Sunday, March 23, 2014

Waiting for Health Insurance

Dear Jayne at USA Today:

Sorry for long delay; I was sidelined for weeks with migraines. Regarding your recent inquiry on the status of my health insurance, I recently received some information: ALthough the letter I received from Covered California in January stated that I was to wait until the County sent me information regarding my Medi-CAL eligibility, I finally called them in frustration. It took 1 1/2 hours and five people on the phone to inform me that I needed to speak to my Case Worker, Dave Katz, for any information regarding my insurance. Dave informed me that the COunty needs me to bring my passport in for certification of citizenship, and that I needed to fill out a form to add myself to my son's existing Medi-CAL services. I submitted these documents just last week, once my migraines subsided, and once again I am waiting to hear back. I did ask WHEN I should be able to use my Medi-CAL insurance. I was told that I am authorized to receive Medi-CAL insurance, but they don't know when my insurance number will be activated for use.

In the meantime I have had to cancel two doctors appointments (Cardio and Neuro) due to lack of an insurance card, and I have had to use emergency services when I became dehydrated from migraines/vomiting. I have requested that the COunty provide health insurance retroactive to January of this year, so I am hoping that the $1,800 ambulance and $900 ER services will be covered, as I lost my ability to pay for services when I became disabled. ER services administered Zofaran for acute nausea/vomiting, and 2 additional drugs for pain (Demerol plus one other). They told me I should be able to get prescriptions for these exact same drugs to keep on hand in case of another attack, in order to prevent unnecessary use of ER services. I do not know if Medi-CAL will cover these drugs, however, and more importantly I cannot administer a fluid IV on my own. Some POTS patients have an IV port inserted in their arm so they can hook up an IV when needed. Again, I don't know if Medi-CAL will cover this treatment.

The most frustrating aspect I have yet to address: Most doctors do NOT accept Medi-CAL, including my AUtonomic Specialist/Cardio. And since I am unable to travel, I have no idea if/how I will find a doctor willing to treat me, and how to get there? I decided to ask my new General Practitioner to request an electric wheelchair for me in addition to or instead of a Walker, as Medi-CAL does not provide Medical Transport unless you are blind or in a wheelchair. Even though I prefer to walk as much as possible I have to solve this logistical problem before I can even go see a doctor. I am simply not able to travel beyond a very small radius with the symptoms I have. My fear is that there may be a limit to how far they will transport you to a doctor appointment (some San Diego County residents travel to Riverside County in order to find a Medi-CAL doctor). I also have to wonder how the cost of Medical Transport compares to the money they save by limiting which Doctors can see us. I can't imagine that it costs less money to pay a Medical Transport driver and van for 5 hours travel and wait time, than it does to pay a local doctor a fair rate outright. Any logic is defied in this scenario.

Yesterday I did some reading online on one of the Dysautonomia forums. ONe fellow who studied medicine ( and actually comprehends the white papers on POTS unlike me!) provided a lot of helpful information. He verified the need for POTS patients to get IV fluids on an as-needed basis (when flare-ups are acute/worsening), and he does not hesitate to go to the ER when he needs fluids. He recommended contacting your GP first, in case they have time to treat you in office. This scenario frustrates me. While it is a comfort to know that ER services are covered, it would be even better to prevent such episodes in the first place through proper care and maintenance. However, I fear that the narrowing of treatments and services provided by insurers (to save costs), and the lack of doctors available to poor patients may in fact result in a very expensive and ineffective scenario.

In addition to POTS, I also suffer from Bipolar disorder. Psychiatrists and Psychologists do not normally accept insurance, and I am very afraid that I will have to go to the ER for acute mental health episodes when they arise. I am beyond frustrated; the lack of any sense in our health care system is enough to make one suicidal.

Sincerely, Naomi Spellman

No comments:

Post a Comment