Tuesday, July 23, 2013

The Problem with Healthcare in America

So here's my dilemma - 

I have had Cigna insurance for my kids through my job. I can't afford it any longer, so I applied for insurance through the state. They qualified for Medicaid. Great! I cancelled the Cigna, but the change won't take effect until Sept. 1st. No big deal. 

Last week, when all this stuff went down with Austin and Savannah, I tried making an appointment with their primary care physician assigned to them with Cigna since that doctor is at least a little familiar with my kids. However, because they now have Medicaid, that doctor refused to see them. I argued that they still had Cigna until September, but no dice. They flat-our refused. No problem.

I called the PCP assigned to them through Medicaid. They refused to see Austin and Savannah because they're a pediatrician's office and Austin and Savannah are too old at 17 and 18. When I explained everything going on and told them I was desperate to get follow-up care for my kids right now, they still refused. In fact, last week when I told her about the positive HIV test and how I was certain it was incorrect, she had the same condescending, judgmental, and condemning attitude. "Why does he donate blood regularly?" I heard once more. It makes me want to take the negative test, march over to the office and thrust it in her face while shouting, "See this?! I was right and you suck!"

Anyway, the receptionist at the pediatrician's office assigned by Medicaid recommended I call Medicaid and get a different provider assigned to Austin and Savannah. Fine. No problem. I called Medicaid. After about 20 minutes on the phone with them, I was given another number to call. After speaking to someone else and explaining the whole problem yet again, I was told, "Austin and Savannah were already assigned a doctor. The name and number is on their cards."

"I know! But that doctor won't see them! He's a pediatrician and says my kids are too old. Can they get a different doctor? An internal medicine doctor in the area, please?"

After several more minutes of trying to get her to understand the situation, she finally says, "Well, I show that you still have Cigna. I can't switch doctors until the Cigna is gone."

"I did cancel the Cigna, but those changes won't take place until September first. What do I do in the meantime? No one will see my kids. My daughter is having health issues and my son just got out of the hospital and needs follow up in a week, not two months!"

"I don't know, but I can't do anything until the Cigna is gone."

Today, their primary care doc with Cigna called to schedule an appointment for Austin since they'd received copies of his records from the hospital.

"Oh, so you'll see him now? You wouldn't see my kids last week because of the insurance issues. After she took a minute to look at his file, she said, "Oh you're right. We can't see him. He has Medicaid now."

"So he has to go without any follow-up care because you guys refuse to see him even though he still has Cigna and even though YOU called ME to schedule an appointment?"

"That's correct. I'm sorry."

"Gee thanks! Thanks for NOTHING! That's for nothing, everyone!" Healthcare isn't about the patient's health. It's all about insurance and who will pay for what. Period. As far as I can tell, no one takes into account the patient's needs at all. I admit that I was spoiled with the most amazing doctors who went above and beyond back in Chicagoland, but here? It has been my experience that no one gives a crap about anyone.

Now I need to find a place to take Austin for a follow-up appointment and whole new set of HIV testing so I can take those negative results back to the hospital where I will lie on the floor kicking and screaming until they agreed to amend his medical record. (Anyone who has seen this video of me, knows I have no problem lying on the floor while kicking and screaming in public.) I wonder if I can also get them to go back through records and see who was given negative HIV results during the same time frame because most likely, that person is positive and doesn't know it, thanks to the hospital's screw up.

24 comments:

kungfu_mom said...

Can you call the original Cigna doctor and just request an appointment? Tell them nothing about the Medicaid and move on? Tell them you were wrong and the Medicaid doesn't take effect until the Cigna terminates 9/1. Just a little white lie to get your kids seen.

Dawn said...

They already know about the Medicaid. It's in the system. :(

Kathy McPherson said...

Wow. That is insane. This is one of those times I'm glad I live in Canada even though we have to pay 40% income tax and 13% tax on everything we buy here in Ontario.

Kristin of course said...

Too many stories like this. It's awful. I have a friend who was doing his medical internships (whatever its called) rotations and one of them was at our VA hospital and I believe he was on the heart floor. Anyway, he was still in med school so he was being watched. So heavyset man is brought in for heart problems, he's going to have the procedures done and my friend was doing routine questioning and asked if he had been checked for diabetes. The man said no. So my friend went to his doc teacher to ask about running those tests too and the the doc told him flat out no. That they were the heart floor, they were authorized to ONLY treat the heart, it was not their problem to deal with anything else.

Seriously. As a med student, my friend has become quickly disillusioned with the system.

And have you read about how many doctors are shutting down private practices because they can't afford to comply with the new healthcare laws? That they either have to quit practicing or become an employee basically of a hospital system which can afford it.

Cheryl said...

Is there a patient advocate at the hospital that he was at that could help you or help direct you to the right person? How ridiculous!

pepsiplease said...

LAWYER

Chris said...

If you have the files, could you go to an urgent care for the follow-up? They would probably run an HIV test too. One of your readers HAS to know someone in the health care profession that might be able to help.Good luck, and Dawn? You and the kids are in my prayers.

Genie books said...

Do you have a tv station that likes to fight for the little guy?

Janice said...

Call Cigna. See if they can't assure the doctors office that they'll cover anything prior to 9/1. September is a long way away.

my3texasboys said...

Can sign a waiver saying that you do not want Medicaid to be filed? Or call Cigna and see if they can recommend a doc in the area that takes Cigna and Medicaid?

Shellie said...

Oh, I see you have that same curse! How frustrating: it is enough to go all postal. I think kicking and screaming would be very ladylike at this point. How can we just find you an advocate in your area? What town are you in? I will ask around.... There's some good ideas here from readers. We have a news guy in Utah who takes on cases like this and makes them public and funny how that changes the treatment you get. If the kids are still Cigna this month, call Cigna and talk to the biggest wig you can get handed up to to get you into a doctor's office somewhere. The whole thing is so unreal though. Whatever happened to the Hippocratic oath?! What happened to Florida?

Scraplynn said...

It's only going to get worse the more the government gets involved. Sorry for your struggles. I wish I could help..

Kat said...

List Medicaid as secondary insurance. People have two insurances all the time.

Shawna S said...

Hugs. Keep fighting the good fight. You can do it!

Frau Mahlzahn said...

From a European perspective this is just unbelievable, *gasp*. We do have health care issues, but if you need to be seen by a doctor, you will be.

Gosh, I keep my fingers crossed, that they will be able to work out this insurance thing and pray that Austin and Savannah will get the care they need.

So long,
Corinna

Sarah said...

So sorry you're having to go thru this. It's tragic example of the horrible state of healthcare in US. Will pray you can get the kids in to be seen by someone.

Mary Anne said...

That's crazy. Medicaid is the payer of last resort. So, they cover what Cigna won't. If you go to the Cigna doctor, they have Cigna and it will pay, you will be responsible for whatever Cigna doesn't cover since they don't take Medicaid. That's nonsense that they won't change your Medicaid doctor until the Cigna expires. The kids having double insurance is a PLUS for Medicaid, why are they insisting you drop it.

Amy said...

You tell them Cigna is PRIMARY with the medicaid secondary. Call Medicaid back and ask to speak to a supervisor. If your plan there is like ours here - customer service is in India someplace and you'll have to go thru 18 people to get someone who actually understands English. Once you get to a supervisor - you can file a complaint on the DR that's refusing to treat the kids. Tell them you want ALL the kids switched to a different primary since that Dr is obviously going to be a jerk. Most pediatricians take kids at LEAST till 18 and my old one would see the kids till they were 21. Of course, the kids didn't like going there anymore with the cute little animals but... then it was their choice. With your primary doc (thru Cigna) you might also ask to speak to the office manager. They know more than the yahoos that answer the phones for appointments and they might agree to see the kids at least this one time before Sept.

Good luck! With the new Obamacare - Health care is becoming a joke. Drs closing down. Routine tests are being denied now. Receiving medical treatment is hit and miss. I've had 3 doctor offices so far tell me they can't do this or that because of new Obamacare laws. My son has a torn ACL and Meniscus and can't walk without it locking, popping and throwing him on the ground. It took 3 months to get an MRI approved and the new rules insist on Physical therapy before they'll do surgery. Cause don't you know those little pieces floating in his knee totally detached are going to jump up and magically reconnect in the right places? Obamacare is designed to give the most benefits to those who need it least (males aged 20-40) with those who need the most care (children and the elderly) receiving the least of the benefits on his pyramid. It's going to get a LOT worse.

Elizabeth said...

This is where I get really angry with those that are so against a system like the have in Europe. I will tell you my story about when I lived in France for two years. I was not part of their system, BUT it was still a piece of cake to seek medical help and get it on the spot, even being from America. Doctors in Europe are very hands on, as in, if you call their office He or she will answer the phone! Not a nurse, not a receptionist, the doctor himself! The visit for a non EU citizen was $35 dollars! They have this great system where if there is an emergency and an ambulance comes, it is a full ER with a doctor on board. So no long waits in the ER waiting to be seen. Sure their system isn't perfect, but I think we need a happy in between, which I believe it what Obama care is all about.
In contrast to our French situation, when we moved back to the States, my husband was laid off and when we tried to buy our own insurance they wouldn't even cover my husband because he was using a C-pap machine for sleep apnea. And my daughter had a strange asthma situation when she was 8 and they wouldn't cover her as a 15 year old! What the hell is that all about???
So basically our health care system is all about insurance GREED. The people that are against Obama's plan have never experienced stuff like yourself or me!!!

Kiki Nakita said...

I now live in America, but grew up in Britain on the NHS. Any school age children receive free medical, dental, orthodontic and vision. Sure, it's not perfect, and many Brits like to complain, but it's dependable. In America, it’s the insurance companies who are deciding on our care. I’d rather be selfless and pay higher taxes if it meant I’d also have the opportunity to have dependable healthcare when I or my family needs it.

Suburban Correspondent said...

So sad that I find all of this totally believable.

amyvillarreal said...

Call the office/care manager at the Cigna Dr office. They still have Cigna, so not sure why the Dr. is denying you. If you get no where try a local low cost clinic...they have worked with me while our medical card was 'pending' and will often cover costs you incur before the medical card kicks in, but it is a process. Worst case, go back to the ER. In the meantime, find a low cost/free legal service (Administer Justice here in IL). To me it sounds like the Cigna Dr. is breaking the law by denying healthcare when they still have coverage.

Amanda Scouten said...

That's why we had to switch from Cigna to United Healthcare. No doctors were taking Cigna anymore. They said it's bc Cigna doesn't pay like the other insurances. I hope you get it all straightened out!

Cat said...

And this is why people end up going to the ER for routine health care.

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