end and mine. As the reason I was sent to him in the first place, was well documented.

I have already seen a nero doc about this, he said see the Vein specialists. OK, saw them.. they told me, nope not the blood flow, see a Chiropractor. Now I have to ask a stupid question here, how much more proof do they need ?  Almost a year I have been at this mind you and then after all that, they up and say, it doesn’t meet the “needs” test.

Ready to flat pull out my hair here !!!



Saber rattling and medical frustrations and FMS

Well, I did a fair amount of saber rattling today, as yet again, a whole host of medical things, have yet to be done, mostly paperwork and referrals, that to me, are important but I seem to be the only one, who thinks so.

Now what is the most aggravating part, is things like my doctors office for example: Most of the people in my doctors office, either A: Do not speak English well enough to even understand what I am saying, or B: Act like they have no idea, what I am talking about, even with the paperwork right in front of their face.

This concept is further complicated, by my HMO, who has people within, who are so lame brained, they cannot look beyond whats in front of them on their database, and see why there is even a problem here.

Allow me to do a brief recap, over a mt and half ago, my doctor ordered some durable medical goods for me. Now, 6 weeks later, the paperwork needed from her office, still has not been given to the suppler, who are themselves, very frustrated with this as they have asked for it over and over.

If not for how good my PCP herself, has been to me, I would change clinics, entirely over this gross neglect on the part of the medical records office, who is the one who ultimately handles such things.

A neglect I hasten to add, that could easily result major damage or even death to me. I made it very clear to the supplier today and plan to make it clear to my clinic come Monday, that if anything at all happens to me, for their neglect, I will be suing, somebody !

( I have, among other things, Neurally mediated hypotenson, which means, in places like the shower for example, I get dizzy and have nearly fainted on more than one occasion. Now I leave the visual of me falling out of the shower, and onto the comode, counter top etc, up to your imagination, but lets just say it is highly likely I would, at the very least, break something, if not outright die as a result )

Now, at this same time, orders were given for me to see a specialist, however my HMO has one, a very short list of said doctors and two, none of them on that list will see me, without forcing me to change my PCP. Now, this disregards their deal with my HMO, all in the HMO agree to that and formal complaints and other actions have been filed. 

However, what topped the whole business with them today, is the fact that one of them called and left a message for me, saying of a doctor they had found for me, an hours drive away!

Now, if this doctor were a one time shot, ok, can see that, but this would be someone I would be seeing at minimum, once a mt for likely, years. Not to mention the fact, I already made it very clear from the start, that such long trips, are out of the question.

So yet another call to my HMO, and some good news finally, I happened to get one in my HMO, who understood the problem and went the extra steps and plans to do more for me, to get it done, or at least she will try. Now She.. I will present to her bosses, as the only one I have dealt with in their office on this matter, to date, who really tired to handle the problem.

Now, all of this was on my plate, yesterday… but I did not a thing about it, for one simple reason. I was so pissed off by all of this and over being forced to take some extraordinary steps over something so simple as some paperwork, that if I had spoken to or seen any of them … lets just say it would be as my mate said which was ” ah.. the security guards would be earning their paychecks ?”  as they most certainly would have, which would not have gotten things done, even if cussing a few people out, would have been emotionally satisfying.

But here is the most heinous part about this whole affair. I am a very sick woman, who has difficulty just getting through my day, on a good day, and this is how I am being treated by the very people, who are supossed to be helping me here ?

To that I say, not only is it uncalled for, with people like this for my so called freindly helpers, I do not need them as enemies, which is the ONLY thing that saves them from a very righteous wrath and yet all of these people, are cleverly disgused as so called.. health professionals. 

Tired of the whole damn mess




How the Health care system makes it hard to get help

Some days, it feels like the medical system, doesn’t WANT you to get help.

For example: Still fighting to get a Chiropractor, but at least, after many weeks and phone calls, I have a shot at it, but again, I have to get yet more paperwork from my doctor, the same one who approved it, over a mt ago.

In short, I had to find one on my own, as no one at the place that runs my HMO, had clue one of what to do, when none of the ones, on a very short list, were available. And I cannot help but think, what if what I needed was something dire ?

Another example: Almost a mt ago, durable goods were ordered for me, but..  again, delay, they need paperwork, and they have asked my doctors office for it, over and over. With them calling me, to ask me to try and get it for them.

Only for me to find out today that the medical record department, is off for two weeks, and where is the paperwork I likely need delivered to them  ? I am willing to bet it’s sitting behind a locked door, with no one home, to process it into my doctors hands, until they get back from wherever the clinic itself, sent them.

This was not due to illness or even a vacation mind you, the clinic itself, sent the main medical record keeper, off somewhere else. Likely a budget cutting move, so they could spread out her services to more than one clinic.

I found this out, as also today, I tried to leave paperwork and a message for my doctor with her nurse, only to be told that no, it has to go through the medical record dept.

( Which is new, as I have left my Doctor many messages before, but, she’s got a new nurse whose a stickler for the so called rules, I guess, although why anything has to go through medical records, first, is beyond me, as that just delays anything you need done. If medical records needs a copy, they can get it after the fact, to my way of thinking. ) 

I had to get the clinic social worker into the game, ( whom I have come to know well, she growls rather well, to get things done )  in order to make my Doctors nurse take the papers, at all, by having someone besides me say that no, it cannot go through medical records, as there is no one there. Which the nurse of course, did not know.

This is hardly the first time I have run into brick walls, over and over, having to chase my own tail, and waste many hours trying to find someone who knows how to resolve the problem.

For the husband, it’s the same thing for social services, dept A tells him that dept B deals with that, only to go to dept B and get told.. oh no.. dept A deals with that and so on… 5 hours of his day gone, to really no proper purpose, other than to keep a mess of pencil pushers in THEIR jobs, but he was no closer to anyone helping him find a job. And it gets worse, as some of the things she told him, made even my jaw drop, and I thought I had seen it all.

In short, if you need healthcare, no matter how your paying for it, short of cash on the barrel, you are put though endless hoops and needless delays, all to keep a mess of record keepers, employed.

They will tell you its to prevent fraud, however, since fraud is more rampant now, than ever before, they have stopped nothing with their tactics. All they have done, is make it harder for legitimate people, to get the services they need.

So got a few things at least in the proper hands today, now I will have to ride herd on everybody, to see it all done … for someone who is already ill, this is downright unreasonable that I have to do all of this, just to get the care I need.

More soon…



Social services, and SSI with FMS

Well our social services is at its best again, still no medicaid card, the number for my food stamps that recently had to be renewed, says : your call cannot be completed: and waiting on hold, again, with yet another agency, whose system said before : we cannot take your call at this time: Dang and things went so well the other day.

And they wonder why the system costs so much ! Speaking to them now and find out since they messed up and did not send me the application to the right address in the first place, and I finally get it from them weeks later, after several phone calls and send it back and it takes 30 days to process, which likely means, no benefits this mt, at all. 

And it’s all their fault, as I put in a change of address with everyone, and I do mean everyone, personally and repeatedly. Including the office in Austin just recently, that I was just speaking to, as in over 3 weeks ago, for the 5th time.

One of them told me point blank, their system habitually, does a security reboot every month, and often puts old information, back in the system. Meaning they know it does this and do nothing about it.

This explains why one month I will get my medicaid card, on time and the next I do not get it, at all. Until I call and ask for a replacement, which can take weeks. I mean does no one notice that it seems I move every other month ? So much aggravation, and totally uncalled for. And little I can do about it but make calls and cuss.

Sigh, oh well, at least by all the Gods, I am not alone and doing without on account of any of this, for which I can be grateful.

I just hope that my medicaid comes in soon, as prescriptions I can get with just the number, but for doctors, they need the current card, so they have 10 days to get it to me. Or it will mean an appointment its taken me 6 mts to get, will have to be blown off.

But at least the hardware ordered for me, is complete, they are just waiting on Medicaid to approve it all, so one more down. It always seems the list is ever growing, as I no more than get one problem solved, and three more show up..

More soon….



Phone calls and the Medical system, a PIA

I spent most of the day on the phone, waiting forever, being routed to mail boxes, leaving messages, taking them and generally chewing up an entire afternoon, and for what ? To get appointments, get referrals, leave messages for my doctor, get my medications refilled, and I am not done yet. Almost nowhere anymore does a live human being, answer the phone !

I realize they are busy, but this wait forever for them to pick up, or have them transfer it only to hear ” sorry this number is not part of the system” or “leave a message at the tone with your name, medical ID number etc” and hope you get a call back, is beyond frustrating. I have been playing telephone tag with two of them, for over a week now.

And this was doing it using direct numbers, I will NOT if I can possibly avoid it, use the main number which handles all appointments, the reason why ? Well let’s just say I would have gotten a lot less done, as I would have spent an hour or more, on hold !

I have spent up to 2-3 hours, with the phone tied up, waiting for someone to answer the main system number, only to be told most often, sorry, there are no appointments available. As that number, only handles appointments, at best, two weeks at a time.

( Mind you, this is after they made a huge deal of saying, new system, get an appointment within 3 days ! I have yet to see it happen ) Not only that, they want you to call, at the unholy hour of 6 or 7 am, saying that you would have a better chance to get the appointment. I cannot count how often I did it, only to wait on the phone for hours and still be told, no. I flat refuse anymore, unless forced to, to do that !

I have a phone that only has X amount of charge on it and you cannot put it back on the charger, without it hanging up, and I have run that charge out, twice today. It is good for almost 3 hours.

But, I did get several things done, so I can be happy about that, but the gauntlet you have to run in order to do it, is just exhausting.

The only other good thing for the day, is the rain, sorta came and spit at us, and I was right, it has made me feel a bit better. I cannot really complain for the lack of more, given how some storms have done major damage here in the city, we are blessed that we have escaped that.

More soon…




Stonewalled by Medical care and FMS

Well, I finally found out what the problem was with all the Chiropractics listed in my healthcare book and have basically set the dogs on em. They are all under contract to my health care plan, but are reneging on the deal they made with the Health care company.

So no, I am not crazy, they are under agreement with my health care provider, yet are trying to force anyone who wants to see them, to shift over to their MD, which is not the deal they made.

So heads are gonna roll, and she ( the specialist who deals with such things ) will, if needed find me a totally new Chiropractor in the local area, who she can talk into joining the health plan if she has to, and most of the ones on the list now, just might find they get no more business from my HMO.

Just goes to show, it pays to complain sometimes 🙂 And hopefully it will mean that the next person who needs such a doctor, will not have to run into being stonewalled, as I have been, so a win-win for everybody ( except perhaps the doctors currently on the list, but that is their problem, as they created that situation for themselves )

Anyway, so have been on the phone all day thus far, I did manage at least to finally get an appointment with the Vein specialist that was ordered over 6 mts ago but never followed up on, so at least one thing nailed down for the day.

Tomorrow I get to run the same issue with the GI people and hope, they do not tell me something like, an appointment, 2 mts from now. As I plan to be a total pain in the butt about it, and do some strong arming of my own if needed. It does not pay to be passive when it comes to healthcare and social systems. The tests I just went through, well prove that things need to be done and I plan to harp as much as needed, to see them done.

More soon…



Medical care and red tape !

The red tape and hoops they make you go though, to get medical care is just insane ! I HAD an appointment with a doctor today, that according to the handbook I was given, I do not reed a referral to go see. Only to find out that yeah, I do.

Or worse, that I am supposed to change them to my Primary care doctor, which is even more insane ( given that the one I want to see, is a Chiropractor who could not BE my PCP ) And since it is again, Friday, I cannot do a thing about it, until Monday.

This is particularly irritating, as I just saw my PCP, a few days ago and could have gotten the referral from her, if  I had known that I needed one. She would have been more than happy to give it to me, as she agreed with the need to see the specialist, and get this.. even SHE did not know that a referral was needed.

Now, I consider myself an educated person, especially when it comes to medical care ( with FM you kinda have to be ) but Medicaid/Medicare, has got to be the most complex system, I have ever seen, as most of the write ups in their so called handbook, are incomplete and often, contradictory.

You almost have to be a doctor, or worse, a lawyer, to understand the things. And half the stuff that you need to know, is not in it, and you have to call them, to find out. Just bonkers, the bloody lot of it, to make a person wait and go through all this red tape, just to get an appointment … that they will pay for.

Health care should not be this complicated !  Going off to grump for a while, and re-read the damn manual, and tear their website apart again, and see if I can figure out, what I missed.

More soon