So this week I received a letter from Medicare stating I owe them $14.4k because they forked over the money to pay for my hospitalization after my partial hysterectomy surgery. Oh, they paid for the surgery - but the fact that I didn't just get up and walk away from it that night and had the audacity to stay 48 hours to make sure I was not, you know, bleeding internally WAS JUST OUTRAGEOUSLY GREEDY.
Never mind they already paid it and it's been two and a half fucking years; I have to back pay them. SO I now have to rally both my GYN and cardiology team to submit ample documentation to support the justification for that stay.
I am too stressed out to make any witty jokes. I just want to live a fucking normal life where having a chronic illness that needs constant upkeep isn't a punishable offense.
EDIT EDIT:
Upon further inspection, the bill is actually for the provider - not the beneficiary (i.e. ME). I just received a copy to keep me aware of what is going on. So, apparently, UCLA did not bother to submit the claim until Nov 18th - and by that time I'd had my surgery, was discharged 48 hours later and re-admitted with an infection. I don't know if that was some diabolical strategy on someone's part to make sure I had my surgery anyway, or just some really lazy jackass, but wow. Now, I'm not out of the woods quite yet - I fully expect UCLA to be petty assholes and come after me for those charges, even though Medicare made it very clear that they deemed me unaware of the situation (which I was) and not at fault or responsible.
This could potentially get ugly.
Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts
Friday, May 16, 2014
Sunday, November 11, 2012
Sunday Confessional: The Costly Heart
Yes, Yes, I know that there are a pile of new interviews waiting to be posted and that I still need to bog about my visit to the Children's Hospital of Philadelphia, but this confessional was inspired by a piece of mail.
Every month or so I receive a Medicare Summary Notice, detailing all of the expenses my health costs them through the claims processed from one date to another (usually 2 months behind the date of receiving this letter).
This newest summary, for claims processed early August through mid-September, is seven pages long, most of the them printed double-sided. Among the claims listed is my liver biopsy, which took place July 27th. Keep in mind that I was an outpatient.
When added up, with all of the tests, fluids and medicines, anesthesia, techs, machines, man power, and recovery room, the grand total of this one day at UCLA came to: $23,591.23
Now, do I have $23,591.23 just lying around in old mayonnaise jars buried in my front lawn? Of course not. I have two insurances: a federal insurance and a state insurance.
Is it perfect? Far from it.
Is it controlling? Indubitably.
Is there room to improve them? Without a doubt.
Despite its flaws, am I still grateful for these insurances and will I continue to remain medical bill debt free so long as they are in effect? You Betcha.
One day I hope to have a less demeaning, stigmatized, controlling insurance - one that permits me to earn an income that matches the cost of living; one that does not dictate how long I can explore the world; one that allows me to save my hard-earned pennies; an insurance that actually permits me to enjoy the life they help preserve.
Every month or so I receive a Medicare Summary Notice, detailing all of the expenses my health costs them through the claims processed from one date to another (usually 2 months behind the date of receiving this letter).
This newest summary, for claims processed early August through mid-September, is seven pages long, most of the them printed double-sided. Among the claims listed is my liver biopsy, which took place July 27th. Keep in mind that I was an outpatient.
When added up, with all of the tests, fluids and medicines, anesthesia, techs, machines, man power, and recovery room, the grand total of this one day at UCLA came to: $23,591.23
Now, do I have $23,591.23 just lying around in old mayonnaise jars buried in my front lawn? Of course not. I have two insurances: a federal insurance and a state insurance.
Is it perfect? Far from it.
Is it controlling? Indubitably.
Is there room to improve them? Without a doubt.
Despite its flaws, am I still grateful for these insurances and will I continue to remain medical bill debt free so long as they are in effect? You Betcha.
One day I hope to have a less demeaning, stigmatized, controlling insurance - one that permits me to earn an income that matches the cost of living; one that does not dictate how long I can explore the world; one that allows me to save my hard-earned pennies; an insurance that actually permits me to enjoy the life they help preserve.
Monday, March 19, 2012
How to Woo Your Social Worker
My last post discussed the necessary evil that is Medi-Cal, or medicaid. Now it is time to take a giant step back from my fragile little ego and share with you some facts and helpful hints on what I like to call wooing your social worker.
Let's be real - we have a broken system, but that is no reason to blame or take it out on the people that work for said system. It's like my daddy said,
"Rachael. These people don't wake up in the mornin' and think, Gee, who am I gonna screw over today?"
He had to say that to talk me off of the proverbial ledge when I was having one of those insurance related panic attacks over something that wasn't really a big deal.
Important Aside of Importance: Now, I do hear of cases where people just like me - poor and sickly - get rejected. It is not totally unheard of that someone lets their bad day get to them and they take it out in their work. I was rejected twice before finally being accepted. Nothing had changed, really, not in the realm of my health or income. In fact, when I was finally accepted I was working and going to school. So yes, some miserable people are out there and you're just going to have to fight their bullshit.
However, the focus of this post is strictly on the social worker (which everyone on Medi-Cal is assigned) and even some helpful tips when you have to go into the Social Security office because some scary worded letter you couldn't decipher told you to.
When Going in Person
- Trickier than just a phone call because you have to be open and friendly from head to toe, so you're going to have to check your body language and disgruntled Professional Patient baggage at the door.
- Start off with a bright and bubbly "Good Morning!" (I'd say the alternate to that in "Good Afternoon!" but let's be real, do these places ever stay open beyond 12pm?)
- Offer your hand (to shake, not marry) to the person you're meeting unless it's just the behind-the-plated-window-glass person. Do not try to shove your hand up that tiny ass half-circle they've got going on. You can, however, practice your bubbly "Good Morning!" on the window person and note tone, inflection and sincerity by their reaction.
- Before you begin whatever business you're there for, take a moment to ask, "How are you?" or "How is your morning going?" This shows the social worker that you recognize they are an individual who is just doing his or her job.
- Compliment them once. Do a full scan over your social worker's desk and person and find something you can compliment them about. No need to be excessive and do it more than once, and it helps if you find something you do actually like - I usually go for a fun manicure because I appreciate a colorful set of nails.
- Be organized. If you had to bring paperwork - say, a bank statement, pay stubs and tax forms, have it all in a neat folder and ready to hand over when asked.
- Have a list of prepared questions in hand so you're not struggling to speak. When I first started playing this awful game I would sit there, confused and bogged down by my own silence, not getting the answers I needed to succeed because I was just too terrified to ask questions.
- End your visit with a smile and a sincere thanks for their assistance. Handshake optional.
You'll notice some overlap between the above and below, but there are some new tips too.
On the Phone
- Check your fear and anger. Don't jump on the phone the minute some confusing or bad news comes your way. Calm down, have a rant online or on the phone, maybe fix yourself a snack to give your brain a little happy. Watch cute animal videos on YouTube or your favorite comedian to lighten your black mood. This is vital.
- If you have a tough time explaining yourself or keeping on track, write down the issue at hand so you can look at it for reference. You don't have to be a magical wordsmith like moi, just a sentence or two and some key points.
- Have your paperwork in hand, make sure your Case # is present as well. These folk are too busy in their day to remember your name and yes, we are all just numbers living in this Brave New World.
- No matter how long you have to wait on that line and listen to whatever bullshit muzak or automated info babble, you start that conversation off with the sunniest, most cheerful, "Hello! Good Morning/Afternoon!" you can muster. It gets shit off on the right foot and lets the social worker know you're not going to scream at her/him.
- Before you begin whatever business you're calling about, take a moment to ask, "How are you?" or "How is your morning going?" This is HUGE with phone conversations. As above, this basic courtesy informs the social worker that you recognize they are a real person on the other end and not some nameless worker bee. Bonus, this small pleasantry can break down their defenses as well and it'll remind them that not everyone on the other line is a rude leech.
- Steal their thunder. A little playing dumb/self-deprecation goes a looooooooong way. Call yourself out on whatever you need help with. Something like, "I know the answer is probably staring right at me but would you please explain..." or "You know, I'm realizing now that I'm not as clever as I thought I was because I just can't seem to figure out..."
- Joke and make light of the situation. It goes hand in hand with the previous tip.
- Write shit down as your social worker is instructing you. Always keep several pens and pads of paper next to your phone and take notes. This isn't really part of the process of wooing, but in case you need someone to repeat what they just said you can let them know you're writing it down "So I don't have to call back and bother you again!"
- Reiterate what they say back to them to let them know you understood and are listening.
- Always be sure to end your conversation with, "Thanks so much for your help. You have a nice day." Or something akin to that. Thanks and Well Wishes leave people with a nice, warm and fuzzy feeling.
I have come away from so many social situations a wiser, more learned person. With each lesson my communication skills have grown stronger (well, I think so anyway).
All of the above tips may seem like basic manners 101 but we do get caught up in our drama and sometimes forget that "the enemy" is mostly never the person who is actually designated to help us.
If you need help working some wordsmith magic, please don't hesitate to contact me and let me know. I'd be happy to help.
Let's be real - we have a broken system, but that is no reason to blame or take it out on the people that work for said system. It's like my daddy said,
"Rachael. These people don't wake up in the mornin' and think, Gee, who am I gonna screw over today?"
He had to say that to talk me off of the proverbial ledge when I was having one of those insurance related panic attacks over something that wasn't really a big deal.
Important Aside of Importance: Now, I do hear of cases where people just like me - poor and sickly - get rejected. It is not totally unheard of that someone lets their bad day get to them and they take it out in their work. I was rejected twice before finally being accepted. Nothing had changed, really, not in the realm of my health or income. In fact, when I was finally accepted I was working and going to school. So yes, some miserable people are out there and you're just going to have to fight their bullshit.
However, the focus of this post is strictly on the social worker (which everyone on Medi-Cal is assigned) and even some helpful tips when you have to go into the Social Security office because some scary worded letter you couldn't decipher told you to.
When Going in Person
- Trickier than just a phone call because you have to be open and friendly from head to toe, so you're going to have to check your body language and disgruntled Professional Patient baggage at the door.
- Start off with a bright and bubbly "Good Morning!" (I'd say the alternate to that in "Good Afternoon!" but let's be real, do these places ever stay open beyond 12pm?)
- Offer your hand (to shake, not marry) to the person you're meeting unless it's just the behind-the-plated-window-glass person. Do not try to shove your hand up that tiny ass half-circle they've got going on. You can, however, practice your bubbly "Good Morning!" on the window person and note tone, inflection and sincerity by their reaction.
- Before you begin whatever business you're there for, take a moment to ask, "How are you?" or "How is your morning going?" This shows the social worker that you recognize they are an individual who is just doing his or her job.
- Compliment them once. Do a full scan over your social worker's desk and person and find something you can compliment them about. No need to be excessive and do it more than once, and it helps if you find something you do actually like - I usually go for a fun manicure because I appreciate a colorful set of nails.
- Be organized. If you had to bring paperwork - say, a bank statement, pay stubs and tax forms, have it all in a neat folder and ready to hand over when asked.
- Have a list of prepared questions in hand so you're not struggling to speak. When I first started playing this awful game I would sit there, confused and bogged down by my own silence, not getting the answers I needed to succeed because I was just too terrified to ask questions.
- End your visit with a smile and a sincere thanks for their assistance. Handshake optional.
You'll notice some overlap between the above and below, but there are some new tips too.
On the Phone
- Check your fear and anger. Don't jump on the phone the minute some confusing or bad news comes your way. Calm down, have a rant online or on the phone, maybe fix yourself a snack to give your brain a little happy. Watch cute animal videos on YouTube or your favorite comedian to lighten your black mood. This is vital.
- If you have a tough time explaining yourself or keeping on track, write down the issue at hand so you can look at it for reference. You don't have to be a magical wordsmith like moi, just a sentence or two and some key points.
- Have your paperwork in hand, make sure your Case # is present as well. These folk are too busy in their day to remember your name and yes, we are all just numbers living in this Brave New World.
- No matter how long you have to wait on that line and listen to whatever bullshit muzak or automated info babble, you start that conversation off with the sunniest, most cheerful, "Hello! Good Morning/Afternoon!" you can muster. It gets shit off on the right foot and lets the social worker know you're not going to scream at her/him.
- Before you begin whatever business you're calling about, take a moment to ask, "How are you?" or "How is your morning going?" This is HUGE with phone conversations. As above, this basic courtesy informs the social worker that you recognize they are a real person on the other end and not some nameless worker bee. Bonus, this small pleasantry can break down their defenses as well and it'll remind them that not everyone on the other line is a rude leech.
- Steal their thunder. A little playing dumb/self-deprecation goes a looooooooong way. Call yourself out on whatever you need help with. Something like, "I know the answer is probably staring right at me but would you please explain..." or "You know, I'm realizing now that I'm not as clever as I thought I was because I just can't seem to figure out..."
- Joke and make light of the situation. It goes hand in hand with the previous tip.
- Write shit down as your social worker is instructing you. Always keep several pens and pads of paper next to your phone and take notes. This isn't really part of the process of wooing, but in case you need someone to repeat what they just said you can let them know you're writing it down "So I don't have to call back and bother you again!"
- Reiterate what they say back to them to let them know you understood and are listening.
- Always be sure to end your conversation with, "Thanks so much for your help. You have a nice day." Or something akin to that. Thanks and Well Wishes leave people with a nice, warm and fuzzy feeling.
I have come away from so many social situations a wiser, more learned person. With each lesson my communication skills have grown stronger (well, I think so anyway).
All of the above tips may seem like basic manners 101 but we do get caught up in our drama and sometimes forget that "the enemy" is mostly never the person who is actually designated to help us.
If you need help working some wordsmith magic, please don't hesitate to contact me and let me know. I'd be happy to help.
Thursday, March 15, 2012
Beware the Ides of Medicaid
Today I received my Medi-Cal re-determination papers. They come every March and the fact that I received this years on the "Ides of March" is pretty fucking telling.
I don't talk about insurance woes very often because...well, it's just not something I've really been able to laugh about. Ever since turing 21 in 2003 I have had a roller coaster ride dealing with the Social Security Administration and Medi-Cal, California's own special brand of medicaid. Going through the wringer with both of these institutions has put a lot of regret, anxiety and stress on me. I had more panic attacks in the 2006-2007 than my in my whole life combined. I was assaulted with nonsensical notices and changes at every turn and for two solid years I refused to go near the mailbox. Every penny I earned was scrutinized, judged and come every paycheck, a decision was made to either reduce my benefits or keep me on. I was a hamster in a wheel, running and running and running. Unlike the hamster, my life actually depends on it.
After being able to logically sit back and assess the situation I've figured out the matter by which we are judged so fucking mercilessly. You see, unlike Medicare, which actually takes MY HEALTH HISTORY into consideration and cannot ever deny that I'm a person who will need constant, life-long care, Medi-Cal judges me purely on financial matters. This makes sense to a certain degree. Medi-Cal was created to help those of us with low-incomes to receive & finance medical care. Pretty nice, right?
There are two dark points to Medi-Cal and I'll address both
1) Social Stigma brought on by Fuckheads
You hear it all of the time; some asshole scamming "the system" to freeload off of taxpayers money so they can sit on their ass all day and contribute nothing to society. This is probably the main reason why I don't publicly speak about my being on Medi-Cal. I don't want the bullshit judgment that comes along with it.
I'm not going to lie, though. There are definitely a bunch of twats who scam the system. I don't know any of them personally by name and I couldn't pick them out of a line-up, but I know they're there. It's due to these dregs that Medi-Cal sends out these re-determinations papers and examines every single penny earned. This is why I don't think the TSA is all that intrusive. I deal with this insurance bullshit on a regular basis. The pat-down is a lot friendlier and welcoming.
Secondly, and the more alarming flaw with being on Medi-Cal:
2) Beneficiaries have to remain poor to receive benefits. Always.
Unless some magical windfall happens like the lotto or a great aunt leaving her fortune to us, or The Job of Your Dreams is landed with enough of a pay to cover our medical expenses, Medi-Cal sets us up for constant poverty and failure to dig out of the hole of financial despair. I would need to make roughly double, maybe even triple, the amount allocated to Medi-Cal beneficiaries in order to cover whatever Medicare does not. That's purely medical costs I am taking into consideration - not living expenses.
My problem is - where is this magical job that is going to be super cool about me missing work for medical appointments? About taking time off for surgeries and subsequent healing process? What if, like my last surgery, I get an infection and I'm out of commission for 4 months?
This is why when I quit my career in child care I knew, ultimately, I could only be an agent of one. A freelance writer. And y'all know just how rare those are nowadays.
So it's been slow going and everything from my bank account to how long I travel is domineered and dictated by a force I cannot be without.
Trust me, there are moments where I have given serious thought to turning in my US citizenship in favor of a country that has more appealing healthcare. Ultimately, though, I want the USA to work it the fuck out.
It is unquestionably the shittiest part about growing up with a congenital heart defect. Brace yourselves, adolescents, you are in for a bumpy ass ride.
LEAVE your comments, questions, fears or rants on the medicaid system!
I don't talk about insurance woes very often because...well, it's just not something I've really been able to laugh about. Ever since turing 21 in 2003 I have had a roller coaster ride dealing with the Social Security Administration and Medi-Cal, California's own special brand of medicaid. Going through the wringer with both of these institutions has put a lot of regret, anxiety and stress on me. I had more panic attacks in the 2006-2007 than my in my whole life combined. I was assaulted with nonsensical notices and changes at every turn and for two solid years I refused to go near the mailbox. Every penny I earned was scrutinized, judged and come every paycheck, a decision was made to either reduce my benefits or keep me on. I was a hamster in a wheel, running and running and running. Unlike the hamster, my life actually depends on it.
After being able to logically sit back and assess the situation I've figured out the matter by which we are judged so fucking mercilessly. You see, unlike Medicare, which actually takes MY HEALTH HISTORY into consideration and cannot ever deny that I'm a person who will need constant, life-long care, Medi-Cal judges me purely on financial matters. This makes sense to a certain degree. Medi-Cal was created to help those of us with low-incomes to receive & finance medical care. Pretty nice, right?
There are two dark points to Medi-Cal and I'll address both
1) Social Stigma brought on by Fuckheads
You hear it all of the time; some asshole scamming "the system" to freeload off of taxpayers money so they can sit on their ass all day and contribute nothing to society. This is probably the main reason why I don't publicly speak about my being on Medi-Cal. I don't want the bullshit judgment that comes along with it.
I'm not going to lie, though. There are definitely a bunch of twats who scam the system. I don't know any of them personally by name and I couldn't pick them out of a line-up, but I know they're there. It's due to these dregs that Medi-Cal sends out these re-determinations papers and examines every single penny earned. This is why I don't think the TSA is all that intrusive. I deal with this insurance bullshit on a regular basis. The pat-down is a lot friendlier and welcoming.
Secondly, and the more alarming flaw with being on Medi-Cal:
2) Beneficiaries have to remain poor to receive benefits. Always.
Unless some magical windfall happens like the lotto or a great aunt leaving her fortune to us, or The Job of Your Dreams is landed with enough of a pay to cover our medical expenses, Medi-Cal sets us up for constant poverty and failure to dig out of the hole of financial despair. I would need to make roughly double, maybe even triple, the amount allocated to Medi-Cal beneficiaries in order to cover whatever Medicare does not. That's purely medical costs I am taking into consideration - not living expenses.
My problem is - where is this magical job that is going to be super cool about me missing work for medical appointments? About taking time off for surgeries and subsequent healing process? What if, like my last surgery, I get an infection and I'm out of commission for 4 months?
This is why when I quit my career in child care I knew, ultimately, I could only be an agent of one. A freelance writer. And y'all know just how rare those are nowadays.
So it's been slow going and everything from my bank account to how long I travel is domineered and dictated by a force I cannot be without.
Trust me, there are moments where I have given serious thought to turning in my US citizenship in favor of a country that has more appealing healthcare. Ultimately, though, I want the USA to work it the fuck out.
It is unquestionably the shittiest part about growing up with a congenital heart defect. Brace yourselves, adolescents, you are in for a bumpy ass ride.
LEAVE your comments, questions, fears or rants on the medicaid system!
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