Thursday, January 16, 2014

How's that new Affordable Care Act plan working out for you?

Dear ‪Jayne O'Donnell at USA Today:

In response to your inquiry about new ACA policies: I completed application at Covered Cailfornia Xchange website in November/December (took 3 tries but I didn't mind). Went to see a GP for first time in 25 years on Jan 4th. GP was good enough to see me without charging me, despite I had received no card yet, nor any word from Medi-CAL. She nicely agreed to act as my GP, and initiated paperwork to procure a Walker thru Medi-CAL. Well ... looks like my excitement was premature. I received letter today from Covered California, stating: "You do not qualify for the Enhanced Silver Healthcare Plan, because based on your application you may qualify for Medi-CAL. . ." I would be happy at this point with the Basic Lead Plan, but I am to wait for word from CA state SSI office regarding my qualification for Medi-CAL.

What I did find out from my new (as yet unpaid) GP is: The migraine nasal spray that is recommended for patients like me (who vomit during migraines) is NOT covered by Medi-CAL. Also, the anti-inflammatory medication which puts most of my neurologic symptoms into remission (such as not-being-able-to-walk-due-to-tremors) is NOT covered by Medi-CAL. I suspect that the new medication just approved by the FDA to treat Orthostatic Intolerance will NOT be covered by Medi-CAL. Apparently they decided to focus on just the pre-WWII treatment methods for now. And of course one CANNOT see a Psychologist under most insurance plans including Medi-CAL, as they just don't have enough of those coveted Insurance Code options to sprinkle allover their bills the way the other docs do*. NOR are we allowed to go see the dentist. It seems I have the misfortune to be born an individual generally not covered by Medi-CAL. Would that I were born without teeth! Or a brain!

In the meantime I am making plans to mod my Walker. How to add patterns/colors to the plain frame and seat. How to pad the plastic seat, and affix a Police Car Alarm Light so people will stop trying to run me over in the intersection during tremors. And how to cover up the huge plastic UPC label Medi-CAL affixes to the leg. Because if I lose my Walker (for example, due to untreated orthostatic intolerance) I would prefer that someone deserving get ahold of it. Perhaps someone who did not get their application approved for a Walker. No offense, Medi-CAL. I appreciate any effort made on my behalf and those who are in need of medical help.

All in all it seems like things are looking up for "uninsurables" but it depends which diagnoses you have and how many. Poor sick people are apparently still the least likely to receive adequate treatment or meds-that-actually-work. The funny thing is: this permanent underclass costs more to maintain than does adequate treatment for these same individuals – it surely would be if costs for medical treatment in this country reflected the actual cost of manufacture (Mark-ups can exceed 40 times the cost of manufacture). Imagine if we returned to work instead of languishing without treatment. In the meantime I am dreaming up how to work my way into the electric wheelchair with real foam padding and unicorn-theme hologram Mag wheels.

No, I don't blame Obama. This system, however flawed, is mos def an improvement. But we are the only nation ever to implement Universal Healthcare without a single-payer system – ensuring that the elaborate pyramid scheme called "Health Insurance" is still intact, and even more profitable than before. Thank you, politicians, for lining your pockets with billions of dollars of Health Insurance Lobby $ over the last half century. This prevented you from being sensible or sincere in efforts to reform healthcare. You and the insurance administrators have our lifetime healthcare premiums locked up in your pants pockets. Noooooiiice pants, BTW!

Thank you, Naomi Spellman

*These medical codes allow doctors to get paid for services rendered. In order to be adequately reimbursed from Insurance, doctors' offices must falsely load up these codes and over-bill, due to insurance companies refusal to pay a significant portion of legitimate services already provided. Doctors and other health care providers attend classes in medical school which teach them how to manipulate these codes and over bill in order to be adequately reimbursed for their services. Doctors who no longer accept insurance now say they are earning more, as they were paying their accountant between $40-65 to prepare just one of these elaborate Insurance bills. The problem with Psychologic counseling is: they can't very well break-down a one or two hour Therapy session (such as CBT) into discrete codes.

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