My oldest daughter, the one born with kidney and urinary system defects, has ongoing health problems related to the defects which she will continue to have for the rest of her life. She is highly sensitive to getting kidney infections in the partial kidney. Over the past year they have been recurring more often. Last year she was in the hospital twice. We didn't have a primary doctor at the time. Living in a rural area, there aren't many choices. The doctors either don't take Medicaid or they can not take on any new Medicaid patients. The state regulates how many Medicaid patients doctors can see. So people are left without a primary doctor. That means no medical care. We had no choice but to take her to the ER. Thankfully, she wasn't admitted. She did have to take a course of antibiotics. We have Medicaid, or rather...Virginia Premier (one of the state HMOs for Medicaid). Ever since the Virginia government started the HMO programs, the quality of health care for Medicaid recipients went.... god, I can't even think of a word. It's like not even having health care coverage. You have health insurance in name only, because they don't want to pay for anything.
VA Premier paid for my daughter's antibiotics, so I didn't know there was a problem. Then I started receiving bills from the hospital stating Medicaid/VA Premier refused to cover the payments. I called the hospital to find out why. They said VA Premier/Medicaid said there was 'other' insurance which had to pay first. I knew of no 'other' insurance. So I called VA Premier. They have horrible customer service, by the way. I couldn't get any explanation out of them. I called the social worker but couldn't get an explanation there either. So I was left with the hospital bills, thousands of dollars worth.
In order for a family to qualify for Medicaid in the state of Virginia, they have to be below poor. They have to be practically destitute, barely above the zero income level. So for them to stick thousands of dollars in hospital bills on the family qualifying for Medicaid is pretty low and disgusting. They know that family can't pay for them. Another bad strike on their credit to help compound the entire poverty problem. Back when things were a little better, we did have another health insurance so Medicaid became the secondary insurance. They paid whatever the first insurance didn't cover. But those days are long gone. All we have is the state. I still have those unpaid medical bills hanging around.
Last fall, we finally found a new doctor accepting Medicaid patients. I made appointments for all the kids to get seen. Then came February with the Norovirus pandemic. The doctor prescribed medications to help stop the vomiting. Once again VA Premier reared its ugly head and refused to cover some of the medication. Actually the medication I'm referring to is Zofran. They used to cover it and then stopped covering it at all to now only covering 12 pills in a 30 day period. I know, it makes no sense. Twelve pills were not going to cut it and the entire family was sick. Zofran is an orally-dissolvable pill. It may not be as strong as others in its' class but it is the only one that will work (outside of a hospital IV) if a person can not hold anything down and has diarrhea. So the doctor had to work out a plan for the family since VA Premier refused to cover more than 12 pills for each person. Health insurance companies should not have the power to decide what medications you can or can't take. Do they have degrees in medical science? I think not. The doctors seeing you should have the say, along with yourself, since it is your body after all. But that isn't how America runs. The people without the medical degree or any medical knowledge whatsoever gets to decide your medical care. My 2 year old son had to be taken to the ER in the middle of the night because he would not stop vomiting. VA Premier/Medicaid refused to cover all of his bill nor the medication the ER gave him to stop the vomiting. Guess who got stuck with the bill? We did. He does not have ant other insurance so they have no excuse for it. When I had to go to the ER last summer for the severe bacterial infection, VA Premier/Medicaid refused to pay for the bill too and I had no other insurance. We got stuck with that bill too. They are both unpaid.
Anyway, the doctor set my daughter up to see a nephrologist, a kidney specialist. She was overdue for the kidney reflux test. She has had kidney reflux in the past and had surgery to try to correct it. The nephrologist who did the surgery told me it was a fairly new procedure so he wasn't sure if it would be a permanent fix. With her having more kidney infections, it could be a sign that the reflux is starting again. Kidney reflux creates severe infections which then leads to kidney damage. Kidney damage then results in kidney failure. So it is best to keep the infections at bay and promptly treat them when they do occur. We have been unable to do this because of the state regulations making the few doctors unable to take more patients. Plus VA Premier has limitations on where in the state you can get seen and what hospitals you can go to and so on. They make it exceedingly difficult to get medical care. Medicaid used to be taken throughout the whole state. Not any more, at least not the HMO version. But the state government did that on purpose to save money instead of giving quality care to the poor.
I had to cancel the appointment for the nephrologist because on April 30, 2012, I received a letter from VA Premier stating that my daughter's coverage would be canceled on April 30, 2012. Yeah, it was to be canceled the same day I received the notice. Wasn't that so nice of them to give us such a long prior notification? Plus there was no explanation as to why it was being canceled. So I called VA Premier again. All they said was they didn't know why it was canceled and that I would have to speak to the case worker at social services. I called the case worker the same day. She didn't answer so I had to leave a message. I continued to do this twice a week until today. She never returned my call. We tried to get a prescription filled for my daughter and it was denied.
Today I said enough was enough. Despite being ill and running a high fever myself, we went to the social services office. Guess what? She wasn't there. Neither was her supervisor. Friday is still a work day, right? We are paying taxes for them to be at work, right? So I told the receptionist that someone needed to look into it and give me an explanation. One of the other workers said that she didn't see a reason why my daughter's VA Premier was canceled but that regular Medicaid was still active. As for the unpaid medical bills, I would have to talk to the worker on Monday. I'm sure I won't get a return call for that either. They said Medicaid should cover my daughter's prescriptions and medical care. OK.
Then we went to the pharmacy to get her prescriptions filled, using regular Medicaid. Once again it was denied. The pharmacist was feeling pretty bad for us by this point, but what could they do. They gave us a paper showing why Medicaid denied coverage. It said that Medicaid was denying coverage due to some 'other' insurance which had to pay first. I had a reason now but no real answer as to this mysterious 'other' insurance causing problems. Now I was pissed and beyond frustrated.
So I thought of one more thing. I called the Division of Child Support Enforcement. I asked them if the absent father had insurance on her. Guess what? He did, not from trying to be nice either. Trying to stay calm, I asked them why they did not notify me of the insurance and why I was not sent insurance cards. She said she thought a notice was sent when he got coverage on February 28, 2012. I never received anything from them except a notification this week that they were sending his employer a wage-withholding order. If he had the job in February, then why were they just now getting around to sending a wage-withholding order? We have only received $70 in child support for the past four months. So no, I don't believe that they sent me a notification for the insurance. It would have eventually gotten here. I told her about the unpaid hospital bills and the prescriptions. She said she didn't know if he had medical coverage last year and that she would try to get the insurance company to send my daughter a card. TRY!!!! They can enforce that coverage is taken out but they can't enforce that the child be sent a card so they could actually get medical care? What stupidity is that? How is that going to help? I asked her if I could request for the absent father to not get insurance (it isn't as if he will be at this job long- he never does stay long) and she said the state of Virginia mandated that noncustodial parents be forced to get coverage for children covered by Medicaid. Why? So they can not be notified or sent cards so they can't seek medical care because Medicaid won't cover them either? Another Medicaid scam to save the government money?
I am so frustrated! I have to wait around to see if a card will be sent. Meanwhile my daughter can't see her doctor, can't get her prescriptions filled, and can't get her medical tests done. It will only last a couple of months before he moves on to another job. That is what he does. Then there will be another lapse in insurance coverage. It is just bullshit! What fucking idiot came up with this mandate anyway? If the man leaves his child and can only get made to help with raising that child by going to court, then he isn't going to be able to handle the responsibility of something as important as medical coverage. Most men who owe child support try to dodge paying it as much as they can. Believe me, he is just like that. Instead of fucking up the child's life with on and off again coverage, why don't they just have the absent fathers pay a certain amount into a fund to go towards Medicaid while leaving the child on the Medicaid coverage. That would make more sense and give the child stable health insurance coverage. But then our government never does anything which makes sense.
They don't care about poor children. They don't care about people having medical care. I think the Virginia government has done all these negative things to the Medicaid program on purpose so that they do not have to pay out as much. Virginia tax dollars go towards the cost of Medicaid. Plus the Federal government gives states funding from income taxes to go towards the Medicaid program. Billions of dollars go into Medicaid. If the state caps doctors on the number of Medicaid patients they can see, then there are a lot of people left without a doctor and without medical care. Those people aren't costing anything because they can't get care. Hospital bills aren't being paid and medication is being rejected for payment- so no money spent there either. Very few dentists accept Medicaid-covered children, so that lessens the amount the state has to pay. Dental coverage for poor adults isn't even covered at all, so that saves the state money. You can only go to an eye doctor once every two years and can only get the cheapest glasses there. When they do pay on a bill, they only pay a tiny fraction. For example: on a hospital bill for my son the bill came to $800+, but they only paid $30 on it. It is medical coverage in name only because it is severely gimped in what is covered. So where exactly does all the billions of dollars go to exactly? It isn't going to cover medical expenses. What is Virginia doing with all the money it receives for Medicaid? What? I want an answer!
Doesn't everyone in America deserve better quality health care? Health care should be between a doctor and a patient. NOT a doctor, a patient, and a corporation.
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