CARD CARRYING MEMBER OF MEDICAID
I am the canary in the mine. My throat is hoarse from trying to warn others that their health insurance is in imminent jeopardy. The powers that be have found they can save countless amounts of money denying health care to others. Many companies already
feel no need to offer medical coverage and sick leave as employment benefits. The depth of people’s desperation concerning their health care is enormous. Corporations have found that employees are willing to pay even more of their premiums to keep the barest of coverage in force. They can gauge just how tight to squeeze by watching what the government has done to Medicaid and Medicare recipients. There has been almost no out cry as healthcare money is decreased and diverted to other programs.
The fear of being turned away by doctors and hospitals when you are at one of the most vulnerable points in your life allows these unspeakable acts to be set in motion. Don’t wait until you are closed in a state-controlled cage to do something. Fight against these despicable actions while there is still time. Don’t waste your words misjudging women like me—those too disabled to work-- who have no other option for obtaining healthcare. I am not devaluing your paycheck with my myriad of illnesses. Blame the pharmaceuticals, doctors, hospitals and everyone else who is reaping huge profits from the suffering of others. Many of us know that our government would rather bomb people, in other countries, than spend money on the most helpless in this country.
I use the word Medicaid to describe my “insurance” coverage even though it is technically an M.C.O. A number of states now use the initials, M.C.O. (Managed Care Organization.) to represent this same service. These letters presumably lull you into thinking that they are akin to an H.M.O. or a P.P.O. They all basically blend into alphabet soup that leaves little to stick to your ribs except the illnesses you are trying to have treated.
Maryland is one of the states that opted for this form of coverage. I fought for a year to try to get the state to fix the problems in the medical system that already existed. Yes, there were problems, but none that couldn’t be fixed at a cheaper price. Revamping the entire system was something that benefited those who didn’t need the states so called “entitlement” help anyway.
When the new plan—amusingly called “Health Choice” by Maryland-- was implemented, you were required to pick an M.C.O. you thought you would like to belong to. The M.C.O’s were not allowed to solicit our business. We had no basis on which to make our decision. Our choice was comparable to drawing a name out of a paper bag. Hopefully your pick was one of the ones that offered a decent choice. Unless you knew someone who had experience with the few carriers offered, your only hope was that your pick was a livable one. We’re talking about something as important as our health, but what it amounts to is the luck of the draw.
On the previous year’s enrollment date, you are permitted to change to one of the other M.C.O.’s if you are dissatisfied. (Make sure to save your bag—those things cost money.) Each year you are mailed a paper with a list of insurance names. It’s the absolute blind date of medical care. Some of my previous choices would have been easier to take if I had put the brown bag over my head.
Last year I wanted to change plans but because our area postal system was contaminated with anthrax, my papers did not arrive. When my partner called the state she was told that it was up to me to prove that I hadn’t received the packet. The only way to prove it was if the postal service returned the packet to the state. No one, including the state was getting mail, but that was of no consequence. I had no choice but to limp along for another year with less than satisfactory coverage.
This was truly a hardship because I am under the Special Populations section of Maryland Medicaid due to a number of incurable illnesses. These illnesses require seeing different specialists. This presents a problem because many specialists do not want to deal with Medicaid or the mountain of paperwork the government heaps on them. A number of doctors have told me that they either not participate in the program or spend extra money to hire someone to handle the paperwork. If you wanted a system to collapse under it’s own mismanagement, this is how you would go about arranging it.
You are not allowed to have any of the books that explain what the insurance covers to make an informed choice. The doctors, hospitals, pharmacies, and specialists that take part in each plan remain a mystery until you are enrolled. Through the years I have been enrolled in this “system” I have learned to lower my expectations.
Everyone is required to choose a primary care doctor who will be in charge of decision making. Hopefully, you will find someone who is compassionate and willing to send you to a specialist when needed. Don’t expect to find the address or phone number of numerous providers in your book. Many times you will find doctors listed who do not accept your plan. When you phone their office it helps if you’ve developed a thick skin. Numerous people, including office personnel, feel that those who need the state’s help must also be lawbreakers.
When medicaid was first changed incentives were offered to get primary care doctors to enroll in the program. (At the beginning of the year a lump sum of money is paid per patient.) In the past—presumably—box seats to sporting events, cruises, tickets to plays, expensive meals, etc., were given to entice the doctor to rein in the cost of the treatment that was offered to patients. If you have an ailment that requires frequent monitoring, this cuts into the insurance carriers and doctors’ “profit.” It creates an atmosphere that you might not receive adequate care for incurable illnesses that require a lot of time and treatment. You are not always given options, concerning your health, if they are costly. Prescriptions, and other profit reducing treatments, are not as readily supplied as they once were.
You need a referral by your primary doctor to see a specialist, to receive diagnostic testing or have a surgical procedure. (The doctor then has to have the approval of the health plan before issuing the referral. Her training is not enough to make a sensible decision while you are in the office.) I have learned to go through the yellow pages of the phone book and locate the address and phone number for myself. It’s the least frustrating plan of action. This way you can hope to find someone that you’ve had experience with and ask your doctor to refer you to them. It also saves the doctor’s staff work in locating the necessary information required to fill out each referral request for the M.C.O. They get the final say in how many visits you are allowed and what else they feel is necessary. “You Will Not Be Seen By A Medical Person without This Referral!” Just look around the office and you will see it written in various languages, taped on numerous walls.
A few exceptions that do not require a referral are a mammogram and a Pap smear. You may also go to the emergency room if it’s deemed that it’s truly an emergency. “If you think you need emergency care (see the section “Emergency Care”), call 911 or go to the nearest emergency room right away.” Hope that your injury isn’t a neurological one, and that you can remember where your book is, and what it said to do.
There are a few examples of what constitutes emergencies: “An emergency is when not seeing a doctor right away to get care could result in death or very serious bodily harm. The problem is so severe that someone with an average knowledge of health can tell the problem may be life threatening or cause serious damage to your body.” Severe bleeding, chest pain, loss of consciousness, very bad bleeding, very bad burns, shakes called convulsions or seizures.”
You are supposed to call your doctor before going to the emergency room. She, or a replacement, should be available on a 24-hour basis. “You may also call our Nurse HelpLine 24 hours a day, 7 days a week for help.” This judgment can also be made by someone who has no medical training. If you do get to talk to a nurse their priority appears to be having you wait until the doctor is back in her office. If I feel that my health is in jeopardy I dispense with all of the above and let the hospital sort out whose authority I have trampled. What are they going to do? Give me another illness? In this day and time that is not as unlikely as it once was, but I’m not going to play a guessing game when I believe that my life is in jeopardy. Why should my wheelchair receive better maintenance than I do?
If I were truly a canary I would have flown out of various emergency rooms and doctor’s offices. Only the absolute need of my medical health kept me lying on the stretcher. I’ve witnessed my file being tossed back and forth because the doctors in the ER did not want to treat someone with so many health problems. I’ve listened with total shame while the list of my illnesses was read aloud for everyone to hear. At a new specialist’s office I heard him scream at his nurse about making an appointment for me. He said, “How in the hell am I going to get her out of here in five minutes with all of the problems she has?”
As a feminist I am ashamed to write these things and tell you that I was silent. Silent because I was afraid of not receiving the treatment I needed without delay. If I couldn’t speak up how can I hope that others will? I won’t blame it on multiple sclerosis, systemic lupus, osteoporosis that has caused me to break each of my ankles twice, heart, kidney and other diseases. Perhaps the overwhelming pain caused me to hope that someone would at least be humane enough to ease what hurt—if only temporarily. I gave up on cures a long time ago, but I still want to enjoy what’s left of my life with my partner of twenty-seven years.
Be your own canary in the mine. Make a shrill noise that no one can ignore. If we all refuse to be treated in this manner maybe it will give hope that the medical system as we now know it will change. Women who are receiving state aid cannot do it alone. We need the help of our more fortunate sisters.
Let your legislators know by phone, email, fax, letter writing and your vote that you will not tolerate this ongoing disassembly of the medical safety net for the poor and disabled. In an election year what you do can truly make a difference.